Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Wednesday, July 01, 2020 at 8:00 PM to 10:00 PM EST. We apologize in advance for any inconvenience this may cause you.
Who will be affected?
Readers: No access to all 28 journals. We recommend accessing our articles via PubMed Central
Authors: No access to the submission form or your user account.
Reviewers: No access to your user account. Please download manuscripts you are reviewing for offline reading before Wednesday, July 01, 2020 at 7:00 PM.
Editors: No access to your user account to assign reviewers or make decisions.
Copyeditors: No access to user account. Please download manuscripts you are copyediting before Wednesday, July 01, 2020 at 7:00 PM.
JMIR Preprints
A preprint server for pre-publication/pre-peer-review preprints intended for community review as well as ahead-of-print (accepted) manuscripts
Background: Patients often communicate with primary care centres remotely (e.g. by telephone or e-mail) before seeking in-person care. Some patients and providers are not fully satisfied with these routes. A novel route is to develop a patient-facing symptom entry website, which streamlines the subsequent triage process for clinicians. However, it remains unclear what the optimal set of features might be for such systems, and what benefits they may bring to providers. Objective: To evaluate a patient-facing personalised symptom-entry website (developed by Certific OÜ, Estonia) for its acceptability to primary health care providers. Methods: In-depth interviews were conducted in 8 primary care centres in Estonia, covering 8 nurses and 6 doctors, 3-6 months after the implementation of a novel patient-facing website. Results: The software was well received by the staff with all interviewees expressing desire that more patients initiate their remote query via the website. As compared to an e-mail request, the software was reported to satisfy staff concerns for privacy and data security which they felt to be important; save provider time and effort needed for gathering sufficient detail for triage; and helped structure patient symptom descriptions to free provider time from having to synthesize free-text. Staff concerns about safety with the new software were effectively alleviated by implementation decisions to integrate the new software alongside telephone requests. Challenges reported by staff included the effort needed to get patients to use the website. While previous research has criticised poorly-designed multiple-choice systems, our findings suggest that an appropriately designed and personalised multiple-choice system is preferable to healthcare staff, as it lowers their cognitive demands, workload and may enhance workplace wellbeing. Conclusions: Interviewed primary healthcare staff felt that the symptom entry and information condensing system designed by Certific was highly acceptable and desirable. They particularly valued a perceived reduction in cognitive demands. This holds promise for increasing staff wellbeing, reducing provider workload and increasing efficiency, which could be assessed in future studies.
Journal Description
JMIR Preprintscontains 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!).
JMIR Preprints is a preprint server and "manuscript marketplace" with manuscripts that are intended for community review. Great manuscripts may be snatched up by participating journals which will make offers for publication.There are two pathways for manuscripts to appear here: 1) a submission to a JMIR or partner journal, where the author has checked the "open peer-review" checkbox, 2) Direct submissions to the preprint server.
For the latter, there is no editor assigning peer-reviewers, so authors are encouraged to nominate as many reviewers as possible, and set the setting to "open peer-review". Nominated peer-reviewers should be arms-length. It will also help to tweet about your submission or posting it on your homepage.
For pathway 2, once a sufficient number of reviews has been received (and they are reasonably positive), the manuscript and peer-review reports may be transferred to a partner journal (e.g. JMIR, i-JMR, JMIR Res Protoc, or other journals from participating publishers), whose editor may offer formal publication if the peer-review reports are addressed. The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal.
For pathway 2, if authors do not wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter. Also, note if you want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc), please specify this in the cover letter.
Manuscripts can be in any format. However, an abstract is required in all cases. We highly recommend to have the references in JMIR format (include a PMID) as then our system will automatically assign reviewers based on the references.
Background: Patients often communicate with primary care centres remotely (e.g. by telephone or e-mail) before seeking in-person care. Some patients and providers are not fully satisfied with these ro...
Background: Patients often communicate with primary care centres remotely (e.g. by telephone or e-mail) before seeking in-person care. Some patients and providers are not fully satisfied with these routes. A novel route is to develop a patient-facing symptom entry website, which streamlines the subsequent triage process for clinicians. However, it remains unclear what the optimal set of features might be for such systems, and what benefits they may bring to providers. Objective: To evaluate a patient-facing personalised symptom-entry website (developed by Certific OÜ, Estonia) for its acceptability to primary health care providers. Methods: In-depth interviews were conducted in 8 primary care centres in Estonia, covering 8 nurses and 6 doctors, 3-6 months after the implementation of a novel patient-facing website. Results: The software was well received by the staff with all interviewees expressing desire that more patients initiate their remote query via the website. As compared to an e-mail request, the software was reported to satisfy staff concerns for privacy and data security which they felt to be important; save provider time and effort needed for gathering sufficient detail for triage; and helped structure patient symptom descriptions to free provider time from having to synthesize free-text. Staff concerns about safety with the new software were effectively alleviated by implementation decisions to integrate the new software alongside telephone requests. Challenges reported by staff included the effort needed to get patients to use the website. While previous research has criticised poorly-designed multiple-choice systems, our findings suggest that an appropriately designed and personalised multiple-choice system is preferable to healthcare staff, as it lowers their cognitive demands, workload and may enhance workplace wellbeing. Conclusions: Interviewed primary healthcare staff felt that the symptom entry and information condensing system designed by Certific was highly acceptable and desirable. They particularly valued a perceived reduction in cognitive demands. This holds promise for increasing staff wellbeing, reducing provider workload and increasing efficiency, which could be assessed in future studies.
Large language models (LLMs) are rapidly advancing medical AI, offering revolutionary changes in healthcare. These models excel in natural language processing, enhancing clinical support, diagnosis, t...
Large language models (LLMs) are rapidly advancing medical AI, offering revolutionary changes in healthcare. These models excel in natural language processing, enhancing clinical support, diagnosis, treatment, and medical research. Breakthroughs like GPT-4 and BERT demonstrate LLMs' evolution through improved computing power and data. However, their high hardware requirements are being addressed through technological advancements. LLMs are unique in processing multimodal data, thereby improving emergency, elder care, and digital medical procedures. Challenges include ensuring their empirical reliability and mitigating biases while maintaining privacy and accountability. The paper emphasizes the need for human-centric, bias-free LLMs for personalized medicine and advocates for equitable development and access. LLMs hold promise for transformative impacts in healthcare.
Background: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Onli...
Background: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Online health interventions will be the trend to prevent the rising HIV epidemic. Objective: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Online health interventions will be the trend to prevent the rising HIV epidemic. Methods: Four databases were searched and studies from 2008 to January 2023 were screened. Eligible randomized controlled trials (RCTs) were included. Basic study characteristics, intervention strategies and study results were extracted and compared for data analysis. BCTs used were identified according to the definitions from the BCT taxonomy by Michie and Abraham in 2008. Frequencies of BCTs were counted to uncover the commonly used techniques in online HIV prevention programs. Results: A total of 27 RCTs are included in this review. Commonly used BCTs identified include prompt intention formation (100%, 27/27), provide information about behavior-health link (96%, 26/27), provide general encouragement (96%, 26/27), provide information on consequences (89%, 24/27), and provide instruction (85%, 23/27). BCTs with a provision nature are more observed in interventions with significant improvement in HIV knowledge, while more use of BCTs with the nature of initiating actions are observed in studies with significant increase in condom-use self-efficacy. Studies with a significant increase in condom use have used BCTs that manage and maintain behavior the most among the three outcomes. Conclusions: This is the first systematic review that examined the use of BCTs in online HIV prevention interventions for adolescents and young people. Commonly used BCTs found in this review can serve as important references for constructing more effective online interventions in the future. Clinical Trial: N/A
Background: Internet gaming disorder (IGD) is a prevalent public health issue among adolescents. Few studies have, however, examined the relationships between IGD symptoms, low self-control, and meani...
Background: Internet gaming disorder (IGD) is a prevalent public health issue among adolescents. Few studies have, however, examined the relationships between IGD symptoms, low self-control, and meaning in life (MIL). Objective: The present study aimed to examine the mediating role of IGD symptoms in the relationships between low self-control and meaning in life and adolescents’ family and school functioning. Methods: A sample of 2,064 adolescents (46.9% females, mean age = 14.6 years) was recruited from five middle schools in Sichuan, China in 2022. Indirect effects of low self-control and MIL on family and school functioning via IGD symptoms were analyzed via structural equation modeling (SEM). Results: All scales showed satisfactory model fit and scalar measurement invariance by gender. Males showed significantly greater IGD symptoms and lower levels of self-control than females. Impulsivity, temper, search for meaning, and lower presence of meaning were significantly associated with greater IGD symptoms. There were significant indirect effects from impulsivity, temper, and presence of meaning to family and school functioning via IGD symptoms. Multigroup SEM across gender found that the positive association between search for meaning and IGD symptoms existed in males but not females. Presence of meaning significantly and negatively moderated the association between impulsivity and IGD symptoms. Conclusions: The findings support a mediating role of IGD symptoms in the relationships between low self-control and MIL and functioning and a buffering role of MIL on the associations between impulsivity and IGD symptoms among the ethnic minority adolescents. The results have implications for targeted interventions to help males with lower self-control and presence of meaning.
Background: Cancer is a genetic disease, where gene alterations play a significant role in the disease onset and pathogenesis. Analysis of the underlying gene interaction pathways could reveal new bio...
Background: Cancer is a genetic disease, where gene alterations play a significant role in the disease onset and pathogenesis. Analysis of the underlying gene interaction pathways could reveal new biomarkers and could also potentially help in the development of targeted drugs for therapeutics. Microarray techniques have emerged as powerful tools capable of simultaneously measuring the expression levels of thousands of genes, making them invaluable in cancer biology research. However, the processing of the resultant datasets poses significant challenges due to their high dimensionality. Also, feature extraction becomes essential to discern the crucial features within these extensive datasets. Objective: To mitigate these difficulties advanced computational techniques like Machine Learning (ML) could be instrumental. LASSO- regression-based classification is an advanced ML technique that can help in feature selection by evaluating individual parameters like genes. Methods: This study focuses on uncovering key prognostic genes for breast cancer using a combination of LASSO regression-based classifier and statistical bioinformatics models. Differentially expressed genes (DEGs) were identified using the "Limma" package in R, and significant genes were further filtered using the LASSO-based classifier significance coefficient. Genes common to both methods were considered as the focus of this study. Additionally, Protein-Protein Interaction (PPI) networks of these key genes were constructed using STRING, and hub genes, significant modules, and associated genes were identified using Cytoscape. Results: This study identified CCR8, CXCL11, CCL23, CCL24, CCL28, and CCL21 as signature prognostic genes for breast cancer, revealing a strong association between chemokines and breast cancer pathogenesis. Extensive literature searches were conducted to validate and confirm their prognostic significance in the disease. Conclusions: These findings are pivotal for enhancing our comprehension of the pathways involved in breast cancer. Additionally, they hold promise as novel biomarkers for diagnostic purposes and may also reveal significant therapeutic targets for the management of breast cancer.
Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limite...
Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. Objective: The objective of this study was to investigate the perceptions and acceptance of clinicians and people with concussion using MyGuide Concussion, an online concussion self-management tool. Methods: Using a mixed-methods content analysis approach, people with concussion and clinicians who used MyGuide Concussion over the past two years were interviewed and their responses were analyzed. Results: Participants reported two key benefits of using the online self-management tool: 1) the tool’s emphasis on the interconnectedness of physical and psychological symptoms, and 2) the ability to provide reassurance that symptoms being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions, and believed the content was useful for increasing clients’ independence in managing their own recovery. Conclusions: Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for people with concussion that require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use. Clinical Trial: N/A
Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. The lay theories of self-control (i.e., the belief about whether self-control can be improved,...
Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. The lay theories of self-control (i.e., the belief about whether self-control can be improved, also called self-control mindset) may interplay with self-control and gaming disorder. Objective: This is a pioneer study to examine the longitudinal associations between self-control mindset and the severity of gaming disorder symptoms with a one-year, two-wave, school-based longitudinal survey. Methods: A total of 3,264 students (338 in Grades 4-5 and 2,926 in Grades 7-10) from 15 schools in Hong Kong participated in the classroom surveys. We employed cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder. Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity. Subgroup analyses of boy and girl participants revealed that growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls but not in boys, while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys and girls after one year. Conclusions: Our findings demonstrated the negative impact of gaming disorder on one’s self-control belief and also implied that promoting a growth mindset regarding self-control is a promising strategy for gaming disorder prevention and early intervention, especially for girls.
Background: Reading medical articles is a challenging and time-consuming task for doctors, especially when the articles are long and complex. There is a need for a tool that can help doctors to proces...
Background: Reading medical articles is a challenging and time-consuming task for doctors, especially when the articles are long and complex. There is a need for a tool that can help doctors to process and understand medical articles more efficiently, accurately and fast.Generative artificial intelligence (AI) tools can assist doctors in analyzing medical articles, but there is no research evaluating medical articles and understanding the capabilities of new generative AI tools. Objective: This study aims to critically assess and compare the comprehension capabilities of Large Language Models (LLMs) in accurately and efficiently understanding medical research articles using the STROBE checklist. Methods: The study is a methodological type of research. The study aims to evaluate the understanding capabilities of new generative AI tools in medical articles. We designed a novel benchmark pipeline that can process PUBMED articles regardless of their length using various generative AI tools. Using this benchmark pipeline, we compared the answers of several generative AI tools (Chat-GPT 3.5-turbo, chat-GPT-4, Palm, Claude v1, Gemini pro) with the golden standard for 50 medical research articles from PUBMED. The experienced medical professor's answers to these questions are assigned as the golden standard. This study will evaluate the performance of various Large Language Models (LLMs) in accurately answering specific questions related to different sections of a scholarly article: title and abstract, methods, results, and discussion in fifteen questions from the STROBE Checklist Results: Among the answers given by LLMs to the questions, the LLM that gave the most correct answers (66.9%) was GPT 3.5. This was followed by GPT 4-1106 version (65.6%), Palm2- (62.1%), Claude v1 (58.3%), Gemini pro (49.2%) and GPT-4 0613 version (44.1%). LLMs showcased distinct performances for each question across different parts of a scholarly article - with certain models like Palm 2 and GPT 3.5 showing remarkable versatility and depth in understanding. Conclusions: This study is the first study to evaluate the performance of different LLMs in evaluating their ability to understanding medical articles using the Retrieval-Augmented Generation (RAG) method by giving documents.
Background: People with intellectual and other disabilities tend to have problems performing multistep tasks. To alleviate their problems, technology solutions have been developed that provide task-st...
Background: People with intellectual and other disabilities tend to have problems performing multistep tasks. To alleviate their problems, technology solutions have been developed that provide task-step instructions. Instructions are generally delivered on people’s request (e.g., as they touch an area of a computer or tablet screen) or automatically, at preset intervals. Objective: The present study carried out a preliminary assessment of a new tablet-based technology system that presented the task instructions when people walked close to the tablet rather than when they performed fine motor responses (e.g., scrolling) on the tablet screen. Methods: The system consisted of a tablet and a wireless camera and was programmed to present the first or next instruction of a task sequence as soon as the participants approached the tablet, that is, as the participants were spotted by the camera that was positioned before the tablet. Six participants were involved in the study. For three of them, two instructions were used for each task step. For the other three participants, a single instruction was used for each task step. Instructions consisted of pictorial representations combined with brief verbal description of the corresponding action (task step). The impact of the system was assessed for each of the two groups of participants using a non-concurrent multiple baseline design across individuals. Results: All participants were successful in using the system. Their mean frequency of correct task steps were close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to get the task instructions from a regular tablet through scrolling responses. Conclusions: The findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be a useful tool for supporting the performance of multistep tasks.
Background: Virtual reality (VR) is a type of extended reality (XR) technology increasingly used by rehabilitation practitioners to support rehabilitation following illness or injury that affect the u...
Background: Virtual reality (VR) is a type of extended reality (XR) technology increasingly used by rehabilitation practitioners to support rehabilitation following illness or injury that affect the upper limbs. There is robust evidence articulating how consumer-grade VR presents significant cyber security implications, such as security and privacy risks with software and hardware interfaces and use of cameras. However, little is known about how these risks translate in the use of VR systems in healthcare settings. The objective of this review is to identify cyber security risks associated with clinical VR systems, and to develop guidance for health informatics and rehabilitation practitioners to support the safe use of VR in healthcare. Objective: This scoping review aims to identify cyber security and privacy risks to XR technologies and components, including threats, attacks and attackers, with a focus on VR. Furthermore, we aim to understand how these risks can be mitigated in a clinical XR environment, in particular VR environment, by understanding the unique concerns for a healthcare setting and identifying relevant technologies, frameworks and strategies to mitigate these risks. Methods: A scoping review of the literature performed in one database (Google Scholar) identified 482 articles from the years 2017 to 2024. After abstract screening, 53 studies were extracted for a full text review, of which 29 were included in the analysis. The review followed the PRISMA extension for Scoping Reviews, and publications were reviewed using the Covidence software. Data on technology, cyber threats and risk mitigation were extracted. Results: Of the included studies, 79% were published between 2020 and 2023, and 55% focused on VR. The majority identified a privacy threat or mitigation strategy or both (26 papers, 90%). 90% of the XR components investigated were head-mounted display (HMD) devices and the greatest cyber threat identified to these components was information disclosure (76%). Risk mitigation strategies were mapped against the National Institute of Standards and Technology (NIST) Cybersecurity Framework, where 62% of studies identified a preventative mitigation strategy (18/29). The least established cyber security function for XR systems was recovery after a cyber security incident, with only one potential strategy. Conclusions: Findings were mapped against an enterprise risk management (ERM) model to contextualise cyber security risks for healthcare organisations. The most significant threat posited for a healthcare VR system was privacy threats, which can disclose personal data from which medical related data may be inferred, and immersive manipulation threats, which can impact user safety. Many potential mitigation strategies were identified for all types of threats, but none have been implemented beyond a proof-of-concept. None of the threats or mitigations have been studied in a healthcare context, which requires further research.
Background: Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to get familia...
Background: Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to get familiar with all available literature and find appropriate interventions. Objective: To summarize and assess the certainty of evidence of interventions proposed to decrease the digital addiction from published systematic reviews. Methods: An umbrella review of published systematic reviews was undertaken. Included studies were systematic reviews and meta-analyses of quantitative primary studies assessing an intervention that aimed to reduce digital addiction. Results: studies assessing 21 associations were included in the umbrella review, of which 4 (80%) were high-quality systematic reviews. Weak evidence was observed in 19 associations, whereas null associations appeared in the rest 2 associations. These associations pertained to nine interventions (group counseling, intergrated internet addiction prevention program, psychosocial intervention, reality therapy, self-control training program, cognitive behavior therapy (CBT), interventions to reduce screen time in child and exercise) and ten outcomes (self-control, self-esteem, IGD symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety and depression). CBT could reduce anxiety (0.939, 95% CI, 0.311 to 1.586), IGD symptoms (1.394, 95% CI, 0.664 to 2.214) and time spent gaming 1.259, 95% CI, 0.311 to 2.206) and IA scores (-2.097, 95% CI, -2.814 to -1.381). Group counseling had a large effect size on improving self-control (1.296, 95% CI, 0.269 to 2.322) and reduced internet addiction levels (-1.147, 95% CI, -1.836 to -0.997). Exercise intervention reduced IA scores (-2.322, 95% CI, -3.212 to -1.431) and depression (-1.421, 95% CI, -2.046 to -797) and interpersonal sensitivity (-1.433, 95% CI, -2.239 to -0.627). Conclusions: The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.
Background: The field of mental health technology presently has significant gaps that need addressing, particularly in the domain of daily monitoring and personalized assessments. Current non-invasive...
Background: The field of mental health technology presently has significant gaps that need addressing, particularly in the domain of daily monitoring and personalized assessments. Current non-invasive devices like wristbands and smartphones are capable of collecting a wide range of data, which has not yet been fully utilized for mental health monitoring. Objective: The paper aims to introduce a novel dataset for Personalized Daily Mental Health Monitoring and a new Macro-Micro Framework. This framework is designed to employ multimodal and multitask learning strategies for improved personalization and prediction of emotional states in individuals. Methods: Data was collected from 242 individuals using wristbands and smartphones, capturing physiological signals, speech data, and self-annotated emotional states. The proposed framework combines macro-level emotion transformer embeddings with micro-level personalization layers specific to each user. It also introduces a dynamic restrained uncertainty weighting method to effectively integrate various data types for a balanced representation of emotional states. Several fusion techniques, personalization strategies, and multitask learning approaches were explored. Results: The proposed framework was evaluated using the Concordance Correlation Coefficient (CCC), resulting in a score of 0.503. This result demonstrates the framework's efficacy in predicting emotional states. Conclusions: The paper concludes that the proposed multimodal and multitask learning framework, which leverages transformer-based techniques and dynamic task weighting strategies, is superior for the personalized monitoring of mental health. The study indicates the potential of transforming daily mental health monitoring into a more personalized application, opening up new avenues for technology-based mental health interventions.
Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples....
Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples. Incorporating patients as stakeholders and meaningfully engaging them in biomedical research first requires transparency of research activities. Objective: Here we describe the process and results of using participatory design methods to build a mobile application in which breast cancer patients could learn about their biospecimens collected for research, the status of their use in research protocols, and about the breast disease biobank collection. This decentralized biobanking application (“de-bi”) provided patient-friendly interfaces overlaying institutional biobank databases. Methods: This research occurred in two phases. In Phase 1, we designed app screens containing different information that patients could learn about ongoing research involving their samples. Embedding these screen designs in a survey, we sought to gauge patients’ interests in receiving information about research or about their biospecimens. We engaged some survey respondents in short interviews to discern their views on the importance of having this information and their opinions on its presentation and design. We held a design workshop in which participants gave feedback on the screens and suggested improvements.
For Phase 2, we then refined the user interfaces developed a functional app prototype. As we developed the app, we consulted institutional stakeholders to enhance compatibility with regulations and local data architectures. We then presented the app at a second workshop, where participants shared thoughts on usability and design of the app. In this phase we also conducted cognitive walkthroughs with individual participants to measure their success in using the app and to gain in-depth feedback on its functionality. Results: Survey and interview participants were interested in learning the status of their donated biospecimens (47%), the outcomes of research done on their specimens (30%), and in connecting with other patients similar to them. A design workshop assessing initial app screens revealed confusion in language and data presentation, though participants wanted to learn about their samples and expressed interest in using an app to do so.
A second design workshop and cognitive walkthroughs assessed a functioning mobile app prototype integrated with institutional biobank data. These activities revealed further interest in the ability to track and learn about donated biospecimens. Half of participants struggled with the onboarding process. These results informed updates to the app design and functionality. Conclusions: Designing a patient-facing mobile app that displays information about biobanked specimens can facilitate greater transparency and engagement in biomedical research. Co-designing the app with patient stakeholders confirmed interest in learning about biospecimens and related research, improved presentation of data, and ensured usability of the app in preparation for a pilot study.
Background: Paraphasias are speech errors that are often characteristic of aphasia and they represent an important signal in assessing disease severity and subtype. Traditionally, clinicians manually...
Background: Paraphasias are speech errors that are often characteristic of aphasia and they represent an important signal in assessing disease severity and subtype. Traditionally, clinicians manually identify paraphasias by transcribing and analyzing speech-language samples, which can be a time-consuming and burdensome process. Automatic paraphasia detection can greatly help clinicians with the transcription process and ultimately facilitate more efficient and consistent aphasia assessment. Objective: This study investigates a novel machine learning framework for automatic paraphasia detection that is trained end-to-end (i.e., a unified network that takes speech audio as input and outputs text that indicates what was said and identifies which words are paraphasias). We use the AphasiaBank corpus, which contains audio data collected from persons with aphasia (PWAs) that has been transcribed and labeled with paraphasias by trained speech-language pathologists. Methods: We propose a novel sequence-to-sequence (seq2seq) architecture for performing both automatic speech recognition (ASR) and paraphasia detection tasks. We explore the impact of leveraging pretrained speech models as well as different learning objectives for optimizing this model. This approach can be advantageous in learning synergistic representations that benefit both ASR and paraphasia detection tasks. We compare against a previous state-of-the art method that uses a multi-step pipeline approach consisting of ASR, hand-engineered feature extraction, and paraphasia detection. Results: We show that the proposed seq2seq is able to outperform the multi-step pipeline approach for word-level and utterance-level paraphasia detection. We achieve word-level performance improvements of 16.9%, 36.4%, and 9.5% and utterance-level improvements of 5.2%, 13.9%, 18.9% for phonemic, neologistic, and phonemic+neologistic paraphasias, respectively. Conclusions: These results highlight the performance improvements of learning to detect paraphasias end-to-end rather than through a multi-step pipeline approach with separate ASR and paraphasia detection models. The advantage of learning both ASR and paraphasia detection tasks end-to-end is that this unified model can learn joint representations that are beneficial to both ASR and paraphasia detection tasks rather than optimizing both of these separately. Future work will explore the efficacy of a deployed paraphasia detection model at assisting medical professionals with annotation.
Introduction:
The evolving global health landscape highlights the importance of travel medicine, making it necessary for healthcare professionals to understand the epidemiologic profiles among varied...
Introduction:
The evolving global health landscape highlights the importance of travel medicine, making it necessary for healthcare professionals to understand the epidemiologic profiles among varied traveler populations and keep themselves updated in this rapidly changing field.
However, in Italy, travel medicine clinics have significant gaps in resource allocation, staff training, and infrastructure. This is the protocol of a cross-sectional study that aims to create and validate a questionnaire to assess the knowledge, attitudes, and practices of healthcare professionals in travel medicine in Italy. The final goal is to provide a tool to evaluate the state of travel medicine, guide training initiatives, and monitor trends over time.
Methods:
The study population consists of healthcare professionals who practice travel medicine in Italy. The questionnaire will be developed by adapting an existing English survey and conducting a scoping review to align the questionnaire with contemporary scientific discourse. The validation process includes face validity, content validity, and expert evaluation. The sample size, determined through power analysis, ranges from 218 to 278 participants. The questionnaire will undergo a pilot test on a smaller sample size (10% of the total) to identify and address any issues. Statistical analysis will include central tendency and dispersion measures, categorical summaries, group comparisons, and regressions.
This research received ethical approval and informed consent will be collected from all participants.
Discussion:
This cross-sectional study will guide strategic planning and targeting training and awareness activities in areas deemed most critical or lacking.
The study's structured approach and periodic assessments will facilitate the identification of educational gaps, the dissemination of best practices, and the overall improvement of healthcare services for travelers in Italy.
Background: Exercise intervention is effective in managing diabetes when delivered in a personalized manner. Personalization of exercise intervention following a systematic fitness assessment can lead...
Background: Exercise intervention is effective in managing diabetes when delivered in a personalized manner. Personalization of exercise intervention following a systematic fitness assessment can lead to better health outcomes Objective: This study aimed to analyze the effect of digitally delivered fitness assessments and exercise prescriptions on the fitness and health outcomes of people with diabetes. Methods: Participants diagnosed with type 2 diabetes (n=86) enrolled in the Fitterfly Diabetes program which included interventions in nutrition, fitness, and mental health delivered via a digital platform. The participants underwent a video call-based fitness assessment consisting of the 1-minute push-up test, wall sit test, 1-minute sit-up test, V-sit and reach test, and 6-minute walk test. Trained physiotherapists conducted the assessments, developed personalized exercise plans, and shared them with the participants via the app. Regular follow-ups were taken. The participants were re-assessed after 90 days. Results: There was a statistically significant improvement in the fitness-related outcome measures (p<0.05), the anthropometric measures (p<0.05), and HbA1c (p<0.05) post-intervention. Improvement in exercise duration was associated with better outcomes in fitness tests and anthropometric measures. Conclusions: Personalized exercise intervention delivered digitally can help achieve better health outcomes in people with type 2 diabetes.
Background: The aging population in China is becoming increasingly severe, and there is a health inequality phenomenon among urban and rural elderly. With the development of ICT, eHealth has become on...
Background: The aging population in China is becoming increasingly severe, and there is a health inequality phenomenon among urban and rural elderly. With the development of ICT, eHealth has become one of the important factors affecting health. Urban elderly could more conveniently access health information and medical services, while rural elderly may have difficulty enjoying the digital dividends brought by eHealth, highlighting the phenomenon of the “digital health divide”. Objective: This study analyzes the digital health divide and determinants among urban and rural elderly from the perspective of capital theory. Methods: The model for analyzing the digital health divide among urban and rural elderly is constructed based on capital theory. Analysis of variance is used to verify the digital health divide among urban and rural elderly. Structural equation modeling is used to analyze the factors, and the Blinder-Oaxaca decomposition method is used to analyze the main causes. Results: There are three levels of digital health divide among urban and rural elderly, namely digital access divide (F=11.39, P<.01), digital usage divide (F=39.53, P<.001), and digital outcome divide (F=30.20, P<.001). The influence of different levels of divide is transmitted along the digital chain, the impact coefficient of digital access divide on digital usage divide is β=0.060 (P<.05), and digital usage divide on digital outcome divide is β=0.363 (P<.001). The digital usage divide is the most significant level, and cultural capital (β=0.221, P<.001), social support (β=0.361, P<.001), economic capital (β=0.111, P<.01), and habits (β=0.248, P<.001) are most dominant factors contributing to the rural-urban digital usage divide. The Blinder-Oaxaca decomposition results further indicate that cultural capital (33.9%) and social capital (22.5%) are the main factors influencing digital usage divide among urban and rural elderly. Conclusions: here exists digital health divide among urban and rural elderly, and the influence of three level of divide is transmitted along the digital chain. The digital usage divide is the main level, cultural capital and social capital are the main reasons for its formation. To against these divides among urban and rural elderly, interventions in policy, society, technology, and economics are recommended.
Background: No established tools are currently capable of quantitatively measuring engagement for health promotion tools, including Digital Therapeutics. Objective: We evaluate the engagement index (E...
Background: No established tools are currently capable of quantitatively measuring engagement for health promotion tools, including Digital Therapeutics. Objective: We evaluate the engagement index (EI) in commercial health management app for long term use by comparing it with the new EI created by the researchers based on the original EI. Methods: Participants were recruited from cancer survivors enrolled in a randomized controlled trial evaluating the impact of mHealth apps on recovery. We used 240 of these patients who were randomly assigned the Noom app. The study validated a new EI compared to an existing EI, with data analysis performed for long-term use. The new EI was calculated based on adapted measurements from the Web Matrix Visitor Index, focusing on click depth, recency, and loyalty indices. Results: The old EI demonstrated limited predictive ability for EI values between 6 to 9 months, with a mean squared error (MSE) of .10 and r-squared of .05. However, the new EI displayed enhanced predictive performance. All three new EIs, with different combinations of features, exhibited a lower MSE and higher r-squared compared to the old EI. Cox regression analysis revealed the old EI presented significant hazard ratios (HR) for click depth and loyalty indices, while the new EI consistently demonstrated significant HRs for loyalty and recency indices. Conclusions: We evaluated the effectiveness of the EI and proposes potential enhancements due to the ongoing need for a standardized index to measure patient compliance with mHealth applications. We emphasize the importance of log data and suggest avenues for future research to address the subjectivity of the EI and incorporate a broader range of indices for comprehensive evaluation.
Background: Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits...
Background: Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits to the emergency department and/or readmission to the hospital. Digital home monitoring (DHM) may improve postoperative care compared to standard methods. Objective: We conducted a feasibility study for a randomized controlled trial (RCT) to assess DHM's effectiveness following thoracic surgical procedures compared to standard care. Methods: We conducted a two-arm parallel-group pilot RCT at a single tertiary care center. Adult patients undergoing thoracic surgical procedures were randomized 1:1 into two groups: the digital home monitoring (DHM group) and the standard of care (control group). We adhered to the intention-to-treat analysis principle. The primary outcome was predetermined RCT feasibility criteria. The trial would be feasible if more than 75% of trial recruitment, protocol adherence, and data collection were achieved. Secondary outcomes included 30-day emergency department visit rates, 30-day readmission rates, postoperative complications, length of stay, post-discharge 30-day opioid consumption, 30-day quality of recovery (QOR-40), patient/program satisfaction, caregiver satisfaction, healthcare provider satisfaction and cost-per-case. Results: All RCT feasibility criteria were met. The trial recruitment rate was 87.9% (95% CI: 79.4% – 93.8%). Protocol adherence and outcome data collection rates were 96.3% (95% CI: 89.4% - 99.2%) and 98.7% (95% CI: 92.9% - 99.9%), respectively. Eighty patients were randomized, with 40 (50%) in the DHM group and 40 (50%) in the control group. Baseline patient and clinical characteristics were comparable between the two groups. The DHM group had fewer unplanned ED visits (2.7% vs. 20.5%; p=.02), fewer unplanned admission rates (0% vs. 7.6%; p=.24), lower rates of postoperative complications (20% vs. 47.5%, p=.01) shorter hospital stays (4.0 vs. 6.9 days; p=.05), but more opioid consumption (111.6 ± 110.9 vs. 74.3 ± 71.9 mg morphine equivalents; p=.08) compared to the control group. DHM also resulted in shorter ED visit times (130 ± 0 vs. 1048 + 1093 minutes; p=.48) and lower cost per case ($12,145 ± 8,779 vs. $17,247 ± 15,313; p=.07). The quality of recovery scores was clinically significantly better than the controls (185.4 ± 2.6 vs. 178.3 ± 3.3; p<.0001). All 37 patients who completed the intervention answered the program satisfaction survey questionnaires (100%; 95% CI: 90.5% - 100%). Only 36 out of 80 caregivers responded to the caregiver satisfaction questionnaires at the end of the 4th week post-hospital discharge (47.7%; 95% CI: 35.7% to 59.1%). Healthcare providers reported a 100% satisfaction rate. Conclusions: This pilot RCT demonstrates the feasibility of conducting a full-scale trial to assess DHM's efficacy in improving postoperative care following thoracic surgery. DHM shows promise for enhancing continuity of care and warrants further investigation. Clinical Trial: This study was registered with ClinicalTrials.gov (NCT04340960)
Background: Frailty and sarcopenia are more prevalent among LTCF residents than community dwellers, with exercise, especially multicomponent and PRT, being essential for management. However, LTCFs, pa...
Background: Frailty and sarcopenia are more prevalent among LTCF residents than community dwellers, with exercise, especially multicomponent and PRT, being essential for management. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to healthcare professional shortages. The Nintendo Switch RingFit Adventure (RFA) exergame (exergame-RFA), which combines resistance, aerobic, and balance exercises, offers a potential solution by boosting motivation and reducing staff intervention needs. Objective: We aimed to evaluate the clinical effectiveness of the exergame-RFA in improving muscle mass and functional performance among elderly LTCF residents. Methods: This was a randomized controlled trial, conducted from August 2022 to September 2023, involved elders ≥60 years in rural southern Taiwan LTCFs. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises via RFA, lasted 30 minutes, twice weekly for 12 weeks. Primary outcomes measured were the study of osteoporotic fracture index, appendicular skeletal muscle mass index, handgrip strength, and gait speed. Secondary outcomes included box and block test, (BBT), maximal voluntary isometric contraction of dominant upper extremity (MVIC), muscle thickness under sonography (sono-thickness), ADLs by the Kihon Checklist, quality of life by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the cognition by brain health test (BHT). We employed an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed analysis of variance, with time as a within-subject factor and intervention as a between-subject factor, was used to compare the training effects on outcomes. Results: The study recruited 96 individuals, with 60 undergoing randomization and 55 completing the study. Significant group X time interactions were observed in the exergame-RFA group in all primary outcomes (all p< .01, except p= .011 for HGS) and most secondary outcomes, including MVIC of biceps and triceps muscle, sono-thickness of biceps muscle, BBT, Kihon checklist, and BHT. Conclusions: Exergame-RFA significantly improve muscle mass, strength, and functional performance among elderly residents of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. Clinical Trial: This trial was registered at ClinicalTrials.gov (NCT05360667)
Background: Despite a growing awareness among healthcare professionals regarding the benefits of exercise and physical activity, the integration of exercise recommendations into healthcare practices r...
Background: Despite a growing awareness among healthcare professionals regarding the benefits of exercise and physical activity, the integration of exercise recommendations into healthcare practices remains sub-optimal. The complexity of the recommendations, which necessitate interdisciplinary knowledge, poses challenges in formulating the structured exercise plans. The rapid development of Large Language Models (LLMs) and Chatbots, offers a potential solution by leveraging AI's capabilities to enhance the precision and personalization of fitness and health recommendations. Objective: This paper provides a systematic summary of existing research in the landscape of LLMs and Chatbot applications for exercise recommendations and physical activity, encompassing important topics, theoretical frameworks, methodologies, and potential avenues for further exploration. Methods: A comprehensive literature search was conducted across databases, including Web of Science, PubMed, IEEE, and arXiv. The focus was on studies that utilized LLMs or Chatbots in recommendations for exercise, physical activity or fitness. The search was limited to English-language articles, and the selection process involved two reviews and arbitration in case of disagreement among reviewers. Results: The review identified 598 articles initially, narrowing down to 11 reports after applying inclusion and exclusion criteria. The current research domain is remarkably active, playing a pivotal role in the field of exercise health, and studies predominantly focus on integrating LLMs and Chatbots with Just-In-Time Adaptive Interventions (JITAIs) to design personalized exercise programs and evaluate the quality of AI-generated exercise recommendations. The primary LLMs utilized in this field are predominantly from the ChatGPT series developed by OpenAI. Conclusions: Notably, the review underscores the need for further advancements to match the expertise of exercise professionals and address individualized, evidence-based physical activity recommendations. While LLMs and Chatbots demonstrate promising utility in exercise recommendations and physical activity recommendations, there is a critical need for further development to enhance their accuracy, adaptability, and alignment with professional healthcare standards. The future direction emphasizes the fine-tuning of models, enhanced integration of wearable technology with AI and dynamic feedback loops in optimizing personalized health interventions.
Background: Breast cancer is prevalent among women in the United States. Non-metastatic disease is treated by partial or complete mastectomy procedures. However, the rates of those procedures vary acr...
Background: Breast cancer is prevalent among women in the United States. Non-metastatic disease is treated by partial or complete mastectomy procedures. However, the rates of those procedures vary across practices. Generating real-world evidence on breast cancer surgery could lead to improved and consistent practices. Objective: The paper aims to determine whether All of Us data are fit for use in generating real-world evidence on mastectomy procedures. Methods: Our mastectomy phenotype consisted of adult female participants who had CPT4 or SNOMED codes for a partial or complete mastectomy procedure. We evaluated the phenotype with a novel data quality framework that consisted of five elements: conformance, completeness, concordance, plausibility, and temporality. Also, we used a previously developed adjectival rating matrix with categories of poor (providing little to no data), fair (using only internal EHR data), and good (using internal and external benchmark/data) to evaluate each data quality dimension (DQD). Our subgroup analysis compared partial to complete mastectomy procedure phenotypes. Results: There were 3,704 participants in the partial or complete mastectomy cohort. The geospatial distribution of our cohort varied substantially across states. For example, our cohort consisted of 817 (22.1%) participants from Massachusetts but fewer than 20 participants from multiple other states. We compared the sociodemographics of the partial (n = 2,445) and complete (n = 1,259) mastectomy subgroups. Those groups differed in the distribution of education (P = .02) and income (P < .001) levels using chi-square analysis. The DQD conformance was rated as good. A total of 3,216 (86.7%) participants in our cohort had CPT4 codes for a mastectomy that did not conform to a SNOMED standard. The DQD completeness was rated as fair. The prevalence of breast cancer related concepts was higher in our cohort compared to adult female participants who did not have a mastectomy procedure (P < .001). The DQD concordance was rated as fair. In both the partial and complete mastectomy subgroups, the correlations among concepts were consistent with the clinical management of breast cancer. The DQD plausibility was rated as fair. Although we did not have external benchmark comparisons, the distributions of concepts by age group and time were consistent with expectations. The DQD temporality was rated as fair. The median time between biopsy and mastectomy was seven weeks. Conclusions: Our data quality framework was implemented successfully on a mastectomy phenotype. Moreover, the framework allowed us to differentiate breast-conserving therapy and complete mastectomy subgroups in the All of Us data. The results of our analysis could be informative for future breast cancer studies with the OMOP CDM.
Background: Commercial wearable devices, which are often capable of estimating heart rate via photoplethysmography (PPG), are increasingly used in health promotion. In recent years, researchers have i...
Background: Commercial wearable devices, which are often capable of estimating heart rate via photoplethysmography (PPG), are increasingly used in health promotion. In recent years, researchers have investigated whether the accuracy of PPG-measured heart rate varies based on skin pigmentation, focusing particularly on accuracy of such devices among users with darker skin tones. As such, manufacturers of wearable devices have implemented strategies to improve accuracy. Given the ever-changing nature of the wearable device industry and the important health implications of providing accurate heart rate estimates for all individuals no matter their skin color, it is imperative that studies exploring the impact of pigmentation on PPG accuracy are regularly replicated. Objective: We aimed to contrast heart rate readings collected via PPG using the Garmin Forerunner 45 in comparison with an ECG during various levels of physical activity across a diverse group of participants representing a range of skin tones. Methods: Heart rate data were collected from adult participants (18-64 years of age) at a single study session using the Garmin Forerunner 45 PPG-equipped smartwatch and the Polar H10 ECG chest strap. Skin tone was self-reported via the Fitzpatrick scale. Each participant completed two 10-minute bouts of moderate intensity walking or jogging separated by a 10-minute bout of light walking. Results: A series of mixed ANOVAs indicated no significant interaction between Fitzpatrick score and phase of the activity bout (i.e., rest at start, first intensity ramp-up phase, first steady-state phase, active rest, second ramp-up phase, second steady-state phase). Likewise, there was no significant main effect for Fitzpatrick score, though there was a significant main effect for phase, which was driven by greater ECG-recorded heart rate relative to PPG during the first ramp-up phase. Conclusions: Our findings support prior research demonstrating no significant impact of skin tone on PPG-measured heart rate, with significant differences between PPG- and ECG-measured heart rate emerging during dynamic changes in activity intensity. As commercial heart rate monitoring technology and software continue to evolve, it will be vital to revisit the impact of skin tone and other individual-level factors on sensor accuracy, especially as new and more robust measures of skin tone are made accessible.
Background: Understanding the similarities of cancer patients is essential to advancing personalized medicine, improving patient outcomes, and developing more effective and individualized treatments....
Background: Understanding the similarities of cancer patients is essential to advancing personalized medicine, improving patient outcomes, and developing more effective and individualized treatments. It enables researchers to discover important patterns, biomarkers, and treatment strategies that can have a significant impact on cancer research and oncology. In addition, the identification of previously successfully treated patients supports oncologists in making treatment decisions for a new patient who is clinically or molecularly similar to the previous patient. Objective: The planned review aims to systematically summarize, map, and describe existing evidence to understand how patient similarity is defined and used in cancer research and clinical care. Methods: To systematically identify relevant studies and to ensure reproducibility and transparency of the review process, a comprehensive literature search will be conducted in several bibliographic databases, including Web of Science, PubMed, LIVIVIVO, and MEDLINE, covering the period from 1998 to February 2024. After the initial duplicate deletion phase, a study selection phase will be applied using Rayyan, which consists of three distinct steps: Title and Abstract Screening, Disagreement Resolution, and Full-Text Screening. To ensure the integrity and quality of the selection process, each of these steps is preceded by a pilot testing phase. This methodological process will culminate in the presentation of the final research results in a structured form according to the PRISMA-ScR flowchart. The protocol has been registered in the Journal of Medical Internet Research (JMIR). Results: This protocol outlines the methodologies employed in conducting the scoping review. A search of the specified electronic databases and after removing duplicates resulted in 1,183 unique records. As of March 2024, the review process has moved to the full-text evaluation phase. At this stage, data extraction will be conducted using a pre-tested chart template. Conclusions: The scoping review protocol, centered on these main concepts, aims to systematically map the available evidence on patient similarity among cancer patients. By defining the types of data sources, approaches, and methods used in the field, and aligning these with the research questions, the review will provide a foundation for future research and clinical application in personalized cancer care. This protocol will guide the literature search, data extraction, and synthesis of findings to achieve the review's objectives.
Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the U.S., characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by...
Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the U.S., characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health (mHealth) platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across four distinct phases. In Phase 1, a comprehensive needs assessment will be conducted across three diverse schools, each employing a range of teaching methods, including in-person, online, and hybrid modalities. Following this, in Phase 2, school administrators and teachers undergo intensive training sessions on Neolth’s functionalities and intervention processes, as well as understanding barriers and facilitators of implementing a digital mental health program at their respective school. Phase 3 involves recruiting middle and high school students aged 11-18 from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, Phase 4 will include a year-long pretest-posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 has been successfully completed in August 2023, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study’s completion is scheduled for 2024, with data expected to provide insights into the real-world usage of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention’s efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies.
Background: The World Health Organization reported that cardiovascular diseases (CVDs) are the number one cause of death globally. CVDs are characteristically chronic, with complex progression pattern...
Background: The World Health Organization reported that cardiovascular diseases (CVDs) are the number one cause of death globally. CVDs are characteristically chronic, with complex progression patterns involving episodes of several comorbidities and multi-morbidities. When dealing with chronic diseases, physicians often adopt a “watchful waiting” strategy, and actions are postponed until information from an evolving clinical scenario is available. Given a patient’s current state, the ability to predict progression paths can enable effective monitoring leading to timely intervention decisions. Population-level transition probabilities and progression patterns can be revealed by applying time-variant stochastic modeling methods to longitudinal patient data from cohort studies. The resultant computational model can be embedded in interactive decision support tools for clinicians. However, to date, no study has attempted to accomplish this for the CVDs. Objective: This study aims to apply advanced stochastic modeling methods to uncover the transition probabilities and progression patterns from longitudinal episodic data of CVD patients and thereafter utilize the computational model to build an interactive clinical decision support artifact demonstrating actionability of such models in monitoring disease progression. Methods: Our data was sourced from nine epidemiological cohort studies by the National Heart Lung and Blood Institute (NHLBI) and comprises chronological records of 1274 patients associated with 4839 CVD episodes across 16 years. We then employed the Continuous-time Markov Chain (CTMC) method to develop our model, which offers a robust approach to time-variant transitions between disease states in chronic diseases. Results: Our study presents time-variant transition probabilities of CVD state changes, revealing distinct patterns of CVD progression against time. We find that the transition from myocardial infarction (MI) to stroke has the fastest transition rate (mean transition time 3 days), and MI to angina is the slowest (mean transition time 1457 days). Congestive Heart Failure (CHF) is the most probable first episode (44%), followed by stroke (26%). The resultant artifact is actionable as it can act as an eHealth decision support tool, helping the physicians gain critical insights into treatment and intervention strategies by predicting a patient's disease progression path and comparing it against the population pattern visualized by the model. Conclusions: Past research does not provide actionable decision support tools based on a comprehensive ten-state CTMC model to unveil complex CVD progression patterns from real-world patient data and support clinical decision-making. This paper aims to address this crucial limitation in extant health informatics literature. Our stochastic model-embedded artifact can help clinicians in efficient disease monitoring and timely treatment decisions guided by unbiased insights from real patient data. Furthermore, the proposed model can unveil progression patterns of any chronic disease of interest by inputting only three data elements: a synthetic patient identifier, episode name, and episode time in days from a baseline date.
Background: The benefits of SC (smart contracts) for sustainable healthcare are a relatively recent topic that has gathered attention given its relationship with trust and the advantages of decentrali...
Background: The benefits of SC (smart contracts) for sustainable healthcare are a relatively recent topic that has gathered attention given its relationship with trust and the advantages of decentralization, immutability, and traceability that could be introduced in healthcare. Nevertheless, there is a lack of studies exploring the role of SC in this sector based on the frameworks propounded by the literature that reflect the business logic -that has been customized, automatized, and prioritized- and the system trust. This study will address this lacuna Objective: This study aims to provide a comprehensive understanding of SC in healthcare based on reviewing the frameworks propounded by the literature. Methods: A structured literature review based on PRISMA principles was performed. A quantitative assessment of the studies, based on machine learning and data reduction methodologies, is complemented by a qualitative, in-depth, detailed review of the frameworks propounded by the literature. Results: A total of 70 studies, which depicted 19% of studies about this subject, met the selection criteria and were analyzed. Three factors depicted the advances in the topic. Two of them were referred to the leading roles of SC: (a) healthcare process enhancement and (b) assurance of patients’ privacy protection. The first role included six themes, and the second one three themes. The third factor encompassed the technical features that improve systems’ efficiency. The in-depth review of these three factors and the identification of stakeholders allowed us to characterize the system trust in healthcare SC. Conclusions: This comprehensive review allows us to understand the relevance of SC and the potentiality of their use in patient-centric healthcare that considers more than technical aspects. It also provides insights for further research based on specific stakeholders, locations, and behaviors.
Background: Decision aids empower patients to understand how treatment options match their preferences. Choice experiments, a valuable method to clarify values used within decision aids, present patie...
Background: Decision aids empower patients to understand how treatment options match their preferences. Choice experiments, a valuable method to clarify values used within decision aids, present patients with hypothetical scenarios to reveal their preferences for treatment characteristics. Given the rise in research embedding choice experiments in decision tools and the emergence of novel developments in embedding methodology, a scoping review is warranted. Objective: This scoping review examines how choice experiments are embedded into decision tools and how these tools are evaluated, to identify best practices. Methods: This scoping review was conducted following best practices in line with the PRISMA extension for scoping reviews. The searchers were conducted on MEDLINE, PsycInfo, and Web of Science databases using key search terms. Data were extracted using data charting tables created in Excel. A narrative synthesis was used to summarize the data and illustrations were used to visualise the results using tables and figures. Results: Overall, 22 tools were included in the scoping review. The methodology, development and evaluation details of tools were extracted from 33 papers. These tools were developed for a variety of health conditions including musculoskeletal conditions, oncological conditions, and chronic conditions. Most tools (78%) originated in the USA. The primary purpose (91%) of these tools was to assist patients in comparing or choosing treatments. The most commonly included attributes in the choice tasks were efficacy and side effects. Adaptive conjoint analysis was the most frequent (10 tools) design approach. Conjoint analysis designs used a higher number of tasks (16 -20) while DCEs and adaptive conjoint analysis designs used low (6) to moderate (12) number of tasks. Sawtooth software was commonly used to embed choice tasks in the tools. After completing the choice tasks patients received tailored information in the form of attribute importance scores, highlighting which treatment characteristics mattered most to the patient based on their choices (16 tools), and/or a "best match" treatment recommendation aligned with the patient's preferences (5 tools). A high degree of heterogeneity was observed in the evaluation methodologies and outcome measures used to assess the decision tools. The decisional conflict scale emerged as the most frequently employed outcome measure. Conclusions: This study highlights several methodological challenges that require further investigation. Future research should focus on determining the most effective methods for embedding choice tasks in decision tools, presenting balanced information, and selecting suitable outcome measures to evaluate these tools.
A number of seismic shifts is expected to reshape the future of medicine. The global population is rapidly aging, significantly impacting global disease burden. Medicine is undergoing a paradigm shift...
A number of seismic shifts is expected to reshape the future of medicine. The global population is rapidly aging, significantly impacting global disease burden. Medicine is undergoing a paradigm shift, defining and diagnosing diseases to earlier stages and shifting the healthcare focus from treating diseases to preventing them. The application and purview of digital medicine is expected to broaden significantly. Furthermore, the COVID-19 pandemic further accelerated the shift towards predictive, preventive, personalized, and participatory (P4) medicine, and identified healthcare accessibility, affordability and patient empowerment as core values in the future digital health era. This “left shift” towards preventive care is anticipated to redefine healthcare, emphasizing health promotion over disease treatment. In the future, the traditional triad of preventive medicine--primary, secondary, and tertiary prevention--will be realized with technologies such as genomics, artificial intelligence, bioengineering and wearable devices, wearables, and telemedicine. Breast cancer and diabetes serve as case studies to demonstrate how these technologies such as personalized risk assessment, AI-assisted and app-based technologies have been developed and commercialized to provide personalized preventive care. Overall, preventive medicine and the use of advanced technology will hold great potential for improving healthcare outcomes in the future.
Background: The recent mpox outbreak has resulted in 31,010 cases and 55 deaths in the U.S., and 91,417 cases worldwide from May 2022 to October 2023. Like other disease outbreaks (e.g., HIV) with per...
Background: The recent mpox outbreak has resulted in 31,010 cases and 55 deaths in the U.S., and 91,417 cases worldwide from May 2022 to October 2023. Like other disease outbreaks (e.g., HIV) with perceived community associations, mpox is at risk of causing stigma, exacerbating homophobia, and potentially hindering healthcare access and social equity. Objective: To synthesize discussions among sexual minority men and gender diverse (SMMGD) individuals on mpox, given limited representation of SMMGD voices in existing mpox literature. Methods: BERTopic (a topic modeling technique) was employed with human validations to analyze mpox-related tweets (n = 8,688; October 2020—September 2022) from 2,326
self-identified SMMGD individuals in the U.S.; followed by content analysis and geographic analysis. Results: BERTopic identified 11 topics: health activism (29.81%); mpox vaccination (25.81%) and adverse events (0.98%); sarcasm, jokes, emotional expressions (14.04%); COVID-19 and mpox (7.32%); government/public health response (6.12%); mpox symptoms (2.74%); case reports (2.21%); puns on the virus’ naming (i.e., monkeypox; 0.86%); media publicity (0.68%); mpox in children (0.67%). Mpox health activism negatively correlated with LGB social climate index at U.S. state level, ρ = -.322, P = .031. Conclusions: SMMGD discussions on mpox encompassed utilitarian (e.g., vaccine access, case reports, mpox symptoms) and emotionally-charged themes—advocating against homophobia, misinformation, and stigma. Mpox health activism was more prevalent in states with lower LGB social acceptance. Findings illuminate SMMGD engagement with mpox discourse, underscoring the need for more inclusive health communication strategies in infectious disease outbreaks to control associated stigma. Clinical Trial: NA
Background: The potential of artificial intelligence (AI) chatbots, particularly the fourth-generation chat generative pretrained transformer (ChatGPT-4), in assisting with medical diagnosis is an eme...
Background: The potential of artificial intelligence (AI) chatbots, particularly the fourth-generation chat generative pretrained transformer (ChatGPT-4), in assisting with medical diagnosis is an emerging research area. However, it is not yet clear how well AI chatbots can evaluate whether the final diagnosis is included in differential-diagnosis lists. Objective: This study aimed to assess the capability of ChatGPT-4 in identifying the final diagnosis from differential-diagnosis lists, and to compare its performance with that of physicians, for case report series. Methods: We utilized a database of differential-diagnosis lists from case reports in the American Journal of Case Reports, corresponding to final diagnoses. These lists were generated by three artificial intelligence (AI) systems: ChatGPT-4, Google Bard (currently Google Gemini), and Large Language Models by Meta AI 2 chatbot. The primary outcome was focused on whether ChatGPT-4's evaluations identified the final diagnosis within these lists. None of these AIs received additional medical training or reinforcement. For comparison, two independent physicians also evaluated the lists, with any inconsistencies resolved by another physician. Results: Three AIs generated a total of 1,176 differential diagnosis lists from 392 case descriptions. ChatGPT-4's evaluations concurred with those of the physicians in 966 out of 1,176 lists (82.1%). The Cohen kappa coefficient was 0.63 (95% confidence interval: 0.56-0.69), indicating a fair to good agreement between ChatGPT-4 and the physicians' evaluations. Conclusions: ChatGPT-4 demonstrated a fair to good agreement in identifying the final diagnosis from differential-diagnosis lists, comparable to physicians for case report series. Its ability to compare differential-diagnosis lists with final diagnoses suggests its potential in aiding clinical decision-making support through diagnostic feedback. While ChatGPT-4 showed a fair to good agreement for evaluation, its application in real-world scenarios and further validation in diverse clinical environments are essential to fully understand its utility in the diagnostic process. Clinical Trial: Not applicable
Background: Maternal and child health outcomes are positively influenced with early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as infor...
Background: Maternal and child health outcomes are positively influenced with early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women pre-to post-pregnancy, user engagement remains low. Objective: This study aims to explore the factors that shapes women’s DH adoption and sustained usage across the maternal journey from pre-conception to post-birth, to improve user engagement with DH tools. Methods: 1-hour semi-structured qualitative interviews were conducted with 44 women from pre- to post-pregnancy (age range: 21-40 years) about their experiences with DH. This study is part of a larger study on women’s maternal experiences with healthcare and DH, and focuses on the factors that affected women’s DH adoption and sustained usage. Interviews were audio recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Five main themes and ten subthemes were identified that affected women’s adoption and sustained usage of DH tools. These included themes on their pre-existing attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility and perceived value of the tool. Conclusions: Themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology (UTAUT) 2 model. The applicability of the model and need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the five themes with DH adoption and sustained usage are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation on tools for women to optimise their DH engagement and the benefits they derive from it. Clinical Trial: NCT05099900
Background: Patients have recently gained federally mandated, free, and ready electronic access to clinicians’ computerized notes in their medical records (‘open notes’). This change from longs...
Background: Patients have recently gained federally mandated, free, and ready electronic access to clinicians’ computerized notes in their medical records (‘open notes’). This change from longstanding practice can benefit patients in clinically important ways, but studies show some patients feel judged or stigmatized by words or phrases embedded in their records. Therefore, it is imperative that clinicians adopt documentation techniques that help both to empower patients and minimize potential harms. Objective: At a time when open and transparent communication among patients, families and clinicians can spread more easily throughout medical practice, this inquiry aims to develop informed guidelines for documentation in medical records. Methods: Through a series of focus groups, guidelines for language for documentation in medical records were developed by health professionals and patients. Using a structured focus group decision guide, we conducted four group meetings with different sets of 27 participants: physicians experienced with using open notes (5), patients accustomed to reviewing their notes (8), medical student educators (7), and resident physicians (7). To generate themes, we used an iterative coding process. First-order codes were grouped into second-order themes based on the commonality of meanings. Results: The participants identified 10 potentially important guidelines for developing notes sensitive to patients’ needs. Conclusions: The process identified ten discrete themes that should help clinicians use and spread patient-centered documentation. Clinical Trial: N/A
Background: This study assesses the quality of life during hospitalization using a stroke patient-reported outcomes scale. It investigates the current status of patient-reported outcomes in stroke pat...
Background: This study assesses the quality of life during hospitalization using a stroke patient-reported outcomes scale. It investigates the current status of patient-reported outcomes in stroke patients and explores their correlation with blood lipids. Objective: To investigate the status of reported outcomes in stroke patients and to study the relationship with blood lipid. Methods: Convenient sampling was employed to select a cohort of 195 stroke patients as the study participants. The Stroke-PRO scale was used to assess patients' conditions across physical, psychological, social, and therapeutic domains.Multiple linear regression analysis was applied to identify factors influencing stroke patient-reported outcomes, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. This approach aimed to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. Results: The Stroke-PRO score in this study was (4.09±0.29). By multiple linear regression analysis, residence, occupation, physical exercise, Barthel, Braden, NHISS at admission and stroke type were the influencing factors for reported outcomes of stroke patients (P< 0.05). Correlation analysis showed that triglyceride, serum total cholesterol and low density lipoprotein were negatively correlated with stroke-Pro scores in Stroke patients (P< 0.05), while high density lipoprotein was positively correlated with stroke patients (P< 0.05). Conclusions: Stroke patients have a low level of health and reported outcomes that need to be improved.Nursing staff should pay attention to the quality of life and blood lipid indexes of patients, actively capture the actual health status, and take early intervention measures to promote the recovery of patients.
Background: Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and can increase its DF content by incorporating defatted rice bran (DRB). Objec...
Background: Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and can increase its DF content by incorporating defatted rice bran (DRB). Objective: This first human study on DRB fortified bread, primarily aims to assess the effect of DRB bread on the relative abundance of a composite of key microbial genera and species in stool samples. Secondary outcomes include clinical (cardiovascular risk profile), patient-reported (daily bread consumption and bowel movement, digestive comfort, general well-being, total DF intake), biological (stool microbiota gene abundances, stool and plasma metabolites). Exploratory outcomes include physiome (whole gut and regional transit time, and gas fermentation profiles) outcomes in healthy adults with low DF intake. Methods: The BREAD (Bread Related Effects on Microbial Distribution) study is a two-armed, placebo-controlled, double-blind, randomized, crossover study. The study duration is fourteen weeks: two weeks lead-in, four weeks intervention per phase, two weeks washout, and two weeks follow-up. Sixty healthy adults with low DF intake (<18g/day (females), <22g/day (males)) were recruited in Christchurch, New Zealand between June and December 2022. Randomized participants consumed three (for females)/ four (for males) slices of fortified bread per day, then placebo white bread and vice versa. The DRB fortified bread provided 8 g (for females) and 10.6 g (for males) of total DF, while the placebo (a matched commercial white toast bread) provided 2.7 g for females and 3.6 g for males of total DF. Before and after each intervention phase, participants provided stool and blood samples to assess biological responses; completed a three-day food diary to assess usual intakes; online questionnaires to assess gut symptoms, general and mental well-being, daily bread intake and bowel movement via an app; underwent anthropometry and blood pressure measurements; drank blue food dye to assess whole gut transit time. In addition, 15 participants from the cohort ingested Atmo gas-sensing capsules to assess gut regional’s fermentation gas profile. Results: At the time of writing, data was still being analysed. Results will be published as separate manuscripts. Conclusions: This study will offer insights into the prospect of consuming DRB fortified bread to effectively modulate health-promoting gut microbes and their metabolism, and DF intake in healthy adults with low DF intake. Clinical Trial: ACTRN12622000884707
Background: Sedentary lifestyles, poor nutritional choices, inadequate sleep, risky substance use such as alcohol and tobacco, fewer positive relationships, and increased stress are all contributing f...
Background: Sedentary lifestyles, poor nutritional choices, inadequate sleep, risky substance use such as alcohol and tobacco, fewer positive relationships, and increased stress are all contributing factors to the all-time high prevalence of chronic disease in society. The positive impact of incorporating all six pillars of lifestyle medicine on several chronic conditions was the driving force behind the development of this implementation study. To our knowledge, this is the first rural virtual and in-person lifestyle medicine program in Ontario, which is adapted from the successful lifestyle medicine program launched in 2019 at New York Health and Hospitals. Objective: This pilot study aims to assess the feasibility of establishing a comprehensive virtual and in-Person lifestyle medicine program for patients with chronic diseases in the Parry Sound area. Methods: Participants who want to join the Complete Lifestyle Medicine Intervention Program - Ontario (CLIP-ON) can self-refer or be referred by their healthcare provider. The intensive phase occurs in groups of five to fifteen participants who receive individual virtual or in-person care from one of the interdisciplinary team (physician, health coach, registered dietician, and kinesiologist) every two weeks over the six months. Anthropometric and cardiometabolic variables such as BMI, blood pressure, HbA1c and cholesterol are used to assess each participant before, at three months (midway), and immediately after completing the program. Participants are surveyed for lifestyle habits, wellness, perceived barriers, program satisfaction and qualitative feedback at three- and six- months. Feasibility will be assessed by investigation of participant recruitment, retention, acceptability, adoption, attendance rate to the lifestyle medicine classes, drop-out rate (and reasons), participant satisfaction, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability. Additional qualitative feedback will be collected via separate participant and provider focus groups led by a qualitative research expert. Results: Patient recruitment began in September 2023. Eight eligible participants are included in the first cohort which is scheduled to be complete by April 2024. Quantitative and qualitative feedback will be collected from participants and providers to inform about the feasibility and impact of the study. Recruitment for the second cohort will begin in March 2024. This study was approved by the Laurentian University Research Ethics Board (6021397) on July 6, 2023, and is registered with ClinicalTrials.gov (NCT06192251). Conclusions: The quantitative and qualitative evaluation of the virtual and in-person CLIP in this study will enable assessment of the program’s impact on psychological and physical health. Combined with the identification of key program barriers and opportunities, design enhancements can be informed to establish a template program inclusive of all ages and cultural backgrounds for other rural communities interested in novel virtual and in-person lifestyle medicine interventions. The piloting of this project will also provide opportunities to establish new collaborations with the local public health office, other existing programs, and non-profit organizations. Clinical Trial: NCT06192251
Background: Long occupational work hours, paid or unpaid overtime, and shift work are a common component of the labor force in high, middle, and lower-income economies globally. Bowel movement frequen...
Background: Long occupational work hours, paid or unpaid overtime, and shift work are a common component of the labor force in high, middle, and lower-income economies globally. Bowel movement frequency and stool form in occupational settings may be important markers of stressful working conditions as well as diurnal gut microbiota action, gastrointestinal discomfort, and disorders of gut-brain interaction (DGBI). Characterizing DGBI in shift and non-shift workers could help identify the impact of diurnal work patterns on worker’s physical and mental health, including anxiety related to bowel movements. Objective: The paper outlines the ITS POO TIME protocol describing a web-based multi-methods research project on DGBI, stool characteristics, psychological factors, sleep, diet and anxiety related to bowel movements in occupational settings. Methods: Study 1 comprises a web-based survey to acquire quantitative data from adults who are engaged in paid employment. We seek to assess occupational characteristics, organizational factors concerning toilets, as well as standardized questionnaires for stool form and frequency, DGBI assessed by Rome-IV criteria, sleep, diet, bowel movement anxiety (i.e. parcopresis), and distress. Study 2 is a qualitative study (Poo Story) which asks open-ended questions about respondents’ attitudes to defecation at work as well as patterns, behaviours, as well as strategies utilized to reduce anxiety or embarrassment. Results: The findings of ITS POO TIME will elicit important information on what factors are associated with bowel movements and stool types in occupational settings and identify associations pertinent to occupational health. Data collection commenced in January 2019 and finished enrolment in December 2023. Study 1 obtained 1872 responses, while Study 2 received 337 responses, and the primary results are expected to be published in 2024. Conclusions: The results of the research described in this research protocol will have direct implications for industry, employers, and policy makers concerning DGBI, stress, and worker health. Clinical Trial: NA
Background: Outcomes in children with type 1 diabetes (T1D) are influenced by psychosocial factors including family dynamics and parent and child psychological well-being. Early instruction for caregi...
Background: Outcomes in children with type 1 diabetes (T1D) are influenced by psychosocial factors including family dynamics and parent and child psychological well-being. Early instruction for caregivers on evidence-based family management skills that support family adjustment to T1D immediately following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for clinic-wide interventions to support caregivers in learning these skills. Objective: We hypothesized that a self-guided online family skills management program (addressing caregiver social support as well as family problem solving, communication, and supportive behavior change strategies) initiated at the time of type 1 diabetes (T1D) diagnosis would improve glycemic outcomes at 1 and 2 years post-diagnosis in children with T1D. In this study, we report on the feasibility and acceptability of this program. Methods: We evaluated a sample of 37 children with newly diagnosed T1D. Parent participants were asked to complete online modules addressing social support, family problem solving, communication and supportive behavior change strategies. Module completion was analyzed for percent completion, patterns of completion and differences in completion rates by co-parenting status. Qualitative open-ended feedback was collected at the completion of each module. Results: 84% of the 37 participants initiated the online program. 68% completed some content and 48% completed all five modules. Completion rates were higher when co-parenting partners engaged in the intervention together. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. Conclusions: In this study, we found that a self-guided digital family support intervention initiated at the time of a child’s T1D diagnosis was largely feasible and acceptable. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management. Clinical Trial: The study was pre-registered at clinicaltrials.gov: 1303325.
Background: The evolution of healthcare systems has been driven by aging populations, chronic diseases, and rising expectations for quality care. This evolution coincides with significant advancements...
Background: The evolution of healthcare systems has been driven by aging populations, chronic diseases, and rising expectations for quality care. This evolution coincides with significant advancements in information and communication technologies (ICT), which offer the potential to enhance healthcare accessibility, efficiency, and patient outcomes through tools such as telemedicine, electronic health records, and mobile health apps. Objective: This article aims to explore the integration of health information technologies (HIT) in healthcare delivery, focusing on the experiences of Catalonia, a region with universal healthcare coverage and a single public health insurer. It discusses the transition from paper to digital systems, the development of health information registries and platforms, and the challenges and successes encountered over the past twenty-five years. Methods: We systematically analyse the implementation processes of HIT in Catalonia, detailing the architectures and usage trends of these platforms over time. We also provide a qualitative analysis of the organizational, political, and cultural barriers to integrating HIT and evaluate the impact of these technologies on creating more personalized, data-driven care. Results: Catalonia's experience highlights the potential of HIT to facilitate integrated care pathways and improve health outcomes. However, challenges such as organizational resistance, political hurdles, and cultural differences, along with a fragmented approach to health information management, have impeded the full realization of these benefits. Conclusions: The evolution of HIT in Catalonia over the past quarter-century provides valuable insights and lessons for other regions aiming to navigate the complex landscape of digital healthcare transformation. However, the effectiveness of such strategies is contingent on a robust primary care network and a unified healthcare model.
The future of healthcare digitalization in Catalonia, and potentially elsewhere, hinges on overcoming legacy data fragmentation and moving towards a genuinely integrated health and social information system that streamlines the strategic use of health data. This transition is not just about adopting new technologies but also about a paradigm shift in healthcare delivery, moving from referrals and transferability of responsibility towards a collaboration emphasizing a holistic approach to patient care for improved health outcomes. Clinical Trial: N/A
Background: Electronic Health Records (EHRs) have revolutionized the accessibility and sharing of patient data among healthcare providers, fostering a more coordinated and efficient delivery of care....
Background: Electronic Health Records (EHRs) have revolutionized the accessibility and sharing of patient data among healthcare providers, fostering a more coordinated and efficient delivery of care. Over the past 25 years, the evolution of EHRs has significantly contributed to scientific achievements in healthcare, improving the accuracy and efficiency of patient care and supporting better health outcomes. Despite their numerous benefits, EHRs face challenges including interoperability issues, common data models, system compatibility, privacy concerns, and data cleaning complexities. Objective: The objective of our study was to examine the evolution of EHRs over the past 25 years, focusing on their advancements in technology, interoperability, and the impact on healthcare delivery and research. We aimed to identify the challenges and limitations of EHRs in facilitating disease management and understanding, as well as their contribution to epidemiological studies, pragmatic clinical trials, and health economic studies. Methods: We conducted a comprehensive review of literature from PubMed database pertaining to the development and implementation of EHRs over the past quarter-century. Studies from January 2000 to February 2024 were included. Finally, 1,377 studies were selected for the analysis and presentation. Results: Studies that utilized EHR data were for various research purposes, including epidemiological studies, clinical trials, cost-effective studies, and policy studies. We highlighted significant advancements in EHR technology that facilitated improved management and understanding of diseases through comprehensive data collection and analysis over the past 25 years. However, challenges related to data interoperability, privacy, and inconsistencies were also identified. The studies underscored the importance of EHRs in creating more accurate representations of clinical practices and patient populations. We also saw great efforts in incorporating data from different sources and formats with the EHRs, as well as new analytic tools and platforms. Conclusions: EHRs have emerged as a pivotal component of modern healthcare systems, enhancing the efficiency and accuracy of patient care and supporting advanced clinical research. Despite facing interoperability and data management challenges, the benefits of EHRs in improving healthcare delivery and facilitating significant scientific achievements are undeniable. To maximize their potential, there is a critical need for improved resource sharing, collaborations among healthcare providers, and the development of consistent data formats and policies in healthcare networks. Clinical Trial: NA
Background: Motivational Interviewing (MI) is frequently used to facilitate behavior change. The use of change talk during motivational interviews can predict subsequent behavior change. Yet, no studi...
Background: Motivational Interviewing (MI) is frequently used to facilitate behavior change. The use of change talk during motivational interviews can predict subsequent behavior change. Yet, no studies have compared the information obtained from traditional face-to-face motivational interviews and computer-mediated motivational interviews or result in the same amount of behavior change. Objective: This study investigated if face-to-face motivational-type interviews and computer-mediated motivational-type interviews (MTIs) elicit the same amount of change talk and behavior change when young adults discuss their ambivalence about using marijuana. Methods: One hundred and fifty frequent marijuana users, occasional marijuana users, and non-marijuana users participated in the study; all participants reported being at least moderately ambivalent about their current level of marijuana use. Participants were randomly assigned to complete a brief motivational-type interview using either the standard face-to-face format or a computer-mediated format. Amrhein’s manual for assessing the presence of ‘change talk’ and ‘sustain talk’ was used to code the language produced by respondents in each interview format. Reduction in marijuana use was assessed at a two-month follow-up. Results: Word count was significantly higher in face-to-face MTIs than computer-mediated MTIs. Face-to-face MTIs also elicited significantly more reasons for reducing future marijuana use (i.e., change talk) even after controlling for verbosity. The strength of an interviewee’s statements denoting a commitment to reduce their marijuana use (i.e., change talk) and their subsequent frequency of marijuana use at two-month follow-up were negatively correlated, r=-.41, P<.001. The association between Time 1 change talk and Time 2 marijuana use depended upon the type of motivational interview that participants experienced: face-to-face MTI versus computer-mediated MTI. A negative binomial regression with a log link function was used to probe this relationship after controlling for two covariates: gender and Time 1 marijuana use. Among participants in the face-to-face MTI condition, Time 2 marijuana use decreased as the strength of Time 1 change-talk increased, although this finding was not significant (B=-.21, P=.08). Among participants in the computer-mediated MTI condition, however, Time 2 marijuana use was not significantly related to the strength of Time 1 change talk (B=.19, P=.16). Conclusions: The implications of these findings for conducting computer-mediated motivational interviews are discussed.
Background: Digital media frequently contains positive portrayals of alcohol content, which has been shown to be associated with alcohol-related cognitions and behaviors. Because youth are heavy media...
Background: Digital media frequently contains positive portrayals of alcohol content, which has been shown to be associated with alcohol-related cognitions and behaviors. Because youth are heavy media consumers and have access to unsupervised, repeat viewing of content on personal mobile devices, it is critical to understand the frequency of encountering alcohol content in adolescents’ daily lives and how adolescents engage with the content. Objective: This paper describes the protocol for a study that examines exposure to digital media alcohol content in the natural environment among adolescents. Methods: Adolescents (n=302; 32% man, 19% non-binary, 51% woman; 26% Asian, 4% American Indian, 22% Black, 5% Other, 52% White; 26% Hispanic/Latinx; mean age 16.21 years, SD=0.77) enrolled in high school were recruited through social media to participate in a prospective study comprised of bursts of ecological momentary assessment (EMA) reports coupled with longer surveys. Video-conferenced group orientation sessions and online survey completion were followed by 21-day EMA reports involving scheduled reports in four blocks of time across the day as well as self-initiated media reports. Reports of exposure to alcohol content included descriptions of the media platform, indices of engagement, source characteristics, beliefs and perceived norms about content, context, and sponsored/branded content presence. Participants were asked to submit exposures to alcohol content in the media as an image (screenshot, photo) or text description to be objectively coded. At each week’s end, participants completed an online survey assessing alcohol use and norms about drinking. This protocol was conducted in three bursts, four months apart, over an 8-month period. Results: EMA reports will be merged with coded image/text entries and weekly and baseline/follow-up survey data. Self-reported alcohol exposure will be explored descriptively and differences in media exposure across subgroups (e.g., gender, drinking status) will be tested. Event-level data will be compared with random prompt data using multilevel models to examine differences at times of exposure vs. non-exposure. Prospective associations between media alcohol content exposure and alcohol use will be explored over one-week and 4-month timeframes. Mediation of the association between media alcohol exposure and drinking will be tested to explore putative cognitive mechanisms. Conclusions: By characterizing adolescents’ real-world exposure to alcohol content in the media, the study will provide critical information to develop and implement interventions to target youth behavior that are well-suited to delivery via mobile devices. Next steps are to conduct focus groups with a subset of the participants to understand their lived experience of in vivo exposure to media alcohol content and reactions to proposed intervention targets. The present study and subsequent qualitative work will launch a program of research to counter the effects of alcohol-related media exposure as it is experienced by adolescents in an effort to minimize underage alcohol involvement.
Background: The World Health Organization stresses the importance of a COVID-19 early warning surveillance system. Integrating syndromic and wastewater data could help in robust estimation of an impen...
Background: The World Health Organization stresses the importance of a COVID-19 early warning surveillance system. Integrating syndromic and wastewater data could help in robust estimation of an impending COVID-19 outbreak. Objective: to integrate syndromic data (AFI, ARI, ILI, and SARI) and wastewater SARS-COV-2 (WW SARS-CoV-2), to compute an early warning surveillance index and second, to demonstrate whether this index can serve as an early warning COVID-19 system. Methods: In a longitudinal study conducted in Trichy, India between July 2022-January 2023 for a period of 30 weeks, syndromic data (Acute Febrile Illness (AFI), Acute Respiratory Illness (ARI), Influenza Like Illness (ILI), Severe Acute Respiratory Infection (SARI)) was collected via an app from 13,965 households using multistage sampling from 40 city wards. Additionally, SARS-CoV-2 was isolated from 932 wastewater samples collected from 40 different city wards, using the skimmed milk flocculation technique. Integration of this data on an Information Communication Technology platform formed a COVID-19 surveillance index (WAP index). Time series modelling using Autoregressive integrated moving average (ARIMA) of WAP index was used to predict COVID-19 outbreaks. Results: The cumulative incidence of ILI cases (85.6 ± 9.2, P < .001), was significantly higher among city wards as compared to (AFI P < .01, ARI P < .01, ILI P < .01, SARI P < .05). Significant inter week differences were observed in incidence of syndromic data and wastewater SARS-CoV-2 positivity (week 1-30, 83.3% - 0%, P < .001). A significant positive correlation existed between syndromic indicators, WAP index scores, and COVID-19 cases (r=0.758, P <.01). WAP index scores rose two weeks prior to rise of COVID-19 cases in the city. The ARIMA (1,0,2) model predicted COVID -19 cases with significant covariates of ARI and SARI, closely aligning with observed values within 95% confidence limits. Conclusions: Integrated community-based surveillance is invaluable in managing the COVID-19 pandemic, empowering health administrators to enforce effective lockdown measures Clinical Trial: nil
Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels...
Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels of disability and dependence, and may reduce quality of life. Significant transient and long term change to earnings do occur and can thrust individuals into poverty. People with DCM (PwDCM) face many challenges accessing state financial assistance. This can have a cumulative negative financial effect due to the association between DCM and low socioeconomic index. Objective: We aimed to assess if delivering workshops centred around access to financial support, could assist PwDCM, living in the United Kingdom. Methods: A series of two virtual workshops was targeted at accessing financial support for English patients under the state pension age, with an anonymised survey delivered to participants after each session. The first session was on Universal Credit (UC) and the second on Disability Financial Support (DFS). Survey responses were analysed using descriptive statistics and free text answers underwent inductive thematic analysis. Results: The average rating on the utility of UC was 9.00/10, with the mean score of wanting further sessions being 8.67/10. Pre-session confidence levels were 5.11/10 rising to 8.00/10. 56% of participants requested one-to-one sessions (5/9). For DFS, the average session utility rating was 10/10, with the desire for further sessions rated as 8.71/10. Pre-session confidence levels were 4.43/10 rising to 9.57/10. A total of 43% of participants requested one-to-one sessions (3/7). Following inductive thematic analysis, themes regarding the delivery, occurrence and context emerged. One participant gave negative feedback which included the length of the session and perceived problems around confidentiality and data protection. Conclusions: The pilot series was largely perceived as a success, with participants finding them useful and increasing their self-rated confidence in navigating the UK financial support system. Given the small sample size, it is hard to predict the success of future sessions but with the lessons learnt from the pilot, Myelopathy.org are keen to host future sessions and explore options to extend the intervention to other countries. Finally, given that the hurdles in accessing financial support extend beyond DCM, such workshops may be relevant to other organisations.
Background: The rising prevalence of urinary incontinence (UI) among older adults, particularly those living in nursing homes (NHs), underscores the need for innovative continence care solutions. The...
Background: The rising prevalence of urinary incontinence (UI) among older adults, particularly those living in nursing homes (NHs), underscores the need for innovative continence care solutions. The implementation of an unobtrusive sensor system may support nighttime monitoring of NH residents' movements and, more specifically, the agitation possibly associated with voiding events. Objective: This study explores the application of an unobtrusive sensor system to monitor nighttime movement, integrated into a care bed with accelerometer sensors connected to a pressure redistributing care mattress. Methods: Six participants followed a seven-step protocol. The obtained dataset was segmented into 20s windows with a 50% overlap. Each window was labelled with one of the four chosen activity classes: in bed, agitation, turn and out of bed. A total of 1416 features were selected and analyzed with an XGBoost algorithm. At last, the model was validated using ‘leave one subject out cross-validation’ (LOSOCV). Results: The trained model attained a trustworthy overall F1-score of 81.51% for all classes, and, more specifically, an F1-score of 83.87% for the class 'Agitation'. Conclusions: The results from this study provide promising insights in unobtrusive nighttime movement monitoring. The study underscores the potential to enhance the quality of care for NH residents, via a machine learning model based on data from accelerometers connected to a viscoelastic care mattress, thereby driving progress in the field of continence care and AI-supported healthcare for older adults. Clinical Trial: Ethical approval to conduct the research was obtained from the KU Leuven Social and Societal Ethics Committee with protocol number G-2020-2214.
Background: Adverse drug events pose a significant public health burden leading to hospitalisation, disability, and death. Even those adverse events categorised as non-serious can severely impact on p...
Background: Adverse drug events pose a significant public health burden leading to hospitalisation, disability, and death. Even those adverse events categorised as non-serious can severely impact on patient quality of life, adherence, and persistence to a prescribed treatment. Monitoring medication safety, however, is challenging. Online patient reports posted on social media may be a useful supplementary source for obtaining real-world data on adverse drug events. While sophisticated techniques continue to be developed to identify adverse events from social media, a consensus has not been reached as to the value of the data extracted in relation to more traditional data sources. Objective: To evaluate and characterise the utility of social media in adverse drug event detection and pharmacovigilance as compared to other data sources. Methods: We undertook a scoping review. We searched 11 bibliographical databases as well as Google Scholar, handsearching and forward and backward citation searching. Records were screened in Covidence by two independent reviewers at both title and abstract stage and the full-text screening stage. Studies were included if they used any type of social media (such as Twitter or patient forums) to detect any type of adverse event associated with any type of drug medication and then compared the results ascertained from social media to any other data source (such as spontaneous reporting systems or clinical literature). Data were collated using a data extraction sheet piloted by the authors. Data were extracted on the types of adverse events and drugs searched for and included, the methods used (such as machine learning), limitations of the methodology, availability of data and code, details of the comparison data source, the results, and conclusions. Results: We screened 6538 unique records with 73 publications representing 60 studies meeting our inclusion criteria. A wide variety of methods were used in the studies. The most common social media platforms used were Twitter and online health forums, and the most common comparison was spontaneous reporting systems although other comparisons were made such as with the scientific literature and product labels.
The results and conclusions of the studies varied. Although similar patterns of adverse event reporting tended to be identified the frequencies were lower in social media. Social media data was found to be useful in identifying new or unexpected adverse events and adverse events in a more timely manner. Most studies advocated the use of social media as an adjunct to traditional data sources. Some indicated the value of social media in understanding patient perspectives such as the impact of adverse events. Conclusions: This scoping review provides a valuable summary of a large body of research and important information for pharmacovigilance, as well as, suggestions for future directions of further research in this area.
Background: Current gold-standard chronic pain management applies a bio-psycho-social lens to clinical care, integrating medication, psychosocial support, and physical reconditioning to promote sustai...
Background: Current gold-standard chronic pain management applies a bio-psycho-social lens to clinical care, integrating medication, psychosocial support, and physical reconditioning to promote sustained treatment success, increase quality of life, and control symptoms. However, only 40% of chronic pain patients consider themselves to be managed adequately. There is a dearth of evidence-based treatment pathways or Models of Care (MoC) that consistently utilise this holistic approach. Objective: The aim of this study is to 1) identify the barriers and facilitators to access and engagement in existing MoC for chronic pain, 2) explore aspects of the delivery of care that can be improved, and 3) develop an improved MoC for pain clinics in NSW by directly liaising with people with chronic pain and their families. Methods: A two-phase qualitative study, utilising semi-structured focus groups, will be conducted. Both phases will follow the same structure, such that patients, carers and clinicians will independently provide input into the proposed MoC; which will then be summarised and integrated by the research team. The focus groups in phase one will generate recommendations for primary changes to the existing MoC, these will then be integrated and presented for evaluation to each stakeholder group during phase two. The phase two focus groups will discuss the feasibility and acceptability of the areas for improvement identified. Participants will be encouraged to interact and speak freely across three core domains: 1) experience of chronic pain management, 2) Barriers and Facilitators to delivering/accessing gold standard MoC, and 3) key improvement points to existing models. Each focus group will last 90 minutes and will be audio-recorded and transcribed verbatim for qualitative analysis. Results: Data collection was initiated in September 2023 and is expected to end by September 2025. Till February 2024, we have completed the focus group with clinicians (n=12) and patients (n=7) in phase one. Data have not been analysed formally and will be reported in the future publication. Conclusions: The study will explore the perceptions of key stakeholders on the efficiency and outcomes of the current MoC and identify barriers preventing access and the delivery of care. The co-designed MoC can be used to inform appropriate, feasible and acceptable implementation of pain services in the future.
Background: Although older adults are most in need of utilizing health information systems such as electronic Personal Health Records (PHR), existing literature has given poor attention to this vulner...
Background: Although older adults are most in need of utilizing health information systems such as electronic Personal Health Records (PHR), existing literature has given poor attention to this vulnerable group of users. Objective: The current study aimed to understand the determinants of the intention to use electronic Personal Health Record (PHR) systems among elderlies. Methods: Hands-on workshops were organised to clarify various functions of a PHR system for 135 seniors and increase their knowledge of using the system for self-management of their chronic conditions. After the completion of the training, a survey was conducted to evaluate the usage intention toward PHR through the lens of Health Belief Model (HBM). The data were analysed using Partial Least Squares (PLS) path modelling. Results: Data analysis of 135 responses received uncovered that the seniors’ usage intention toward the PHR is a function of PHR’s perceived usefulness, perceived barriers, perceived confidence, and cues to action. Of these, perceived usefulness was found to be the strongest predictor. The results also indicated that perceived susceptibility and perceived severity do not significantly impact the seniors’ intention for the PHR. Conclusions: According to the findings and based on the HBM literature, if individuals perceive more benefits and fewer barriers to the PHR, greater self-efficacy, and better cues to action, they are more likely to adopt the system. Clinical Trial: N/A
Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health condi...
Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socio-economic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the UK which investigate their health and wellbeing and assess needs and health inequalities. We describe the methodology, recruitment strategies and key sociodemographic features of participants recruited for the second national round of Positive Voices (PV2022). Objective: The objectives of the survey are to examine:
1. How satisfied are people living with HIV with the current standard and model of HIV care?
2. What are the self-reported prevalences of associated chronic diseases (such as
cardiovascular disease, metabolic conditions, mental/neurocognitive disorders) and their
risk factors in PLHIV?
3. What are the current models/patterns of accessing care for HIV and associated chronic
conditions?
4. How prevalent is HIV-related stigma and discrimination experienced by people with HIV?
5. What are the prevalence and key determinants of sexual and other health-related risk
behaviours among people living with HIV in the UK?
6. How has the COVID pandemic impacted the health and well-being of people living with
HIV? Methods: PV2022 was a cross-sectional questionnaire study that included people attending HIV care at 101 UK clinics between April 2022 and March 2023. Data from the HIV and AIDS Reporting System (HARS), a national surveillance database of people with HIV attending care, held at the UK Health Security Agency (UKHSA), was used as a sampling frame. Information collected in PV2022 included: demographic and socioeconomic factors, HIV diagnosis and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors and additional challenges experienced due to the COVID-19 pandemic. HARS linkage was used to extract clinic-recorded information on antiretroviral therapy (ART), HIV viral load (VL) and CD4 count.
Initially, probabilistic sampling was used to provide a randomly selected representative sample of patients who were invited to participate by completion of a paper or online questionnaire. At the start of 2023, due to under-recruitment largely as a result of the impact of the COVID-19 pandemic and mpox outbreak, an alternative sequential recruitment strategy was initiated in 14 of the largest clinics to increase participant numbers. Results: In total, 4,618 participants completed the survey questionnaire, of these, 3690 participants were recruited through the initial recruitment and 928 through the sequential strategy. In total 4,540 participants could be linked to HARS. The overall response rate, calculated as number of people who completed a questionnaire out of all those who either accepted or declined to participate, was 50%. The survey responses represent approximately 1 in 20 people living with diagnosed HIV in England, Wales, and Scotland. Three-quarters of participants were male (74%), over half were of white ethnicity (65%), and nearly a quarter were of black African ethnicity (24%). Conclusions: Currently, PV2022 is the largest survey of people with HIV in the UK. The findings from PV2022 will be used to investigate the health and wellbeing of people with HIV and associations with demographic, socioeconomic, lifestyle and HIV-related factors. Findings will inform the HIV Action Plan for England, interventions to improve patient-centred care, and the provision of HIV clinical and support services.
Background: E-cigarette use has been a public health issue in the US. On June 23, 2022, the FDA issued marketing denial orders (MDOs) to Juul Labs Inc. for all of their products currently marketed in...
Background: E-cigarette use has been a public health issue in the US. On June 23, 2022, the FDA issued marketing denial orders (MDOs) to Juul Labs Inc. for all of their products currently marketed in the United States. However, one day later, on June 24, 2022, a federal appeals court granted a temporary reprieve to Juul Labs that allowed it to keep its e-cigarettes on the market. As the conversation around Juul continues to evolve, it is crucial to gain insights into the sentiments and opinions expressed by individuals on social media Objective: To better understand the response of the general public to the policy, and the life-cycle of public health-related policy on social media. Methods: 6,023 tweets and 22,288 reply/retweets were collected from Twitter (rebrand as X) between Jun 2022 and October 2022. We conducted a descriptive analysis, topic modelling utilizing the state-of-the-art BERTopic technique, and sentiment analysis. Results: We found that the life cycle of reactions to the FDA’s ban on Juul lasted no longer than a week on Twitter. Not only the news related to the announcement itself but the surrounding discussions (the 6 topics presented in the study) diminished shortly after June 23rd, 2022—the date when the ban was officially announced. Of the top 50 most retweeted tweets, we found posters responded from neutral (23/45, 51.11%) to more negatively (19/45, 42.22%) on the corresponding topics. Conclusions: We observed a short life-cycle for this news announcement with more negative sentiment toward the FDA’s ban on JUUL. Policymakers could employ tactics such as ongoing updates and reminders about the ban, highlighting its impact on public health, and actively engaging with influential social media users who can help sustain the conversation.
The immediate context in which a person lives shapes their experience of impairment and disability. Assistive technology (AT) tools are the interface between impairment and context. This article prese...
The immediate context in which a person lives shapes their experience of impairment and disability. Assistive technology (AT) tools are the interface between impairment and context. This article presents a new framework for the design of assistive technology. It provides a theoretical exploration of the relationship between context, assistive technology and impairment. For this, first, we examine the theoretical challenges raised by the interface AT and impairments, considering dominant conceptual models of disability. Then, we analysed the role of context in the design, distribution and use of AT. Our framework addresses the current disconnect between the population the technology aims to serve and the innovation ecosystem. Disability is very diverse, and persons with diverse impairments benefit from different technology. Because of this diversity, we focus on visual impairment. We conclude this article by laying out a new framework for the design of AT that addresses the role of the context in which a person lives and aims to enable personal freedom in it. We do it by using the lenses of the capabilities approach. Our framework goes beyond the classical approach of only looking at AT as a tool for task performance. We argue that AT becomes a conversion tool that enables disabled persons to reach full social participation, addressing the variety of social and environmental contexts in which persons with disabilities live. Finally, we provide recommendations for future research.
Background: Neurodiversity encompasses diverse cognitive variations, including conditions like Down syndrome, affecting cognitive and emotional development. Individuals within the neurodiverse spectru...
Background: Neurodiversity encompasses diverse cognitive variations, including conditions like Down syndrome, affecting cognitive and emotional development. Individuals within the neurodiverse spectrum may encounter challenges related to executive functions, impacting daily activities and social participation. This review recognizes Down syndrome within the broader context of neurodiversity, exploring the intersection of executive functions and serious games as interventions for cognitive development. Objective: The primary goal of this review is to analyze three interconnected themes: neurodiversity, executive functions, and serious games. While considering the positive impact of serious games on children with Down syndrome, the focus extends on exploring broader applications within neurodiversity. Methods: As of January 20, 2024, a thorough search was conducted on Scopus and WoS, covering serious games, executive functions, and neurodiversity with an emphasis on Down syndrome. Due to limited results, separate equations were used to explore the relationship between serious games and Down syndrome, as well as serious games and executive functions. Two independent reviewers evaluated retrieved studies, highlighting specific game applications in the neurodiverse context. Results: Out of 18 articles, three focused on serious games and Down syndrome, while 15 addressed serious games in the context of executive functions within neurodiversity. The studies collectively emphasized serious games' effectiveness in enhancing cognitive development and overall quality of life for individuals within the neurodiverse spectrum. Conclusions: The synthesis of findings suggests that serious games hold potential to improve cognitive abilities and promote inclusion in educational settings for individuals with diverse cognitive profiles. Beyond Down syndrome, serious games, along with web applications, robotics, and virtual reality, emerge as promising therapeutic tools. Game design elements and exergaming demonstrate the ability to enhance cognition and skill development. Positive effects have been observed not only in older adults' attention, executive functions, and speech processing but also in various neurodiverse populations. However, further research is needed to explore long-term effects, optimize game design, and assess their impact on several aspects of neurodiversity.
Background: Major Depressive Disorder (MDD) is a common diagnosis among adolescents. Cognitive-behavioral therapy (CBT) is recommended as the first line of treatment. Digital Health Interventions (DHI...
Background: Major Depressive Disorder (MDD) is a common diagnosis among adolescents. Cognitive-behavioral therapy (CBT) is recommended as the first line of treatment. Digital Health Interventions (DHIs), such as apps, could contribute to treatment. Advantages could be easy accessibility and availability, reduced time for face to face (f2f) therapy, and the ability to intensify therapy by incorporating it into the everyday lives of patients. Challenges such as low adherence rates are common in DHIs. Therefore, they need to undergo rigorous testing for feasibility and effectiveness. Objective: An evaluated, CBT-based f2f therapy program for depression in adolescents was transformed into an app called e-MICHI. This study examined its feasibility and efficacy for use in blended therapy in out-patient settings. Methods: Adolescents aged 12 to18 with MDD were recruited from two university hospitals. Participants were actively recruited based on defined eligibility criteria. The intervention combined 3-weekly f2f sessions with daily app engagement over a six-week period. Feasibility was measured using various variables, including adherence and engagement rates, satisfaction ratings, and transfer of techniques to everyday practice; efficacy was assessed using the Beck Depression Inventory-II (BDI-II) and the Children’s Depression Rating Scale-Revised (CDRS-R), among other measures. Data was analyzed using a repeated measures ANOVA. Results: e-MICHI was positively evaluated by both, participants and therapists. Participants demonstrated high adherence rates and reported consistent practice of the e-MICHI techniques. Use of the app was associated with a significant reduction of depressive symptoms (before app use vs. three-month follow-up, BDI-II: mean -7.09, P<.001; CDRS-R: mean -10.56, P<.001). Conclusions: While acknowledging its limitations, the study confirms the feasibility of e-MICHI for treating adolescent depression in outpatient settings. Clinical Trial: DRKS (German Clinical Trial Register): DRKS00022420
Background: Due to the high prevalence of mental health illnesses and mood disorders, strategies involving the use of technology have been proposed to facilitate the detection and follow-up of patient...
Background: Due to the high prevalence of mental health illnesses and mood disorders, strategies involving the use of technology have been proposed to facilitate the detection and follow-up of patients. Objective: This article describes the usability evaluation of a system designed for treating mood disorders in the population of the Department of Cordoba, Colombia. Methods: A scenario-based methodology was implemented, which represented the main functionalities of the software for telehealth care. Three test cycles were conducted with the involvement of 30 users representing different roles (patients, patient' relatives, mental health clinical care personnel, and program logistics personnel). The NASA-TLX (1) and PSSUQ (2) scales were used to measure the workload and the level of effort to complete the different tasks of the system. Results: The usability evaluation results over the two test cycles were encouraging and showed PSSUQ scores of 2.2 and 2.3, respectively. Conclusions: The workload showed improvements between both test cycles, prioritizing patient-type user-oriented interfaces.
Background: Chat Generative Pre-Trained Transformer (ChatGPTTM) is a large language model (LLM)-based chatbot developed by OpenAITM. ChatGPT has many potential applications to healthcare, including en...
Background: Chat Generative Pre-Trained Transformer (ChatGPTTM) is a large language model (LLM)-based chatbot developed by OpenAITM. ChatGPT has many potential applications to healthcare, including enhanced diagnostic accuracy and efficiency, improved treatment planning, and better patient outcomes. Healthcare professionals’ perceptions of ChatGPT and similar artificial intelligence tools are not well known, and understanding these attitudes is important to inform the best approaches to explore their use in medicine. Objective: Our aim was to evaluate the healthcare professional's awareness and perception about potential applications of ChatGPT in the medical field, including potential benefits and challenges of adoption. Methods: We designed a 33-question online survey that was distributed amongst healthcare professionals via targeted emails, professional Twitter and Linkedin accounts. The survey included a range of questions to define respondent demographic characteristics, familiarity with ChatGPT, perceptions of this tool’s usefulness and reliability, and opinions on its potential to improve patient care, research, and education efforts. Results: One hundred and fifteen healthcare professionals from 21 countries responded to the survey, including physicians, nurses, researchers, and educators. 101 (87.8%) had heard about ChatGPT mainly from peers, social media, and news, and 77 (76.2%) had used ChatGPT at least once. Participants found ChatGPT to be helpful writing manuscripts (n=31, 45.6%), e-mails (n=25, 36.8%), and grants (n=12, 17.6%), accessing the latest research and evidence-based guidelines (n=21, 30.9%), providing suggestions on diagnosis or treatment (n=15, 22.1%), and improving patient communication (n=12, 17.6%). Respondents also felt that the ability of ChatGPT to access and summarize research articles (n=22, 46.8%), to provide quick answers to clinical questions (n=15, 31.9%), and to provide patient education materials (n=10, 21.3%) were also helpful. However, there are concerns regarding utilization of ChatGPT such as the accuracy of responses (n=14, 29.8%), limited applicability to its practice (n=18, 38.3%), legal and ethical considerations (n=6, 12.8%) mainly regarding plagiarism or copyright violations. Participants stated safety protocols such as data encryption (n=63, 62.4%), access control (n=52, 51.5%) may assist in ensuring patient privacy and data security. Conclusions: Our results show that ChatGPT use was widespread among healthcare professionals in daily clinical, research, and educational activities. The majority of our participants have found ChatGPT to be useful however there are concerns about patient privacy, data security, and its legal and ethical issues as well as the accuracy of the information ChatGPT provides. Further studies are required to understand the impact of ChatGPT and other LLMs on clinical, educational, and research outcomes and concerns of its utilization have to be addressed systematically and through appropriate methods.
Background: Artificial intelligence (AI) is widely applied across several industries, including medical education. The content validation and its answers are based on training datasets and the optimiz...
Background: Artificial intelligence (AI) is widely applied across several industries, including medical education. The content validation and its answers are based on training datasets and the optimization of each model. The accuracy of large language models (LLMs) AI in basic medical examinations and the factors related to its accuracy have been explored. Objective: Aimed at evaluating factors associated with the accuracy of large language models (ChatGPT, GPT-4, Google Bard, and Microsoft Bing) in answering multiple-choice questions from basic medical science examinations. Methods: We employed questions that were closely aligned with the content and topic distribution of Thailand's Step 1 National Medical Licensing Examination. Variables such as the difficulty index, discrimination index, and question characteristics were collected. These questions were then simultaneously input into ChatGPT, GPT-4, Microsoft Bing, and Google Bard, and their responses were recorded. The accuracy of these LLMs and their association factors were analyzed using multivariable logistic regression. This analysis aimed to assess the effect of various factors on model accuracy, with results reported as Odds ratio (OR). Results: The study revealed GPT-4 as the top-performing model with an overall accuracy of 89.07% (95% CI 84.76 - 92.41), significantly outperforming the others (p < 0.001). Microsoft Bing followed with an accuracy of 83.69% (95% CI 78.85 - 87.80), ChatGPT at 67.02% (95% 61.20 - 72.48), and Google Bard at 63.83% (95% CI 57.92 - 69.44). The multivariable logistic regression showed a correlation between question difficulty and model performance, with GPT-4 demonstrating the strongest association. Interestingly, no significant correlation was found between model accuracy and question length, negative wording, clinical scenarios, or the discrimination index for most models, except for Google Bard, which showed varying correlations. Conclusions: The GPT-4 and Microsoft Bing models demonstrated equal and superior accuracy compared to ChatGPT and Google Bard in the domain of basic medical science. The accuracy of these models is significantly influenced by the item's difficulty index (p). Indicating that the LLMs have more accuracy on easier questions. This suggests that the more accurate models, such as GPT-4 and Bing, can be valuable tools for understanding and learning basic medical science concepts.
Background: Online surveys of internet panels such as Amazon’s Mechanical Turk (MTurk) are common in health research. Non-response in longitudinal studies can limit inferences about change over time...
Background: Online surveys of internet panels such as Amazon’s Mechanical Turk (MTurk) are common in health research. Non-response in longitudinal studies can limit inferences about change over time. Objective: We (1) describe the patterns of survey responses and non-response among MTurk members with back pain, (2) identify factors associated with survey response over time, (3) assess the impact of non-response on sample characteristics, and (4) assess how well inverse probability weighting can account for differences in sample composition. Methods: We surveyed MTurk adults who identified as having back pain. We report participation trends over three survey waves and use stepwise logistic regression to identify factors related to survey participation in successive waves. Results: A total of 1,678 adults participated in Wave 1. Of those, 983 (59%) participated in Wave 2 and 703 (42%) in Wave 3. Participants who did not drop out took less time to complete prior surveys (30 minutes vs. 35 minutes in Wave 1, p<0.005; 24 minutes vs. 26 minutes in Wave 2, p=0.019) and reported having fewer health conditions (6 vs. 7, p<0.005). In multivariate models, higher odds of participation were associated with less time to complete the baseline survey, older age, not being Hispanic, not having a bachelor’s degree, being divorced or never married, having less pain interference and intensity, and having more health conditions. Weighted analysis showed slight differences in sample demographics and conditions, and larger differences in pain assessments, particularly for those who responded to Wave 2. Conclusions: Longitudinal studies on MTurk have large, differential dropouts between waves. This study provided information about the types of individuals who are more likely to drop out over time which can help researchers prepare for future surveys.
Background: Despite the usefulness of artificial intelligence (AI)-based diagnostic decision-support systems, the over-reliance of physicians on AI-generated diagnoses may lead to diagnostic errors. O...
Background: Despite the usefulness of artificial intelligence (AI)-based diagnostic decision-support systems, the over-reliance of physicians on AI-generated diagnoses may lead to diagnostic errors. Objective: We investigated the safe use of AI-based diagnostic-support systems with trust calibration, adjusting trust levels to AI’s actual reliability. Methods: A quasi-experimental study was conducted at Dokkyo Medical University, Japan, with physicians allocated (1:1) to the intervention and control groups. The participants reviewed medical histories of 20 clinical cases generated by an AI-driven automated medical history-taking system with an AI-generated list of 10 differential diagnoses and provided one to three possible diagnoses. Physicians were asked to consider whether the final diagnosis was included in the AI-generated list of 10 differential diagnoses in the intervention group, which served as trust calibration. We analyzed the diagnostic accuracy of physicians and the correctness of trust calibration in the intervention group. Results: Among the 20 physicians assigned to the intervention (n=10) and control (n=10) groups, the diagnostic accuracy was 41.5% and 46.0%, respectively, without significant difference (odds ratio 1.20, 95% confidence interval [CI] 0.81–1.78, P=.42). The overall accuracy of the trust calibration was only 61.5%, and despite correct calibration, the diagnostic accuracy was 54.5%. Conclusions: Trust calibration did not significantly improve physicians' diagnostic accuracy when considering differential diagnoses generated by reading medical histories and the possible differential diagnosis lists of an AI-driven automated medical history-taking system. This study underscores the limitations of the extant trust-calibration system and highlights the need to apply supportive measures of trust calibration rather than solely utilizing trust calibration.
Background: The demand for mental health services in the community continues to exceed supply. At the same time, technological developments make the use of artificial intelligence-empowered Conversati...
Background: The demand for mental health services in the community continues to exceed supply. At the same time, technological developments make the use of artificial intelligence-empowered Conversational Agents (CAs) a real possibility for helping to fill this gap. Objective: The objective of this review is to identify existing empathic CA design architectures within the mental healthcare sector and to assess their technical performance in terms of classification accuracy. In addition, the approaches used to evaluate empathic CAs within the mental healthcare sector in terms of their acceptability to users will be evaluated. Finally, this review aims to identify limitations and future directions for empathic CAs in mental healthcare. Methods: A systematic literature search was conducted across six academic databases to identify journal articles and conference proceedings using search terms covering three topics: ‘conversational agents’, ‘mental health’, and ‘empathy’. Only studies discussing CA interventions for the mental healthcare domain were eligible for this review with both textual and vocal characteristics considered as possible data inputs. Quality was assessed using appropriate risk of bias and quality tools. Results: A total of 19 articles met all inclusion and exclusion criteria. The observed terms used to identify a CA varied from ‘chatbot’ (47%), ‘conversational agent’ (32%), ‘dialog system’ (11%), ‘virtual assistant’ (5%) to ‘conversational AI agent’ (5%). Transformer-based (37%) and hybrid (26%) engines were the most employed designs. A technical evaluation of CA performance was conducted for 17 of the 19 papers reviewed. While a variety of single-engine CAs exhibited good accuracy (F1 scores >95%), superior accuracy was achieved using hybrid engines that were able to provide a more nuanced response. However, human evaluations of CAs were less positive. Only five (26%) of the 19 studies referred to an explicit definition of empathy and only 84% of the selected studies used human evaluation to assess the effectiveness of the CA designs. A direct evaluation of empathy of the CA was involved in only five studies using questionnaire responses, response ratings and in-depth interview responses. The human evaluation of CAs was performed mostly by end-users (75%), while experts in Mental Health (MH) assessed CAs in the remaining studies (25%). A variety of measures were used to evaluate the level of empathy exhibited by CAs. For example, Patient Health Questionnaires were used to show an improvement in the mean mood from 5.79 to 7.38 on a 10-point scale for one particular CA. In three other studies, empathy ratings were recorded with empathic percentages of 56%, 75% and 79%, with average empathy scores and emotional relevance scores of 2.85 or 3.05 out of 5 respectively in other studies. Conclusions: CAs with good technical and empathic performance are now available to users of mental healthcare services. Clinical Trial: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022348130
Background: Mental health is crucial for proper execution of daily duties by healthcare personnel. However, there have been limited efforts to bring mental health services and care closer to this cruc...
Background: Mental health is crucial for proper execution of daily duties by healthcare personnel. However, there have been limited efforts to bring mental health services and care closer to this crucial group. Objective: To assess the effectiveness of "Psicovida," a mobile application, in enhancing mental health care for healthcare workers by reducing symptoms of depression and emotional distress through the implementation of cognitive-behavioral therapy-based activities over a three-month period. Methods: This quasi-experimental study employed a randomized, controlled design with initial and final assessments. Participants were healthcare workers from a public hospital in Ecuador, including doctors and nurses. Eligibility criteria included being over 18 years old, having at least 12 months of service at the institution, and owning a smartphone. The intervention involved the use of the "Psicovida" app, which provided weekly tasks based on cognitive-behavioral theories for a period of 3 months. Data collection included demographic information and self-administered tests (PHQ-9 and GHQ-12) to evaluate psychological well-being and identify non-psychotic psychiatric conditions before and after the intervention. Results: The study found that healthcare personnel who used the "Psicovida" mobile application reported significant reductions in symptoms of depression and emotional distress. These improvements were more pronounced in users who initially exhibited higher levels of these symptoms, compared to those in the control group who did not use the app and either maintained their symptom levels or experienced an increase in depressive and emotional distress symptoms. Conclusions: The "Psicovida" mobile application, when used as a supplementary mental health care tool, shows promise in reducing symptoms of depression and emotional distress among healthcare personnel. This study underscores the potential benefits of integrating mobile health technologies into mental health care strategies for healthcare workers, highlighting the importance of accessible and flexible support systems in managing mental health challenges within this crucial workforce.
Background: Primary hypertension (PH) poses significant risks to children and adolescents. Few prediction models for the risk of PH in children and adolescents currently exist, posing a challenge for...
Background: Primary hypertension (PH) poses significant risks to children and adolescents. Few prediction models for the risk of PH in children and adolescents currently exist, posing a challenge for doctors in making informed clinical decisions. Objective: This study aimed to investigate the incidence and risk factors of PH in Chinese children and adolescents. It also aimed to establish and validate a nomogram-based model for predicting the next year PH risk. Methods: A retrospective cohort (N=3,938, between January 1, 2008 and December 31, 2020) and prospective (N=1,269, between January 1, 2021 and July 1, 2023) cohort were established for model training and validation. An independent cohort of 190 individuals was established for external validation of the model. The result of the least absolute shrinkage and selection operator (LASSO) regression technique was employed to select the optimal predictive features, and multivariate logistic regression to construct the nomogram. The performance of the nomogram underwent assessment and validation through the area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration curves, decision curve analysis (DCA), clinical impact curves, and sensitivity analysis. Results: The PH risk factors that we have ultimately identified include gender, age, family history of hypertension, fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL-C), and uric acid (UA), while factor breastfeeding has been identified as a protective factor. Subsequently, a nomogram has been constructed incorporating these factors. AUCs of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.849 in the external validation cohort. C-index of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.849 in the external validation cohort. The nomogram has been proven to have good clinical benefits and stability in calibration curves, DCA, clinical impact curves, and sensitivity analysis. Finally, we observed noteworthy differences in UA levels and family history of hypertension among various subgroups, demonstrating a high correlation with PH. Moreover, the web-based calculator of the nomogram was built online. Conclusions: We have developed and validated a stable and reliable nomogram that can accurately predict PH risk within the next year among children and adolescents in primary care and offer effective and cost-efficient support for clinical decision support for the risk prediction of PH.
Background: The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems in order to safeguard a globally connected society, especially those in low-to-middle inco...
Background: The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems in order to safeguard a globally connected society, especially those in low-to-middle income countries. Africa’s rapid adoption of digital technological interventions created a new frontier of digital advancement during crises or epidemics. The use of digital tools for disease surveillance can assist with rapid outbreak identification and response, handling duties such as diagnosis, testing, contact tracing, and risk communication. Malawi was one of the first countries in the region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Objective: The aim of this study is to seek expert consensus using the Delphi methodology to examine Malawi's COVID-19 digital surveillance response strategy and to assess the digital tools using the World Health Organization mHealth Assessment and Planning for Scale Toolkit. Methods: This protocol follows the Guidance on Conducting and REporting DElphi Studies. Participants must meet the following requirements: must have first-hand experience on the design, implementation and maintenance with COVID-19 digital surveillance systems. There will be no restrictions on the level of expertise or years of experience. The panel will consist of approximately 40 participants. We will use a modified Delphi process whereby rounds one and two will be hosted online via Qualtrics and round three will encompass a face-to-face workshop held in Malawi. Consensus will be defined as ≥70% of participants strongly disagree, disagree, somewhat disagree or strongly agree, agree, somewhat agree. During round three, the face-to-face workshop, participants will be asked to complete, the mHealth Assessment and Planning for Scale Toolkit assessment on the digital tool on which they are experts. The MAPS toolkit, will enable the panel members to assess the digital tools from a sustainable perspective from six distinct, yet complementary axes i.e. 1) Groundwork, 2) Partnerships, 3) Financial Health, 4) Technology & Architecture, 5) Operations and 6) Monitoring and Evaluation. Results: The ability of a country to collate, diagnose, monitor, and analyze data forms the cornerstone of an efficient surveillance system, allowing countries to plan and implement appropriate control actions. Malawi was one of the first countries in the African region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Conclusions: We anticipate findings from this Delphi study will provide insights into how and why Malawi was successful in deploying digital surveillance systems. In addition, findings should produce recommendations and guidance for the rapid development, implementation, maintenance and impact of digital surveillance tools during a health crisis.
Background: Background: Urbanization & industrialization is contributing to the change in the lifestyle and food preferences especially in children. Childhood obesity is mainly a lifestyle-oriented di...
Background: Background: Urbanization & industrialization is contributing to the change in the lifestyle and food preferences especially in children. Childhood obesity is mainly a lifestyle-oriented disorder. It is a rising global burden with its lifelong implications. If not treated in childhood period, it may land up in adulthood with serious complications. In Ayurveda, Sthaulya is the condition which can be referred to obesity. Being over-obese is termed as Atisthula which is a santarpanottha (overnutrition) vyadhi (disorder) and is counted under eight censurable physiques. Treatment of Sthaulya is Karshana (Therapeutic Scrapping). Navak guggulu’s efficacy is already proven for treatment of Obesity. Vachaharidradi gana is a group of Karshana herbs mentionaed in Ashtang Hriday. So, in this study the efficacy of Vachahardidradi gana vati will be compared with Navak guggulu to treat overweight children. Objective: Evaluation of the efficacy of Navak Guggulu along with diet restriction and Suryanamaskara versus Vachaharidradi Gana Vati along with diet restriction and Suryanamaskara in children (10 – 16 years) with Sthaulya (Overweight). Methods: After doing the drug analysis, a total of 86 overweight children fitting into inclusion criteria from 10 to 16 years of the age group will be selected and will be distributed in 2 groups having 43 each. One group will be trial group and other group will be control group. Control group will be given Navak Guggulu and trial group will be given Vachahardiradi gana vati tablet. The medicines will be provided to subjects in double blinding manner. Both the groups will receive medicines for 90 days along with diet restriction and Suryanamaskara and they will be followed up every 15 days and their assessment during each visit will be recorded in the case record form. Final follow-up will on 180th day. Results: Results will be drawn from the observations of subjective and objective parameters. Conclusions: Conclusion of the study will be drawn based on statistical data calculated from the collected data and overall improvement. Clinical Trial: CTRI No. - CTRI/2023/03/051135 (clinical trial registry India)
Dated –28/03/2023
Background: Day surgery is increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effec...
Background: Day surgery is increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The eHealth application ikHerstel is one such tool but although it administers its functions in the home, its implementation hinges on caregivers within the hospital. Objective: A feasibility study was conducted in order to investigate the feasibility of an additional, patient-oriented implementation strategy for ikHerstel. Our research question was: How well are patients able to use ikHerstel independent of their caregiver? Methods: We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through online surveys. Descriptive analysis and open coding were used to analyse the data. Results: Recruitment yielded 213 registrations, of whom 55 patients were included. The patient-oriented implementation strategy yielded a reach of 53.9%. All participating patients (100%) received an account for the ikHerstel app and 84.1% created a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it with an average 7.0 out of 10 and 53.8% of patients (28/52) explicitly reported no difficulties in using it. A major concern of the implementation strategy was the conflict in recommendations between ikHerstel and caregivers, as well as the concomitant feelings of insecurity experienced by patients. Conclusions: We may conclude that this strategy is less optimal compared to implementation as usual yet it allows use to reach a population of patients who are otherwise be left unserved. This shows that focus should lie on broadening ikHerstel’s implementation to more hospitals rather than improving the implementation of a patient-oriented strategy.
Background: Over 1.9 billion people are diagnosed as being obese or overweight. Digital technologies have varying effects in affecting weight loss in participants. Precision health exploits the benefi...
Background: Over 1.9 billion people are diagnosed as being obese or overweight. Digital technologies have varying effects in affecting weight loss in participants. Precision health exploits the benefits of digital health and data by being able to provide highly tailored, or personalised, pathways to service users. Obesity is a multi-morbid condition caused in part by lifestyle risk factors including dietary choices, sleep hygiene, exercise and mental health. Objective: The objective was to assess the effect of participants choosing their health “focus” on joining the NHS-certified Gro Health app to support holistic remote weight management. Methods: Participants were invited to engage with a precision behavioural change tool that addresses the four pillars of health; mental health/wellbeing, nutrition, sleep and exercise “Gro Health” by their primary care team or local authority and invited to use the tool’s education programmes, access MDT health coaching and track their health. Gro Health onboards users to self-select where they would like to place their health “Focus” on either; Sleep, Exercise, Nutrition or Wellbeing which tailors their experience of the digital tool. Outcome variables; weight, HbA1c, PHQ8, Karolinska Sleepiness Scale, and Patient Activation Measure (PAM) compared users across “focus” groups. Results: 438 participants downloaded the Gro Health app. Mean age 41.9 (± 13 years) and body weight on sign up was 95.59kg (SD 5.6). The majority of participants identified as female (51.1%) with mostly users of white ethnicity (71.2%). 72% of participants chose nutrition as their focus, with the greatest weight loss between baseline and 12-month recordings (MD=7.01, ±2.83) observed for these individuals, compared to those who selected exercise, sleep or wellbeing as their focus. The largest improvement in sleepiness and depression was for individuals who chose sleep as their focus. Conclusions: Allowing a participant to self-select their focus influences their health outcomes and can support multiple therapeutic benefits. A precision behavioural change tool can support holistic health management and the continuum of obesity management and is an effective way to deliver scalable and engaging precision behavioural change.
Background: In Saudi Arabia, the use of digital media and technology, such as the Internet and smartphones, has experienced significant growth. This has contributed to concerns about problematic digit...
Background: In Saudi Arabia, the use of digital media and technology, such as the Internet and smartphones, has experienced significant growth. This has contributed to concerns about problematic digital media use and its negative impacts on wellbeing, especially among young people. However, there is a paucity of research on stakeholder perspectives regarding intervention strategies to address these issues. Objective: The goal of the study was to gather insights from a range of societal stakeholders, including young people, parents, policy makers, industry leaders, clinicians, educators, and digital media users and non-users, to inform the development of culturally tailored interventions to improve digital wellbeing in Saudi Arabia. Methods: One hundred participants, sampled purposefully, completed an survey online. Participants answered questions regarding their experiences and perspectives on digital media use and digital well-being. We examined distributions of categorical variables for questions related to participant digital media use time, reasons for use, impacts of use, strategies to self-regulate use, and perceived likelihood of success of different interventions to improve digital wellbeing in Saudi Arabia (e.g., education programs, media campaigns, Internet use restrictions). Results: Among participants, 64% were male, and 51% were under 25 years old (range from 15 to 64). Participants were primarily identified as regular digital media users (25 %), persons with problematic Internet use (19%), or clinicians/healthcare professionals (17%). Most participants reported extensive daily screen time use, with 50% reporting four or more hours of digital media use for recreation on weekdays, and 59% on weekends. Participants reported differential impacts of their digital media/technology use ranging from positive (e.g., contact with family and friends, performance at school/work) to negative (e.g., disrupted sleep, reduced physical activity). Of all participants, 77% reported attempts at regulating their digital media use by using various strategies such as deleting apps from their phones or taking periodic digital detox breaks. Participants thought it was likely (endorsed by 50% of participants or more) that all potential intervention approaches presented to them would be effective to improve digital wellbeing in Saudi Arabia. Educational programs for parents, school programs for children, and apps designed to regulate digital media use were endorsed by at least 75% of respondents. Children and adolescents were perceived as the primary target population for these interventions. Conclusions: Our findings, based on perspectives of a diverse group of stakeholders, suggest that interventions to enhance digital wellbeing in Saudi Arabia should prioritize young people and focus on education-based interventions and apps designed to regulate digital media use. By incorporating stakeholder perspectives, culturally tailored interventions can be developed to address specific needs and challenges associated with digital media use in the Saudi context.
Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot and Happify, have shown promise in alleviati...
Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot and Happify, have shown promise in alleviating these symptoms. Objective: This study aims to investigate the effectiveness and acceptability of Woebot and Happify in reducing loneliness and depression among college students after the COVID-19 pandemic. Methods: A mixed-methods approach was employed over four months. Sixty-three participants aged 18-27 from Sungkyunkwan University in Seoul, South Korea, were initially recruited, with inclusion criteria of elevated loneliness (UCLA Loneliness Scale score ≥ 34-40) and depression (PHQ-9 score ≥ 6). Attrition resulted in a final sample of 27 participants. Participants were randomly assigned to Woebot (n=22), Happify (n=21), or a control group using Bondee, a metaverse social network messenger app (n=10). Quantitative measures (UCLA Loneliness Scale, PHQ-9) and qualitative assessments (user feedback, focused interviews) were used. Results: Modest decreases in loneliness and depression post-intervention were observed, although not statistically significant (likely due to small sample size). Welch's ANOVA found no significant differences between intervention groups (UCLA Loneliness: P=.5917; PHQ-9: P=.5058). Qualitative data indicated user satisfaction, with suggestions for improved app effectiveness and personalization. Conclusions: Despite limitations, the study suggests the potential of well-designed digital interventions in alleviating college students' loneliness and depression. Findings underscore the importance of accessible digital tools, mental health literacy education, and comprehensive support systems. Further research with larger samples is needed.
Background: In recent years, with the continuous development of mobile communication technology, the large-scale popularization of intelligent mobile devices such as cell phones and tablet computers h...
Background: In recent years, with the continuous development of mobile communication technology, the large-scale popularization of intelligent mobile devices such as cell phones and tablet computers has prompted the emergence of mobile medical service platforms.With the aging trend of chronic diseases in China becoming more and more obvious, the public's demand for health information and the degree of portability is getting higher and higher, making it a certain requirement for the development and updating of mobile medical service platforms.Therefore, it is crucial to analyze the advantages and shortcomings of the current Chinese mobile medical and provide constructive suggestions. Objective: To comprehend the development of mobile medical service platforms in domestic general hospitals, study and compare the characteristics of various platforms, and make constructive recommendations for enhancing the quality of mobile medical services. Methods: Taking the mobile medical service platforms such as the latest version of mobile APP or hospital WeChat public number currently applied by the top 50 hospitals in the Fudan University 2022 Comprehensive Ranking of Chinese Hospitals as the object of study. Adopting the network survey method and literature analysis method, we construct a preliminary evaluation indicator system of the user interface containing three first-level indicators, 13 second-level indicators, and 19 third-level indicators of visual design, interaction design, and technological development, as well as a service function evaluation index system consisting of four modules, namely, service items, information content, health education, and evaluation system, to evaluate the current status of the functions of the mHealth service platform. Results: China's general hospital mobile medical service platform meets the requirements for a basic user interface design and offers a basic booking function in its service function. At the same time, the majority of hospitals focus on expanding their basic services and implementing relevant innovation. Since China's smart hospital is still in its early stages of development, construction took comparatively little time, homogenization between platforms is more evident, and platform construction innovation still needs to be further enhanced. Conclusions: The construction of mobile medical service platform in domestic hospitals is still in the initial stage, and the key to the development of mobile medical service is to improve the user experience, perfect the functional modules, take into account the users of different age levels and focus on privacy protection.
Background: In today’s digital society, the acquisition of parenting information through online platforms such as social networking sites (SNS) has become widespread. Amid the mix of online and offl...
Background: In today’s digital society, the acquisition of parenting information through online platforms such as social networking sites (SNS) has become widespread. Amid the mix of online and offline information sources, there is a need to discover effective information-seeking methods for solving parenting problems. Objective: This study aimed to identify patterns of information use among parents of young children in the digital age and elucidate the characteristics of these patterns through a comparative analysis of social support and parental self-efficacy. Methods: An online survey was administered with fathers and mothers of children aged 03 years. Convenience sampling, facilitated by an online survey company, was adopted, and data from 227 fathers and 206 mothers were analyzed. The survey included questions on personal characteristics; frequency of use of different sources of parenting information (websites, SNSs, parenting apps, family, friends, and professionals); perceived social support; and parental self-efficacy. K-means cluster analysis was used to extract the patterns of parenting information use, followed by covariance analysis. Results: Eight clusters were identified. Three clusters presented patterns with a combination of online and face-to-face information sources. Results from the analysis of covariance constructed with clusters and covariates revealed significant explanatory models for family support (F(17, 380)=5.98, P<.001), friend support (F(17, 380)=6.49, P<.001), and parenting self-efficacy (F(17, 379)=6.14, P<.001). Compared to Hybrid / Multichannel clusters, clusters with patterns with a relatively greater reliance on online information compared to face-to-face sources, a bias toward information from family sources, and a low frequency of information use across all sources were characterized by lower levels of social support and parental self-efficacy. Conclusions: This study adds to the evidence that online information can effectively supplement offline information in addressing parenting challenges, albeit with limited functionality as a substitute. These findings suggest the importance for parenting support professionals to simultaneously enhance information literacy and strengthen social relationships among parents, tailored to their information use patterns.
Background: We Can Do This was a web-based application (web-app) developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use. Objective: This paper...
Background: We Can Do This was a web-based application (web-app) developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use. Objective: This paper reports on a process evaluation of the web-app’s acceptability and feasibility when used by clients and clinicians in residential rehabilitation services and primary care. Methods: Clinicians and clients who had used the web-app were recruited via Aboriginal Community Controlled Health Services and Aboriginal residential rehabilitation services in urban and regional Victoria and South Australia. Non-identified usage data was collected from all participants. After using the web-app, those who indicated a willingness to be interviewed were contacted and interviewed by phone or in person and asked about the feasibility and acceptability of the web-app. Results: Interviews with ten clients and eleven clinicians highlighted that both clients and clinicians found the content coherent, relatable, empowering and culturally safe. Barriers to using the web-app for clients included a lack of internet connectivity and personal issues such as scheduling. Conclusions: Process evaluation is often under-valued. However, as We Can Do This was new, innovative and targeted a hard-to-reach population, understanding its feasibility and acceptability as a clinical tool was essential to understanding its potential. We Can Do This is unique as the only evidence-based, culturally appropriate online therapeutic program specifically designed for Aboriginal and Torres Strait Islander people who use methamphetamine. Findings suggest it was both acceptable and feasible as a low-cost adjunct to usual care in residential rehabilitation and primary care settings.
Background: The rapid growth of online medical services has highlighted the significance of smart triage systems in helping patients find the most appropriate doctors. However, traditional triage meth...
Background: The rapid growth of online medical services has highlighted the significance of smart triage systems in helping patients find the most appropriate doctors. However, traditional triage methods often rely on department recommendations, and are insufficient to accurately match patients’ textual questions with doctors' specialties. There is an urgent need to develop algorithms for recommending doctors. Objective: To develop and validate a patient-doctor hybrid recommendation model with response metrics (PDHR model) for better triage performance. Methods: A total of 646,383 online medical consultation records from the Internet Hospital of the First Affiliated Hospital of Xiamen University were collected. Semantic features representing patients and doctors were developed to identify the set of most similar questions and to semantically expand the pool of recommended doctor candidates, respectively. The doctors’ response rate was designed to improve candidate rankings. These three characteristics combine to create the PDHR model. Five doctors participated to evaluate the efficiency of the PDHR model through multiple metrics and questionnaires, as well as the performance of SBERT and Doc2Vec in text embedding. Results: The PDHR model reaches the best recommendation performance when the number of recommended doctors is 14. At this point, the model has an F1-score of 76.25%, a proportion of high-quality services of 41.05%, and a rating of 3.90. After removing doctors’ characteristics and response rates from PDHR model, the F1-score decreased by 12.05%, the proportion of high-quality services fell by 10.87%, the average hit ratio dropped by 1.06%, and the rating declined by 11.43%. According to whether those five doctors were hit by PDHR model, SBERT achieved an average hit ratio of 88.60%, while Doc2Vec achieved an average hit ratio of 53.40%. Conclusions: The PDHR model uses semantic features and response metrics to enable patients to accurately find the doctor that best suits their needs.
Background: Pregnant radiographers work in potentially hazardous environments of ionizing radiation and therefore require more stringent monitoring of fetal radiation dose. PregiDose, a mobile applica...
Background: Pregnant radiographers work in potentially hazardous environments of ionizing radiation and therefore require more stringent monitoring of fetal radiation dose. PregiDose, a mobile application, was the proposed technological intervention to address occupational health and safety needs of pregnant radiographers. Objective: The main objective of this paper is therefore to present a technical report of the implementation of a mobile application development life-cycle (MADL) towards the development of PregiDose. Methods: The MADL model comprised of seven steps namely 1) Identification, 2) Design, 3) Development, 4) Prototyping, 5) Testing, 6) Deployment, and 7) Maintenance. The team consisted of a project manager, a user experience (UX) designer, a user interface (UI) designer, two Flutter developers, and a test analyst. The entire development process was executed over a five-month period (August to January 2024). Results: The development process involved several team engagements and testing sessions. This emanated in the final mobile application which comprised of three core functional areas, namely Home (Dose Tracker), Journal, and Explore, each aimed at addressing the clients needs. Conclusions: PregiDose was developed through a rigorous MADL process model aimed at ensuring high quality, usability and usefulness of the app. The application of the model serves as a valuable framework that can be used to guide other mHealth apps.
Background: Intimate partner violence (IPV) and violence against children (VAC) are global issues with severe consequences. Intersections shared by the two forms of violence have led to calls for join...
Background: Intimate partner violence (IPV) and violence against children (VAC) are global issues with severe consequences. Intersections shared by the two forms of violence have led to calls for joint programming efforts that prevent both IPV and VAC. Parenting programmes have been identified as a key entry point for addressing multiple forms of family violence. Building on the IPV prevention material that has been integrated into the parenting programme ParentText, a digital parenting chatbot, this pilot study seeks to explore parents’ engagement with the IPV prevention content in ParentText, and explore preliminary impacts on IPV. Objective: This study aimed to assess parents’ and caregivers’ level of engagement with the IPV prevention material in the ParentText chatbot and explore preliminary indications of the chatbot’s impact on experiences and perpetration of IPV, attitudes toward IPV, and gender-equitable behaviours following the intervention. Methods: Caregivers of children 0-18 years were recruited through convenience sampling by research assistants in Cape Town in South Africa and by UNICEF Jamaica staff in three parishes in Jamaica. Quantitative data from women (N=47) and, in South Africa, men (N=21) caregivers were collected electronically via weblinks sent to users’ phones using Open Data Kit. The primary outcome was IPV experience (women) and perpetration (men), with secondary outcomes including gender-equitable behaviours and attitudes toward IPV. Descriptive statistics were used to report sociodemographic characteristics and engagement outcomes. Linear, Poisson, and logistic regression models were used to investigate potential changes in IPV outcomes between pre- and post-test. Results: The average daily interaction rate with the programme was 0.57 and 0.59 interactions per day for women and men in South Africa, and 0.21 for women in Jamaica. The rate of completion of at least one IPV prevention topic was 25% (5/20) for women and 5% (1/20) for men in South Africa, and 21% (6/28) for women in Jamaica. Exploratory analyses detected significant pre-post reductions in overall IPV experience among women and in men’s overall harmful IPV attitudes. Conclusions: This pilot study is the first to our knowledge that investigates user engagement with and indicative outcomes of a digital parenting intervention with integrated IPV prevention content. Study findings provide valuable insights into user interactions with the chatbot and shed light on challenges related to low levels of chatbot engagement. Indicative results which suggest reductions in IPV and improvements in attitudes after the programme are promising, yet, modest. Further research using a randomized controlled trial is warranted to establish causality. Clinical Trial: The trial is embedded within a larger study registered with ClinicalTrials.gov (NCT05003518) on 12/08/2021.
Background: Data models play a crucial role in facilitating clinical research and taking full advantage of clinical data stored in medical systems; data, as well as the clear relationships between the...
Background: Data models play a crucial role in facilitating clinical research and taking full advantage of clinical data stored in medical systems; data, as well as the clear relationships between them, are expected to be in a standardized format to establish reproducible research. Using the Fast Healthcare Interoperability Resources (FHIR) standard for clinical data representation would be a practical methodology to enhance and accelerate interoperability and data availability for research. Objective: To investigate data models utilizing the FHIR standard, to offer a comprehensive overview of the best practices for developing and implementing these data models as well as presenting a summary of tools, mappings, limitations and other important details in the selected models. Methods: To ensure the extraction of reliable results, we followed the instructions of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We analyzed the indexed articles in PubMed, Scopus, Web of Science, IEEE Xplore, ACM digital library, and Google Scholar using Boolean operators to merge relevant keywords and their related terms. Results: Based on the reviewed articles, we categorized them into two main groups; pipeline-based data models and non-linear data models. We summarized each included article and extracted information about the FHIR resources, technologies and standards, and mappings. We additionally aimed to extract and summarize the limitations of each research to provide a comprehensive view of the potential challenges and limitations that future researchers may face. Conclusions: Based on the results of our review, FHIR can be a very promising standard in developing interoperable data models and infrastructures, despite presenting some challenges in the development phase. Policymakers and healthcare specialists can utilize this standard in any field such as healthcare, research, administration, finance, and so on. Additionally, when developing data models, this standard can also be integrated with other health-related standards to propose more interoperable solutions.
Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnorm...
Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. These disorders are associated with diminished quality of life, school absence, increased health care use, and co-morbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of the mechanisms underlying the effect and the identification of additional treatment targets could contribute to the refinement of the treatment. Objective: This protocol paper describes a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms. Methods: First, the timing of the onset of the effect is examined through a single-case design study involving six children and six adolescents (sub-study 1). Following this, a pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (sub-study 2). Finally, spanning across these two sub-studies, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (sub-study 3). Results: Recruitment of participants began in June 2022 and is currently ongoing. The study is expected to be completed by January 2025. Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. Clinical Trial: Clinicaltrials.gov (NCT05237882 and NCT05486585) and OSF: https://osf.io/c49k7
Background: Measuring vital signs (VS) is important in potentially unwell children, as a change in VS may indicate a more serious infection than is clinically apparent or herald clinical deterioration...
Background: Measuring vital signs (VS) is important in potentially unwell children, as a change in VS may indicate a more serious infection than is clinically apparent or herald clinical deterioration. However, currently available methods are not suitable for regular measurement of VS in the home or community setting, and adherence can be poor. The COVID-19 pandemic highlighted a need for the contactless measurement of VS by non-clinical personnel, reinforced by the growing use of virtual medicine. Lifelight® is an app being developed as a medical device for the contactless measurement of VS using remote photoplethysmography via the camera on smart devices. The VISION-D (Measurement of Vital Signs by Lifelight® Software in Comparison to the Standard of Care – Development) and -V (Validation) studies demonstrated the accuracy of Lifelight compared with standard of care measurement of blood pressure, pulse rate, and respiratory rate in adults, supporting certification of Lifelight as a class I Conformité Européenne (CE) medical device. Objective: To support further development of the Lifelight app, the VISION-Junior study (clinicaltrials.gov identifier NCT05850013) is collecting high-quality data to enable the accurate measurement of VS (pulse rate, respiratory rate and oxygen saturation) in pediatric patients. Methods: The study is recruiting pediatric patients (age <18 years) attending the Sunderland Royal Hospital Paediatric Emergency Department of the South Tyneside and Sunderland NHS Foundation Trust. High-resolution videos of the face (and torso in children aged <5 years) and audio recordings (to explore the value of cry, wheeze, cough, and other sounds in predicting illness) are made using the Lifelight Data Collect app. VS are measured simultaneously using standard of care methods (finger clip sensor for pulse rate and oxygen saturation; manual counting of respiratory rate). Feedback from patients, parents/carers, and nurses who use Lifelight is collected via questionnaires. Anticipated recruitment is 500 participants, with sub-targets for age, sex, and skin tone distribution (Fitzpatrick six-point scale). Early data will be used to refine the Lifelight algorithms. A separate dataset will be retained to test the performance of Lifelight against predefined targets. Results: A total of 303 participants were recruited from June to December 2023; recruitment will continue until March 2024. Algorithm refinement is in progress. The performance of Lifelight compared with standard of care measurement of VS will then be tested. Recruitment will resume if further data are required. The analyses are expected to be completed by mid-April 2024. Conclusions: This study will collect data that enable development of Lifelight for the measurement of VS in pediatric patients. Clinical Trial: ClinicalTrials.gov NCT05850013
https://clinicaltrials.gov/study/NCT05850013
Background: A healthcare dashboard is a visual representation of vital healthcare data designed to emphasize key information for individuals and organizations, aiding them to make informed decisions....
Background: A healthcare dashboard is a visual representation of vital healthcare data designed to emphasize key information for individuals and organizations, aiding them to make informed decisions. [5] These dashboards are increasingly utilized worldwide to track and report emerging and widespread diseases, trends, and other information to allow the public to make better healthcare decisions. [6, 7] Some examples include the Johns Hopkins COVID-19 dashboard, the Centers for Disease Control and Prevention FluView Interactive dashboard, the World Health Organization Monkeypox dashboard, and the State of Pennsylvania’s Cancer Statistics dashboard. Objective: This study identifies the top 15 attributes of a healthcare dashboard. The objective of this research is to enhance healthcare dashboards worldwide to benefit the public by making better healthcare information available for more informed decisions by the public and to improve population-level healthcare outcomes. Methods: The authors evaluated 250 US government and commercial healthcare dashboards and conducted a survey of healthcare dashboards with 218 individuals identifying the best practices to consider when creating a public healthcare dashboard.
The dates of the survey and data collection were from June 2023 to August 2023.
These features ranked in descending order of importance are (1) easy navigation, (2) historical data, (3) simplicity of design, (4) high usability, (5) use of clear descriptions, (6) consistency of data, (7) use of diverse chart types, (8) compliance with Americans with Disabilities Act, (9) incorporated user feedback, (10) mobile compatibility, (11) comparison data with other entities, (12) storytelling, (13) predictive analytics with Artificial Intelligence (AI), (14) adjustable thresholds, and (15) charts with tabulated data. The prior study on COVID dashboards with 118 participants showed similar results.[3] Both studies validated top attributes of healthcare dashboards as easy navigation, simplicity of design, high usability, use of clear descriptions, and use of diverse chart types. Future studies can extend the research to other types of dashboards such as bioinformatics, financial, and managerial dashboards as well as confirm these top 15 best practices with further evidentiary support. Results: The authors conducted a survey of 218 (n=218) individuals above the age of 18. The survey consisted of 15 questions. Responses of “yes” counted as one point, while responses of “no” counted as 0 points. The authors calculated a total of 3,259 responses - 2,945 responses of “yes” and 314 responses of “no”. The Use of Charts with Tabulated Data had the lowest percent agreement of “yes” responses of 83%, whereas Easy Navigation had the highest percent agreement of “yes” responses of 96%, and the use of Predictive Analytics using Artificial Intelligence had “yes” responses of 87%, ranking at the 13th most popular attribute. Conclusions: As technology evolves, the availability of resources and data has become increasingly easier and better. With a click or a quick search, consumers have access to an abundance of healthcare data and data dashboards which aid in making informed healthcare decisions. However, healthcare dashboards may not be of the highest quality or as easily understood. Through our observational review and multiple surveys, we evaluated the effectiveness of healthcare dashboards in the United States to better understand and improve their design elements. From our analysis, we were able to develop and confirm the top 15 best practices of healthcare dashboard design from the ease of navigation to the use of predictive analytics. These 15 top best practices were assessed as the most important aspects of a healthcare dashboard’s effectiveness. The studies validated and concluded that the top five attributes of healthcare dashboards, such as easy navigation, simplicity of design, high usability, use of clear descriptions, and use of diverse chart types. As identified and analyzed, the best practices can be incorporated in order to design and disseminate effective healthcare dashboards making valuable healthcare information available to the public. Ultimately, the availability of better healthcare dashboards will help consumers make better and more informed healthcare decisions resulting in better healthcare outcomes.
Background: Diapers are commonly used in elderly patients with urination disorders. In this study, we want to verify how well we estimate the weight of urine measured in conventional diapers using a s...
Background: Diapers are commonly used in elderly patients with urination disorders. In this study, we want to verify how well we estimate the weight of urine measured in conventional diapers using a smart diaper system (SDS). Objective: The aim of the current research is to determine the degree of accuracy of technology which has been specifically designed for the management of urination routines and the use of incontinence pads in older adults. Methods: From January to December 2022, 97 participants from three senior nursing homes were tested on elderly patients with at least one chronic disease. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. Results: The average age of 97 participants was 86.48 years, with 10 males and 87 females. Seventy-three patients (75.3%) with hypertension and 86 patients (88.7%) with dementia, and 86 patients (88.7%) with two or more comorbidities accounted for the majority. Pearson's correlation coefficient and intraclass correlation coefficient was 0.971 and 0.985 (P <.001). In Bland-Altman's figure, the difference in the mean between the two tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight are very consistent. And the difference between the mean of the two tests is -0.045 of standardized mean difference, and all measurements are located within the 95% confidence interval, so this confirms that the two test methods are interchangeable. Conclusions: This study showed the possibility that heath care givers could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications.
Background: Up to 80% of information from a medical visit is forgotten by patients. Visit audio recordings are an innovative strategy to support the communication of information. Objective: The object...
Background: Up to 80% of information from a medical visit is forgotten by patients. Visit audio recordings are an innovative strategy to support the communication of information. Objective: The objective of this trial was to determine the feasibility, acceptability, and preliminary effectiveness of sharing audio recordings of primary care visits with older adults with multimorbidity. Methods: We used a two-arm, randomized, controlled, feasibility trial with 3-month follow-up. Patients aged ≥65 years, with diabetes and hypertension were recruited from academic primary care settings in NH, TN, and TX. Patients were randomized to receive online access to audio recordings of scheduled visits for three-months or care as usual (after visit summaries). Primary outcomes were acceptability and feasibility assessed using several indicators: acceptability- recruitment of 90 patients; recording use; and the Appropriateness of Intervention Measure (AIM; >3), feasibility- retention rate; protocol adherence; and the Feasibility of Intervention Measure (FIM; >3). Interviews were conducted with clinicians (n= 14) and patients (n= 19). Exploratory outcomes included patient activation, satisfaction, adherence, and quality of life. Results: We met recruitment (n=91) and retention (98%) targets. We exceeded acceptability and feasibility metrics: FIM (Median 4; IQR 3 – 4); AIM (Median 4; IQR 3 – 4); fidelity to protocol (92%); and 40 of 45 patients (85%) accessed their recordings. Interviews noted benefits of greater recall, understanding, and family engagement, with little impact on visit interactions. Concerns were minimal. Exploratory outcomes included better PROMIS Mental Health Score for Audio vs Usual Care patients at 3-months; 51.5 (SD 7.7) vs. 47.7 (SD 9.9), P=0.04. Conclusions: Sharing visit recordings online with older adults is feasible and acceptable. A larger trial is needed to determine the impact of sharing recordings on patient health outcomes. Clinical Trial: NCT04344301
Background: The management of Neurodegenerative Diseases (NDDs) in older population is usually demanding and involves care provision by various healthcare services, resulting in a greater burden to be...
Background: The management of Neurodegenerative Diseases (NDDs) in older population is usually demanding and involves care provision by various healthcare services, resulting in a greater burden to be placed on the healthcare systems in terms of both costs and resources. The convergence of various health services within the integrated healthcare models, enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative healthcare solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and healthcare professionals, with reported discrepancies in the needs and divergent preferences amongst these groups. Objective: Complementing a previous publication, that reported on the needs and requirements of end-users in the development of the EU funded project Personalized Integrated Care Solution for Elderly “PROCare4Life”, the current paper aims to report about the opinions of other key stakeholders in the fields of academia, media, market, and decision makers, for improving the acceptability and implementation of an integrated ICT-based healthcare platforms supporting the management of NDDs. Methods: The study included 30 individual semi-structured interviews, that took place between June and August 2020 in five European countries (Germany, Italy, Portugal, Romania, Spain). Almost all the interviews were done on the web, except for participants who asked to be interviewed in-person. In that cases the Covid-19 PROCare4Life safety procedures were applied. Results: Two themes and five sub-themes were identified. Users’ engagement, training and education, and the role played by the media were identified as strategic measures to ensure acceptability of the ICT healthcare platforms. Whereas sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The gradual transformation and responding to the various needs of the end-users in the ICT-based healthcare platforms requires a shared dialog between different experts such as: researchers, policy makers, technology developers, and media experts. Addressing typical barriers for ICT adoption among older population such as technology complexity and digital literacy among the potential users, need to be considered by providing a tailored system. Future projects are required to plan and budget training measures for end-users, ensuring that the time needed for training on the technology is planned for. Furthermore, overcoming costs of technology adoption can be facilitated by offering tailored pricing models. A comprehensive research on the users’ needs shall comprise four main aspects: Identifying the challenges associated with illness; researching the digital skills and preferences of the target groups; adjusting the ICT functionalities to the real unmet needs of end users; and the inclusion other key stakeholders in the research.
Background: Childhood obesity prevalence has remained high, especially in minority populations with low incomes. This epidemic has been attributed to various dietary behaviors including increased cons...
Background: Childhood obesity prevalence has remained high, especially in minority populations with low incomes. This epidemic has been attributed to various dietary behaviors including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. The purpose of this study was to assess the feasibility and acceptability of Intervention INC, a Web-based tool comprising a 6-chapter interactive nutrition comic. The tool’s preliminary effectiveness on diet-related psycho-social variables and behaviors was also explored. Objective: The purpose of this study was to assess the feasibility and acceptability of Intervention INC, a Web-based tool comprising a 6-chapter interactive nutrition comic. The tool’s preliminary effectiveness on diet-related psycho-social variables and behaviors was also explored. Methods: 89 Black/African American and Hispanic pre-adolescents (mean age=10.4±1.0 years, 61% female, 62% Black, 42% Hispanic, 53% overweight/obese, and 34% annual household income <$20,000) from New York City participated in a pilot two-group randomized study, comprising a 6-week intervention and a 3-month follow-up period. Participants were randomly assigned to the experimental (E) (n=45) group, who received the web-based comic tool, or the comparison (C) (n=44) group, who received online nutrition newsletters. Primary measures included feasibility (measured by tool usage) and usability (measured by a 30-item questionnaire) at intervention mid-point (T2) and intervention end (T3). Semi-structured interviews were also conducted at the same time to assess participant acceptability and satisfaction. Secondary measures included attitudes, beliefs, and behaviors related to fruit, vegetable, water, sugar and junk food intake, which were collected at baseline (T1), T2, T3 and at 3-month follow-up (T4). Descriptive analyses were conducted for usage and usability data. Interviews were systematically analyzed to facilitate identification of patterns/themes. Secondary data were analyzed using mixed models with repeated assessments (T1-T3), condition (E-C), and time by condition interaction. Within- and between-group effect sizes were reported. Results: During the intervention, 72.3% and 60.3% of the E and C groups, respectively, accessed their tool on a weekly basis. Mean total usability score was moderately high for both groups (on 5-point Likert scale), however, the E group score was higher (4.01 ± 0.37 and 3.81 ± 0.51, respectively; p=0.048). Overall, children in both groups found their tool to be acceptable and very few reported any difficulties logging in or accessing content. Within-group effect sizes for dietary beliefs and attitudes were generally larger in the E group at T3, however, improvements were largely diminished by T4. The E group reported a statistically significant (p<.05) increase in fruit, vegetable and water intake, which were maintained at T4. Conclusions: This pilot and feasibility study suggests an interactive comic tool may be an appealing and useful format to promote positive dietary behaviors in minority preadolescents. However, further research, including a full-scale RCT with a longer follow-up period, is warranted to determine the effectiveness of Intervention INC. Clinical Trial: NCT03165474
Background: Real-world walking speed is being proposed as the sixth vital sign to track functional health; this requires consideration of how the context of activity affects the individual. For examp...
Background: Real-world walking speed is being proposed as the sixth vital sign to track functional health; this requires consideration of how the context of activity affects the individual. For example, as it gets colder outside healthy adults walk faster and increase their cadence (steps/min). Environmental factors (weather conditions, time of year, time of day) and the individual (disease-group, gender, height, BMI) may have a varied impact on walking speed across disease cohorts. Objective: The aim of the paper is to examine the relationship between temperature and wind speed with measures of outdoor walking speed (cadence) across disease groups and healthy adult controls. Expected differences between disease groups and healthy controls were expected to be found. Methods: As a part of a technical validation study assessing worn mobility trackers (Mobilise-D), participants were asked to carry a smartphone with an installed tracking app recording GPS location, step activity and local temperature and wind speed, of walking bouts for seven consecutive days. A total of 57 participants were assessed included: 16 healthy adults, 12 patients with Multiple Sclerosis, 17 patients with Chronic Obstructive Pulmonary disease and 12 with Parkinson’s disease. Results: Pearson and Spearman Rank correlation coefficients were obtained for associations between hourly temperature and wind speed against hourly measurements of cadence and physical activity. Temperature and wind speed were found to be positively correlated with cadence (CI: -.437, -.228). Fisher’s r groupwise comparison established significant differences for associations of weather and mobility between health adults and COPD (p <.001), MS (p =.032), and PD (p = .007). The opposite effect of temperature on physical activity was observed in MS compared against COPD, PD and HA groups. Conclusions: Mobility impaired disease groups are affected by the weather in a dissimilar pattern to that of healthy adults. This should be accounted for when measuring digital mobility outcomes of various patient groups. Smartphone apps for real world cadence appear to be very similar to those recorded by wearable sensors for both healthy adults and disease groups
Background: The growing healthcare challenges from a rapidly expanding aging population necessitates examination of effective rehabilitation techniques that mitigate age-related comorbidity and improv...
Background: The growing healthcare challenges from a rapidly expanding aging population necessitates examination of effective rehabilitation techniques that mitigate age-related comorbidity and improve quality of life. To date, exercise is one of a few proven interventions known to attenuate age-related declines in cognitive and sensorimotor functions critical to sustained independence. This work aims to implement a multi-modal imaging approach to better understand the mechanistic underpinnings of the beneficial exercise induced adaptations to brain and behavior in sedentary older adults. Due to the complex cerebral and vascular dynamics that encompass neuroplastic change with aging and exercise, we propose an imaging protocol that will model exercise induced changes to cerebral perfusion, cerebral vascular reactivity (CVR) and cognitive & sensorimotor task-dependent fMRI after prescribed exercise. Objective: Our hypothesis is that the 12-week aerobic exercise intervention will increase basal perfusion and improve CVR as measure by increased magnitude of reactivity in areas susceptible to neural and vascular decline (inferior frontal and motor cortices) in previously sedentary older adults. To better understand the neural versus vascular adaptations in the motor and inferior frontal cortices, we will map changes in basal perfusion and CVR over target regions of interest (inferior frontal and the motor cortices) that we have demonstrated to be beneficially altered during fMRI BOLD (verbal fluency and motor tapping) by increased cardiovascular fitness. Methods: Sedentary adults (aged 65-80) will be randomly assigned to either a 12-week aerobic-based, interval-based cycling intervention or a 12-week balance and stretching intervention. Assessments of cardiovascular fitness using the YMCA submaximal VO2 test, basal cerebral perfusion using arterial spin labeling (ASL), CVR using hypercapnic fMRI, cortical activation using fMRI during verbal fluency and motor tapping tasks, and a battery of cognitive-executive and motor function tasks outside of the scanning environment will be performed before and after the interventions. Results: Our own studies and others show that improved cardiovascular fitness in older adults’ results in improved outcomes related to both physical and cognitive health as well as quality of life. A consistent but unexplained finding in many of these studies is a change in cortical activation patterns during task-based fMRI that corresponds with improved task performance (cognitive-executive and motor). Conclusions: To date, exercise is one of the most impactful interventions aimed to improve physical and cognitive health in aging. This study aims to better understand the mechanistic underpinnings of improved health and function of the cerebrovascular system. If our hypothesis of improved perfusion and cerebrovascular reactivity following a 12-week aerobic exercise intervention are supported, it would add critically important insight about the potential of exercise to improve brain health in aging and could inform exercise prescription for older adults at risk for neurodegenerative disease brought on by cerebrovascular dysfunction.
This paper reports on the growing issues experienced when conducting internet-based research. Non-genuine participants, repeat responders, and misrepresentation are common issues in health research po...
This paper reports on the growing issues experienced when conducting internet-based research. Non-genuine participants, repeat responders, and misrepresentation are common issues in health research posing significant challenges to data integrity. A summary of existing data on the topic and the different impacts on studies is presented. Seven case studies experienced by different teams within our institutions are then reported, primarily focused on mental health research. Finally, strategies to combat these challenges are presented, including protocol development, transparent recruitment practices, and continuous data monitoring. These strategies and challenges impact the entire research cycle and need to be considered prior to, during and post data collection. With a lack of current clear guidelines on this topic, this report attempts to highlight considerations to be taken to minimise the impact of such challenges on researchers, studies and wider research. Researchers conducting online research must put mitigating strategies in place, and reporting on mitigation efforts should be mandatory in grant applications and publications to uphold the credibility of online research.
Background: The application of artificial intelligence to health and healthcare is rapidly increasing. Several studies have assessed the attitudes of health professionals but far fewer have explored p...
Background: The application of artificial intelligence to health and healthcare is rapidly increasing. Several studies have assessed the attitudes of health professionals but far fewer have explored perspectives of patients or the general public. Studies investigating patient perspectives have focused on somatic issues including radiology, perinatal health, and general applications. Patient feedback has been elicited in the development of specific mental health solutions, but broader perspectives towards AI for mental health have been under-explored. Objective: To understand public perceptions regarding potential benefits of AI, concerns, comfort with AI accomplishing various tasks, and values related to AI, all pertaining to mental health. Methods: We conducted a one-time cross-section survey with a nationally representative sample of 500 United States-based adults. Participants provided structured responses on their perceived benefits, concerns, comfortability, and values on AI related to mental health. They could also add free text responses to elaborate on their concerns and values. Results: A plurality of participants (49.3%) believed AI may be beneficial for mental healthcare, but this perspective differed based on socio-demographic variables (p<0.05). Specifically, Black participants (OR = 1.76) and those with lower health literacy (OR=2.16), perceived AI to be more beneficial, and females (OR=0.68) perceived AI to be less beneficial. Participants endorsed concerns related to the use of AI for mental health regarding its accuracy, possible unintended consequences such as misdiagnosis, confidentiality of their information, and loss of connection with their health professional. Over 80% of participants also valued being able to understand individual factors driving their risk, confidentiality, and autonomy as it pertained to the use of AI for their mental health. When asked about who was responsible for misdiagnosis of mental health conditions using AI, 81.6% of participants found the health professional to be responsible. Qualitative results revealed similar concerns related to the accuracy of AI and how its use may impact the confidentiality of their information. Conclusions: Future work involving the use of AI for mental health should investigate strategies for conveying the level of AI's accuracy, factors that drive risk, and how data are used confidentially so that patients may work with their health professionals to determine when AI may be beneficial. It will also be important in a mental health context to ensure the patient-health professional relationship is preserved when AI is utilized. Clinical Trial: Not applicable
Background: On February 28, 2023, the Facebook page of the United Nations Children's Fund (UNICEF) South Africa, announced the beginning of the HPV vaccination campaign for 2023. The announcement read...
Background: On February 28, 2023, the Facebook page of the United Nations Children's Fund (UNICEF) South Africa, announced the beginning of the HPV vaccination campaign for 2023. The announcement read: ‘‘Protect your daughter from cervical cancer and make sure she gets her HPV vaccine at school.” The post garnered several comments and reactions from Facebook users. Objective: The aim of this study was to examine the attitudes of Facebook users, who commented on the UNICEF South Africa post, towards HPV vaccination to inform the development and implementation of interventions that can increase HPV vaccine acceptance and uptake Methods: We used basic thematic analysis approach to analyse the content of the comments. Two authors (EJM and AJ) independently coded the responses through line-by-line readings as pro-vaccination, anti-vaccination or neutral. After labelling the data with the three main codes, we then used an inductive thematic analysis approach to extract emerging themes from the comments within each code. Results: Several comments were questions regarding the eligible criteria for vaccination, side effects, consent form, and vaccination strategies. Many Facebook users were hesitant towards HPV vaccination due to various reasons including concerns around side effects, religious beliefs, vaccine stock outs, and their distrust in the institutions or systems involved in vaccination programmes. Few users accepted HPV vaccination because they believed that it was a very important thing to do, beneficial for the children’s health, and they have vaccinated their children before. Conclusions: Our findings of the current study contribute to the promotion of acceptance and uptake of HPV vaccination by developing and implementing social media-based interventions tailored to address identified barriers that are associated with hesitant to HPV vaccination.
Background: Background: In Brazil, Men Who Have Sex with Men (MSM) are disproportionately affected by the HIV epidemic, mirroring global trends. Despite advancements in HIV prevention, such as Pre-Exp...
Background: Background: In Brazil, Men Who Have Sex with Men (MSM) are disproportionately affected by the HIV epidemic, mirroring global trends. Despite advancements in HIV prevention, such as Pre-Exposure Prophylaxis (PrEP), uptake among different MSM age groups remains uneven, influenced by diverse sexual behaviors, risk perceptions, and social stigmas. Objective: Objectives: To investigate factors associated with PrEP intentions among Brazilian MSM of different age groups. Methods: Method: A cross-sectional electronic survey involving Brazilian MSM aged 18 years and above. Results: Results: PrEP intentions were expressed by over half of the participants, 55.1%. Regarding protective knowledge and PrEP intentions, among those under 25 years, frequent barebacking was associated with a 25.4 times higher prevalence of PrEP intentions. Conversely, having one or more casual sexual partners in the last 30 days was associated with a 22% lower frequency of PrEP intentions. The practice of chemsex was also associated with a lower prevalence of PrEP intentions. In the age group of 25-49 years, it was observed that the practice of double penetration was associated with a higher prevalence of PrEP intentions, as well as being a receptive or versatile partner. Still within this age range, the prevalence of PrEP intentions was over 10% among those who exhibited some unique characteristics, such as a previous diagnosis of syphilis and non-use of condoms due to the intensity of sex or when sexual partners are known. However, being single, the partner's PrEP use, and gouinage, as an HIV/AIDS prevention practice, were exclusively associated with lower prevalences of PrEP intentions. Regarding MSMs aged ≥50 years, a higher prevalence of PrEP intentions was associated with the practice of double penetration, as well as being a receptive or versatile partner. On the other hand, chemsex practice was associated with a lower prevalence of PrEP intentions. Group sex practice was independently associated with a lower prevalence of PrEP intentions exclusively among MSMs aged ≥50 years. Conclusions: Conclusion: The study highlights significant generational differences in the factors influencing PrEP intentions among Brazilian MSM. It underscores the need for tailored HIV prevention strategies that consider the unique behaviors and perceptions of different age groups. By addressing these nuances, public health initiatives can better promote PrEP use, catering to the diverse needs of the MSM community and contributing effectively to the reduction of HIV infection rates.
Background: Orthopedic trauma care encounters challenges in follow-up treatment due to varying and often limited patient information provision, treatment variation, and the chaotic setting in which it...
Background: Orthopedic trauma care encounters challenges in follow-up treatment due to varying and often limited patient information provision, treatment variation, and the chaotic setting in which it is provided. Additionally, the pressure on healthcare resources is rising globally. To address these issues, digital follow-up treatment pathways were implemented for orthopedic trauma patients, aiming to optimize healthcare resource utilization and enhance patient experiences. Objective: To assess the feasibility of digital follow-up treatment pathways from the patient's perspective and their impact on healthcare resource utilization. Methods: A concurrent mixed-method study was conducted parallel to the implementation of the digital follow-up treatment pathways in an urban level-2 trauma center and teaching hospital between October 1, 2022 – April 1, 2023. Inclusion criteria were: 1) minimum age of 18 years, 2) active account for the study institution’s web-based patient portal ; 3) able to read and write in Dutch; and 4) no cognitive impairment or pre-existing motor impairment. Data were collected via electronic patient records and surveys at three time points: T0: within three days of the ED visit, T1: 4-6 weeks post-injury and T2: 10-12 weeks post-injury. Semi-structured interviews were performed at 10-12 weeks post-injury. Quantitative data were reported descriptively and the digital treatment pathway group was compared to a similar control group using anonymous data from a pre-existing institutional database to compare for healthcare resource utilization. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited effcacy. Results: In total, 66 patients were included for quantitative data collection. Survey response rates were 100% at T0, 92% at T1, and 79% at T2. Respondent groups per time point did not significantly differ from one another. For qualitative data collection, 15 semi-structured interviews were performed. Patients reported a median satisfaction score of 7 (IQR:6-8) with the digital treatment pathway and an 8 (IQR 7-9) for overall treatment, reflecting positive experiences regarding the functionality, actual and intended use, and safety of treatment. The digital treatment pathways reduced secondary healthcare utilization, with fewer follow-up appointments by phone in digital treatment pathway patients (median 0, IQR: 0-0) vs. the control group (median 1, IQR: 0-1). Qualitative data highlighted positive experiences with functionalities, intended use and safety, but also identified areas for improvement, such as managing patient expectations, platform usability, and protocol adherence. Conclusions: Utilization of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reduced healthcare resource utilization. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for involved healthcare professionals. These insights can guide clinicians and policymakers in effectively integrating similar digital tools into clinical practice Clinical Trial: Na
Background: In response to the high patient admission rates during the SARS-CoV-2 (COVID) pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm sy...
Background: In response to the high patient admission rates during the SARS-CoV-2 (COVID) pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We aimed to find out whether the provisional ICU setting led to a greater alarm burden and more alarm fatigued staff. Objective: We aimed to compare the alarm situation between provisional COVID ICUs non-COVID ICUs during the second Corona wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by healthcare staff. Methods: Our approach involved a comparative analysis of alarm data from two provisional COVID-19 ICUs and two stationary non-COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the two ICU types. We analyzed alarm log data from the patient monitoring systems of all participating ICUs to inferentially check the differences. Additionally, we assessed staff’s alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on healthcare personnel. Results: COVID ICUs had significantly more alarms per bed per day than non-COVID ICUs and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-specific alarm type patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs were alarm fatigued. However, physicians and nurses in COVID ICUs showed a significantly higher level of alarm fatigue. Conclusions: Staff in COVID ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management as part of the preparations emphasizing the importance of alarm management training for future pandemics.
Background: Suicide remains a leading cause of death among Veterans, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation and suicide attempts (SI/SA). mTBI worsens impulsivi...
Background: Suicide remains a leading cause of death among Veterans, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation and suicide attempts (SI/SA). mTBI worsens impulsivity and contributes to poor social and occupational functioning, which further increasing the risk of SI/SA. Repetitive transcranial magnetic stimulation (TMS) is a neuromodulation treatment approach designed to mimic endogenous brain rhythms. Intermittent theta burst stimulation (iTBS) is a "second-generation" form of TMS that is safe, shorter in duration, displays a minimal side effect profile, and is a promising treatment approach for impulsivity in mTBI. Our novel treatment uses frontal pole stimulation to target the ventromedial prefrontal cortex (VMPFC) and may reduce impulsivity by strengthening functional connectivity between the limbic system and frontal cortex, potentially saving lives. Objective: The objectives of this study are to (1) develop an iTBS intervention for individuals with mTBI and SI, (2) assess the feasibility and tolerability of the intervention, and (3) gather preliminary clinical outcome data on SI, impulsivity, and functioning that will guide future studies. Methods: This is a pilot, double-blinded, randomized controlled trial. In developing this protocol, we referenced SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials). We will enroll 50 subjects (25 active iTBS and 25 sham iTBS). The iTBS intervention will be performed daily, five days a week, for two weeks. We will collect quantitative outcome measures before and after the intervention. Measures included will assess functioning (Social and Occupational Functioning Assessment Scale (SOFAS), Veteran RAND-36), impulsivity (Urgency, Premeditation (lack of), Preservation (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale – Negative Urgency subscale (UPPS-P)), SI (Beck Suicide Scale (BSS), Columbia Suicide Severity Rating Scale (C-SSRS)), PTSD symptoms (PTSD Checklist for DSM-5 (CAPS-5) (PCL-5)), and depressive symptoms (Patient Health Questionnaire-9 (PHQ-9), Inventory for Depressive Symptoms – Self-Report (IDSSR)). We will collect qualitative data through semi-structured interviews to elicit feedback on the subject’s experience and symptoms. Results: This study protocol was approved by the Edward Hines Jr Veterans Administration Hospital Institutional Review Board (Hines IRB#14-003) and registered on ClinicalTrials.gov (NCT05647044). This novel treatment is a 5-year research project (04/01/2023 – 03/31/2028) funded by the VA Rehabilitation Research & Development (RR&D) service (CDA2 grant IK2 RX002938). Study results will be disseminated at or before the project’s end date in March 2028. Conclusions: We will provide preliminary evidence of the safety, feasibility, and acceptability of a novel frontal pole iTBS treatment for mTBI, impulsivity, SI/SA, and functional deficits. Clinical Trial: ClinicalTrials.gov (NCT05647044); https://clinicaltrials.gov/study/NCT05647044
Background: Rapid and flexible data collection efforts are necessary for effective monitoring and research on tobacco and nicotine product use in a constantly evolving marketplace. Objective: To docum...
Background: Rapid and flexible data collection efforts are necessary for effective monitoring and research on tobacco and nicotine product use in a constantly evolving marketplace. Objective: To document the first two years of the Rutgers Omnibus Study. Methods: Launched in February 2022 and fielded quarterly thereafter, we survey convenience samples of 2000 to 3000 US adults ages 18 to 45 years recruited through Amazon Mechanical Turk. The questionnaire includes core and rotating modules and is designed to take approximately 10 minutes to complete via Qualtrics. Fielding duration is approximately 10 days per wave. Each wave includes both unique and repeating participants, and responses can be linked across waves by an anonymous ID. Results: Sample sizes range from 2,082 (Wave 8) to 2,989 (Wave 1), and the 8-wave longitudinal dataset includes 10,334 participants, of whom 2,477 have three or more data points. Key demographics are consistent across waves and similar to that of the general population, while tobacco product trial and past-30-day use is generally higher. Conclusions: The Rutgers Omnibus Study is a quarterly survey that is effective for rapidly assessing the use of emerging tobacco and nicotine products and can also be leveraged to conduct survey experiments, generate pilot data, and address both cross-sectional and longitudinal research questions.
Background: The Corona Virus Disease of 2019 (COVID-19) pandemic motivates research efforts to address this catastrophe from the beginning of 2020 year up to the present. The year 2021 is coming to an...
Background: The Corona Virus Disease of 2019 (COVID-19) pandemic motivates research efforts to address this catastrophe from the beginning of 2020 year up to the present. The year 2021 is coming to an end, and there have been several developments in pharmacotherapy for COVID-19. In terms of antiviral therapy, monoclonal antibody combinations become one of COVID-19 immunotherapy. Remdesivir and Favipiravir are the two antiviral medications typically used to treat COVID-19. Objective: The purpose of this study compares the effects of a combination of antibodies (casirivimab and imdevimab), remdesivir, and favipiravir on COVID-19 swab results in COVID-19 hospitalized patients at discharge. Methods: In this study, 265 COVID-19 patients with polymerase chain reaction (PCR) confirmation and indications for antiviral medication were non-randomized into three groups with a ratio of (1:2:2): REGN3048-3051(group A); Remdesivir (group B); Favipiravir (group C). Non-Randomized Single-blind Controlled study was the study design. The study's medication is provided by Hospital of Mansoura University. Following ethical permission, the study was conducted for approximately 6 months. Results: Compared to Remdesivir and Favipiravir, casirivimab and imdevimab cause more negative swab results at discharge. The three antivirals also have no significant adverse effects. All three antivirals are considered safe with these findings. Casirivimab and imdevimab achieve more negative swab results than Remdesivir & Favipiravir. Conclusions: Casirivimab & imdevimab achieve more negative swab results than Remdesivir and Favipiravir. All three antivirals are safe with no significant toxicity. Clinical Trial: Clinical Trial Registration: Clinicaltrials.gov, NCT05502081
Background: Cardiovascular disease (CVD) and stroke are the leading causes of mortality and major contributors to disability worldwide. Consequently, evidence-based medicine highlights the significanc...
Background: Cardiovascular disease (CVD) and stroke are the leading causes of mortality and major contributors to disability worldwide. Consequently, evidence-based medicine highlights the significance of mitigating CVD and stroke risk factors to reduce the global health burden. The persistent and incurable nature of such chronic illnesses makes it crucial to continuously monitor signs and symptoms to reduce hospital readmissions and improve quality of life. As a result, mobile health technology has expanded rapidly to provide such continuous support. However, there is limited evidence about the utility of mHealth in MI and stroke patients and their long-term care. Objective: This scoping review aims to give an overview of the literature that highlights different mHealth interventions for post-hospitalization care of MI and stroke patients. Methods: We applied the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) methodology. A literature search was carried out across four databases—CINAHIL, PubMed, Scopus, and Cochrane— for studies between 26th July 2015 to 31st January 2023. All interventional trials were included if their primary intervention included mHealth for MI and stroke patients. All case reports, animal studies, or grey literature were excluded. Results: In total, 23 articles were selected with over 9471 people with MI and stroke using mHealth intervention with a mean age of 59.7 years and a total of 2738 women (28.91%). A total of four different mHealth interventions were identified including smartphone applications (n = 14, 60.9%), text messages (n = 4,17.4%), telephone calls (n = 3, 13.1%), and internet-based platforms (n = 2, 8.7%). Conclusions: This scoping review confirms that mHealth interventions have a positive impact on the long-term needs of MI and stroke patients. However, robust randomized trials are needed to further extend the applicability of these findings because of heterogeneous outcomes across all articles. Future high-quality research should focus on uniform outcome measures to investigate which mHealth intervention is superior for continuous healthcare management. Clinical Trial: N/A
Background: Large language models (LLMs) are increasingly used in the mental health field, with promising results in assessing mental disorders. However, correctness, dependability, and equity of LLM-...
Background: Large language models (LLMs) are increasingly used in the mental health field, with promising results in assessing mental disorders. However, correctness, dependability, and equity of LLM-generated information have been questioned. Amongst other, societal biases and research underrepresentation of certain population strata may affect LLMs. Because LLMs are already used for clinical practice, including decision support, it is important to investigate potential biases to ensure a responsible use of LLMs. Objective: We aimed to estimate the presence and size of bias related to gender and sexual orientation produced by a common LLM, exemplified in the context of ED symptomatology and health-related quality of life (HRQoL) of patients with AN or BN. Methods: We extracted 30 case vignettes (22 AN, 8 BN) from scientific articles. We adapted each vignette to create 4 versions, describing a female vs. male patient living with their female vs. male partner (2x2 design), yielding n=120 vignettes. We then fed each vignette into Chat Generative Pre-trained Transformer-4 (ChatGPT-4) thrice with the instruction to evaluate them by providing responses to two psychometric instruments, the RAND-36 questionnaire assessing HRQoL and the eating disorder examination questionnaire (EDE-Q). With the resulting LLM-generated scores, we calculated multilevel models (MLMs) with a random intercept for gender and sexual orientation (accounting for within-vignette variance), nested in vignettes (accounting for between-vignette variance). Results: The MLM with N=360 observations indicated for the RAND-36 mental composite summary, a significant association with gender (conditional means: 12.8 for male and 15.1 for female cases; 95% CI of the effect=[-6.15, -0.35]; p=.037) but neither with sexual orientation nor an interaction effect (ps>.370). We found no indications for main or interaction effects of gender or sexual orientation for the EDE-Q overall score (conditional means: 5.59-5.65; ps>.611). Conclusions: LLM-generated estimates of mental HRQoL in AN or BN case vignettes are at risk of being affected by cases’ gender, with male cases scoring lower. Given the lack of real-world epidemiological evidence for such a pattern, our study highlights relevant risk of bias when applying generative AI in the context of mental health. Better understanding and mitigation of risk of bias related to gender and other factors, such as ethnicity or socioeconomic status, are highly warranted to ensure responsible use of LLMs when conducting diagnostic assessments or providing treatment recommendations.
Background: Smartphones have become an indispensable part of people's lives, and the fear of being without them, what has been termed 'nomophobia', is a growing phenomenon. The connections among nomop...
Background: Smartphones have become an indispensable part of people's lives, and the fear of being without them, what has been termed 'nomophobia', is a growing phenomenon. The connections among nomophobia, mental health measures, smartphone usage, and daily activities remains largely unexplored. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone usage, potentially empowering them to manage and regulate their smartphone usage more effectively. Objective: This paper aims to explore the relationship between young depressive adults and smartphones, and investigate nomophobia by analysing data obtained from a pilot study of depression in a youth cohort. In addition to passive sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire (NMP-Q), which forms the basis of our investigation. Thus, we here examine associations between smartphone use, various clinical psychometric measures and nomophobia. Methods: During an 8-week period, data collected by smartphone sensors, self-reported Ecological Momentary Assessments, and psychometric evaluations were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. We explored statistical associations between smartphone-derived behavioral features, psychometric indicators, and nomophobia. Additionally, we utilized behavioral and psychometric data to develop a regression model demonstrating the prediction of nomophobia levels. Results: Our findings reveal that nomophobia is positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. We also have developed exploratory predictive linear regression models that demonstrates the feasibility of predicting an individual's NMP-Q score based on their smartphone sensing data. Conclusions: Our work is the first paper to explore the relationship between NMP-Q and smartphone sensor data. It provides valuable insights of the predictors of nomophobia level, contributing to how individuals behave and engage with their smartphones, and paving the way for future studies.
Background: The patient-provider relationship in obstetrics and gynecology (OB/GYN) is uniquely complex due to the sensitive nature of exams and topics. Previous studies on desired OB/GYN provider tra...
Background: The patient-provider relationship in obstetrics and gynecology (OB/GYN) is uniquely complex due to the sensitive nature of exams and topics. Previous studies on desired OB/GYN provider traits lack evaluation of current relationships, barriers to care, and evolving patient preferences. Objective: To investigate if there are changes in patient preferences, patients’ concerns relating to current provider relationships, and prominent barriers to care post the #MeToo movement. Methods: A mixed-methods cross-sectional survey, utilizing a convergent parallel design, was conducted. OB/GYN patients from the US were recruited through social media from October to December 2019. Participants (n=1039) with experience with an OB/GYN provider, aged 18 and above, were included. Survey content included demographics, current relationships, provider traits, barriers to care, and qualities desired in providers. Quantitative data were analyzed to create descriptive statistics including means, standard deviations, and frequencies. Qualitative data from open-ended survey questions were reviewed for data-transformation and data-validation purposes. Results: Findings reveal that trust and comfort are paramount to patients, with listening skills ranked highest. The most significant shift in preferences is the increasing importance of provider gender, with 80.7% indicating same-gender preference. Barriers to care include daily commitments (67.5%). Participant demographics show a well-educated cohort (54.7% with higher degrees), with 83% emphasizing trust in provider relationships. Conclusions: The study highlights evolving patient preferences in OB/GYN provider characteristics, emphasizing gender identity as a significant factor. Trust and communication play pivotal roles in patient-provider relationships. The findings underscore the importance of patient-centered care, provider education, and quality improvement efforts in the OB/GYN setting to enhance patient experiences and outcomes. Further research involving diverse populations is necessary to ensure broad applicability.
Background: Providing evidence-based, well-designed psychotherapy teaching for medical students and residents is urgently needed. Objective: The aim of this project is to measure the effectiveness of...
Background: Providing evidence-based, well-designed psychotherapy teaching for medical students and residents is urgently needed. Objective: The aim of this project is to measure the effectiveness of a new multimodal psychotherapy teaching program for medical students and residents in China. Methods: This study will be a two-arm randomized controlled trial (RCT). The intervention group will receive a two-day multimodal-based intensive educational intervention with 8 weeks follow-up (supervision-based online teaching). The wait-list control group will not receive the intervention until the end of the study. Both groups will be followed up for 8 weeks. This trial will be conducted at the Sir Run Run Shaw Hospital. This study aims to recruit about 160 medical students and residents, with approximately 80 in each group. Results: The primary outcome measure is the changes in the Facilitative Interpersonal Skills task (FIS) scores. Secondary outcome measures include: training program acceptability; trainees’ psychotherapy knowledge; utilization of psychotherapy; and self-reported self-efficacy and self-reported motivation for psychotherapy. Conclusions: If this CBT-based brief and short-term psychotherapy skill training program is proven effective, the mental health impact of its nationwide expansion could be enormous.
Background: Generalised Anxiety Disorder(GAD) is estimated to affect 1 in 8 people in the UK seeking help from their GP in primary care; where treatment options may either be unacceptable to patients...
Background: Generalised Anxiety Disorder(GAD) is estimated to affect 1 in 8 people in the UK seeking help from their GP in primary care; where treatment options may either be unacceptable to patients (e.g. medication), or may be delayed (e.g. psychotherapy delivered through NHS Talking Therapy services). These barriers leave an important treatment gap that may be filled by Digital Mental Health Interventions, offering immediate, evidence-based care. Objective: This study aimed to evaluate the efficacy and user acceptability and safety of the Resony Anxiety app, a digital therapeutic intervention for individuals with self-reported anxiety using a pre-post study design. Methods: A total of 86 UK-based participants were recruited and underwent a 6-week intervention using the Resony Anxiety app as a standalone unguided intervention. Primary and secondary outcome measures included the GAD-7 and DASS-21 questionnaires. Results: The participants reported a significant reduction in anxiety of 3.27 points on the GAD-7 after six weeks, with continued improvement during the follow-up period. The effect size was medium for GAD-7 and small for DASS-21 as measured using Hedge’s g. Qualitative feedback indicated that 95% of participants enjoyed using the app, and 64% found it effective in managing their anxiety. 77% of the participants would recommend the app to a friend or family member with anxiety. Conclusions: This study indicates that the Resony Anxiety app is effective and safe in reducing anxiety in adults. Future studies with larger samples and more robust experimental designs, such as randomised controlled trials, are needed to confirm these initial promising findings.
Background: Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper-limb (UL) movements needed for completing activities...
Background: Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper-limb (UL) movements needed for completing activities of daily living. Traditional laboratory and clinical motor assessments require extensive and stationary equipment, time-consuming in-person visits, and may not be fully engaging for children. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential alternative solution for UL motor assessment. Objective: This feasibility study examines whether MoEvGame can assess children’s whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to i) design and develop a novel mHealth gamified software tools to examine theory-driven features of UL movement, ii) analyze spatiotemporal game data with new algorithms and statistical techniques to quantify movement performance as a parameter of speed, accuracy, and precision, and iii) validate assessment methods with healthy participants from school. Methods: Elementary school children (N=31, median age=9.0 years, and IQR=5.0-14.0) participated by playing five games. The game tasks were focused on key features of skilled motor control: (i) whole limb reaching, (ii) fine motor control and manual dexterity, and (iii) bilateral coordination. Spatiotemporal game data were transferred and stored in a cloud-based data management server for further processing and analysis. We applied change point detection (i.e., PELT), signal processing techniques, and other algorithms to calculate movement speed and accuracy from spatiotemporal parameters. Different statistical methods (i.e., Pearson correlation, mean, standard deviation, p-value, 95% confidence interval) were used to compare speed-accuracy tradeoffs and evaluate the relationship between age and motor performance. Results: A negative correlation was identified between speed and accuracy in the whole limb movement (r= -0.30 to -0.42). Significant relationships between age and whole limb/manual dexterity performance were found: older participants exhibited lower errors with faster completion times compared to younger participants. Significant differences in bimanual coordination were found related to phase synchronization (In-phase Congruent, μ=28.85 σ=18.97 vs Anti-phase Congruent, μ=112.64 σ=25.82 and In-phase Mirrored, μ=23.78 σ=16.07 vs Anti-phase Mirrored μ=121.39 σ=28.19). Moreover, the average speed (RPS) and travel distance (m) of the in-phase mode were significantly higher than those of the anti-phase coordination. Conclusions: Results of this feasibility study show that spatiotemporal data captured from the mHealth application can quantify motor performance. Moving beyond traditional assessments, MoEvGame incorporates gamification into ubiquitous and accessible technology as a fast, flexible, and objective tool for UL motor assessment.
Background: Monitoring of various clinical outcomes and parameters such as lipid levels is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform th...
Background: Monitoring of various clinical outcomes and parameters such as lipid levels is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective: This systematic review and meta-analysis aim to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods: We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in and/or the development of abnormal lipid parameters. Secondary outcomes include body mass index, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to evaluate the overall certainty of evidence. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Conclusions: This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Clinical Trial: Prospero registration number: CRD42024483138
Background: Rheumatoid arthritis (RA) is an autoimmune disease that affects joints and can have extra-articular manifestations. The etiology of RA is unknown, and healthcare systems bear a considerabl...
Background: Rheumatoid arthritis (RA) is an autoimmune disease that affects joints and can have extra-articular manifestations. The etiology of RA is unknown, and healthcare systems bear a considerable burden due to its increasing prevalence. Ayurveda has taken the foremost place in managing the corresponding disease “Amavata” through a variety of interventions. The study is aimed to generate leads regarding the effectiveness of composite Ayurveda regimens in the management of RA. Objective: The clinical study is designed to evaluate the effectiveness and tolerability of a composite Ayurveda regimen in RA. Methods: The study will be an Open-label, Community-based interventional study with a black box design comprising a sample size of 200 participants of age between 18 and 65 years, diagnosed as per ACR Criteria (2010). Treatment will be classified based on major disease presentation patterns and customized based on the presence of associated symptoms. The outcome measures include change in Disease Activity Score (DAS)-28 with ESR and disease-specific biochemical & inflammatory markers, change in the participant's assessment of pain, Disability Index score, frequency of use of conventional analgesic/NSAIDs(Non-steroidal anti-inflammatory drugs). Tolerability will also be assessed through occurrence of adverse events. Results: The execution of the study has been initiated in April 2023 with the IEC approval followed by CTRI registration on 20th June 2023. The recruitment of participants has been initiated, as of 7th January 2024, 240 participants have been enrolled and 237 are continuing while 3 participants have dropped out due to incompliance. Conclusions: The present study will help to assess the effectiveness of composite Ayurveda interventions in various patterns of disease presentation and their tolerability in RA. Clinical Trial: The study is registered with the Clinical Trial Registry of India (CTRI/2023/06/054203) on 20th June 2023.
Background: Digital interventions typically involve using smartphones or personal computers to access online or downloadable self-help, and may offer a more accessible and convenient option than face-...
Background: Digital interventions typically involve using smartphones or personal computers to access online or downloadable self-help, and may offer a more accessible and convenient option than face-to-face for some people with mild to moderate eating disorders. They have been shown to reduce eating disorder symptoms significantly, but treatment dropout rates can be high. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centred digital interventions which are engaging and meet users’ needs.
Objective: To understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Objective: To understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Methods: We conducted a meta-synthesis of qualitative studies. We searched six databases for published and unpublished literature from 2013 to 2023. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. Results: Eight studies were included after screening 2,435 search results. Eight meta-themes were identified. Meta-themes include (1) Appeal of digital interventions, (2) Role of digital interventions in treatment, (3) Value of support in treatment, (4) Communication at the right level, (5) Importance of engagement, (6) Flexibility of digital interventions, (7) Shaping knowledge to improve eating disorder behaviours, and (8) Design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible to fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviours. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalised content and functions. Users preferred an intervention that offered diary functions to log their food, moods and binges as these supported engagement. Conclusions: Users found digital interventions for eating disorders to be a practical and effective method of intervention. However, users emphasised the importance of an intervention that recognises the range of eating disorder symptoms and severity and meets their language, lifestyle and engagement needs. An ideal intervention would allow users to tailor content, functions, appearance, and format of content. Increased personalisation may increase adherence to digital interventions for people with mild to moderate eating disorders. Future studies should investigate more diverse samples and include populations that are often overlooked in mental health research (for example, older adults and men). Future studies may also investigate the use of artificial intelligence and machine learning to further improve digital interventions. Clinical Trial: PROSPERO (CRD42023426932)
Background: Access to trustworthy, understandable and actionable health information is a determinant of health and an essential component of Universal Health Coverage and Primary Health Care. The Worl...
Background: Access to trustworthy, understandable and actionable health information is a determinant of health and an essential component of Universal Health Coverage and Primary Health Care. The World Health Organization (WHO) has developed a new digital resource for use with the general public to improve health and well-being at and across different life phases and to support people to care for themselves, their families and community. Objective: The aim of this manuscript is to describe the methodology used to develop the resource – ‘Your life, your health: Tips and information for health and well-being’ – in order to explore a potentially transferable approach to making trustworthy health information accessible, understandable and actionable for the general public in a digital format. Methods: A five-step process was used to develop Your life, your health. This included: a) a review and synthesis of existing WHO technical guidance, member state health and health literacy plans and international human rights frameworks to identify priority messages; b) the development of messages and graphics to be accessible, understandable and actionable for the public through the application of health literacy principles; c) engaging with experts and other stakeholders to refine messages and message delivery; d) presentation of priority content in an accessible digital format; and e) piloting with potential users to develop and adapt the resource based on feedback and new evidence. The ‘Your life, your health’ online resource adopts a life course approach to organize health information based on priority actions and rights that support people’s health and wellbeing at, and across, different life phases as well as on specific health topics. The resource supports users in developing health literacy skills through advice on how to ask questions of health workers, how to make good decisions about personal and family health, and how best to use digital media to obtain health information. It also reflects the ambitions of the Sustainable Development Goals, to provide “essential” information on the social determinants of health, and clarifies the different roles that individuals, frontline workers, governments and the media play in promoting and protecting health. Results: The ‘Your life, your health’ online resource adopts a life course approach to organize health information based on priority actions and rights that support people’s health and wellbeing at, and across, different life phases as well as on specific health topics. The resource supports users in developing health literacy skills through advice on how to ask questions of health workers, how to make good decisions about personal and family health, and how best to use digital media to obtain health information. It also reflects the ambitions of the Sustainable Development Goals, to provide “essential” information on the social determinants of health, and clarifies the different roles that individuals, frontline workers, governments and the media play in promoting and protecting health. Conclusions: Making health information available – including to the public – is an essential step in the global health information system. The development process for the ‘Your life, your health’ online resource outlined in this article offers a structured approach to public communication which can be adapted for use within and beyond the WHO to translate technical health guidelines into accessible, understandable, and actionable health information for the general public.
Background: The Tobacco Heating System (THS, commercialized as IQOS®) is a smoke-free heated tobacco product that was introduced in the United States (US) in 2019 and authorized by the US Food and Dr...
Background: The Tobacco Heating System (THS, commercialized as IQOS®) is a smoke-free heated tobacco product that was introduced in the United States (US) in 2019 and authorized by the US Food and Drug Administration as a modified risk tobacco product (MRTP) in 2020. THS consists of a holder and specially designed tobacco sticks that are heated instead of burned to produce a nicotine-containing aerosol. Objective: The aim of this study was to describe selected sociodemographic characteristics of adults who used IQOS (AUI), tobacco use patterns (e.g., tobacco use history, exclusive and dual-use, switching from cigarette smoking, etc.), risk perceptions of the product, and understanding of MRTP messages among AUI. Methods: The IQOS Cross-sectional Postmarket Adult Consumer Study was a study of AUI aged ≥21 years who were recruited from a consumer database via direct mail and emails. Participants completed the online survey between September and November 2021. Results: The survey was completed by 645 current and 43 former AUI who had used at least 100 tobacco sticks prior to the assessment. Of the 688 participants, 61% were male, 73% were non-Hispanic white, and the mean age was 45. The vast majority (99%) of AUI had ever smoked combusted cigarettes before first trying THS. At the time of assessment, 49% were still smoking after an average of 1 year of THS use. Among those, 83.6% smoked fewer cigarettes compared to before first trying THS. Among all AUI, over 80% had never used a cessation treatment or had not used it in the past 12 months. Approximately 80% of AUI demonstrated correct understanding of the MRTP message. Conclusions: This study is the first to provide evidence that THS can help adult smokers in the US completely switch away from cigarettes or reduce smoking.
Background: Osteoarthritis (OA) is more prevalent and severe among women compared to men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigra...
Background: Osteoarthritis (OA) is more prevalent and severe among women compared to men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigrant women. Prior research advocated for greater access to culturally-safe OA information for both diverse women and healthcare professionals. The Internet can reduce disparities by facilitating access to health information, but online materials can vary in quality. Objective: We aimed to assess the quality and cultural safety of online OA materials for persons affected by OA and healthcare professionals. Methods: We employed content analysis to describe publicly-available materials on OA first-line management developed by Canadian organizations for affected persons or healthcare professionals. Searching, screening and data extraction were done in triplicate. We identified materials by searching Google, MEDLINE and the references of OA-relevant guidelines and policies, and consulting our research team and collaborators. We assessed quality using DISCERN and a compiled framework for affected persons and healthcare professionals, respectively. We compiled frameworks to assess cultural safety. We derived an overall score, categorized as low (<50%), moderate (50% to 69%) or high (≥70%+) for criteria met. Results: After screening 176 items and eliminating 129, we included 47 OA materials published between 2013 and 2023. Of those, 43 were for persons with OA. Most were developed by charities (31, 72.1%), based on expert advice (16, 55.2%), and in the format of booklets (15, 34.9%) or text on web pages (10, 23.3%). Of those, 10 (23.3%), 20 (46.5%) and 13 (30.2%) scored low, moderate and high for quality; and 11 (25.6%), 21 (48.8%) and 11 (25.6%) were rated low, moderate and high cultural safety, respectively. Of the 47 included OA materials, 4 were for healthcare professionals. They were developed by a consortium (2, 50.0%), charity (1, 25.0%) and a professional society (1, 25.0%), and largely based on expert advice (3, 75.0%). Format included infographics (3, 75.0%) and text on web pages (1, 25.0%). Of those, 1 (25.0%), 1 (25.0%) and 2 (50.0%) were rated low, moderate and high quality, respectively; and all were rated low for cultural safety. Quality and cultural safety did not appear to be associated with OA material characteristics (e.g. type of developer, development method, format). Conclusions: Overall, included OA materials for persons affected by OA and healthcare professionals were low to moderate quality and cultural safety. These findings reveal the need for further efforts to improve existing or develop new OA materials for both affected persons, including ethno-culturally diverse immigrant women, and healthcare professionals. Further research is needed to assess the quality and cultural safety of OA materials developed by organizations outside of Canada, and to establish a framework or instrument to assess cultural safety in the OA context.
Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may...
Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities has not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE (via PubMed), Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies of adult populations, including caregivers, and studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on healthcare professional education were excluded. Articles were limited to those published in the English language. The review followed the Joanna Briggs Institute (JBI) guidelines for scoping reviews and is reported in line with the PRISMA-ScR guidelines. Titles and abstracts were screened by one reviewer. Full texts were screened by two reviewers. Data extraction was guided by the research question. Results: The search identified 8087 unique publications. Thirteen studies met the inclusion criteria. Telehealth training was commonly described as once-off pre-telehealth visit phone calls to service users, facilitated primarily by student volunteers, accompanied by written instructions. The training content included how to download and install software, troubleshooting, and adjusting device settings. Older adults were the most common target population for the training. All but one of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited evidence that training improved participants’ competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving broader digital skills of service users. There is a need for further studies to evaluate outcomes of telehealth training activities in geographically-diverse areas.
Background: The burgeoning volume of scientific literature being generated today places a great burden on evidence reviewers. On average, only 2% to 8% of articles yielded by a search strategy are ult...
Background: The burgeoning volume of scientific literature being generated today places a great burden on evidence reviewers. On average, only 2% to 8% of articles yielded by a search strategy are ultimately included in a systematic review. Due to the burden of increasing information loads, there is a demand for methods that improve efficiency while maintaining accuracy in performing evidence reviews. Objective: This systematic review aims to determine the accuracy and efficiency of AI-assisted abstract selection compared to manual abstract selection, as assessed by diagnostic performance and workload saved over sampling (WSS). Methods: Two reviewers searched PubMed, Proquest, and Cochrane Library for studies evaluating the diagnostic performance and/or workload savings achieved by any AI tool, whether through full or semi-automation, in the title and abstract screening phase of literature review. Variance-weighted random effects meta-analysis was done to generate univariate measures of sensitivity, specificity, and WSS for the studies using RevMan verson 4.3 and the ‘meta’ and ‘mada’ packages on R version 4.3.1. Bivariate analysis was also performed for the measures of diagnostic accuracy and a hierarchal summary operating characteristics curve (HSROC) was generated. Results: Twenty-two studies were included in this review, where 13 reported diagnostic performance, 14 reported WSS, and five studies reported both outcomes. In fully automated workflows, AI tools had a sensitivity of 85.6% (95% CI: 60.8%-95.8%) and a specificity of 88.7% (95% CI: 58.7%-97.7%) with considerable heterogeneity, which likely stems from the differences in the SRs and AI techniques used. In semi-automated workflows, sensitivity was 87.6% (95% CI: 77.2%-93.6%) and specificity was 94.1% (95% CI: 60.0%-99.4%) also with considerable heterogeneity. Among studies on full automation, the median workload savings for 100% recall was 50.0% (IQR: 10.2), while for studies on semi-automation, the median workload savings was 55.6% (IQR: 16.4). Conclusions: Given the findings of this review, the diagnostic performance of AI tools appeared to be superior when used in semi-automated workflows rather than fully automated ones. This suggest that AI tools hold great potential in augmenting the accuracy and efficiency of human reviewers during study selection in literature review.
Background: A core competency of integrative health (IH) education is applying evidence to clinical practice. Low rates of online health literacy put consumers at higher risk of misinformation. Practi...
Background: A core competency of integrative health (IH) education is applying evidence to clinical practice. Low rates of online health literacy put consumers at higher risk of misinformation. Practitioners may serve to reduce this risk. Integrative Health (IH) crosses multiple healthcare disciplines and is therefore well-suited to improve the health information ecosystem. IH practitioners must demonstrate evidence-based medicine (EBM) skills and electronic health information literacy (eHL) to make a positive impact. The Fresno Test of Evidence-Based Medicine (FEBM) is a validated, performance-based assessment used in medical education. However, the scenarios included in this assessment do not reflect IH practices. Objective: This study used a multi-phase pilot observational design to assess feasibility of incorporating eHL and EBM assessments into graduate coursework while adapting and validating the FEBM for an IH audience (FEBM-IH). Methods: Re-validation of the FEBM-IH began with a discipline-focused adaptation, which was reviewed by an expert panel. The FEBM-IH was then administered to IH students and faculty. Independently scored assessments determined inter-rater reliability, internal consistency, item discrimination, and item difficulty. Results: Outcome completion rates suggest the FEBM-IH and eHL assessment tools are feasible (>64% completion) to include in online courses, with 68.9% (102/148) eligible participants joining and 76.5% (78/102) completing all questions in all measures. The FEBM-IH demonstrated excellent assessor agreement (kappa = 0.97, p < 0.001), high internal consistency (α=0.799), and acceptable item discrimination (0.26-0.68). Conclusions: Self-perceived eHL scores showed a 3-point increase in median score by course’s end, suggesting improvements in eHL. Tools were feasible to integrate; FEBM-IH maintains acceptable validity; and further exploration of the relationship between EBM and eHL is warranted. Clinical Trial: NA- Not a Clinical Trial
Infrapubic penile implant surgery is a viable option for patients with severe penile curvature, shortening, and impaired penile rigidity due to fibrosis of the corpora cavernosa (Sadeghi-Nejad, 2007)....
Infrapubic penile implant surgery is a viable option for patients with severe penile curvature, shortening, and impaired penile rigidity due to fibrosis of the corpora cavernosa (Sadeghi-Nejad, 2007). Studies have shown that patients who undergo penile implant surgery, particularly the infrapubic approach, experience significantly better erectile function and treatment satisfaction compared to those receiving other treatments such as sildenafil citrate and intracavernous prostaglandin E1 (Rajpurkar & Dhabuwala, 2003). The infrapubic approach offers advantages such as ease of reservoir placement, rapid implantation, and direct vision during the procedure, as well as avoiding an extra incision on the scrotum, which can hinder rehabilitation (Montague & Angermeier, 2000; Vollstedt et al., 2017). Additionally, it has been noted that the infrapubic approach can be quickly learned by urologists who are already comfortable with the trans‐scrotal approach (Kramer & Chason, 2010). However, it is important to consider the drawbacks associated with the infrapubic approach, such as the higher risk of surgical errors during the placement of the device in the corpora (Kramer et al., 2010).
Background: The research reports the development of a behavioral satisfaction questionnaire (BSQ) for the use in cognitive-behavioral therapies (CBTs). Objective: It is purposed for semi-structured ps...
Background: The research reports the development of a behavioral satisfaction questionnaire (BSQ) for the use in cognitive-behavioral therapies (CBTs). Objective: It is purposed for semi-structured psychoanalytic interviews, but can also be used for self-report. The design of BSQ seeks to organize a referential scale with a psychodynamic perspective, in order to bridge the gaps among neurological / psychiatric therapies, psychological therapy, and patient / visitor autonomy. Methods: The psychometric evaluations are dissected into different dimensions in the questionnaire design, with a paradigmatic conceptual framework. Results: The test trial has demonstrated high affinity with other major psychometric methods. Conclusions: The BSQ design is valid in overall assessments on complicated psychological case. Clinical Trial: The test trial is registered on ClinicalTrials.gov with the identifier NCT05930912.
Background: Interoperability and electronic health records (EHR) standards in medicine Objective: What is the latest evidence related to EHR data interoperability, and standards in medicine? Methods:...
Background: Interoperability and electronic health records (EHR) standards in medicine Objective: What is the latest evidence related to EHR data interoperability, and standards in medicine? Methods: N/A Results: The need for interoperability is evident in every part of a typical health care organization, as many clinicians in a hospital setting need to communicate with their counterparts in the community and as such the EHRs should be able to share data automatically and seamlessly across institutions and display it in useful ways. Conclusions: Currently, a usable and reliable patient data at the point of care regardless of socioeconomic background is critical to the management of patients in medicine, especially the chronically ill.
Background: Due to the varying symptomology of Alzheimer’s disease (AD), primary care providers (PCPs) find it challenging to disentangle normal cognitive age-related dysfunction versus those indivi...
Background: Due to the varying symptomology of Alzheimer’s disease (AD), primary care providers (PCPs) find it challenging to disentangle normal cognitive age-related dysfunction versus those individuals on the clinical pathway of AD. Mobile health (mHealth) technology shows great potential in for improving health outcomes because of its mobility, instantaneous access for both the patient and PCP, and ease of use. Objective: This critical review aims to summarize findings from other reviews published recently on mHealth platforms used in remote cognitive screening or therapy for AD. Methods: Rapid scoping review techniques were still used to synthesize and create a broad understanding of mHealth platforms and it usage in AD screening or therapy. The PubMed data base was searched on November 8, 2023, for relevant reviews using the strategy mobile and cognitive impairment: “((mhealth) OR (mobile health)) AND (subjective cognitive decline OR mild cognitive impairment OR Alzheimer disease)”. Limits were placed in terms of article type (systematic review or review), and language (English). Results: The initial search identified 23 unique citations. The titles and abstracts were assessed based on the inclusion criteria, and of the 23 unique citations, 7 (30%) were excluded after title and abstract screening. Of those remaining, 5 (2%) were excluded as they were not relevant to the topic, 2 (9%) did not include mHealth components, 1 (4%) did not include AD-related outcome and 1 (4%) was a narrative review. Hence, of the 16 (70%) reviews included for full-text screening, 7 (30%) were included in the research synthesis. Conclusions: mHealth platforms have the potential to increase cognitive screening uptake and allow PCPs to remotely monitor their patients, provide support to caregivers and collect relevant health data. Yet, some important considerations are cognitive test features (i.e., characteristics, duration or frequency, psychometric properties), characteristics of patient (experience, knowledge and support with technology), usability of platform, and delivery method. Future interventions should consider incorporating social media platforms like WhatsApp or Facebook, to offer more customized, educational services to patients and their caregivers. Clinical Trial: N/A
The study systematically reviewed the literature to investigate the risk factors for wound-related complications after primary versus metastatic tumour surgery.
Screening of English-language publi...
The study systematically reviewed the literature to investigate the risk factors for wound-related complications after primary versus metastatic tumour surgery.
Screening of English-language publications between 2013-2023 on primary and metastatic spinal tumours surgery was conducted. The pooled analysis was done, which compared the risk factors identified in the studies for both metastatic and primary spine, which were defined as patient-related factors and surgery-related factors.
The search strategy identified 506, but only 20 studies were included after screening through inclusion and exclusion criteria. Out of the 20 studies, 17 studies were retrospective studies, 2 were systematic reviews, and 1 was an RCT study. Wound complications were associated with factors such as BMI, female sex, preoperative chemotherapy, smoking history, preoperative radiation, nutrition status, type of surgery, surgery duration, blood loss, preexisting conditions (like diabetes, hypertension) and medication. Holding these risk factors constant, the wound complications were higher for the metastatic spine than primary spine tumours, indicating that patients with metastatic spine tumours had a higher risk of developing wound complications after surgery than those with primary spine tumours.
The risk factors associated with wound complications in metastatic tumours included BMI, blood loss, medication, age, higher blood loss, neurological deterioration after surgery, venous thromboembolism (VTE), smoking, preexisting patient conditions such as diabetes, nutrition status of patients, American Society of Anesthesiologists risk classification (ASA) greater than 2, ambulatory presence, nutrition status of patients and ambulatory presence, history of previous radiation, type of surgery, surgery duration and type of tumour. Risk factors for primary tumours included sacral procedures and the use of equipment when conducting surgery. Given these factors, wound complications were higher for metastatic spine than primary spine tumours.
Background: The COVID-19 pandemic has resulted in changes in all aspects of life. The high number of cases, morbidity, and mortality caused by COVID-19 infection has resulted in the importance of carr...
Background: The COVID-19 pandemic has resulted in changes in all aspects of life. The high number of cases, morbidity, and mortality caused by COVID-19 infection has resulted in the importance of carrying out infectious disease surveillance to suppress the expansion of cases and obtain effective control. Objective: This study aims to evaluate the adequacy of attribute-based COVID-19 surveillance systems with a literature study approach. Methods: Qualitative descriptive research analyzes nine surveillance system attributes on articles that meet the inclusion and exclusion criteria in accordance with "Updated Guidelines for Evaluating Public Health Surveillance Systems". PubMed MesH term, Science Direct, Scopus, Web of Science, Europe PMC, and Google Scholar are some of the databases used for literature retrieval with the list of keywords are ‘Evaluation’; ‘Surveillance’; ‘Attribute’; ‘Nine attributes’; 'COVID-19' AND 'Corona Virus Disease-19' AND ‘SARS CoV-2’; ‘Epidemiological surveillance’. Descriptive data analysis was performed and presented in tables and narratives. Results: The study obtained six articles evaluating the spread of the COVID-19 surveillance system across six countries, including Ghana, Nigeria, Victoria, Indonesia, Ethiopia, and Pakistan. In the implementation method, four (67%) used sentinel surveillance, and two (33%) used epidemiological studies. Based on its activity, 5 (83%) used active and passive surveillance, while 1 (17%) used only passive surveillance. An attribute-based COVID-19 surveillance system adequacy assessment showed that three (50%) met the attribute of > 50%, namely, the surveillance systems in Nigeria, Indonesia, and Pakistan. In comparison, three (50%) did not meet the attributes of < 50%, namely, the surveillance systems in Ghana, Victoria, and Ethiopia. Conclusions: The COVID-19 surveillance system in each country is different in how well it works based on geography, the number of key informants and experts, the way stakeholders work together, and the health system policies in each country. Clinical Trial: Not Applicable
Background: In a bid to enhance eLearning at Mulungushi University School of Medicine and Health Sciences in Kabwe - Zambia, the Strengthening Health Professional Workforce Education Programs for Impr...
Background: In a bid to enhance eLearning at Mulungushi University School of Medicine and Health Sciences in Kabwe - Zambia, the Strengthening Health Professional Workforce Education Programs for Improved Quality Health Care in Zambia (SHEPIZ) project in 2020, conducted an evaluation of Mulungushi University's level of preparedness for eLearning as an initial step towards building the university’s capacity. Objective: This article provides a systematic description of the evaluation process, lessons learned, and implications for the future in enhancing eLearning programs at Mulungushi University School of Medicine and Health Sciences. Methods: The evaluation process took a two-phased approach. The first phase involved a desk review of literature on eLearning evaluation that informed the development of a framework to be used in the evaluation process. In the second phase, actual data was gathered through key informant interviews and a thorough physical assessment of ICT infrastructure. Results: Consequent to the desk review, a modified five (5) criteria evaluation framework was developed that considered key factors around organizational arrangements, Managerial approach, Technical and interface integration, Educational requirements, and Logistic support. An evaluation of the five critical factors demonstrated that Mulungushi University School of Medicine and Health Sciences had inadequate ICT infrastructure with low internet bandwidth and a lack of onsite technical support for the effective implementation of eLearning programs.
Lessons learned and recommendations: Some of the lessons learnt were that: The use of an evaluation framework to assess an institution's readiness for the adoption of eLearning was essential and that implementing eLearning programs might be difficult in the absence of on-site ICT technical staff and critical ICT infrastructure. Some of the recommendations made were that: Mulungushi University needed to conduct a self-assessment using the critical factors framework; have technical staff on site for system maintenance; give lecturers and students the necessary training and assistance to enable them to use eLearning resources effectively. Conclusions: Evaluation of Mulungushi University revealed that most of the critical factors for eLearning had not been fully addressed and the modified critical components framework could be a useful tool for institutional self-evaluation as an antecedent to effective delivery of the eLearning programs.
Background: In Community Medicine, students are made aware of real life situations and practical aspects through field visits. Visits are conducted without topic briefing assuming students will get or...
Background: In Community Medicine, students are made aware of real life situations and practical aspects through field visits. Visits are conducted without topic briefing assuming students will get orientation of the topic on site. Although utility of field visits is known, its cumulative effect with prior briefing is unexplored. Objective: To evaluate effectiveness of topic briefing followed by field visit in improvement of academic performance in the freshly inducted 1st batch of Indian medical graduates. Methods: In 48 freshly inducted MBBS students at our medical college. Two interventions were administered in sequence, Topic briefing session of 30 minutes followed by field visit to Anganwadi center lasting for an hour on the same day. We evaluated the academic performance through MCQ based Pre-test & Post-test and mean scores were compared. Results: Significant improvement was seen in mean total score out of 20 (theory-10 + practical-10) (from 9.14±2.46 at baseline to 14.46±2.01 post briefing to 16.21±1.57 after field visit) (RAMNOVA F-195.6, p<0.0001). Post-hoc Bonferronie’s test revealed significant improvement after both interventions. Mean theory score was significantly improved (from 4.14±1.70 at baseline to 7.81±1.36 post briefing to 8.31±0.77 post field visit) (RAMNOVA F-172.8, p<0.0001) However, post hoc analysis revealed significant improvement post briefing only & not post visit. Mean practical score was also significantly improved (from 5.00±1.81 at baseline to 6.64±1.49 post briefing to 7.91±1.18 after field visit) (RAMNOVA F-64.31, p<0.0001) & Post-hoc analysis also seconded this finding. Conclusions: The pre briefed field visit helped to significantly improve academic performance in both theoretical & practical aspects. Sequential application of topic briefing and field visit led to reinforcement of knowledge and improvement in precision. Clinical Trial: NIl
Background: The on-going interventional trial was conceived from the phenomena of COVID-19 post-vaccination adverse events. The accumulated evidence has proven the null hypothesis with significant res...
Background: The on-going interventional trial was conceived from the phenomena of COVID-19 post-vaccination adverse events. The accumulated evidence has proven the null hypothesis with significant results that falsify the predominant belief in the vaccination method. The alternative hypothesis is adjusted with proton equilibrium and sebaceous immunobiology’s correlations with immune reflex. Objective: The research purposes to locate the infection path. Methods: The sole-participant interventional trial compared the main medicines in myocarditis treatment from Nifedipine to angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor-neprilysin inhibitor (ANRI) with increasing power level. T values and Z statistics are calculated for statistical analysis, and the introduction of proton-pump inhibitor is uncertain with the case’s neurodivergent conditions. Results: Inter-ACEI comparison suggests the introduction of beta blockers regulated the immune reflex through heart rate with the blood-borne pathogen. ANRI superiority suggests S2 pathogens can be more severe without S1 constraints, and raises alerts on SARS-CoV-2 mutational directions from Omicron. Historic data from the participant after the second COVID-19 vaccine shot recorded the viral entry through low-density lipoprotein cholesterol (LDL-C). Conclusions: The study protocol with data refers to SARS-CoV-2’s S2 infection concentration and viral characteristics in LDL-C in human host. It is highly probable that S2 pathogen starts with LDL-C in vaccine poisoning. It is possible that HDL-C levels are responsible for the cytokine storms in neurologically infected cases. The placebo effect is maximized by the vaccine mandates, and the mass psychological biases need time to be narrowed down. Clinical Trial: The study protocol is retrospectively registered on ClinicalTrials.gov with the identifier number NCT05711810.
Background: Here we analyze a vast cohort comprising over 25 million COVID-19 patients collected by the Mexican Government between 2020 and 2023. The dataset contains valuable information on attribute...
Background: Here we analyze a vast cohort comprising over 25 million COVID-19 patients collected by the Mexican Government between 2020 and 2023. The dataset contains valuable information on attributes and comorbidities, enabling us to investigate clinically relevant associations. Objective: Our objective is to unravel the intricate network of relationships between variables within the entire cohort and specific patient subsets, with a particular focus on associations involving fatalities. Methods: We employ the Odds Ratio (OR), estimated from Fisher’s test on 2×2 contingency tables, as a measure of association between variable pairs. We compute a total of 3,899 such measures by examining all possible variable pairs within 25 patient groups. The results are ordered and presented as networks, where variables are depicted as nodes (vertices) and associations at a specific OR threshold are represented as links (edges). The recoded data, along with the results and data mining functions, are publicly accessible. Results: Our findings demonstrate that hospitalization, gender, and age significantly influence disease outcomes, as do comorbidities such as pneumonia, chronic renal problems, diabetes, and hypertension. Interestingly, we observe that the associations of comorbidities are diminished in pregnant women, suggesting a pro- tective effect of pregnancy against the detrimental impact of these comorbidities on COVID-19 patients. Conclusions: Our analysis of variables in Mexican COVID-19 patients reveals a complex network of associations. By visualizing these associations as networks, we provide a clear and accessible representation that enhances our understanding of the factors contributing to fatalities in this population.
Background: The lack of knowledge on stress self-regulation can significantly impact health and
overall well-being. Traditional stress management methods, such as mindfulness
meditation and progress...
Background: The lack of knowledge on stress self-regulation can significantly impact health and
overall well-being. Traditional stress management methods, such as mindfulness
meditation and progressive muscle relaxation, have limitations, including a lack of
interactivity. However, studies have shown that gamification can effectively address
these limitations by integrating stress management techniques into video games. Objective: This study aims to enhance stress self-regulation among younger adults by
evaluating the effectiveness of diaphragmatic breathing exercises embedded in
video games. Specifically, the focus is on Breeze 2, a mobile-based biofeedback game
emphasising a short diaphragmatic breathing exercise. Methods: The evaluation of Breeze 2 involved quantitative data analysis obtained from
questionnaires and physiological data measurements. Twenty student participants
took part in the experiment. Data collection included the administration of a
perceived stress scale questionnaire, a perceived effectiveness questionnaire, and
tracking heart rate variability and breathing rate. Results: The findings suggest that a short breathing session using Breeze 2 effectively
reduces stress, as the perceived effectiveness questionnaire indicates. However, the
reliability of the physiological data measurements is lower than anticipated, making
it challenging to establish relationships between questionnaire scores and
physiological data. Conclusions: It is recommended to conduct a longitudinal study to examine the sustained effects
of using Breeze 2 and to validate the methods of measuring physiological data in
future research. By doing so, a more comprehensive understanding of the
effectiveness of incorporating diaphragmatic breathing exercises in video games for
stress self-regulation can be obtained.
The commentary proposes the concept of bioenergy utilization in clinical technologies. It defines the bioenergy-signal utilization for energy efficacy in biomedical applications....
The commentary proposes the concept of bioenergy utilization in clinical technologies. It defines the bioenergy-signal utilization for energy efficacy in biomedical applications.
The review is summarative to the clinical trials numbered NCT05711810 and NCT05839236 on ClinicalTrials.gov, with the sole participant's recovery from autoimmune pathogens who was also diagnosed as ne...
The review is summarative to the clinical trials numbered NCT05711810 and NCT05839236 on ClinicalTrials.gov, with the sole participant's recovery from autoimmune pathogens who was also diagnosed as neurodivergent during the first interventional trial. The review seeks to bridge the literature gaps between psychiatry and the medical sciences on neurodiversity with the focus on immunobiology. It chooses the concept of adrenaline intolerance during the final phase of the recovery process to summarize the clinical evidences. The first part of the review synthesizes the key locations of autism spectrum disorder (ASD)'s neurological differences to neurotypical individuals. With the anatomic overview, the second part reviews the relevances to the immune system and implications in immune reflex. The third part reviews the neuroatypical hormonic paths based on the ASD participant's data, whereby the final recovery process with hypolipidemic agent intervention posed a contradiction between the neuronal needs and autoimmune needs of the participant's internal conditions. The review predicts that the contradiction offers a new window into the study of sebaceous immunobiology.
ALBI (Albumin-Bilirubin) score is routinely used in grading liver function of hepatocarcinoma and hepatitis patients. In this purposive review, the published values of serum albumin, bilirubin in Vira...
ALBI (Albumin-Bilirubin) score is routinely used in grading liver function of hepatocarcinoma and hepatitis patients. In this purposive review, the published values of serum albumin, bilirubin in Viral hepatitis, Tuberculosis, Scrub Typhus, Enteric fever has been compared with that of melioidosis. Since PubMed yielded zero searches with key words “albumin, bilirubin, melioidosis”, it was searched in Google Scholar, a better retrievable search engine. This yielded 46 relevant articles with 53 ALBI scores for Melioidosis. An equivalent search to retrieve 53 ALBI scores was made in Google Scholar for other confounding diseases of Melioidosis with search words “albumin, bilirubin, hepatitis” “albumin, bilirubin, tuberculosis”, “albumin, bilirubin, scrub typhus”, “albumin, bilirubin, enteric fever”. This raw data was deposited in Harvard dataverse (https://doi.org/10.7910/DVN/QEW20J) and subsequent analysis done is documented in this article. This placed Melioidosis patients and Scrub typhus patients to be on an average grade III ALBI and the patients of Viral Hepatitis, Tuberculosis, and Enteric fever in grade II ALBI.
Background: The research adopts an intercultural heuristics in discussing lust and desire in social structures. It draws a correlation between moral objectivism and legal philosophy. Objective: The re...
Background: The research adopts an intercultural heuristics in discussing lust and desire in social structures. It draws a correlation between moral objectivism and legal philosophy. Objective: The research aims to render a comparative anthropological psychology perspective between the Chinese culture and Western culture. Methods: The method takes an anthropological psychological approach to the linguistic arts and traditional Chinese culture. It uncovers the sex innuendo contents in the Chinese culture disguised in natural philosophy. Results: The research sheds light on the Chinese culture of censorship with the denial of the persons behind power in the Chinese way. Conclusions: Mass psychology is partially mass sexology. The diversity of desire by gender and sexuality is a positive sociological factor. The structural elements of the political problems are not without relevance to Gestalt psychology.
The article hypothesizes the cosmic origins of life forms that are currently known. The hypothesis is divided into two interrelated components of the matter form of life and the environmental conditio...
The article hypothesizes the cosmic origins of life forms that are currently known. The hypothesis is divided into two interrelated components of the matter form of life and the environmental conditions of the matter form. The two are interrelated by the thermonuclear dynamics of oscillation and resonance. The philosophical basis for the hypothesis is that a successful cosmological theory should, at least quantitatively, explain biology. Radiochemical separation on telomeres for unique signatures and spectroscopy development is proposed to test the hypothesis.
The article summarizes the neo-Nazist and fascist element of the "marriage law" construct of the PRC dictatorial regime with multilateralism and globalization. Albeit the politicization of sex, marria...
The article summarizes the neo-Nazist and fascist element of the "marriage law" construct of the PRC dictatorial regime with multilateralism and globalization. Albeit the politicization of sex, marriage, and family is non-gender-and-sexuality specific, its impact is asymmetric in gender & sexuality groups. Apart from some previous social surveys which has become experience, media psychology is the main method in the re-search with the cisgender homosexual psychoanalytic background in the shaping and constant reshaping of the self in the ego-centric dictatorial semantic environment. The purpose of the research was to change the governmental incentives but with the bio-physical dissections of dictatorial chains, sexism was used for human trafficker conversions and retributive justice was used for counter-measurement. Counter-transference on the neo-Nazist and fascist state of mind was conducted with quantum physics approach to cosmology, thermonuclear astrochemistry & astrophysics with the permeative cyber calculation environment. Queer theology was adapted for sexual and mental health in the marriage process combined with the cisgender homosexual solution to Freudian psychology. Cisgender resilience was aided by my husband John Pachankis with his clinical experience & practices. The research concludes that PRC seeks to establish a monolithic cisgender dominance in the United Nations Security Council.
Background: Happiness is a subjective feeling among the general population, but older adults in Nigeria might describe their happiness differently due to multiple factors, including health, family dyn...
Background: Happiness is a subjective feeling among the general population, but older adults in Nigeria might describe their happiness differently due to multiple factors, including health, family dynamics, spirituality, quality of life, nutrition, and frailty. Hence, it has a consequential impact on the promotion of quality living, clinical routine assessment and swift intervention of older adults with possible indices for a mood disorder. Although Nigeria is still lacking data on how the happiness of older adults is expressed, understood, and measured. Objective: Aim and Research Objectives
The study aims to explore determinants of happiness and health-related factors associated with happiness among ambulatory and non-ambulatory older adults in the Nigerian Geriatric Center. Methods: This will employ a case-control design involving older adults that attends a geriatric center in Nigeria, as the case group and non-ambulatory older adults residing in the community will be used as a control group Results: NA Conclusions: Therefore, this study protocol would be critical in creating a research landscape for understanding happiness among older adults in Nigerian geriatric centers. Clinical Trial: NA
