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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: Understanding the dementia disease trajectory and clinical practice patterns in outpatient settings is vital for effective management. Knowledge about the path from initial memory loss complaints to dementia diagnosis remains limited Objective: This study aims to 1) determine the time intervals between initial memory loss complaints and dementia diagnosis in outpatient care, 2) assess the proportion of patients receiving cognition-enhancing medication prior to dementia diagnosis, and 3) identify patient and provider characteristics that influence the time between memory complaints and diagnosis, and the prescription of cognition-enhancing medication. Methods: This retrospective cohort study utilized a large outpatient EHR database from the University of Connecticut Health Center, covering 2010-2018, with a cohort of 581 outpatients. We employed a customized deep learning-based natural language processing (NLP) pipeline to extract clinical information from electronic health record (EHR) data, focusing on cognition-related symptoms, primary caregiver relation, and medication usage. We applied descriptive statistics, linear, and logistic regression for analysis. Results: The NLP pipeline showed precision, recall, and F1 scores of 0.97, 0.93, and 0.95, respectively. The median time from the first memory loss complaint to dementia diagnosis was 342 days. Factors such as the location of initial complaints and diagnosis, and primary caregiver relationships significantly affected this interval. Around 25% of patients were prescribed cognition-enhancing medication before diagnosis, with the number of complaints influencing medication usage Conclusions: Our NLP-guided analysis provided insights into the clinical pathways from memory complaints to dementia diagnosis and medication practices, which can enhance patient care and decision-making in outpatient settings.
Journal Description
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Background: Understanding the dementia disease trajectory and clinical practice patterns in outpatient settings is vital for effective management. Knowledge about the path from initial memory loss com...
Background: Understanding the dementia disease trajectory and clinical practice patterns in outpatient settings is vital for effective management. Knowledge about the path from initial memory loss complaints to dementia diagnosis remains limited Objective: This study aims to 1) determine the time intervals between initial memory loss complaints and dementia diagnosis in outpatient care, 2) assess the proportion of patients receiving cognition-enhancing medication prior to dementia diagnosis, and 3) identify patient and provider characteristics that influence the time between memory complaints and diagnosis, and the prescription of cognition-enhancing medication. Methods: This retrospective cohort study utilized a large outpatient EHR database from the University of Connecticut Health Center, covering 2010-2018, with a cohort of 581 outpatients. We employed a customized deep learning-based natural language processing (NLP) pipeline to extract clinical information from electronic health record (EHR) data, focusing on cognition-related symptoms, primary caregiver relation, and medication usage. We applied descriptive statistics, linear, and logistic regression for analysis. Results: The NLP pipeline showed precision, recall, and F1 scores of 0.97, 0.93, and 0.95, respectively. The median time from the first memory loss complaint to dementia diagnosis was 342 days. Factors such as the location of initial complaints and diagnosis, and primary caregiver relationships significantly affected this interval. Around 25% of patients were prescribed cognition-enhancing medication before diagnosis, with the number of complaints influencing medication usage Conclusions: Our NLP-guided analysis provided insights into the clinical pathways from memory complaints to dementia diagnosis and medication practices, which can enhance patient care and decision-making in outpatient settings.
Background: With obesity posing an increasing public health challenge, the demand for personalized weight loss and fitness solutions has intensified. Given advancements in artificial intelligence, lik...
Background: With obesity posing an increasing public health challenge, the demand for personalized weight loss and fitness solutions has intensified. Given advancements in artificial intelligence, like GPT-4, this study evaluates its effectiveness as a virtual fitness coach for creating personalized plans.
Method: We selected a 24-year-old female from Chongqing, China, providing detailed personal information. Using this, both GPT-4 and three local professional coaches formulated 16-week fitness plans. Senior health science experts evaluated these plans across four dimensions: personalization, effectiveness, comprehensiveness, and safety. Descriptive and inferential statistics were employed for analysis.
Results: GPT-4 excelled in personalization (M=12.80, SD=0.84) compared to coaches (M=11.53, SD=0.46). However, coaches slightly outperformed in effectiveness (GPT-4: M=12.60; Coaches: M=12.80), safety (GPT-4: M=12.20; Coaches: M=12.33), and comprehensiveness (GPT-4: M=12.00; Coaches: M=12.13), with no significant differences (P > .05). These findings highlight comparable performance but suggest potential for GPT-4 in personalized exercise prescriptions.
Conclusions: GPT-4 shows promise as a virtual fitness coach for personalized weight loss and fitness guidance. Yet, due to technological constraints, it cannot fully replace human coaches. Future research should explore enhancing AI models' applicability in sports and their collaboration with coaches for optimal personalized fitness solutions.
Background: The use of virtual mental healthcare increased rapidly in 2020 as a critical response to the COVID-19 pandemic, effectively serving as a contact-free alternative to receiving treatment. Wh...
Background: The use of virtual mental healthcare increased rapidly in 2020 as a critical response to the COVID-19 pandemic, effectively serving as a contact-free alternative to receiving treatment. While virtual care remains a viable option for individuals with geographic and physical barriers to treatment, there are several perceived therapeutic disadvantages (e.g., missing nonverbal signals, handling crises, confidentiality, weakened social connection in group therapy). Objective: The present study sought to develop and validate a survey designed to measure effectiveness of virtual therapy versus in-person treatment across key therapeutic factors (i.e., therapeutic alliance, engagement, rapport, confidentiality). Methods: An exploratory factor analysis (EFA) was conducted to understand factor structure, and Cronbach’s alpha was utilized to determine internal consistency. Incremental validity was demonstrated through a hierarchical linear regression. Results: The EFA revealed a three-dimensional factor structure. Three factors accounted for 61% of the variance and preliminary Cronbach’s alpha (α =0.71) indicates a satisfactory level of internal consistency. Hierarchical linear regression indicated that the Client Satisfaction Questionnaire (CSQ) accounts for additional variance in the Therapy Mode Preference Scale (TMPS). Conclusions: Continual research is warranted to expand the current findings, by validating this standardized tool for assessing the therapeutic impact of virtual versus in-person care in a generalizable population.
Background: Social media platforms offer valuable insights into the patient’s experience, revealing organic conversations that reflect their immediate concerns and needs. Through active listening to...
Background: Social media platforms offer valuable insights into the patient’s experience, revealing organic conversations that reflect their immediate concerns and needs. Through active listening to lived experiences, we can identify unmet needs and discover real-world challenges patients and caregivers face. Objective: This study aimed to develop a reusable framework to collect and analyze evolving social media data, capturing insights into the experiences of individuals with MDS and higher-risk myelodysplastic syndromes (HR-MDS) and their caregivers. The findings can inform the development of appropriate patient support interventions. Methods: We conducted an extensive Google search to identify social posts of interest using validated URLs and keywords on English-language websites relevant to MDS. The search covered the period from 1/1/2008 to 12/31/2022. We utilized scraping algorithms to collect, clean, and standardize pertinent information. To classify the perspective of each experience as either that of a patient or caregiver, we employed classification algorithms. This involved contextualizing and summarizing all user posts, followed by decision tree tagging to assign them to the patient or caregiver category. Advanced algorithms were employed to analyze the semantic and temporal structure of the data. Patients or caregivers were categorized as HR-MDS based on contextual mentions of high-risk in their posts or specific factors aligned with NCCN guidelines (e.g., blast percentage, transplantation, use of high-intensity chemotherapy or hypomethylating agents, or disease progression). Each post was assigned major themes and sentiments using a supervised classification machine learning model. Additionally, we employed a semi-supervised machine learning approach for the identification of latent themes in the data corpus. Results: The data collected comprised approximately 5.5 million words from 42,000 posts across 5,500 threads, involving about 4,000 users predominantly from the US, UK, and Canada. Out of the 1,249 users classified as HR-MDS, 588 (47%) were patients and 661 (53%) were caregivers. Among the HR-MDS users, the predominant sentiments included concern (78%), anxiety (60%), frustration (58%), fear (58%), and confusion (49%). Concern was the predominant sentiment expressed by caregivers (n=971, 59%), and anxiety by patients (n=752, 55%). Common concerns were specifically related to blood counts (n=677, 54%), burden of the disease (43%), QoL (36%), available treatment options and effectiveness (31%), and disease progression and prognosis (31%). Anxiety related to health and disease (48%), treatment (26%), and the diagnostic process (20%) were also common. The most common sentiments related to fear were the potential development of health complications and the manifestation of symptoms (19%) and the progression and exacerbation of MDS (19%). Additionally, confusion was pervasive among participants, with 295 (24%) individuals finding it challenging to comprehend the nuances of MDS and its diagnosis. A systematic analysis of the principal domains for which information is being sought about HR-MDS revealed frequent mention amongst users of acquiring information on therapeutic intervention (19%), and an interest in ongoing research associated with the disease (17%) Conclusions: The application of sophisticated NLP techniques demonstrates promise in effectively identifying the emerging complex themes and sentiments experienced by HR-MDS users, thereby highlighting the unmet needs, barriers, and facilitators associated with the disease. Clinical Trial: NA
Background: Large Artificial Intelligence (AI) language models have been increasingly applied in the medical field for disease prediction, diagnosis, and evaluation. However, research on AI-assisted e...
Background: Large Artificial Intelligence (AI) language models have been increasingly applied in the medical field for disease prediction, diagnosis, and evaluation. However, research on AI-assisted early sepsis identification and screening remains scarce. Here, we conduct a retrospective study to evaluate the diagnostic efficacy of a novel medical large language model-MedGo developed by our collaborating team and us in early sepsis in emergency department (ED). Objective: This study aims to evaluate the performance of a novel medical artificial intelligence large language model, MedGo, in supporting clinical decision-making for emergency department patients with suspected sepsis, specifically focusing on its diagnostic accuracy, comprehensiveness, readability, and analytical capabilities compared to physicians with varying levels of experience. Methods: We retrospectively collected medical history data from 203 eligible patients treated at a tertiary teaching hospital between January 1, 2023 and January 1, 2024. MedGo’s performance was compared to that of junior and senior ED physicians across nine assessment tasks related to the diagnosis and management of sepsis . A five-point Likert scale was used to assess the four dimensions of accuracy, comprehensiveness, readability and case analysis skills. Results: MedGo exhibited diagnostic performance comparable to senior doctors, scoring 4 on the Likert Scale for accuracy, comprehensiveness, readability, and analytical capability, significantly surpassing junior doctors. Furthermore, MedGo's decision support enhanced both junior and senior doctors' diagnostic abilities, with junior doctors' performance equal that of seniors. Notably, MedGo consistently delivered exceptional results in diagnosing early sepsis cases of varying severity. Conclusions: MedGo demonstrates remarkable diagnostic efficacy in early sepsis, effectively supporting clinicians of diverse experience levels in making informed decisions in the time-urgent ED. Although we acknowledge its limitations and emphasize the importance of comprehensive, standardized, systematic, and visualized medical history data in future research endeavors, the results underscore the potential of MedGo as a supportive tool in ED settings, thereby laying the groundwork for future developing specialized sepsis models.
Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, yet interpretation concerns among healthcare providers persist. Confounding factors contribute to false-positiv...
Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, yet interpretation concerns among healthcare providers persist. Confounding factors contribute to false-positive and false-negative AF diagnoses, leading to potential omissions. Artificial intelligence advancements show promise in electrocardiogram (ECG) interpretation. Objective: We sought to examine the diagnostic accuracy of ChatGPT-4omni (GPT-4o), equipped with image evaluation capabilities, in interpreting ECGs with confounding factors and compare its performance to that of physicians. Methods: Twenty ECG cases, divided into Group A (10 cases of AF or atrial flutter) and Group B (10 cases of sinus or another atrial rhythm), were crafted into multiple-choice questions. Total of 100 practitioners (25 from each: emergency medicine, internal medicine, primary care, and cardiology) were tasked to identify the underlying rhythm. Next, GPT-4o was prompted in five separate sessions. Results: GPT-4o performed inadequately, averaging 3 (±2) in Group A questions and 5.40 (±1.34) in Group B questions. Upon examining the accuracy of the total ECG questions, no significant difference was found between GPT-4o, internists, and primary care physicians (p = 0.952 and = 0.852, respectively). Cardiologists outperformed other medical disciplines and GPT-4o (p < 0.001), while emergency physicians followed in accuracy, though comparison to GPT-4o only indicated a trend (p = 0.068). Conclusions: GPT-4o demonstrated suboptimal accuracy with significant under- and over-recognition of AF in ECGs with confounding factors. Despite its potential as a supportive tool for ECG interpretation, its performance did not surpass that of medical practitioners, underscoring the continued importance of human expertise in complex diagnostics.
Background: To understand the acceptance of healthcare technology for older adults, the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) is commonly...
Background: To understand the acceptance of healthcare technology for older adults, the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) is commonly used. However, the divergence in the current literature makes it difficult to predict acceptance and understand how various factors affect older adults’ behavior. Objective: This study aims to 1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use healthcare technology among older adults and 2) and assess the moderating effects of age, gender, geographic region, type of healthcare technology, and the presence of visual demonstrations on these three pairwise relationships. Methods: Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest electronic databases were searched from inception to February 2024. Two independent reviewers screened the titles, abstracts, full texts, and performed data extraction and risk of bias assessments with the Newcastle-Ottawa Quality Assessment Scale. The "meta" package in R was used for data synthesis, conducting random-effects meta-analyses, meta-regression and subgroup analysis. Results: 41 studies with a total of 11,574 participants were included. Random-effects meta-analyses showed significant positive correlations for PU-BI (r = 0.607, 95% CI 0.543 - 0.665, P < .001), PEOU-BI (r = 0.525, 95% CI 0.462 - 0.583, P < .001), and SI-BI (r = 0.551, 95% CI 0.468 - 0.624, P < .001). Moderator analyses indicated significant differences in effect sizes based on geographic region for PEOU-BI (Q-test, P = .04), type of technology for PU-BI (Q-test, P = .04) and SI-BI (Q-test, P = .002), and presence of visual demonstrations for PU-BI (Q-test, P = .03) and SI-BI (Q-test, P = .04). Conclusions: The findings indicate that PU, PEOU, SI significantly impact the acceptance of healthcare technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. Researchers should account for these variables when interpreting previous research and embarking on new studies with the TAM or UTAUT model for older adults. Clinical Trial: Current paper is not RCT
Background: Dementia poses a significant global health challenge, characterized by progressive cognitive decline and functional impairment. With the aging global population, dementia prevalence is pro...
Background: Dementia poses a significant global health challenge, characterized by progressive cognitive decline and functional impairment. With the aging global population, dementia prevalence is projected to surge, reaching an estimated 153 million cases by 2050. While the impact of traditional social isolation on dementia risk has been extensively studied, the influence of digital isolation—a phenomenon unique to the digital age—remains underexplored. Objective: This study investigates the association between digital isolation and dementia risk among older adults, hypothesizing that higher levels of digital isolation significantly increase the risk of developing dementia. Methods: We conducted a longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), analyzing 8,189 participants aged 65 and older from the third (2013) to the twelfth wave (2022). Digital isolation was quantified using a composite Digital Isolation Index, derived from participants' usage of digital devices, electronic communication, internet access, and engagement in online activities. Participants were stratified into low isolation and moderate to high isolation groups. Dementia incidence was assessed using cognitive tests and proxy reports. Cox proportional hazards models were employed to estimate the association between digital isolation and dementia risk, adjusting for potential confounders including sociodemographic factors, baseline health conditions, and lifestyle variables. Results: The moderate to high isolation group demonstrated a significantly elevated risk of dementia compared to the low isolation group. In the discovery cohort, the adjusted hazard ratio (HR) was 1.25 (95% CI: 1.03-1.52, P=0.023), while the validation cohort showed an HR of 1.68 (95% CI: 1.30-2.16, P<0.001). The pooled analysis across both cohorts revealed an adjusted HR of 1.40 (95% CI: 1.20-1.64, P<0.001). Kaplan-Meier curves corroborated a higher incidence of dementia in the moderate to high isolation group. Conclusions: Our findings indicate that digital isolation is a significant risk factor for dementia among older adults. This study underscores the importance of digital engagement in mitigating dementia risk and suggests that promoting digital literacy and access to digital resources should be integral components of public health strategies aimed at dementia prevention.
Background: The coronavirus disease 2019 (COVID-19) pandemic is among the greatest global public health challenges of this century.The WHO and the Johns Hopkins University Center for Systems Science a...
Background: The coronavirus disease 2019 (COVID-19) pandemic is among the greatest global public health challenges of this century.The WHO and the Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE) were two open-access data sources which were widely used in research and decision-making about the COVID-19 epidemic.High-quality data is one key aspect of public health crisis and pandemic preparedness for decision-making, practice, and research about prevention and control. To better respond to pandemics and other health crises in the future, it is necessary to evaluate the quality of pandemic data to improve rapid response to outbreaks. Objective: To evaluate consistency of daily reported Coronavirus disease 2019 (COVID-19) cases in 191 countries from the Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE) and the World Health Organization (WHO) dashboards during 2020-2022. Methods: We retrieved data concerning new daily COVID-19 cases in 191 countries covered by both data sources from January 22, 2020, to December 31, 2022. The ratio of numbers of daily reported cases from the two sources were calculated to measure data consistency. We performed simple linear regression to examine significant changes in the ratio of numbers of daily reported cases during the study period. Results: Of 191 WHO member countries, only 60 displayed excellent data consistency in the number of daily reported COVID-19 cases between the WHO and JHU CSSE dashboards (case number ratio: 0.9-1.1). Data consistency changed greatly across the 191 countries from 2020 to 2022 and differed across four types of countries, defined by income. Data inconsistency between the two data sources generally decreased slightly over time, both for the 191 countries combined and within the four types of income-defined countries. The absolute relative difference between two data sources increased in 84 countries (particularly for Malta, Montenegro, and United States, R2=0.29) but decreased in 40 countries (P<0.05). Conclusions: The inconsistency between the two data sources warrants further research. Construction of public health surveillance and data collection systems for public health emergencies like the COVID-19 pandemic should be strengthened in the future.
Background: Social media is currently serving as a tool for increased digital interconnectedness and has resulted in playing an instrumental role in sharing health-related information with a wide audi...
Background: Social media is currently serving as a tool for increased digital interconnectedness and has resulted in playing an instrumental role in sharing health-related information with a wide audience. In conjunction with the vast availability of information, there has been a rapid spread of misinformation, leading to public mistrust, safety concerns, and discrimination. The COVID-19 pandemic has amplified the threat of misinformation resulting in detrimental health outcomes due to individuals becoming fatigued with COVID-19 health guidance. Although vaccinations are the key to combating COVID-19, the overwhelming amount of misinformation has resulted in diminished vaccine acceptance. Objective: (1) Train and deploy a group of healthcare workers and student volunteers to address anti-vaccine sentiment on Facebook; and, (2) Evaluate the intervention through semi-structured interviews to determine lessons learned and suggestions for future initiatives to address misinformation online Methods: The project utilized volunteers to address vaccine-hesitant comments on Facebook (Met Platforms Inc., Menlo Park, California), with the overall goal of empowering healthcare professionals to engage with vaccine-hesitant individuals online to counteract the spread of vaccine misinformation. Eligible participants included healthcare workers and students in healthcare-related disciplines were recruited through social media and email advertising campaigns by the University of Calgary, School of Nursing contact list. Informational training sessions on Zoom with a duration of 30-minutes followed, to better equip volunteers with the ability to utilize their working knowledge of health communication and behaviour change to correct online misinformation. During the deployment of volunteers, they were provided a file containing Facebook posts that discussed COVID-19 vaccines to act as a starting point for leaving or responding to comments that spread vaccine misinformation. Participants in the project were provided with working knowledge of health communication, behaviour change, and correct misinformation through the informational training sessions. Qualitative evaluation in the form of interviews were used to examine participant experiences, where it was found that volunteers felt that they were adequately equipped to engage in vaccine conversations both online and in healthcare settings. Overall, the project has addressed vaccine hesitancy and valuable insights into the relationship between public engagement and communication in the era of digital interconnectedness. Results: Following the evaluative interview discussions, three main themes emerged regarding the project’s format and training model, the factors motivating volunteers to participate, and overall experiences tackling misinformation on an online platform. The first theme showcased that the training format was effective due to its use of interactive components and overall flexibility, resulting in it being well-received by volunteers. The second identified theme highlighted that a main driving factor for participation included a balance of professional development and societal good. Finally, the third theme revealed that the volunteers' experiences in interacting with the public revealed a rich tapestry of emotions and perspectives, where vaccine hesitancy is interconnected with emotional responses and personal beliefs. Conclusions: The Informed Choice Project provided an opportunity to increase self-efficacy and confidence for more than a dozen healthcare professionals and students while engaging in vaccine-related conversations online. Immediate challenges associated with the COVID-19 pandemic, including combating misinformation and promotion of vaccination were addressed, which has resulted in a more reliable groundwork for shaping future public health communication strategies. To enhance both participant satisfaction and compliance, future interventions should consider utilizing a self-paced format, flexible hours, and highlight the vitality of healthcare professionals as key advocates for trusted sources of information for the public.
Background: Since November 2022, with the debut of OpenAI’s ChatGPT, there has been growing interest in the use of generative artificial intelligence (AI), including in healthcare. However, there is...
Background: Since November 2022, with the debut of OpenAI’s ChatGPT, there has been growing interest in the use of generative artificial intelligence (AI), including in healthcare. However, there is only limited research into doctors’ adoption of these tools and their opinions about their application in clinical practice. Objective: This study aimed to explore the opinions of general practitioners (GPs) in the United Kingdom (UK) about the use of generative AI tools (ChatGPT/Bard/Bing AI) in primary care. Methods: Between February 2nd-24th 2024, using a convenience sample, we administered a web-based mixed methods survey of 1000 GPs in the UK to explore their experiences and opinions about the impact of generative AI on clinical practice. Participants were recruited from registered GPs currently working in the UK using the clinician marketing service Doctors.net.uk. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses and conducted a qualitative descriptive analysis of written responses (“comments”) to 2 open-ended questions embedded in the web-based questionnaire. Results: A total of 1006 GPs responded, with 53% being male and 54% aged 46 years and older. Most GPs (80%) expressed a need for more support and training in understanding these tools. GPs at least somewhat agreed AI would improve documentation (59%), patient information gathering (56%), treatment plans (41%), diagnostic accuracy (40%), and prognostic accuracy (38%). Additionally, 62% believed patients might rely more on AI, 55% felt it could increase inequities, and 54% saw potential for patient harm, but 47% believed it would enhance healthcare efficiency. GPs who used these tools were significantly more optimistic about the scope for generative AI in improving clinical tasks compared with those who did not report using them. Elaborating on the quantitative component of the survey, 31% (307/1006) left comments that were classified into 4 major themes in relation to generative AI in medicine: (1) lack of familiarity and understanding, (2) a role in clinical practice, (3) concerns, and (4) thoughts on future of healthcare. Conclusions: This study highlights UK GPs' perspectives on generative AI in clinical practice, emphasizing the need for more training. Many GPs reported a lack of knowledge and experience with this technology and a significant proportion used non-medical grade technology for clinical tasks, with the risks that this entails. Medical organizations must urgently invest in educating and guiding physicians on AI use and limitations.
Background: Digital health interventions, such as electronic immunization registries (eIR) and electronic Logistic Management Information Systems (eLMIS), have the potential to significantly improve i...
Background: Digital health interventions, such as electronic immunization registries (eIR) and electronic Logistic Management Information Systems (eLMIS), have the potential to significantly improve immunization data management and vaccine logistics in low- and middle-income countries (LMICs). Despite their growing adoption, there is limited evidence on the financial and economic costs associated with their implementation compared to traditional paper-based systems. Objective: We aimed to measure the costs of implementing and maintaining eIR and eLMIS systems in LMICs, and to estimate the affordability of their implementation as compared to the previous paper-based registries. Methods: The study was conducted across four countries: Guinea, Honduras, Rwanda, and Tanzania. A combination of primary and secondary data sources was used for the analysis. Expenditure information regarding the design, development and implementation of the tools was directly obtained from implementers and National Immunization Program offices in all countries. Primary survey data was collected to gauge the operational expenses of immunization information systems, both with and without electronic tools using an Activity Based Costing approach. The cost of immunization information system to the national level was then extrapolated and compared to national spending on immunization as a measure for affordability. Results: The total costs of designing, developing and deploying eIR and/or eLMIS were I$ 1.7, 5.4, 4.7 and 33 million in Guinea, Honduras, Rwanda and Tanzania respectively. Design costs were greatly affected by the degree of customization of the tool, whereas roll out costs were mostly driven by the costs of purchasing hardware and training of health workers. Overall, the implementation of the electronic systems was associated with higher costs in Honduras (I$ 535 per facility, 95% CI 441; 702) and Rwanda (I$ 278, 95%CI 75; 482), a cost reduction in Tanzania (I$ -1,770, 95%CI -2,990; -550) and no significant cost difference in Guinea. The percentage weight of the cost of managing data with the electronic systems over the total national immunization budgets was estimated at 8.6%, 1.1%, 3.7% and 1.8% for Honduras, Rwanda, Tanzania and Guinea, respectively Conclusions: Digital health interventions such as eIR and eLMIS can potentially reduce costs and improve the efficiency of immunization data management and vaccine logistics in LMICs. However, the extent of cost savings is contingent upon the degree to which these digital systems replace traditional paper-based methods. Our study suggests that the economic impact of digital health solutions greatly depends on factors such as infrastructure, implementation, and the extent to which these technologies are integrated into existing healthcare systems. Careful planning and investment are essential to realizing the full economic potential of digital health in LMICs.
Background: Qualitative experience data can inform healthcare providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable inform...
Background: Qualitative experience data can inform healthcare providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide healthcare quality improvement: positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement. Objective: To understand families’ perspectives regarding their child’s surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing postoperative outcomes risk stratification model. Methods: Participants were parents/guardians of children aged 0-18 who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. English second language participants were offered translational services during the consent process and were included if any family member could translate the surveys to their preferred language. Participants were ineligible if they and their families could not understand English or their child had a neurodevelopmental disability. Perioperative survey data were collected from families using the Research Electronic Data Capture tool, including one preoperative survey and follow-up surveys sent on postoperative day (POD) 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until POD 90 was reached. Follow-up surveys included opportunities to leave free-text comments on their child’s surgical experience. Thematic content analysis of free-text comments was completed using NVivo, and quantitative analysis was performed using R. Results: In total, 454/500 (91%) enrolled families completed at least one postoperative survey; 242/454 (53%) provided at least one free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient's age distribution was bimodal (modes at 2-3 and 14-15 years), with 160 (66%) being male. Patients underwent orthopedic (24%), urology (16%), general (15%), otolaryngology (13%), ophthalmology (13%), dental (11%), and plastic (7%) surgeries. Largely positive comments (398/485; 82%) were made on the recovery and clinical care experience. A key theme for improvement included “communication,” with subthemes highlighting parental concerns regarding the “preoperative discussions,” “clarity of discharge instructions,” and “continuity of care.” Other themes included “length of stay” and “recovery experience.” Feedback also suggested survey design amendments for future iterations of this instrument. Conclusions: Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between healthcare providers and parents to align expectations and support proactive family-centred care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous QI initiatives involving near-real-time patient feedback to improve the healthcare experience of patients and families.
Background: Emotion recognition bias in depression is well documented and is proposed to play a causal role in depression. A Cognitive Bias Modification (CBM) intervention targeting the bias in emotio...
Background: Emotion recognition bias in depression is well documented and is proposed to play a causal role in depression. A Cognitive Bias Modification (CBM) intervention targeting the bias in emotional expression perception was developed, but despite robust training effects on emotion perception, the effect on mood was unreliable and weak. We propose a new gamified version of CBM (GCBM) to address potential limitations that may attenuate therapeutic effects. Objective: This study aims to test the effectiveness of GCBM in altering the perception of emotional facial expressions and improving the immediate mood of healthy participants.
Study 1 aimed to investigate the effectiveness of a single session of GCBM on emotion perception and to assess whether the gamified version of the task would produce the same robust training effects on the interpretation of emotional expressions as the original CBM.
Study 2 aimed to compare the effectiveness of a single session of CBM training, CBM (no training) control, and GCBM training on immediate mood. Methods: We reported two between-subjects online experimental studies that recruited participants from the general population. Study 1 (N = 58) tested the effectiveness of GCBM in changing participants' responses to ambiguous facial expressions. The primary outcome was emotion recognition bias, measured by increased identification of happy faces. Study 2 (N = 916) compared the effects of a single session of GCBM training, CBM training and CBM control conditions on immediate mood. The primary outcome was immediate mood after the training, measured by the Immediate Mood Scaler (IMS). Results: Study 1 showed that participants in the intervention condition classified more ambiguous faces as 'happy' after the training compared to controls, indicating an increased perception of happiness in ambiguous faces. (B = 1.73, P < .001). Study 2 provided evidence that GCBM training produced more positive changes in immediate mood compared to the CBM control condition (B = -3.64, P = .003) and compared to the CBM training condition (B = 1.73, P = .044). Conclusions: These studies showed that GCBM may change participants' emotion recognition bias to ambiguous facial expressions and enhance mood compared to both CBM and control conditions. These results suggest that GCBM might be an effective intervention for addressing mood-related cognitive biases. Further exploration of GCBM's long-term effects on mood and its clinical application is needed.
Background: Hypertrophic scarring is a condition where excessive connective tissue growth occurs after deep skin injuries such as burns, frostbite, and surgery. This condition not only affects a patie...
Background: Hypertrophic scarring is a condition where excessive connective tissue growth occurs after deep skin injuries such as burns, frostbite, and surgery. This condition not only affects a patient's physical appearance but also causes symptoms like itching, pain, and limited limb function, significantly impacting their quality of life. TikTok, a popular platform for sharing short videos, has shown potential in spreading health information, particularly in educating people about hypertrophic scarring. Objective: This study aims to analyze the content and quality of short videos related to hypertrophic scarring on TikTok, providing valuable insights for health information dissemination. Methods: This study examined 153 short TikTok videos focusing on hypertrophic scarring. The videos were found by searching for the keywords 'scar hyperplasia' and 'hypertrophic scars' (Language: Chinese). The sources of the videos were thoroughly verified, and the content's comprehensiveness was assessed using a six-core question framework covering definition, signs and symptoms, risk factors, evaluation, management, and outcomes. The reliability and quality of the videos were evaluated using standardized tools such as DISCERN, JAMA benchmarks, the Global Quality Scale (GQS), and HON code. In the comprehensive evaluation of video reliability and quality, we calculated the average scores of four assessment methods (labeled as R) to indicate the overall reliability and quality of the videos. The study also explored the potential relationship between video quality and characteristics. Results: The analysis showed that healthcare professionals uploaded all videos about treating hypertrophic scarring, which matches the hexagonal radar model analysis findings. The quality assessment scores for JAMA, GQS, DISCERN, and HON code had median values of 1 (IQR 1-2), 2 (IQR 2-3), 2 (IQR 2-3), and 3 (IQR 3-4) respectively, indicating a need to improve the quality and reliability of videos on hypertrophic scarring. Additionally, high-quality videos were more popular, based on metrics such as likes, comments, favorites, and shares (P<.001). Interestingly, the time when the videos were uploaded positively correlated with GQS and DISCERN scores (r=0.374, P<.001; r=0.281, P<.001), while the video length did not significantly correlate with evaluation scores. Conclusions: This study emphasizes the need for improved quality and comprehensiveness of short TikTok videos addressing hypertrophic scarring. The information presented should be more reliable and scientifically accurate. When watching videos related to hypertrophic scars, we strongly recommend that viewers prefer content published by healthcare professionals from the Burn Department and Burn Plastic Surgery Department, as well as those from first-tier and emerging first-tier cities. As social media platforms like TikTok increasingly influence health information, viewers should evaluate short videos' scientific validity and reliability before making medical decisions. Moreover, creators of such videos should prioritize scientific accuracy and precision in their content to improve video quality and effectively meet the needs of their audience.
Background: TikTok is regarded as one of the major social media platforms for sharing health-related information, including teaching TikTok users about pregnancy prevention strategies. Adolescent lear...
Background: TikTok is regarded as one of the major social media platforms for sharing health-related information, including teaching TikTok users about pregnancy prevention strategies. Adolescent learners are also using this social media to learn about various types of contraceptives that can be used to prevent pregnancy due to a lack of information on the subject from parents, teachers, and clinic staff, as well as a fear of being judged when discussing such sensitive health topics. However, pregnancy prevention material shared on TikTok can be either accurate or misleading. Objective: The study sought to explore and describe adolescent learners' perspectives on the influence of TikTok in pregnancy prevention in Vhembe District Methods: This study was conducted using a cooperative inquiry qualitative research design. This study stems from the study umbrella study, which aimed to develop strategies for the prevention of adolescent learner pregnancy. Data was collected using the Lekgotla data discussion method. This study's data was analyzed using NVIVO version 14 following the six Tesch thematic phases. Results: Four themes emerged from the data analysis: home-based concoctions recipes used for pregnancy prevention methods, other home-based recipes used for pregnancy prevention methods, home-based pregnancy test recipes, and different types of modern contraceptives used for pregnancy prevention. Conclusions: Adolescent TikTok users learn pregnancy prevention methods that are myth-based and misleading. Regulating content on TikTok is crucial to avoid harm to teenagers using home remedies for pregnancy prevention.
Background: The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends the use of the 5 item SARC F questionnaire by clinicians to screen for probable sarcopenia. The recommended th...
Background: The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends the use of the 5 item SARC F questionnaire by clinicians to screen for probable sarcopenia. The recommended threshold of greater than or equal to 4 has low sensitivity and high specificity in identifying probable sarcopenia. While this high threshold is capable of excluding clients without probable sarcopenia, the difficulty lies in using this screening tool to identify clients with low muscle strength. Objective: This study aims to reassess the SARC-F as used in a primary care clinic for the determination of the incidence of probable sarcopenia and to determine if a test of handrip strength is necessary for diagnosis of probable sarcopenia. Methods: 204 community dwelling older adults (117 male, 87 female) above the age of 65 were screened at their physician visits using the SARC F. Probable sarcopenia was diagnosed using gender-specific grip strength criteria defined by the EWGSOP2 (less than or equal to 27 kg for men, less than or equal to 16 kg for women). A receiver operating characteristic (ROC) curve was used to determine a SARC F threshold that optimized the tradeoff between sensitivity and specificity for the diagnosis of probable sarcopenia. Results: Probable sarcopenia was present in 11.8% of participants. There were no differences in age (73.9 plus/minus 6.2 years) or BMI (29.5 plus/minus 5.8 kg/m2) between genders. Males had greater grip strength (36.3 plus/minus 8.1; 22.4 plus/minus 5.5 kg) and lower SARC-F scores (0.92 plus/minus 1.65, 1.88 plus/minus 2.31) than females. The ROC curve identified a SARC F score of greater than or equal to 2 as an optimal cutoff between sensitivity and specificity (AUC = 0.77, 95% CI: 0.67 to 0.88, p < .05). Accuracy (0.77), false positive rate (0.22), positive predictive value (0.31), and negative predictive value (0.96) were also calculated. Conclusions: A SARC-F threshold of greater than or equal to 2 is recommended as an optimal tradeoff between sensitivity and specificity when identifying community-dwelling older adults with probable sarcopenia. This is lower than the currently accepted recommendation of greater than or equal to 4. Our findings promote the recommended early detection and treatment by medical professionals by the EWGSOP2 by improving the ability to identify individuals with low muscle strength with this screening procedure.
Background: White spot lesions (WSLs) are white marks that can form on teeth during orthodontic treatment with fixed appliances (FA) and become apparent once they are removed. About half of people who...
Background: White spot lesions (WSLs) are white marks that can form on teeth during orthodontic treatment with fixed appliances (FA) and become apparent once they are removed. About half of people who have FA treatment get WSLs. They are usually caused by poor tooth-brushing around the brace.
Several studies explore the prevention and/or treatment of WSL. However, there remain uncertainties about what young people and their parents/guardians know or feel about WSL. A Cochrane review concluded that patient-reported outcomes have been overlooked in WSL prevention studies.
Methods: This protocol describes a mixed-methods study that aims to explore young people’s and their parents/ guardians’ perceptions, attitudes, and feelings towards WSLs. Participants will be recruited from children aged 11-15, undergoing orthodontic treatment at Liverpool University Dental Hospital and their parents/guardians. Part 1 (quantitative) will use a questionnaire and images of pre-treatment malocclusions and post-orthodontic WSLs of varying severity (mild, moderate, severe). Part 2 (qualitative) will involve one-to-one, semi-structured interviews, using open-ended questions with young people and their parents/ guardians.
A sample size of 200 survey respondents for Part 1 and 30 interviewees for Part 2 will be undertaken. The responses for the questionnaire use a Likert scale with the option of free text comments. The qualitative research will be analysed using a modified framework analysis approach; the outcomes will be presented as themes.
Discussion: WSLs can be highly visible when smiling or speaking. Aesthetic defects, caused by WSLs, may expose young people to oral health related stigma and discrimination e.g., bullying or teasing and impact on self-esteem. WSLs may also have cost consequences for patients and NHS dental services, for example, the costs of professionally applied fluoride, restorations, and their maintenance. This study is important for understanding the impact WSLs have on oral health-related quality of life and the decision making of young people and their parents/ guardians.
Objective: This study conducts a comprehensive bibliometric analysis to explore the landscape of research on smart hospitals, highlighting significant research trends, challenges, and future direction...
Objective: This study conducts a comprehensive bibliometric analysis to explore the landscape of research on smart hospitals, highlighting significant research trends, challenges, and future directions.
Methods: We analyzed 5,190 publications from the Web of Science and PubMed databases spanning January 2014 to October 2023, employing text mining and Latent Dirichlet Allocation (LDA) for data categorization into four domains: technological application in healthcare ("Function"), implementation challenges ("Barrier"), operational impacts ("Supply"), and patient outcomes ("Demand").
Results: Our findings show a surge in smart hospital publications post-2016 and following the onset of the COVID-19 pandemic. Sixty topics were defined by LDA analysis, and the "Function" domain was the most researched, indicating strong interest in leveraging technology for improved healthcare delivery. However, there was a significant gap in the "Demand" domain, suggesting a need for more patient-centric research. Thematic mapping and co-occurrence analysis highlighted key technological progress and important challenges, including the need for better interoperability and stronger data security. Additionally, a thorough review of key articles emphasized the practical use of these technologies, underlining the importance of increasing patient engagement and tailoring healthcare services to individual needs.
Conclusion: This study reveals a focus on digital technology applications in hospitals but highlights a critical gap in evaluating their effectiveness and developing management-oriented frameworks for smart hospital analysis. It underscores the need for further exploration of the effect of advanced digital technologies and increased managerial research to enhance hospital services and efficiency.
Background: Non-communicable diseases resulting from sedentary behaviour (SB) are adding further strain on the South African health system, which is already struggling to manage infectious diseases. S...
Background: Non-communicable diseases resulting from sedentary behaviour (SB) are adding further strain on the South African health system, which is already struggling to manage infectious diseases. Some countries have enabled children to reduce SB at school by substituting traditional furniture with sit-stand classroom furniture. Alternating between sitting and standing benefits spinal health, but no such intervention exists in South Africa. It is therefore essential to consider several contextual factors, such as the acceptability of the intervention, its impact on teachers' practices, and the logistical and pragmatic considerations of data collection. This study therefore aimed to assess the feasibility of implementing a classroom-based intervention to reduce SB and improve spinal health in primary school learners. Objective: The study objectives were to assess the pragmatics of delivering and adherence to a classroom-based intervention and assess the pragmatics of measuring physical activity and postural dynamism data with activPAL and Noraxon Myomotion inertial measurement units (IMUs), respectively. Methods: We used a stratified, closed-cohort, randomised, two-cluster, stepped-wedge design with a pragmatic approach. One grade 5 and 6 class each were recruited from contrasting socio-economically categorised, publicly funded primary schools in the Western Cape Province, South Africa. Classroom furniture was substituted with sit-stand desks and health and movement videos were shown during class time. Skin-mounted activPAL physical activity monitors and Noraxon Myomotion Inertial measurement units were used to measure SB and spinal movement respectively. The study was evaluated for feasibility by tracking school retention, successful delivery of the videos and use of the desks, compliance with the wearable sensors, and data accuracy. We deductively analysed teacher interviews and learners' focus groups using Atlas.ti 9 software. Descriptive analysis of quantitative data was done using Microsoft Excel. Results: All feasibility outcomes were met in cluster two. Cluster one withdrew from the study before follow-up SB, postural topography and spinal movements were measured. The study found that it is feasible to conduct a larger trial with minor modifications to the methodology. Conclusions: We recommend a whole-school approach to support the intervention and a monitoring strategy to track the impact of the intervention on the classroom. Furthermore, we recommend contextualised teacher training on how sit-stand desks and health education videos can be utilised as classroom management tools. Clinical Trial: Pan African Trials Registry PACTR201811799476016; Registered 22 November 2018 – retrospectively registered; https://tinyurl.com/y4upoys8
Background: Background
The global shortage of healthcare workers has exacerbated the challenges faced by health systems worldwide. The World Health Organization (WHO) projects a deficit of 10 million...
Background: Background
The global shortage of healthcare workers has exacerbated the challenges faced by health systems worldwide. The World Health Organization (WHO) projects a deficit of 10 million healthcare workers by 2030. While low- and lower-middle income countries will be the most affected, all countries will face significant challenges [1]. In the UK, the National Health Service (NHS) is already under considerable strain [2], with significant effects on the quality of care and health outcomes of patients [3].
At the same time, there is a growing demand for health information and increasing consumer empowerment [4]. In this context, the reliance on digital health tools has surged, particularly decision support tools including online symptom checkers (OSCs) [5, 6]. The ubiquitous access to the internet supports this trend, with 96% of households in the UK having internet access in 2020 [7], which accelerated following the advent of the COVID-19 pandemic given the need of health services to avoid face-to-face contact and preserve urgent care capacity [8].
Symptom checkers are available as websites or applications and can generate a prioritised list of potential diagnoses based on the entered symptoms and suggest suitable actions, such as self-care, consulting a general practitioner (GP), or seeking urgent medical care [9]. By providing preliminary diagnostic guidance and triage recommendations, these tools could potentially alleviate some of the burdens on healthcare systems with the potential to reduce unnecessary healthcare visits by providing timely medical advice and empowering individuals to make informed decisions about their health [10, 11]. The diagnostic and triage accuracy have been found to vary greatly among OSCs, thus raising concerns and calling for caution [12, 13].
The use of OSCs globally varies as: users tend to be young [12, 13], women [6, 14, 15] and more highly educated [6, 14-16]. Having a chronic health condition has also been associated with greater use in one study [16]. A 2022 systematic review on user experience of symptom checkers identified eight relevant aspects of user experience that have been explored in the literature, including motivation, trust, acceptability, satisfaction, accuracy, usability, safety/security and functionality [17]. Of the 31 included studies only 3 were carried among the UK population [18-20] and focused either on cancer symptom checking [19], users with inflammatory arthritis [20] or the use of one specific OSC [18].
Data on the experience and perspectives of potential users living in the UK on the use of OSCs remains scarce and no study has yet quantified or ranked the various factors associated with the use of OSCs. Objective: The aim of this study was to identify, characterise and quantify the factors associated with the use of OSCs among community-dwelling adults in the UK. Specifically, we sought to (i) assess the demographic characteristics of OSC users, (ii) evaluate user perceptions of the usability and effectiveness of OSCs, (iii) identify concerns related to the privacy, security and accuracy of OSCs, and (iv) quantify the weight of these various factors on the adoption and utilisation of OSCs. Methods: Study design
This cross-sectional study aimed to explore factors influencing the use of OSCs among community-dwelling adults in the UK. The study employed a quantitative methodology using an electronic survey tool (eSurvey).
Data collection
This was an open eSurvey, accessible to anyone with the survey link, and required less than 10 minutes to complete. The eSurvey was developed and tested to ensure clarity, usability and technical functionality before fielding. The link to the eSurvey was active on the Imperial College Qualtrics platform between 23 February and 25 March 2024. Study information was disseminated including the Participant Information Sheet (PIS) and link to the survey. Participants were recruited through convenience sampling. The researcher’s personal and professional networks were mobilised to respond and further disseminate the eSurvey among potentially eligible participants. Most participants were recruited via Prolific Academic’s panel [21]. The PIS included information regarding the study’s aims, the protection of participants’ personal data, their right to withdraw from the study at any time, which data were stored, where and for how long, who the investigator was, the purpose of the study and survey length.
Participants were informed that this was a voluntary survey. Informed consent was obtained from all participants. Data collected were stored on a secure database at Imperial College London and only accessible to the researcher team. All responses were pseudo-anonymised to ensure confidentiality.
The selection of factors which may affect the use of OSCs to be included in the survey was guided by a review of existing literature of the topic. Demographic factors including age and gender, as well as perceptions such as perceived usability, effectiveness, reliability, accuracy, safety and privacy have been identified as influential factors from prior studies [6, 16-18, 20, 22].
Before publication, the survey was tested, piloted and revised internally by the study team. In its final version, the survey comprised a total of 25 questions displayed across four screens and gathered data regarding respondents’ awareness, use and perspectives regarding OSCs, as well as basic demographic information (Table 1).
Data analysis
Only questionnaires fully completed were included in the analysis. Duplicate entries from the same IP address within a 24-hour period were also eliminated before analysis. Participant characteristics and responses were summarised using total (n) and relative (%) frequencies. For inferential analyses, 'strongly agree' and 'somewhat agree' were categorised into 'agree,' and 'strongly disagree' and 'somewhat disagree' were categorised into 'disagree, to create binary variables for logistic regression analysis. Relationships between (i) demographic factors, (ii) usability and effectiveness, (iii) reliability and accuracy, (iv) risks and concerns and the use of OSC were assessed using univariable and multivariable logistic regression models, adjusting for age, gender, ethnicity, education level, parenting status, disability and long-term health conditions. Results were deemed statistically significant at a p-value <0.05. The odds ratios for these relationships were quantified to understand the influence of each factor on the use of OSCs and compare them.
All analyses were performed using STATA, version 17 (StataCorp LP, College Station, TX, USA). The Checklist for Reporting Results of Internet E Surveys (CHERRIES) was used to guide reporting [23] (Supplementary file 1). Results: Participants characteristics
A total of 641 individuals took part in the survey with complete responses obtained from 634 respondents. A full description of participants according to age, gender, ethnicity and educational background is provided in Table 2. The largest proportion were between 26 and 35 years old (32.7%), followed by participants aged 36-45 (24.6%). Gender distribution showed a slight predominance of females (46.5%) over males (41.8%), with a smaller percentage identifying as "other" (10.3%). Ethnicity predominantly comprised individuals identifying as White (84.2%), followed by Asian/Asian British (7.1%) and Black/African, Caribbean/Black, British (3.9%). The majority held a college or university degree (71.5%), nearly a third (31.5%) had children under 16 years, 15.1% of respondents reported having disabilities, and 22.9% had one or more long-term health conditions.
Main survey findings
Use of OSC
The majority (85.7%) of participants had used an OSC, while 14.4% reported never having used one. The reasons for non-use of OSC reported by the largest proportion (45.1%) was preference of consulting a healthcare professional directly rather than using OSC, followed by having never heard of them (39.6%); 24.2% of respondents did not trust them. However, two-thirds of the non-users (64.8%) expressed a likelihood of using a symptom checker in the future (Supplementary Table 1).
The most utilised OSC was NHS 111, with 78.6% of respondents indicating that they had used this tool, followed by Healthline (22%). Participants predominantly used symptom checkers before seeking medical advice (94.5%), primarily to better understand symptoms (79.0%) and to determine the need for medical care (77.4%).
Most respondents (77.9%) indicated that symptom checkers offered recommendations for action or triage. Among those who received such recommendations, a significant proportion (79.7%) were directed to seek a consultation with a healthcare professional. Regarding adherence, most participants (59.8%) reported following the recommendations most of the time, 27.7% stated they always adhered to the suggestions provided by the symptom checker, while a smaller proportion (12.3%) admitted to rarely doing so.
Association between demographics and use of OSC
An increase in age was associated with a decrease in OSC use. Specifically, individuals aged 46-55, 56-65 and >65 showed significantly decreased odds of using OSC (adjusted odds ratio (aOR)=0.29, 95%CI 0.11 - 0.72), (aOR=0.27, 95%CI 0.10 - 0.71) and (aOR=0.22, 95%CI 0.06 - 0.78) respectively, compared to the younger (18-25) age group. Similarly, females exhibited higher odds of using OSC compared to males (aOR=1.79, 95%CI 1.05 – 3.06). Having children under 16 years of age also showed significantly higher odds of using OSC (aOR= 3.19, 95%CI 1.56 - 6.51) compared to those who do not have children under 16 years of age. In contrast, neither ethnicity nor educational background exhibited any statistically significant association with the use of OSC. Similarly, disability and long-term health conditions did not contribute to the outcome of using OSC; Table 3.
Associations between OSC use & users’ perceptions of OSCs
The main survey findings are shown in Supplementary Table 1. The segment below highlights key associations between perceived usability and effectiveness, reliability and accuracy, and risks and concerns with using OSCs
Perceived usability and usefulness and use of OSCs
Most of the participants found OSCs easy to use (89.3%), believed they could help with medical decisions (86.0%) and to support their health literacy and self-care (84.7%). A great proportion also (94.6%) agreed that OSCs are useful tools in scenarios with limited access to healthcare professionals, such as rural settings or out-of-hours situations.
Participants who found the symptom checkers easy to use were more than eight times more likely to utilise them compared to those who did not (aOR=8.17, 95% CI 4.25-15.71). Similarly, individuals who found these tools helpful in making better medical care choices were almost three times more likely to use them than those who did not (aOR=2.96, 95% CI 1.62-5.42). Moreover, those who agreed that the symptom checkers improved health literacy and supported self-care showed a heightened likelihood of use (aOR=2.36, 95% CI 1.30-4.28). Participants who perceived the OSC as useful in scenarios with limited access to healthcare professionals were twice as likely to utilise them compared to those who disagreed (aOR=2.15, 95% CI 1.01-4.59); Table 3.
Perceived reliability and accuracy and use of OSCs
Just over half of the respondents expressed confidence and trust in OSCs’ information (57.3%). The perceived accuracy of OSCs’ diagnosis was slightly higher (63.0%) while 79.2% of respondents said they trusted the triage provided by the tools. 69.2% of respondents found using a symptom checker reassuring and made them feel less anxious about their health.
Participants who trusted the suggested diagnosis to be accurate were over twice as likely to use the symptom checkers compared to those who disagreed (aOR=2.24, 95%CI 1.32-3.79). Similarly, individuals who trusted the triage recommendation provided by these tools showed a heightened likelihood of use (aOR=2.33, 95% CI 1.33-4.06). Participants who found using symptom checkers reassuring and anxiety-reducing were significantly more likely to utilise them (aOR=3.85, 95% CI 2.28-6.50). Additionally, the encouragement from family and friends to use symptom checkers significantly influenced their use (aOR=2.05, 95%CI 1.24-3.41). However, encouragement from GPs was not significantly associated with the use of symptom checkers (aOR=1.34, 95%CI 0.79-2.24); Table 4.
Perceived risks and concerns and use of OSCs
Reported concerns included safety (75.9%), privacy (41.7%) and exacerbating inequalities (41.6%). More than half of the respondents (65.9%) worried about replacing traditional consultations and more than a quarter (26.9%) would not feel confident discussing the outcomes of their symptom checker consultation with their GP.
Participants who agreed that symptom checkers are not yet safe enough to rely solely on them and may put their health at risk did not show a significant association with use compared to those who disagreed (aOR=0.59, 95% CI 0.30-1.17). However, concerns regarding privacy and health information security were significantly inversely associated with use, with individuals expressing such worries being less likely to utilise symptom checkers (aOR=0.58, 95% CI 0.35-0.97). Similarly, those who believed that symptom checkers might increase inequalities between patients were less likely to use them (aOR=0.47, 95% CI 0.28-0.79). Concern about OSCs replacing face-to-face or phone consultations was significantly associated with decreased use (aOR=0.47, 95% CI 0.26-0.87); Table 5.
Figure 1 represents the weight of each factor on the use of OSCs. The main factor that significantly increased the probability of using OSCs was the tools’ ease of use (aOR=8.17, 95% CI 4.25-15.71). This was followed by feeling reassured by using the tool and having children. Users of OSCs also usually thought of OSCs as improving their healthcare choices, their health literacy and self-care capacity. Encouragement from friends and family limited healthcare access, better. being female. and trust in the triage and diagnostic accuracy.
Demographic factors associated with a decreased odd of using OSCs included male gender and older age. Concerns regarding privacy and data security, as well as the risk of increased inequalities and loss of face-to-face consultations due to OSCs were also identified as reducing the likelihood of using these tools. Conclusions: Principal results
This study investigated the factors influencing the use of OSC in the UK through a cross-sectional survey of community dwelling adults. Among the key findings, we observed that most participants (86%) had used a symptom checker at some point, with the NHS 111 platform being the most widely used (79%), followed by Healthline (22%). These tools were predominantly employed before seeking medical advice (95%) primarily to better understand symptoms and to determine the need for care. Interestingly, while most OSC non-users expressed a strong likelihood of future use, we observed varying concerns regarding the accuracy of information, safety, privacy and potential increase of inequalities.
Older individuals (aged between 46-55, 56-65 and older than 65) showed significantly decreased odds of using OSC compared to the 18-25 age group independently from other variables. However, females exhibited higher odds of utilising these tools compared to males, and individuals with children under 16 years of age were more than three times more likely to use OSC compared to those who did not have children. Further, although trust in the accuracy of diagnoses and triage recommendations, as well as encouragement from family and friends, positively influenced use, concerns regarding privacy, health information security, inequalities and the potential displacement of traditional consultations were significantly associated with decreased use (Figure 1). No significant associations were found between the use of OSCs and encouragement from GPs to use these tools, concerns about the safety of relying solely on symptom checkers nor potential health risks.
Study strengths and limitations
This study examined a wide range of variables, including demographics, motivations, perceived effectiveness, reliability and concerns regarding OSC and associations with their use providing valuable insights into the complexities surrounding the wide scale adoption and diffusion of these tools in the contemporary setting. While supporting existing evidence on this topic, we identified additional factors associated with the use of OSCs, including the perceived family and friends support as well as having children. By employing regression models, we were also able to quantify the associations between the use of OSCs and a variety of factors, including both demographic factors and respondents’ perceptions regarding the usability, safety, accuracy and concerns associated with OSCs. Crucially, we identified significant predictors of use while controlling for potential confounders and enhancing the internal validity.
This study's large, diverse and representative sample closely reflects the ethnic distribution of the UK population [24], which enhances the generalisability of the findings.
However, this study is also has several limitations. Firstly, cross-sectional studies cannot establish causality and temporal relationships between the factors examined. Secondly, since the survey was only accessible online, it is likely that potentially eligible participants with limited access to internet and / or those less confident with digital technology were excluded and their views absent or at least under-reported. Lastly, this study relies on self-reported data, which may be subject to recall and social desirability biases. Participants' responses regarding their use patterns, preferences and adherence to recommendations may therefore not fully reflect their actual behaviours. Longitudinal studies are indicated to follow-up users over a longer time horizon to better understand how their interactions with OSC evolve and how it influences their health behaviours, healthcare utilisation and health outcomes.
Comparison with existing literature
The findings of this study are in line with prior research, including primary studies and reviews reporting on the socio-demographics of OSC users who tend to be young [6, 14, 15], women [6, 14-16] and with higher education levels [6, 14, 16]. Although having a chronic health condition or a disability was associated with greater use in a study by Meyer et al. [16], we did not find this association in this study’s sample. Regarding the motivations for using OSCs, a better understanding of the causes of symptoms has also been found to be the primary motivation among US users of the Isabel Symptom Checker [16], followed by support for deciding whether to seek care.
The finding that users of OSCs tend to find these tools easy to use and helpful was corroborated by Meyer et al. [16] and Pairon et al. [6]. The strong correlation identified in this study highlights the importance of user-friendly interfaces in promoting the adoption of OSCs. The review by Pairon et al. [6] also emphasized that users value OSCs for their ability to support health-related decisions, especially in determining whether to seek medical care. The results of this study reinforce this by showing that individuals who perceived OSCs as helpful in making better medical care choices were nearly three times more likely to use them.
Compliance with OSC recommendations has also been a point of focus in the literature. Previous studies reported varying levels of adherence to OSC advice, with compliance rates ranging from 57% to 67% [6], whereas this study reports a higher compliance rate, with 87.5% of participants following OSC recommendations most or all of the time. This higher rate of adherence may reflect an increasing reliance on digital health tools, particularly in the context of the COVID-19 pandemic which has accelerated the adoption of telemedicine and online health resources. Further research is needed to continue monitoring these trends and to explore the long-term impact of OSC use on healthcare outcomes.
Finally, issues relating to perceived accessibility, accuracy, security and privacy of OSCs were also identified by Aboueid et al. [22] in their qualitative study exploring young adults’ perspectives on the use of OSCs. Most of their respondents thought of OSCs as more useful to self-triage than self-diagnosis, which reflects the fact that only 63% of the respondents in this study trusted the diagnosis provided by the OSC, compared to 79.2% for the triage suggestion.
Implications for research
Although this study identified demographic disparities in the use of OSCs, further research is warranted to understand the underlying reasons for these disparities. Research focusing on the socio-cultural factors, digital literacy and healthcare-seeking behaviours among different demographic groups could provide valuable insights into addressing disparities and promoting equitable access to OSC. In addition, this study’s findings highlight the importance of usability, effectiveness and trust in driving the adoption and utilisation of OSCs. Future research could investigate deeper into the specific features and functionalities of these tools, such as user interface design and decision support algorithms that contribute to their perceived usability, effectiveness and adherence to the recommendations.
This study highlighted concerns regarding the privacy and health information security of OSC, which could impact their acceptance and use, necessitating the development of robust frameworks, regulatory standards and guidelines for OSC platforms to ensure transparency, accuracy and user privacy. Additionally, studies investigating the potential implications of OSC on healthcare inequalities and the doctor-patient relationship are essential for informing policy and practice, whereas research exploring effective strategies for educating users about the capabilities and limitations of these tools, as well as enhancing communication and collaboration between users and healthcare providers, could help build trust and confidence in OSC.
Future research should focus on understanding the socio-cultural factors influencing OSC use and developing strategies to address privacy and security concerns. Additionally, efforts to improve the usability and reliability of OSCs, alongside targeted interventions to promote equitable access, are essential for integrating these tools effectively into the healthcare system. By addressing these issues, OSCs can play a key role in supporting self-care and improving healthcare accessibility and efficiency in the UK.
Conclusion
This study provides insights into the factors influencing the use of OSCs in the UK, highlighting both their increasing and widespread adoption and some of the concerns associated with these digital health tools. The findings indicate that most adults have used OSCs, particularly the NHS 111 service, primarily for understanding symptoms and determining the need for medical care, and that younger individuals, females and those with children are more likely to use OSCs overall. Ease of use, perceived helpfulness in medical decision-making, and trust in the accuracy of diagnoses and triage recommendations are key factors driving OSC use, but these are coupled to concerns about privacy, health information security and the potential for OSCs to exacerbate healthcare inequalities, posing significant barriers to their adoption. The fear of OSCs replacing traditional consultations with healthcare professionals remains common among users, and these concerns must be addressed to enhance user trust and maximize the benefits of OSCs in healthcare delivery.
Background: Many healthcare systems confront considerable strain attributable to an escalating prevalence of older adults living longer leading to an increased number of people with chronic conditions...
Background: Many healthcare systems confront considerable strain attributable to an escalating prevalence of older adults living longer leading to an increased number of people with chronic conditions. Concomitantly the numbers of trained professionals in the healthcare workforce is not keeping up with the increased numbers of people with chronic conditions. In this context, increased digitalization is considered one way to mitigate many of the challenges, but it remains to be documented whether this is of benefit to COPD patients. The Epital Care Model (ECM) constitutes a proactive and data-centric treatment paradigm that leverages patient-reported outcome data and 24/7 telehealth service to facilitate early detection of deteriorating conditions among patients with chronic diseases (1). This approach aims to reduce and address exacerbations early, thereby averting the need for extensive and resource-intensive interventions. It is noteworthy that the Epital frontline service is delivered by trained and certified staff consisting of students from health educations and not by health care professionals. Objective: This clinical controlled trial was conducted to investigate the impact of the virtual component of the ECM framework in COPD on healthcare resource utilization and participants mental wellbeing and social activities. Methods: A pragmatic step-wedged design was employed, involving the random allocation of 184 patients into either an intervention group (n=92) or a control group (n=92), with equitable distribution across four general practice clinics in Denmark. Participants were examined at an 8-month (T1) follow-up and 12-month (T2) follow-up. Healthcare service utilisation and participants’ social activity were assessed and compared using Poisson regression. Mental wellbeing was assessed by comparing the scores on the WHO-5 wellbeing index using an unpaired t-test. Results: A significant reduction of healthcare utilization associated with COPD was found in the intervention group at T2, with reduced hospital admissions (56%), general practitioner visits (78%), on-call doctor consultations (73%), emergency room visits (49% reduction), and outpatient attendances (60% reduction) compared to the control group. Further, there was a significant increase in social activities (p< 0.01) and travel activities abroad (p< 0.01) at T2 in the intervention group, but no difference was found in well-being (WHO-5 index) between the two groups Conclusions: The study highlights the value of the ECM virtual care model in COPD management, offering a potential solution to healthcare workforce shortages and resource constraints as it leads to both a significantly reduced use of healthcare services and at the same time introduces a new kind of workforce to complement the existing workforce. Further research using this model in other chronic conditions and other healthcare systems is warranted based on these findings. Clinical Trial: No trial registration has been performed. The protocol is available from: https://epital.com/temokap-protokol-2/
Background: Health anxiety (HA) by proxy is characterized by ruminations about severe illness in one's child. Although HA by proxy can cause severe distress in affected parents, no targeted treatment...
Background: Health anxiety (HA) by proxy is characterized by ruminations about severe illness in one's child. Although HA by proxy can cause severe distress in affected parents, no targeted treatment has previously been evaluated. Objective: The aim of this study was to investigate the feasibility and effect of the internet-delivered treatment PROXY for parents with HA by proxy. Methods: Four participants with HA by proxy entered a replicated randomized single-case experimental design. They were randomly allocated to a baseline period of 7-26 days before entering the eight-week treatment. The primary outcome was daily measures of anxiety, impact of anxiety and value-based actions analyzed using visual analysis, and supplemented with statistical analyses. Secondary outcomes were measures of anxiety-related symptoms, experience of the treatment and negative events. Results: Visual analysis indicated that PROXY could be an effective treatment for two participants. All par-ticipants were happy about the treatment but two participants experienced that HA for their own health deteriorated during treatment, and two participants thought the treatment was too short. Conclusions: could hold potential as a treatment for HA by proxy. However, more work is required in relation to when and how PROXY should be introduced to parents with HA by proxy. Clinical Trial: ClinicalTrials.gov NCT04830605
Background: The rise of e-health systems, including electronic health records (EHRs), telemedicine platforms, and mobile health applications, has revolutionized healthcare delivery by improving access...
Background: The rise of e-health systems, including electronic health records (EHRs), telemedicine platforms, and mobile health applications, has revolutionized healthcare delivery by improving access, efficiency, and quality of care. However, the increasing reliance on digital platforms has raised significant concerns regarding the privacy and security of personal health information. Objective: This study aims to provide a thorough examination of the privacy issues associated with e-health systems. It seeks to identify and analyze key privacy risks, evaluate current privacy protection measures, discuss their limitations, and suggest potential areas for future research. Methods: We conducted a comprehensive review of the literature on privacy issues in e-health systems. The review included an analysis of current data protection methods, privacy regulations, informed consent practices, and emerging technologies such as blockchain and privacy-preserving algorithms. We also evaluated recent studies on privacy breaches and their impacts on individuals and healthcare systems. Results: Our review identified several critical privacy concerns, including unauthorized data access, data breaches, and inadequate encryption. Current solutions, such as encryption and access controls, have limitations, including insufficient protection and challenges in balancing data utility with privacy. We also observed gaps in compliance with privacy regulations and the need for more robust privacy-preserving technologies. Conclusions: Ensuring the privacy of personal health information in e-health systems is crucial for maintaining public trust and enabling the effective use of digital health technologies. While current measures offer some protection, there is a need for improved privacy solutions and stronger compliance with regulations. Future research should focus on developing advanced privacy-preserving technologies, exploring federated learning models, and addressing ethical concerns related to AI in healthcare. Collaborative efforts among stakeholders are essential for advancing privacy protections and optimizing the benefits of e-health systems.
Background: Patient-Generated Health Data (PGHD) has been recognized as a potential tool in transforming healthcare from clinician-centered to more patient-centered approaches. This transformation is...
Background: Patient-Generated Health Data (PGHD) has been recognized as a potential tool in transforming healthcare from clinician-centered to more patient-centered approaches. This transformation is driven by the potential of PGHD to provide deeper insights into patients' conditions, facilitate personalized care, improve patient quality of life, reduce inefficiencies in data collection, and empower patients. Yet, actual implementation within clinical settings is still at early stages, and therefore impacts on clinical care remain limited. Objective: This study sought to explore the benefits, challenges, and opportunities of integrating PGHD into orthopaedic care by analyzing the reflections of early adopter surgeons and physiotherapists, who have used a digital care management platform. Methods: This qualitative study employed thematic analysis of interviews conducted with surgeons and physiotherapists (n=9) from an early adopter unit using "mymobility" an industry produced software platform. The participants were recruited using snowball sampling, and interviews were conducted from June to July 2022. The interviews focused on current work practices, use of digital tools, experiences with PGHD, and experiences with the mymobility software. Thematic analysis was conducted using NVivo software, focusing on identifying key themes and insights Results: The study identified several benefits of integrating PGHD into orthopaedic care, including improved patient education, enhanced communication and assessment, and increased patient motivation and adherence. However, several challenges were also noted, such as increased clinician workload, questionable data utility, lack of patient centricity, and inability to tailor software to clinical contexts. Suggested opportunities included improving dashboard design, personalizing physiotherapy, and using collected data for improving clinical care. Conclusions: The integration of PGHD into orthopaedic care shows promise, largely in areas suggested by literature. However, significant challenges remain. Future research should focus on addressing solvable challenges such as improving software user interface design and functionality, while embracing the possibility that some challenges lack clear solutions and will likely require careful balancing of design tensions. The findings highlight the need for ongoing development and refinement of PGHD-inclusive systems to better support clinical practice and patient outcomes.
Background: Individuals of childbearing age enter pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monit...
Background: Individuals of childbearing age enter pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk pregnant/birthing people is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, EMBASE, and Cochrane Library were searched to identify relevant studies. Inclusion criteria were: (a) tested a medical or clinical informatics intervention; (b) enrolled pregnant/birthing people; and (c) addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, CDC-defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: 80 studies were identified that met inclusion criteria. Of these, 73% tested technologies for either GDM or perinatal mental health conditions, and 15% tested technologies for preeclampsia. For technology, 32% of the technologies tested were smartphone or tablet application, 26% were telehealth interventions, and 15% were remote monitoring technologies. Most (79%) studies assessed patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile applications. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may therefore be opportunities to use informatics for lesser-targeted conditions and populations.
Background: Disease-modifying therapies ameliorate disease severity of sickle cell disease (SCD), but hematopoietic cell transplantation (HCT) and more recently autologous gene therapy are the only tr...
Background: Disease-modifying therapies ameliorate disease severity of sickle cell disease (SCD), but hematopoietic cell transplantation (HCT) and more recently autologous gene therapy are the only treatments that have curative potential for sickle cell disease (SCD). While registry-based studies provide population-level estimates they do not address the uncertainty regarding individual outcomes of HCT. Computational machine learning (ML) has the potential to identify generalizable predictive patterns and quantify uncertainty in estimates thereby improving clinical decision-making. There is no existing ML Model for SCD and ML models for HCT for other diseases focus on single outcomes rather than all relevant outcomes. Objective: Address the existing knowledge gap by developing, and validating an individualized ML-prediction model, sickle cell predicting outcomes of hematopoietic cell transplantation (SPRIGHT), incorporating multiple relevant pre-HCT features to make predictions of key post-HCT clinical outcomes. Methods: We applied a supervised random forest ML model to clinical parameters in a de-identified CIBMTR dataset of 1641 patients who underwent HCT 1991-2021 and followed for a median of 47.8 months (0.3-312.9). We applied forward and reverse feature selection methods to optimize a set of predictive variables. To counter the imbalance bias towards predicting positive outcomes due to the small number of negative outcomes we constructed a training dataset taking each outcome variable of interest, and performed a two-times repeated 10-fold Cross-Validation. SPRIGHT a web-based individualized prediction tool accessible by smartphone, tablet, or personal computer. It incorporates predictive variables of age, age group, Karnofsky/Lansky score, co-morbidity index, recipient CMV seropositivity, history of ACS, need for exchange transfusion, occurrence and frequency of vasocclusive crisis (VOC) before HCT, and either a published or custom chemotherapy/radiation conditioning, serotherapy, and GVHD prophylaxis. SPRIGHT makes individualized predictions of overall survival (OS), Event Free Survival (EFS), Graft Failure (GF), acute graft versus host disease (AGVHD), chronic graft versus host disease (CGVHD), occurrence of VOC or stroke post-HCT. Results: A web-based ML- prediction tool predicts key outcomes of HCT for SCD based on multiple clinically relevant predictors and has potential use in shared decision-making. Conclusions: A web-based ML- -prediction tool predicts key outcomes of HCT for SCD based on multiple clinically relevant predictors and has potential use in shared decision-making. Clinical Trial: Not Applicable. This is not a clinical trial
Background: Medication non-adherence is a serious problem in cancer with potential impact on patients’ health outcomes and healthcare costs. Technology-based medication adherence (MA) interventions...
Background: Medication non-adherence is a serious problem in cancer with potential impact on patients’ health outcomes and healthcare costs. Technology-based medication adherence (MA) interventions are increasingly introduced, yet their evidence of quality and effectiveness is poor. Objective: This study aimed to test the acceptability, feasibility, and potential effects of SAMSON, a digital solution designed to support MA and self-management in cancer. Methods: This was a two-arm, unblinded, 12-week, pragmatic pilot randomized controlled trial (RCT). Adults who started oral cancer medicines for haematological malignancies within the last 12 months were recruited from a metropolitan specialised hospital. Participants were randomized 1:1 to either the SAMSON solution or the control arm to receive usual care. The SAMSON solution included a smartphone app which allows prompting individually tailored phone alerts and real-time self-care advice, a web-based dashboard for healthcare professionals (HCPs) to monitor patients’ adherence and symptoms, alongside motivational interviewing (MI) teleconsultations delivered by oncology nurses and pharmacists scheduled after recruitment and at weeks 1, 4, 8 and 12, to support patient adherence and side-effect self-management. Primary outcomes were the patients’ acceptance of SAMSON, measured by the Unified Theory of Acceptance and Use of Technology at 12 weeks, and study feasibility, measured by predefined rates of recruitment, randomization, retention, intervention adherence and outcome assessment completion. Secondary outcomes were comparison of MA and clinical self-assessments through online questionnaires, including adherence, toxicity self-management, anxiety-depression-and symptoms, and quality of life, measured at baseline and 12 weeks between the two arms. Data retrieved from the SAMSON app on the tasks completed by patients were used for analysis. Results: Thirty-three patients (78.6% of those who were approached) consented to participate in the trial. Of those, 31 (93.7%) completed baseline surveys and were randomised to SAMSON (n=15) and control arms (n=16). Twenty-eight patients (90.3%) completed week-12 surveys (12 SAMSON and 16 control). Overall, patients rated SAMSON solution as highly acceptable (13/15; 86.7% app usage and 14/15; 93.3% MI teleconsultation delivery). They reported that SAMSON was easy-to-use (10/12; 83.3%) and helpful in improving their MA (6/12; 50%). All study HCPs reported the SAMSON solution was helpful in supporting patients’ MA. Patients completed an average of 99 tasks over the 12-week study period (70.7% of scheduled tasks). Most patients (10/12; 83.3%) completed all five scheduled consultations. All study feasibility measures were higher than the predefined upper thresholds, except the rate of patients’ responses to medication reminders. Conclusions: The results demonstrated that the SAMSON solution is acceptable, usable, and useful for oncology HCPs and patients with cancer. The SAMSON solution is feasible in real-life oncology settings. Our next steps involve refining SAMSON solution based on participants’ feedback, conducting a large-scale RCT to evaluate its clinical and economic effectiveness, and exploring potential commercialisation. Clinical Trial: ACTRN12623000472673
Background: In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, especially in small residential and long-term care centres (CHSLDs) located in se...
Background: In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, especially in small residential and long-term care centres (CHSLDs) located in semi-remote or remote areas. This situation, which is exacerbated by the current overall shortage, exacerbates nurse staffing problems in these facilities. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers (DNSSI) of Quebec’s Ministère de la Santé et des Services sociaux (MSSS) has rolled out a teleconsultation pilot project. Objective: This study aimed to explore nurses’ and nursing assistants’ lived experience of the integration of teleconsultation during night shifts in rural CHSLDs with fewer than 50 residents. Methods: The six-month pilot project was rolled out sequentially in three rural CHSLDs located in two administrative regions of Quebec, between July 2022 and March 2023. A total of 16 semi-structured interviews were conducted with eight nurses and nursing assistants between February and July 2023. Results: Participants’ testimonials revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. Leadership played a significant role in clarifying professionals’ roles and in supporting effective adaptation to teleconsultation. Conclusions: This pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts, it also optimizes professional practices while ensuring the safety and quality of care provided to residents.
Background: Smartphone applications (apps) can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults...
Background: Smartphone applications (apps) can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective: To describe a new electronic cohort (eCohort) of older adults embedded in the Framingham Heart Study (FHS) including baseline smartphone survey return rates and survey completion rates by smartphone type (iPhone and Android users). To report survey results for selected baseline surveys and participant experience with the study app. Methods: FHS Offspring and Omni (multi-ethnic cohort) participants who owned a smartphone were invited to download the study app that contained a range of survey types to report on different aspects of health including self-reported measures from the Patient-Reported Outcomes Measurement Information System (PROMIS). iPhone users also completed four cognitive and physical function testing tasks. Baseline survey return and completion rates were calculated for 12 surveys and compared between iPhone and Android users. We calculated standardized scores for the PROMIS surveys. The Mobile App Rating Survey (MARS) was deployed 30 days after enrollment to obtain participant feedback on app functionality and aesthetics. Results: We enrolled 611 smartphone users (average age 73.6±6.3 years, 56.6% women, 14.4% Omni participants, 77% iPhone users) and 596 (97.5%) returned at least one baseline survey. iPhone users had higher app survey return rates than Android users for each survey (range 85.5 to 98.3% vs 73.8 to 95.2% respectively), but survey completion rates did not differ in the two smartphone groups. The return rate for the four iPhone tasks ranged from 80.9% for the Gait task to 88.9% for the Trail Making Test task. The eFHS participants had better standardized T-scores in six of seven PROMIS surveys compared to the general population mean (T-score =50) including higher cognitive function (55.6) and lower fatigue (45.5). Among 469 participants who returned the MARS survey, app functionality and aesthetics was rated high (total MARS score = 8.6 on a 1-10 scale). Conclusions: We effectively engaged community-dwelling older adults to use a smartphone app designed to collect health information relevant to older adults. High app survey return rates and very high app survey completion rates were observed along with high participant rating of the study app.
Background: People living with dementia are at risk of getting lost and going missing due to memory loss, confusion, and disorientation. Missing incidents involving people living with dementia are inc...
Background: People living with dementia are at risk of getting lost and going missing due to memory loss, confusion, and disorientation. Missing incidents involving people living with dementia are increasing. Alert systems such as Community ASAP can promote community engagement in locating missing persons with dementia and aid search and rescue efforts. However, implications of public disclosure of personal information such as name, age, sex, and physical descriptions within such alert systems have yet to be explored. Objective: This study aimed to identify and discuss the implications of public disclosure of personal information in Community ASAP for people living with dementia at risk of going missing. Methods: This study used a qualitative descriptive research design drawing from naturalistic inquiry. Nineteen participants including people living with dementia, care partners, and service providers were recruited from Ontario, Alberta, and British Columbia, Canada. Semi-structured interviews were used to explore participants’ perspectives on the perceived implications of the release of personal information when using Community ASAP. NVivo 12 was used to manage data and conventional content analysis conducted to identify key themes of the implications of public disclosure of personal information in Community ASAP. Results: Participants were 10 females and 9 males. Three were people living with dementia, five were care partners, four were first responders, and seven were service providers. Four key themes were identified as implications of public disclosure of personal information in Community ASAP: Right to autonomy, safety versus privacy, informed and knowledgeable consent, and stigmatization. Participants discussed how the public disclosure of personal information in Community ASAP could undermine a person’s choice not to be found and contribute to stigmatization. Participants emphasized a need to balance safety and privacy concerns. Informed and knowledgeable consent is important when using an alert system to locate missing persons with dementia. Conclusions: Community ASAP can promote community engagement in locating missing persons with dementia. However, the public disclosure of personal information in alert systems has implications. Users’ right to autonomy, a balance between safety and privacy, informed and knowledgeable consent, and risks for stigmatization are perceived impacts of disclosure of personal information in alert systems.
Background: Remote monitoring programs have an increasingly larger role in hypertension management. Primary care physicians’ (PCP) referral rates to digital health programs are highly variable. Unde...
Background: Remote monitoring programs have an increasingly larger role in hypertension management. Primary care physicians’ (PCP) referral rates to digital health programs are highly variable. Understanding the factors behind a physicians' likelihood to refer is important in understanding how to increase future adoption of programs through referrals. Prior studies have shown that likelihood to refer is dependent on prior knowledge about clinics and their characteristics, providers' own clinical expertise on the area, communication and relationship with their PCP and patient, and the clinic referral process. Objective: The study explores whether knowledge of our remote blood pressure monitoring program program and information on referral patterns influence a PCPs’ intention to refer patients. Methods: This is a mixed methods study integrating quantitative analysis of EHR data regarding frequency of PCPs’ referrals of patients with hypertension to a digital health program and quantitative and qualitative analyses of survey data about PCPs’ knowledge of the program (on a scale of 0-10, with 10 being extremely knowledgeable) and their intention to refer patients. PCPs responded to a clinical vignette featuring an eligible patient which approximated their baseline tendencies to refer. They were then randomized to either receive their own referral data or their own plus their peers’ referral data from the EHR. They were assessed their intent to refer eligible future patients. Descriptive and multivariable linear regression analyses examined the characteristics of participants and the factors associated with their intent to refer patients. Narrative reasons for their intention to refer were thematically analyzed. Results: Of the 242 eligible PCPs invited to participate, 31% (N=70) responded to the survey. From EHR data, the mean (SD) referral rate of patients per PCP was 11.80% (13.30%). The self-reported knowledge of the digital health program was 6.47 (1.81). The mean likelihood to refer for an eligible patient in a vignette was 8.54 (2.12). The mean likelihood to refer in the group that received their own prior referral data was 8.91 (1.28), while in the group that received their own and peer prior referral data was 8.35 (2.19). Regression analyses suggested the intention to refer vignette patient was significantly associated with their knowledge (coefficient 0.46, 95%CI 0.20 to 0.73, P<.001) whereas the intention to refer future patients was significantly associated with their intent to refer the patient in the vignette (coefficient 0.62, 95% CI: 0.46 to 0.78, P<0.001). No evidence of association was found on receiving own plus peer referral data compared with own referral data and intent to refer future patients (coefficient 0.23, 95% CI: -0.43 to 0.89, P=.48). Respondents called for more communication regarding the program’s superior clinical outcomes, its support of patients in their own care, and the simplicity of the technology to improve PCPs’ awareness and uptake of the program. Conclusions: Physicians’ intention to refer patients to a novel digital health program can be extrapolated by examining their intention to refer an eligible patient portrayed in a vignette, and this was found to be significantly influenced by their knowledge of the program. Future efforts should engage PCPs to better inform them so that more patients can benefit from the digital health program.
Background: Mobile Health (mHealth), which refers to health care facilitated by mobile devices, offers a promising strategy for enhancing disease management and treatment for patients with chronic con...
Background: Mobile Health (mHealth), which refers to health care facilitated by mobile devices, offers a promising strategy for enhancing disease management and treatment for patients with chronic conditions. However, there is limited information on how patients with inflammatory bowel disease (IBD) utilize mHealth and their digital preferences. Objective: The aim of the study was to investigate the utilization of mHealth, as well as the preferences, obstacles, and eHealth literacy as reported by patients with IBD in Germany. Methods: From April to May 2023, we sequentially enrolled patients diagnosed with inflammatory bowel disease, such as Crohn´s disease and ulcerative colitis, to participate in a paper-based survey. The survey encompassed inquiries covering sociodemographic details, health characteristics, mHealth utilization, internet usage, eHealth literacy measured through the eHealth Literacy Scale (eHEALS), and preferences related to communication and information. Results: Out of the 200 surveyed participants, almost all individuals (197/200, 98.5%) reported regular smartphone usage, and more than half indicated regular engagement with social media (139/200, 69.5%). Most respondents (168/200, 84.0%) expressed the belief that incorporating medical apps into their routine could positively impact their health. However, only 25 out of 200 patients (12.5%) acknowledged using medical apps, amongst which only two apps were IBD-specific, used by 3 out of 25 participants (12.0%). Furthermore, awareness of useful websites or mobile applications specifically tailored for IBD was limited (45/200, 22.5%). An overwhelming majority of participants (196/200, 98.0%) affirmed their willingness to share data from mobile apps for research purposes. Consent to the transmission of app data to treating physicians was also high (171/200, 85.5%). Most patients (175/200, 87.5%) conveyed a readiness to regularly input data through an application with a preferred duration of up to 5 minutes (109/200, 54.5%) and a frequency of weekly input (76/200, 38.0%). Regarding functions for an IBD-specific app, participants’ most frequent requests were related to electronic prescription (55.0%) and a newsletter about new scientific work and clinical studies (47.0%). Favored key attributes of an app were usability and security. When seeking health-related information, the internet emerged as the predominant source (180/200, 90%). The average eHealth literacy was reported to be high (28.9/40), with a positive correlation observed between higher eHealth literacy and factors such as younger age and more frequent internet usage to receive health information. Conclusions: Patients with IBD are well-qualified and motivated to use mHealth technologies to better understand their chronic condition and optimize their treatment. However, their enthusiasm is curbed by the low actual adoption of mHealth. To fully harness the potential of mHealth in IBD treatment, effective and tailored mHealth solutions, implementation recommendations, and patient education are needed.
Background: Reducing greenhouse gas emissions is a priority that must be addressed to prevent the negative impacts of climate change. Inhalational anesthetic agents are a major source of potent greenh...
Background: Reducing greenhouse gas emissions is a priority that must be addressed to prevent the negative impacts of climate change. Inhalational anesthetic agents are a major source of potent greenhouse gases, and reducing their emissions is a goal that can be readily addressed. Nitrous oxide (N2O) has a prolonged environmental half-life combined with a low clinical potency, leading to relatively large amounts of N2O being stored in cryogenic tanks and H cylinders for use, thus increasing the chance of pollution through leaks. Building on the results of previous studies, Stanford Health Care (SHC) N2O emissions were analyzed at two campuses and targeted for waste reduction as a precursor to system wide reductions. Objective: To determine the extent of N2O pollution at SHC. Subsequently, to determine if using E-cylinders for storage and delivery of N2O at the point of care in its ambulatory surgery centers could reduce emissions within SHC’s system. Methods: Phase 1: Total Palo Alto, CA SHC N2O purchase data for CY2022 was collected and compared (volume and cost) to total Palo Alto clinical delivery data using Epic electronic health record.
Phase 2: A pilot study was conducted in the 8 operating rooms of SHC campus A (Redwood City). The central N2O pipelines were disconnected, and E-cylinders were used in each operating room. E-cylinders were weighed before and after use on a weekly basis for comparison to Epic N2O delivery data over a 5-week period.
Phase 3: After successful implementation, the same methodology was applied to Campus B, one of three facilities in Palo Alto. Results: Phase 1: Total N2O purchased in 2022 was 8,217,449 liters (33,201.8 lbs.), at a total cost of $63,298. Of this, only 780,882.2 liters (9.5%) of N2O was delivered to patients, with 7,436,566.8 liters (90.5%) or $57,285 worth lost or wasted.
Phase 2: Total weight of N2O use from E-cylinders was 7.4 lbs (1lb N2O = 247.5L) or 1,831.5 liters at campus A. Epic data showed total N2O volume delivered was 1,839.3 liters (7.4 lbs).
Phase 3: Total weight of N2O use from E-cylinders was 10.4 lbs or 2,574 Liters at campus B (confirming reliability within error propagation margins). Epic data showed total N2O volume delivered was 2840.3 liters (11.5 lbs).
Over Phase 2 and 3, total use for campuses A and B was less than the volume of 3 E-cylinders (1 E-cylinder = 1590 liters). Conclusions: Converting N2O delivery from centralized storage to point-of-care E-cylinders dramatically reduced waste and expense with no detriment to patient care. The results of this study provide strong evidence for analyzing N2O storage in healthcare systems that rely on centralized storage as well as consideration of E-cylinder implementation to reduce emissions. The reduction in N2O waste will help meet SHC’s goal of Scope 1 and 2 emissions reduction by 50% before 2030.
Background: Virtual reality (VR) is increasingly utilized in healthcare training and assessment, offering immersive experiences through head-mounted displays. Compared to traditional Objective Structu...
Background: Virtual reality (VR) is increasingly utilized in healthcare training and assessment, offering immersive experiences through head-mounted displays. Compared to traditional Objective Structured Clinical Examinations (OSCEs), which are costly and may be burdensome, VR could provide an attractive alternative by recreating scenarios and presenting pathological findings through virtual patients (VPs). VR also enables scalability, standardization, and potential automation of checklist completion, alleviating the cognitive load on examiners. Objective: The study aims to explore the use of a VR OSCE station and compare it to a traditional on-campus OSCE station in undergraduate medical education. It investigates how students perceive workload, fairness, and realism, and compares student performance between the two types of stations. Additionally, the study examines the item and scale analysis of checklist items, the VR-related side effects experienced by students, and their evaluation of the VR station's usability and acceptance. Finally, it identifies the technical challenges involved in conducting and evaluating a VR OSCE station. Methods: This quasi-experimental comparison study is conducted at the University of Bern, comparing a traditional OSCE case with a corresponding VR OSCE case. To assess workload, fairness, realism, VR-related side effects, technology acceptance, and usability, we use validated questionnaires. The official exam checklist is used to compare student performance in both the VR and traditional cases. Additionally, technical challenges encountered during the VR OSCE are documented. Results: Study recruitment and data collection on the traditional OSCE began in April 2024. The VR OSCE will be conducted in the summer of 2024. Conclusions: This study will compare a traditional OSCE with a VR OSCE to assess feasibility, workload, performance, realism, and fairness, ultimately providing insights for the potential integration of VR OSCE into high stakes assessments.
Background: Involving people with lived experience (PLE) in medical education, which may occur with varying levels of patient and caregiver involvement, can be beneficial for patients, their caregiver...
Background: Involving people with lived experience (PLE) in medical education, which may occur with varying levels of patient and caregiver involvement, can be beneficial for patients, their caregivers, and medical students. Benefits have been demonstrated across both patient populations and learner level of training. Including PLE may be particularly impactful in medical education related to children who require comprehensive, individualized, and multidisciplinary care, such as children with medical complexity or developmental disabilities. Despite this, there is no summary of how children with medical complexities or developmental disabilities or their families/caregivers have been included in medical education for medical students, residents, and fellows. In order to advance the effective inclusion of lived experience in medical education related to this patient population, a synthesis of existing literature is needed. Objective: The purpose of this scoping review is to identify and synthesize the literature related to including the lived experiences of children with medical complexity or developmental disabilities, their families, and their caregivers in medical education and the level of engagement of people with lived experience in the process. Methods: To complete the proposed scoping review, MEDLINE, Scopus, PsycINFO, ERIC, Academic Search Premier, and Google Scholar will be searched for studies investigating patient and caregiver involvement in medical education related to children with medical complexity or developmental disabilities. Data will be extracted from studies that meet the inclusion criteria. Studies involving continuing professional development or patients that are not children with medical complexity or developmental disabilities will be excluded. Data will be extracted to identify the stage of curriculum development in which lived experience is included based on Kern’s 6-step approach. Data will also be extracted to examine the level of engagement in medical education of children with medical complexity or developmental disabilities, their families, or their caregivers. Results: Descriptive analysis will be performed to identify the findings from the included sources pertaining to the research objective. Findings will be presented in tables, diagrams, or matrices to demonstrate how lived experience has been incorporated into the six steps of curriculum development and characterize the level of engagement of people with lived experience in this process. Conclusions: Results from this scoping review may identify areas of improvement for medical education, especially pertaining to the care of children with medical complexity and developmental disabilities. The findings could contribute to the development of medical school curricula that lead to improved patient outcomes.
Background: Major Depressive Disorder (MDD) is a psychiatric condition that globally ranks as the 24th leading cause of Disability-adjusted Life Years. Pakistan, a developing nation, grapples with pov...
Background: Major Depressive Disorder (MDD) is a psychiatric condition that globally ranks as the 24th leading cause of Disability-adjusted Life Years. Pakistan, a developing nation, grapples with poverty, resource inequality, population growth, and political instability, which may probable cause MDD among general population. Resultantly high prevalence of MDD in Pakistan in evident from the existing literature. Currently, evidence-based psychotherapies such as Eye Movement Desensitization and Reprocessing(EMDR) are widely available. However, EMDR originated in the United States, it might not be consistent with requirements of non-western countries, so it may require cross-cultural and methodological adaptations. Moreover, therapists have long practiced face-to-face EMDR, but recently, online EMDR modalities have emerged. Nonetheless, it is surprising that there is a dearth of research on both the adaptations of EMDR in Pakistan and its clinical efficacy, particularly its online modes have never been scientifically validated in Pakistan. Objective: Considering lack of research on adaptations and clinical efficacy EMDR in Pakistan, the present study aims to develop a culturally and methodologically adapted EMDR therapy protocol for MDD in Pakistan, determine its treatment fidelity, and then clinically test its efficacy by administering it through the face-to-face and online modalities of EMDR therapy. Methods: This study adopted a mixed-mode exploratory sequential Randomized Controlled Trial design in two phases. In the first phase, qualitative exploratory data will be collected, followed by quantitative data, to accomplish the adaptation process of the EMDR therapy protocol. In the second phase, a consecutive sample of 80 patients will be randomly allocated in a 1:1 ratio to face-to-face and online groups to determine the clinical efficacy of the adapted EMDR therapy protocol in both modalities. Symptoms related data will be collected through clinician administered scales during start, mid, end and follow-up stages of therapy. Data will be analyzed using a variety of qualitative and quantitative statistical techniques. Results: This study has been approved by the Ethics Review Committees of Khushal Khan Khattak University Karak, Pakistan, and University Malaysia Sarawak, Malaysia. It is registered at ClinicalTrials.gov. The process of adapting the DeprEnd-EMDR Depression Protocol has already begun. Recruitment of patients for psychotherapy sessions will start in September 2024. Conclusions: In conclusion, this study addresses significant research gaps concerning the adaptation and clinical efficacy of EMDR therapy in the Asian region, with a particular focus on its online modalities. By employing a rigorous research methodology, the results are likely to make substantial contributions by providing insights into both the adaptation and clinical efficacy of EMDR therapy. This study will extend our understanding of the comparative effectiveness of EMDR therapy in the Asian region, offering valuable information on its applicability and impact in diverse, particularly non-Western, settings. Clinical Trial: ClinicalTrials.gov ID NCT06439043
Background: Alzheimer’s disease (AD) is the most common of dementia, and has associated cognitive and motor disorders, with consequences on daily activities, including handwriting.
Handwriting has...
Background: Alzheimer’s disease (AD) is the most common of dementia, and has associated cognitive and motor disorders, with consequences on daily activities, including handwriting.
Handwriting has been used to study fine motor control or executive functioning in healthy and unhealthy populations. Changes in this skill are present at different stages of the clinical course of Alzheimer’s Disease. Sensorimotor deterioration is observed in handwriting tasks (motion kinematics, such as movement time, speed, and profiles) and brain activity rhythms. Objective: We aim to study the suitability of a handwriting assessment protocol to differentiate handwriting characteristics and the associated brain activity in older people with AD and cognitively healthy. Methods: Subjects from three organizations (one hospital and two Residential Centers for the Elderly) were recruited. Participants were either cognitively healthy or had clinical diagnoses of minor cognitive impairment or dementia, suggestive of AD. When a direct assessment by a neurologist was not feasible, as in the two nursing homes, participants undertook a comprehensive neuropsychological evaluation that supported the existing diagnoses by clinicians in charge. All participants performed a handwriting assessment with the following instruments: Beery Buktenica Visual-Motor Integration Development Test – 6 and Adult Writing Assessment Battery (HAB). The handwriting tasks were carried out on a Wacom digitizing platform, and the data extraction was done through the MovAlyzeR software. Participants wore an EPOC X helmet during handwriting tasks to assess brain activity. Results: The study received funding in May 2023. Data collection was initiated in January 2024. As of April 2024, 21 participants had been enrolled (female: n=17; male, n=3; cognitively healthy: n=9, dementia: n=11). Data collection finished on July 2024. Data analysis and dissemination of findings will be submitted at the beginning of 2025. Conclusions: The findings from this research can contribute to a more in-depth knowledge of this subject and potentially support early identification and treatment. Clinical Trial: ClinicalTrials.gov Protocol Identifier:
NCT06483438
Background: Background Acute pancreatitis is a primarily sterile inflammation caused by premature intracellular protease activation, which has caught the attention of social media platforms such as Bi...
Background: Background Acute pancreatitis is a primarily sterile inflammation caused by premature intracellular protease activation, which has caught the attention of social media platforms such as Bilibili, TikTok, and YouTube. However, the content and quality of medical information on social media exists unclear and indeterminate. Objective: The purpose of the study is to evaluate the content and quality of online videos about acute pancreatitis from Bilibili, TikTok, and YouTube Methods: Methods A video search using acute pancreatic-related keywords was conducted on three video-sharing platforms: Bilibili, TikTok, and YouTube. We recorded basic information presented in the videos and identified the source and content type of each video. The educational content and quality of each video were evaluated using the Global Quality Scale (GQS), Journal of the American Medical Association (JAMA), and Modified DISCERN. A comparative analysis was conducted on the videos obtained from these three sources. Results: Results 300 videos were considered for assessment. Most videos were provided by health professionals (50.7%, 152/300), followed by nonprofit organizations (27.7%, 83/300). Additionally, 13.2% of videos (36/300) were offered by science communicators, and 5.7% (17/300) were provided by general users. The remaining videos were uploaded by news agencies (3.3%, 10/300) and two for-profit organizations (0.7%, 2/300). The content types of the 300 videos were classified into five categories: clinical diagnosis (25%, 75/300), prognosis (5%, 15/300), etiologies and causations (6.7%, 20/300), scientific introductions (51%, 153/300), and treatment methods (12.3%, 37/300). The overall quality of the videos, as evaluated by GQS, JAMA, and Modified DISCERN, was found to be moderate, with scores of 2.67/5, 2.22/4, and 2.63/5 points, respectively. Conclusions: Conclusions Video-sharing platforms have become easily accessible sources for patients seeking information about their diseases. This innovative study demonstrates that social media videos can facilitate public learning about clinical diagnosis, prognosis, treatment methods, etiologies and causations, and scientific introductions of acute pancreatitis. However, both the content and quality of uploaded videos are currently inadequate. In the future, greater efforts should be made to enhance the content and quality of videos on acute pancreatitis and increase public awareness.
Background: Kidney diseases encompass a variety of conditions, including chronic kidney disease, acute kidney injury, glomerulonephritis, and polycystic kidney disease. These diseases significantly im...
Background: Kidney diseases encompass a variety of conditions, including chronic kidney disease, acute kidney injury, glomerulonephritis, and polycystic kidney disease. These diseases significantly impact patients' quality of life and healthcare costs, often necessitating substantial lifestyle changes, especially regarding dietary management. However, patients frequently receive ambiguous or conflicting dietary advice from healthcare providers, leading them to seek information and support from online health communities. Objective: This study aims to analyze social media data to better understand the experiences, challenges, and concerns of kidney disease patients and their caregivers in South Korea. Specifically, it explores how online communities assist in disease management and examines the sentiment surrounding dietary management. Methods: Data were collected from "KidneyCafe," a prominent South Korean online community for kidney disease patients hosted on the Naver platform. A total of 124,211 posts from ten disease-specific boards were analyzed using latent Dirichlet allocation for topic modeling and Bidirectional Encoder Representations from Transformers (BERT)-based sentiment analysis. Additionally, efficiently learning an encoder that classifies token replacements accurately (ELECTRA)-based classification was used to analyze posts related to disease management further. Results: The analysis identified six main topics within the community: Family Health and Support, Medication and Side Effects, Examination and Diagnosis, Disease Management, Surgery for Dialysis, and Costs and Insurance. Sentiment analysis revealed that posts related to Medication and Side Effects topic and Surgery for Dialysis topic predominantly expressed negative sentiments. Both significant negative sentiments concerning worries about kidney transplantation among family members and positive sentiments regarding physical improvements post-transplantation were expressed in posts about family health and support. For Disease Management, seven key subtopics were identified, with inquiries about dietary management being the leading topic. Conclusions: The findings highlight the critical role of online communities in providing support and information for kidney disease patients and their caregivers. The insight gained from this study can inform healthcare providers, policymakers, and support organizations to better address the needs of kidney disease patients, particularly in areas related to dietary management and emotional support.
Background: In the modern economy, shift work is prevalent in numerous occupations. However, shift work often conflicts with the workers’ circadian rhythm and can result in shift work sleep disorder...
Background: In the modern economy, shift work is prevalent in numerous occupations. However, shift work often conflicts with the workers’ circadian rhythm and can result in shift work sleep disorder (SWSD). Proper management of SWSD emphasizes comprehensive and patient-specific strategies and some of these strategies are analogous to the cognitive behavioral treatment of insomnia (CBTI). Objective: In this paper, we aim to develop and evaluate machine learning algorithms that predict physicians’ sleep advice using wearable and survey data. We developed an online system to conveniently and frequently provide individualized sleep and behavior advice with CBTI elements for shift workers. Methods: Data were collected for a period of 5 weeks from shift workers in the ICU at two hospitals (N = 61) in Japan. The data were composed of three modalities, (1) Fitbit data, (2) survey data, and (3) sleep advice. We handcrafted physiological and behavioral features from the raw data and identified clusters of participants with similar characteristics using hierarchical clustering. After the first week of enrollment, physicians reviewed Fitbit and survey data to provide sleep advice from a list of 23 messages. We implemented random forest (RF) models to predict the 7 most frequent messages given by the physicians. We tested our predictions under participant dependent and independent settings and analyzed the most important features for prediction. Results: We found that the clusters were distinguished by work shifts and behavioral patterns. For some clusters, having a work shift on a given day contributed to low wellbeing scores on that day. Another cluster had days with low sleep duration and the lowest sleep quality when there was a day shift on the day before and a midnight shift on the current day. Our advice prediction models achieved higher F1 scores in 27 of 28 t-tests conducted, and the performance differences were statistically significant with P < .001 for 24 tests and P < .05 for 3 tests compared to the baseline. The analysis of the feature importance of our models showed that the most important features matched the message sent to participants. For instance, for message 7 (darken the bedroom when you go to bed), the models primarily examined the average brightness of the sleep environment to make predictions. Conclusions: Although our current system requires physician input, an accurate machine learning algorithm would be promising for automating without hurting the trustworthiness of selected recommendations. The algorithm is limited to the 7 most popular ones among 23 choices due to rare occurrences of the remaining options. Therefore, further studies are necessary to gather enough data to enable predictions for less frequent advice labels. Clinical Trial: UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284.
Background: Background: Cardiovascular disease (CVD) remains a critical global health concern, contributing significantly to global mortality rates, with approximately 70% of cases linked to modifiabl...
Background: Background: Cardiovascular disease (CVD) remains a critical global health concern, contributing significantly to global mortality rates, with approximately 70% of cases linked to modifiable risk factors. While traditional methods for CVD prevention face challenges, digital health technologies offer promising avenues for intervention. However, the extent to which these technologies comprehensively address the spectrum of CVD prevention strategies remains unclear. Currently, there is an absence of systematic evaluations within the existing literature regarding the effectiveness and scope of digital solutions in
CVD prevention. This emphasizes the need for examination and synthesis of available research to guide future developments and implementations. Objective: Objective: This review aims to make a thorough analysis of how digital technologies can effectively tackle the challenges posed by traditional approaches to CVD prevention. This review aims to consolidate existing literature on digital solutions for CVD prevention, delineate the key components of successful CVD prevention targeted by digital solutions, and outline the research gaps requiring attention to foster the development of sustainable and scalable digital solutions for CVD prevention. Methods: Methods: Our methodology involved identifying primary literature on CVD prevention using digital solutions, specifically technologies facilitating remote care beyond traditional telephone use. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework as a guideline, we searched comprehensively in Web of Science, Scopus, and PubMed to retrieve original studies published in English between January 2000 and May 2024. Results: Results: Our search identified 30 eligible studies, with 24 (80%) being randomized controlled trials (RCTs). The digital solutions reviewed for CVD prevention primarily focused on baseline assessment (97%,), physical activity counseling (60%), tobacco cessation (47%), blood pressure management (43%), and medication adherence (33%). Technologies such as smartphones and
wearables (53%), email and short message service (SMS) communications (40%), and websites or web portals (10%) were utilized in the studies. Approximately half of the studies addressed blood pressure, exercise capacity, and weight, whereas less than a third addressed medication use, quality of life, dietary habits, intervention adherence, waist circumference, and blood glucose
levels. Conclusions: Conclusions: Digital solution has the potential to alleviate challenges associated with traditional CVD prevention approaches by enhancing preventive behaviors and monitoring health indicators. However, evaluated interventions have predominantly focused on medication use, quality of life, dietary habits, intervention adherence, and waist. Thus, subsequent studies are crucial with more extensive interventions in CVD prevention for assessing their lasting effect on key cardiovascular outcomes. Clinical Trial: -
Brucellosis is a type of serious zoonosis disease caused by the infection of various Brucella species. The symptoms of Brucellosis generally include fever, fatigue, and night sweat, and there is a sig...
Brucellosis is a type of serious zoonosis disease caused by the infection of various Brucella species. The symptoms of Brucellosis generally include fever, fatigue, and night sweat, and there is a significant variance in symptoms among patients. It is believed that Brucellosis, if not diagnosed and treated in a timely manner, can develop into a chronic condition, but a quantitative guideline is lacking. In this research, we systematically study the Brucellosis data from northern area of China and develop data mining models to explore the association between patients features and various Brucellosis symptoms. We also identify the key variables affecting the development of chronic conditions. Our results show that people working in agriculture, farming, stock breeding and slaughtering related jobs are less likely to develop fever symptoms during infection. Additionally, females or younger patients are more likely to experience fevers with high body temperature. Our results also show that treatment delay has a significant impact on the development of chronic Brucellosis, but the impact is attenuated for diagnosis delay. In other words, non-specific medical treatment can mitigate chronic condition development in the absence of a Brucellosis diagnosis.
Artificial intelligence enabled ambient digital scribes may have many potential benefits, yet results from our study indicate that there are errors which must be evaluated to mitigate safety risks....
Artificial intelligence enabled ambient digital scribes may have many potential benefits, yet results from our study indicate that there are errors which must be evaluated to mitigate safety risks.
Analysis of 25 million Shanghai citizens’ daily movements supports the city-cut approach for travel restrictions in the early stage of the COVID-19 pandemic. The city’s high connectivity and compa...
Analysis of 25 million Shanghai citizens’ daily movements supports the city-cut approach for travel restrictions in the early stage of the COVID-19 pandemic. The city’s high connectivity and compact nature justify the city-cut approach over the geographic distance-based radius-cut approach, effectively containing the spread of COVID-19 within the metropolis.
Background: Breast cancer is one of the most frequent causes of mortality among women’s population. Early diagnosis is critical for successful treatment, but underscreening is frequent. Novel screen...
Background: Breast cancer is one of the most frequent causes of mortality among women’s population. Early diagnosis is critical for successful treatment, but underscreening is frequent. Novel screening methods that are more convenient, such as thermography, are being developed. They could help a wider group of screeners and they could contribute to better compliance with screening and thus to a decline in breast cancer mortality. Objective: The study aims to explore the screeners’ preferences for the screening process, specifically for a novel screening that utilizes artificial intelligence (AI) and thermal imaging. Furthermore, we explore a better understanding of the barriers and facilitators associated with participation in breast cancer screening by currently used mammography. Methods: One online focus group with experts and five focus groups with potential screeners on thermography were carried out. Potential screeners were recruited through an online survey (n=228) focused on addressing barriers and motivations related to screening. Survey data were analyzed using SPSS software. Findings from the focus groups were examined by two researchers utilizing open, axial, and selective coding in MAXQDA software. Results: The information obtained in the focus groups showed that small changes during the procedure (tailored adjustments, such as film or music during the procedure, dimmed light) were appreciated, especially by women without any mammography screening experience. Furthermore, the non-invasiveness of the procedure was seen positively by all participants. Among other important factors that influence the perception of the procedure and can therefore affect the decision whether to go or not, was the way they were treated by medical staff and waiting hours. For certain women, how the interaction goes between them, and the clinicians is more important than the technology itself. Results from the online survey complemented these insights on motivation and barriers. Personal belief in breast cancer prevention was the most indicated motivator for women with mammography experience (44%, n=154), followed by an invitation from a screening program (29%, n=154). Barriers indicated by women without experience were mainly: no recommendation from a doctor (53%, n=74), no warning signals (36%, n=74) or no problem related to breasts (28%, n=74) followed by being too young for mammography (23%, n=74). Conclusions: Even though the thermography was perceived mainly positively, rather than the technique itself, women prioritized how they were treated by medical staff. This includes detailed information in understandable language, empathetic communication and adjustments that fit personal preferences. As we also saw in the results from the survey, doctors play the leading role in the decision to go to the screening, so their change in the approach can encourage greater participation in breast cancer screening initiatives.
Background: Educational technology (EdTech) has been instrumental in the last few decades in promoting inclusive education by overcoming various learning barriers and offering tools and opportunities...
Background: Educational technology (EdTech) has been instrumental in the last few decades in promoting inclusive education by overcoming various learning barriers and offering tools and opportunities to all students, including those with special educational needs and disabilities (SEND). However, there is limited understanding of current classroom practices and policies and of the effects of the COVID-19 pandemic on EdTech use in the inclusive classroom. Objective: This systematic review aims to outline the current knowledge on the use of EdTech to support the learning of students with SEND in inclusive primary schools in high-income countries. Methods: We followed the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) and the Generalized Systematic Review Registration Form in reporting the details of this protocol. The inclusion criteria for the systematic review require that studies focus on students with SEND who are attending the primary stage of school in high-income countries. The studies can be qualitative or quantitative and should explore the design and use of EdTech with these students. Eligible studies must be published between 2016 and 2024, be peer-reviewed with the exception of relevant reports from Non-Governmental Organizations, and be available in English. We systematically searched the ACM, Directory of Open Access Journals, British Educational Index, ERIC, Google Scholar (first 100 records), IEEE, PsycINFO, Scopus, and Web of Science databases. The titles and abstracts of all records will be screened for relevance according to the inclusion criteria. Following this, the full text of the articles will be screened. To ensure the reliability of the screening process, an independent reviewer will screen a percentage of the records for the first screening round. The data extraction process for this systematic review will start with a pilot stage to validate and eventually update the list of entities to be extracted. Following the pilot stage, the final data extraction will be undertaken. An independent reviewer will extract data from a subsample of the records to ensure the reliability of the data extraction process. Results: The database search was conducted in July 2024. The database search identified a total of 549 records. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of September 2024. Conclusions: This study will provide up-to-date evidence of the use of EdTech in inclusive primary school settings in high-income countries and will describe the impact of the COVID-19 pandemic on the use of Ed-Tech with students with SEND. Clinical Trial: https://doi.org/10.17605/OSF.IO/YS7AZ
Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress, shortly after birth, and is generally a benign, self-limited condition. Meanwhile, a lot of studies h...
Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress, shortly after birth, and is generally a benign, self-limited condition. Meanwhile, a lot of studies have linked vitamin D (VitD) levels with probably contributing to neonatal lung development. This study aimed to assess whether the serum levels of VitD are associated with TTN in infants and mothers in natural childbirth. This descriptive-analytical research was performed on 39 infants with TTN and their mothers and 39 control infants and their mothers referred to the Motazedi hospital in Kermanshah University of Medical Sciences. Serum concentrations of VitD were measured in the first 12-24 h of postnatal age in both infants and mothers. In the present study, no significant difference was found between healthy and TTN groups in terms of gender, mother's education level, drug use, asthma, diabetes, 1th min Apgar score, mother's age, birth weight, and birth height. But, there was a significant difference between the two groups of control and intervention in terms of 5th min Apgar score, and birth order. The mean levels of serum VitD were significantly lower in both TTN neonate patients and mothers. The results of the Pearson correlation coefficient indicated that there is a significant relationship between the serum VitD level of mothers and term infants in both groups. We observed that maternal VitD levels can be preventive for the development of TTN in infants through improving respiratory distress, and potentially shortening the duration of tachypnoea in natural childbirth.
Background: Up to 75% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy f...
Background: Up to 75% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard intervention to address insomnia. However, widespread uptake of CBT-I remains limited and new strategies of CBT-I delivery are warranted. Objective: We wished to understand how YACS experience insomnia, how they might incorporate technology-delivered CBT-I into a daily routine and test the feasibility and acceptability of a novel voice-activated virtual assistant-delivered CBT-I prototype. Methods: We conducted four focus groups (6-7 participants per group, N=26 total) to understand the YACS experience of insomnia, their routine use of technology at home, particularly voice-activated virtual assistants such as the Amazon Alexa, and input on how CBT-I might be delivered at home through a smart speaker system. We developed a prototype device to deliver key elements of CBT-I at home along with circadian lighting and monitoring of post-bedtime device use, collected YACS user perspectives on this prototype, and then conducted a single-arm feasibility and acceptability study. Results: Twenty-six YACS experiencing insomnia participated in focus groups to share experiences of insomnia during cancer survivorship and to provide input regarding a CBT-I prototype. Common triggers of insomnia included worry about disease management and progression, disease-related pain and other symptoms, choices regarding personal device use, and worry about the impact of poor sleep on daily functioning. Twelve participants completed device prototype testing, exceeding pre-determined feasibility and acceptability benchmarks and providing qualitative data to inform future device refinement. Conclusions: YACS were highly engaged with our voice-activated virtual assistant-delivered CBT-I prototype and found it acceptable to use. Following final device development, future studies should evaluate efficacy of this intervention among YACS. Clinical Trial: NCT05875129
Background: Alcohol consumption is a leading cause of death and disability worldwide, associated with numerous acute and chronic medical conditions. Digital health interventions offer a promising solu...
Background: Alcohol consumption is a leading cause of death and disability worldwide, associated with numerous acute and chronic medical conditions. Digital health interventions offer a promising solution to overcome barriers associated with traditional treatment methods, providing accessible, scalable, and cost-effective means to support individuals in reducing hazardous drinking. Objective: This pilot study aims to evaluate the feasibility, acceptability, and preliminary efficacy of the "Sober" smartphone app in individuals with hazardous alcohol use. Methods: This single-group, pre-post pilot study included 20 participants with hazardous alcohol use, identified using the Alcohol Use Disorder Identification Test (AUDIT). Participants used the "Sober" app for four weeks, which incorporates cognitive behavioral therapy(CBT)-based interventions. Feasibility was assessed by study and session completion rates, acceptability by participant satisfaction and perceived usefulness, and preliminary efficacy by changes in alcohol consumption and psychiatric symptoms. Results: Of the 20 enrolled participants, 17 completed the study. The app demonstrated high feasibility with an 85% study completion rate, and 58.8% completed all CBT sessions. Participants reported positive acceptability, with average satisfaction and usefulness ratings of 3.8 and 3.7 out of 5, respectively. Preliminary efficacy outcomes showed significant improvements: abstinence days increased from 66.8% to 84.8% (Z=-3.165, P=.002), heavy drinking episodes decreased from 3.3 to 1.9 (t=-2.965, P=.003), and total alcohol consumption reduced from 456.8 mL to 195.9 mL (t=3.159, P=.002). AUDIT scores dropped from 17.5 to 10.7 (t=4.513, P<.001). Additionally, depression (PHQ-9) scores decreased from 5.8 to 4.4 (t=2.908, P=.010), and anxiety (GAD-7) scores from 3.4 to 2.1 (Z=-2.801, P=.005). No adverse events were reported. Conclusions: The mobile application "Sober" shows promise as an effective tool for reducing hazardous alcohol consumption and improving related psychiatric symptoms. The study demonstrated high feasibility and positive acceptability, with significant preliminary efficacy in reducing alcohol use. Feedback from participants and clinicians highlighted areas for improvement, which will be used to refine the app and study design for future research. Further research through a randomized controlled trial is warranted to confirm these findings and optimize the application’s features and content. Clinical Trial: The trial was registered on ClinicalTrials.gov (NCT06502756)
Background: Effective dermatological practices are essential for maintaining healthy skin and addressing health concerns such as acne. Traditional dermatological consultations often face limitations,...
Background: Effective dermatological practices are essential for maintaining healthy skin and addressing health concerns such as acne. Traditional dermatological consultations often face limitations, including accessibility, cost, and variability in expertise. The potential application of Large Language Models (LLMs) in healthcare, particularly for dermatology, is an area of growing interest. Objective: This study aims to evaluate the feasibility of utilizing various mainstream LLMs, including GPT-3.5-turbo, GPT-4, and GPT-4o, as consultants for acne-related health concerns. The primary objective is to determine whether these models can deliver accurate, relevant, and competitive solutions in line with professional dermatological standards. Additionally, the study compares the performance of these models, to identify which offers the best overall performance for acne management consultations. Methods: Real human question data were sourced from major social media platforms, health forums, and dermatology clinics. Personally Identifiable Information (PII) filtering was applied when selecting 37 related questions to ensure privacy compliances. Each LLM generated responses three times. An automated evaluation system using GPT-4o assessed the responses based on ten criteria: accuracy of terminology, evidence support, factual correctness, completeness, ethical considerations, practicality, safety advice, tone, personalization, and up-to-date information. Each response was categorized as Pass, Fail, or Ignore. Results: The evaluation revealed high performance of GPT-3.5-turbo, GPT-4, and GPT-4o in accuracy, with pass rates for correct terminology (95.20%), evidence support (99.10%), and factual correctness (96.10%). Limitations were observed in personalization (24.62%), safety advice (76.88%), and up-to-date information (75.98%). A comparative analysis showed that GPT-4 generally outperformed GPT-3.5-turbo and GPT-4o in most criteria, achieving higher completeness (91.89%) and ethical considerations (97.30%). GPT-4 excelled in tailoring recommendations to individual profiles. In contrast, GPT-4o demonstrated the highest accuracy. Conclusions: All models demonstrated strong performance in accuracy, ethical considerations, and providing polite and respectful responses. However, the models showed limitations in personalization and safety advice. Overall, GPT models at the current stage demonstrated the capability in initial dermatological consultations and assist patient as a self-explanatory tool, but ongoing enhancements are necessary to address their current shortcomings and ensure even more reliable and effective performance in the future.
Background: Telepathology has proven to be a viable solution to provide timely, high-quality diagnostic services to underserviced, remote areas, and is widely applied in the word. The government stron...
Background: Telepathology has proven to be a viable solution to provide timely, high-quality diagnostic services to underserviced, remote areas, and is widely applied in the word. The government strongly supports the development of telepathology to alleviate the shortage of pathologists in China. This study aimed to survey telepathology in China, and analyze the usage and attitudes of both pathologists and patient. Objective: This study aims to analyze the construction, application, and development of telepathology in China from 2018 to 2023, understand the usage, evaluation, and attitudes of pathologists and patients towards telepathology, and analyze the existing problems and improvement suggestions in the application of telepathology. Methods: A national survey was administered to Chinese hospitals in 2018, 2019, 2020 and 2023. A survey to doctors and patients who participated in telemedicine services was conducted in 2019. Based on this data, we analyze telepathology in China. Chi-square test and Fisher's exact probability test were used to test the difference among different years, different levels of hospitals, and different regions. Results: The annual average growth rate of the proportion of telepathology software in the surveyed hospitals was 7.60%, from 29.53% in 2018 to 42.55% in 2023. From 2018 to 2023, the number of telepathology service cases in China has been continuously increasing, with the median number per hospital growing from 51 to 200 cases, and the fastest growth was in the eastern region. Once a week was the dominant frequency(63.64%) among pathologists in China. The average time for participating in telepathology services was mainly 11-20 min and 21-30min. The pathologists' overall satisfaction rate was 99.35%, and the most frequently mentioned difficulties were unreasonable scheduling, small coverage, inadequate publicity, and network problems. 92.20% of the patients received their diagnostic results within 24 hours, all patients were satisfied with telepathology, and 99.29% of them were willing to recommend it to other patients. Conclusions: The construction and application of telepathology in China have achieved significant growth from 2018 to 2023. Despite some existing barriers with its application, both pathologists and patients exhibit high satisfaction with telepathology. Unreasonable scheduling, limited coverage, inadequate publicity, and network issues are the main problems affecting telepathology. Recommendations include expanding service methods, shortening wait times, strengthening publicity, incorporating telepathology fees into medical insurance, and enhancing training for primary healthcare personnel.
Background: Information about orthopedic diseases on the Internet has not been extensively evaluated. Objective: Our purpose was to collect and evaluate online information on arthrochondral injury on...
Background: Information about orthopedic diseases on the Internet has not been extensively evaluated. Objective: Our purpose was to collect and evaluate online information on arthrochondral injury on the current video-sharing platforms in mainland China. Methods: Four independent researchers used the Microsoft Edge web browser in July 2024. Information and data of those videos were recorded and a descriptive analysis was performed. Results: After data extraction, Ninety-nine videos (48 on TikTok and 51 on Bilibili) involved in the search results met the criteria. Most of the videos were low quality. The most common uploader profile was orthopedic surgeons. The most common content in the videos were introduction, while surgical techniques had the least results. The mean DISCERN, JAMA, and GQS scores were 34.4, 2.8, and 2.9, respectively. Higher quality videos had longer duration and better reliability scores. Conclusions: The videos on TikTok and Bilibili, although abundant, are extremely lacking in comprehensiveness and professionalism. Those videos can be effective in increasing public awareness of arthrochondral injury. The lower proportion of expertise and poor quality may make the videos insufficient in medical education. The quality of videos uploaded by orthopedic surgeons is not superior to that of other creators. In the future, more orthopedic surgeons need to participate in online video creation while addressing the issues of poor quality and popularity.
Background: In this rapidly advancing digital landscape, the security of Electronic Health Records (EHRs) is increasingly dependent on robust authentication and access control measures. Despite advanc...
Background: In this rapidly advancing digital landscape, the security of Electronic Health Records (EHRs) is increasingly dependent on robust authentication and access control measures. Despite advancements in cybersecurity, South African public hospitals are particularly vulnerable and targeted by cyber-attacks and data breaches due to vulnerabilities associated with username and password-based authentication. These vulnerabilities pose substantial risks to the security and privacy of EHRs and cause huge disruptions to public hospitals. Objective: With the potential to cause widespread disruption and harm, this study aims to propose a framework for integrating Multi-Factor Authentication (MFA) to enhance to user authentication and access control to EHRs in South African public hospitals. Methods: A qualitative research design was employed to understand security vulnerabilities and risks in password authentication within public hospitals. The study conducted semi-structured interviews with 15 purposively selected IT technicians, network controllers, and IT managers working in public hospitals. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis and NVivo version 12. The study applied a conceptual framework grounded in Protection Motivation Theory. Results: The analysis revealed that public hospitals experienced authentication vulnerabilities such as username enumeration, broken authentication, weak credentials, and credential leakage. Phishing, cryptojacking, ransomware, and password attacks were among the security incidents encountered in public hospitals. Participants expressed that security vulnerabilities in hospitals are due to weak and easily guessable passwords created by staff, the reuse of the same password across multiple systems, irregular password updates, reliance on legacy systems, writing down passwords on paper, and the lack of regular updates to Windows Firewall and Microsoft Defender Antivirus. Conclusions: The study emphasizes the need for developing robust password policies, modernizing legacy systems, and promoting cybersecurity awareness training in public hospitals. Furthermore, the study suggested a framework for public hospitals to effectively address authentication vulnerabilities. and reinforcing data security. The research underscores that, despite the ongoing vulnerabilities and weaknesses of password and username-based authentication, the study concludes that the integration of MFA offers a scalable solution to significantly improve the security and access control of EHRs in public hospitals.
Background: Artificial intelligence (AI)-based clinical decision support systems are increasingly used in healthcare. Uncertainty-aware AI presents the model’s confidence in its decision alongside i...
Background: Artificial intelligence (AI)-based clinical decision support systems are increasingly used in healthcare. Uncertainty-aware AI presents the model’s confidence in its decision alongside its prediction whereas black-box AI only provides a prediction. Little is known about how this type of AI affects healthcare providers’ work performance and reaction time. Objective: To determine the effects of black-box and uncertainty-aware AI advice on pharmacist decision-making and reaction time. Methods: Thirty licensed pharmacists participated in a crossover, randomized controlled trial. Eligible participants were randomized to either the black-box AI or uncertainty-aware AI condition in a 1:1 manner. Participants completed 100 mock verification tasks with AI help and 100 without AI help. The order of no help and AI help was randomized. Participants were exposed to correct and incorrect prescription fills, where the correct decision was to ‘accept’ or ‘reject’, respectively. AI help provided correct (79%) or incorrect (21%) advice. Reaction times, participant decision, AI advice, and AI help type were recorded for each verification. Likelihood ratio tests (LRT) compared means across the three categories of AI type for each level of AI correctness. Results: Participants’ decision-making performance and reaction times differed across the three conditions. Accurate AI recommendations resulted in the rejection of the incorrect drug 96.1% and 91.8% of the time for uncertainty-aware AI and black-box AI respectively, compared to 81.2% without AI help. Correctly dispensed medications were accepted at rates of 99.2% with black-box help, 94.1% with uncertainty-aware AI help, and 94.6% without AI help. Uncertainty-aware AI protected against bad AI advice to approve an incorrectly filled medication compared to black-box AI (83.3% vs 76.7%). When the AI recommended rejecting a correctly filled medication, pharmacists without AI help had a higher rate of correctly accepting the medication (94.6%) compared to uncertainty-aware AI help (86.2%) and black-box AI help (81.2%). Uncertainty-aware AI resulted in shorter reaction times than black-box AI and no AI help except in the scenario where "AI rejects the correct drug". Black-box AI did not lead to reduced reaction times compared to pharmacists acting alone. Conclusions: Pharmacists’ performance and reaction times varied by AI type and AI accuracy. Overall, uncertainty-aware AI resulted in faster decision-making and acted as a safeguard against bad AI advice to approve a misfilled medication. Conversely, black-box AI had the longest reaction times, and user performance degraded in the presence of bad AI advice. However, uncertainty-aware AI could result in unnecessary double-checks, but it is preferred over false negative advice, where patients receive the wrong medication. These results highlight the importance of well-designed AI that addresses users’ needs, enhances performance, and avoids overreliance on AI.
Background: Many ‘toolkits’ for developers have been designed but are sometimes criticised for their tokenistic approach. Few have been assessed for impact in real-world settings. Based on themati...
Background: Many ‘toolkits’ for developers have been designed but are sometimes criticised for their tokenistic approach. Few have been assessed for impact in real-world settings. Based on thematic analysis of 135 codesign workshops four preliminary toolkits were produced to help developers of digital products aiming to keep older people active. Objective: Many ‘toolkits’ for developers have been designed but are sometimes criticised for their tokenistic approach. Few have been assessed for impact in real-world settings. Based on thematic analysis of 135 codesign workshops four preliminary toolkits were produced to help developers of digital products aiming to keep older people active. Methods: Many ‘toolkits’ for developers have been designed but are sometimes criticised for their tokenistic approach. Few have been assessed for impact in real-world settings. Based on thematic analysis of 135 codesign workshops four preliminary toolkits were produced to help developers of digital products aiming to keep older people active. Results: Ten organizations including charitable sector organizations and small businesses were each awarded £5000 to use the toolkits in mini projects to improve their product functionality. Their proposals included digital music and movement, reminiscence, social connectedness, and directory type products. Developers were already broadly aware of many considerations presented but using the toolkist gave them confidence in what they were doing. Using toolkits also enabled developers to demonstrate that they were working with university teams, so instilling client confidence. Toolkits were used for horizon scanning where developers were considering moving into new product areas and prioritising on improving existing products.
Developers reported impacts including 1) better integration and ability to scale up their services; 2) provision of more detailed evaluation and reporting to clients; 3) more useable and appropriate products. These improvements enabled retention and increase in client bases, widening of collaborations, and further funding for product development given their improved confidence. However, developers reported that the funding to use the toolkits for the mini projects was the key catalyst for change. For some, lack of funding (i.e. just toolkit provision) would have meant change occurred at a slower pace, and the quality of development might have been reduced. Conclusions: These preliminary toolkits provided prompts and ideas for the better design of digital products to keep older people active. These toolkits, developed with stakeholders, provide a useful complementary method of learning from the experience of others where designers may not have access to target populations or resources for codesign. The toolkits gave developers and their clients confidence in their work to improve functionality and with the funding helped them improve their products. As part of a mix of different types of support that developers might need, the toolkits can help developers produce products more relevant for older people. The toolkits have subsequently been refined and are available for others to use to help keep older people physically and socially active.
Background: The field of Alzheimer’s disease (AD) moves towards earlier diagnoses in pre-dementia stages, personalized prognosis, and dementia prevention. In the near future, a gap is expected betw...
Background: The field of Alzheimer’s disease (AD) moves towards earlier diagnoses in pre-dementia stages, personalized prognosis, and dementia prevention. In the near future, a gap is expected between the growing demand for Alzheimer-related healthcare and a shrinking workforce. Responsibility is increasingly assigned to individuals to take an active role in their own brain health. Digital tools are thought to offer support with regard to these processes. Objective: The aim of this scoping review is to create an overview of digital tools published in scientific literature in the context of Alzheimer’s disease and dementia, with cognitively unimpaired people and/or people in pre-dementia stages as primary end-users interacting with these digital tools. Additionally, we aim to gain insight into study sample diversity, the stage of maturity and evaluation of these tools, and recommended future directions. Methods: PubMed, IEEE Xplore, Ovid, and Web of Science were searched in January 2023, using terms on Alzheimer’s disease and dementia, (pre-)disease stages, digital tools, and purposes of digital tools. Two independent reviewers screened 2811 records on title and abstract, and subsequently 408 full text articles, based on in- and exclusion criteria. Articles on tools targeting those with an Alzheimer’s disease or dementia diagnosis were excluded. Data extraction included information on the sample characteristics, the digital tool, stage of maturity and evaluation, and future (research) directions. Results: We included 39 articles, which were aimed at primary prevention (15/39; 38.5%), secondary prevention (10/39;25.6%), daily life support (8/39; 20.5%), diagnosis and risk assessment (4/39;10.3%), or decision-making (2/39; 5.1%). Variation in study sample emerged regarding cognitive abilities (healthy (11/39; 28.2%); mild cognitive impairment (11/39; 28.2%), (subjective) cognitive impairment (10/39; 25.6%); ‘no dementia’ (1/39; 2.6%), and variation of cognitive abilities (6/39; 15.4%)). Less variation was found regarding sex (>50% female: 27/39; 69.2%), education ( >50% high education: 13/39; 33.3%), and age (>50% >60 years: 23/39; 59%). Few articles reported on ethnicity (12/39; 30.7%) and digital literacy (11/39; 28.2%). Most tools were in an early evaluation and maturity stage (31/39; 79.5%), comprising pre-prototyping (1/35; 2.9%), prototyping (15/35; 42.9%), pilot testing (19/35; 54.3%), efficacy testing (18/40; 45%), usability testing (12/40; 30%), and feasibility testing (10/40; 25%). Future (research) directions comprise the need for further tool development, attention to diversity, and study advancements, such as large-scale longitudinal studies. Conclusions: 79.5% of tools as reported on in academic literature are considered to be in an early maturity stage. Studies and evidence gathered for digital tools for people (at risk) in pre-dementia stages is thus preliminary and further developments and research is needed before these tools can be implemented for assessing, supporting and preventing cognitive decline.
Background: Regular engagement in exercise is associated with a multitude of physical and mental health benefits. In view of the technical progress, the ageing society and the recent public life restr...
Background: Regular engagement in exercise is associated with a multitude of physical and mental health benefits. In view of the technical progress, the ageing society and the recent public life restrictions during the COVID-19 pandemic, the delivery of interventions using digital devices has become highly popular. This systematic review with meta-analysis examined the effects of online exercise programs on physical activity (PA), motor performance, and mental health. Objective: To examine the effects of online exercise programs on physical activity (PA), motor performance, and mental health. Methods: A systematic literature search was performed using PubMed, Cochrane and Google Scholar. Randomized, controlled trials assessing the effects of online exercise (OE) vs. no exercise (NEX) or face-to-face exercise (FFE) in healthy adults were included. Effect sizes (standardized mean difference/SMD) were pooled using robust variance estimation and the certainty about the evidence was rated by means of the GRADE criteria. Results: A total of 18 articles with moderate to high methodological quality (8/11 points on the PEDro scale) were identified. OE was superior to NEX regarding strength (SMD=0.61), balance (SMD=0.52), endurance (SMD=0.85), PA (SMD=0.46), depression (SMD=1.08), mood/emotion (SMD=0.47), mental wellbeing (SMD=0.79), and self-efficacy (SMD=1.1). Compared to FFE, OE was non-inferior for all tested outcomes. The certainty about the evidence was low to moderate. Conclusions: OE represents an effective strategy to improve PA, physical function and mental health in healthy adults. However, in view of the partly limited certainty about the evidence, additional well-designed studies are warranted to further delineate the value of OE. Clinical Trial: PROSPERO registration number: CRD42022338871
Background: Traditional medical education in Palestinian higher education institutions faces challenges such as limited interactive practical training and the need for more immersive learning experien...
Background: Traditional medical education in Palestinian higher education institutions faces challenges such as limited interactive practical training and the need for more immersive learning experiences. Emerging technologies like Extended Reality (XR), which includes Virtual Reality (VR) and Augmented Reality (AR), are being integrated into educational environments worldwide to address these issues. Objective: This study aims to explore and understand the factors influencing the adoption and impact of using XR in healthcare education within Palestinian universities. Methods: A mixed-methods approach was employed, combining qualitative and quantitative data from surveys and interviews with instructors and students across multiple Palestinian universities. The study also reviews global implementations of XR technologies in medical education to provide a comparative analysis. Results: The findings indicate that XR technologies significantly enhance the learning outcomes in healthcare settings. However, three main themes served as factors influencing educators’ usage of XR including external, internal, and design factors. Despite challenges, such as financial constraints and technical issues, the long-term benefits include better educational outcomes and cost-effectiveness. The study also highlights the initial success of XR implementations in Palestinian universities and their potential to transform medical education. Conclusions: XR technologies hold promise for revolutionizing medical education by providing immersive learning experiences that enhance practical skills and knowledge retention. The study underscores the importance of strategic investments in technology and infrastructure to overcome initial barriers. The adoption of XR technologies aligns with the Sustainable Development Goals (SDGs) of quality education and good health, suggesting a promising future for broader integration in medical and nursing programs in Palestine.
Background: Heart failure is a prevalent and debilitating condition, affecting millions globally and imposing significant burden on patients, families, and healthcare systems. Despite advancements in...
Background: Heart failure is a prevalent and debilitating condition, affecting millions globally and imposing significant burden on patients, families, and healthcare systems. Despite advancements in medical treatments, the gap in effective, continuous, and personalized supportive care remains glaringly evident. To address this pressing issue, virtual healthcare services, delivered by interdisciplinary teams, represent a promising solution. There is a lack of comprehensive data on the benefits of interdisciplinary virtual heart failure remote monitoring support programs on patient adherence, quality of life, and overall healthcare costs in Australia. Understanding the outcomes and experience of remote monitoring enabled chronic disease management programs can inform better resource allocation and healthcare policy decisions. Objective: The purpose of this study was to evaluate the clinical and behavioural outcomes of patients undertaking a Virtual Home Health Heart Failure Program (VHHHFP) and explore the experiences of patients and health care practitioners. Methods: A mixed methods study was conducted in collaboration with patients and health practitioners. Self-reported outcome data (KCCQ12, PHQ4, PAM13 and PREMS) were obtained from the records of patients (n=55) who completed the intensive phase (0- 3 months) of the VHHHFP; and interviews were conducted with patients (n= 9) and health practitioners (n= 6). Results: Thirty-one (77.5%) of the n=55 patients completed the baseline and three-month follow-up KCCQ12 assessment. The mean KCCQ12 Summary Score at three months was 72.20 which was significantly higher than the mean Summary Score at baseline of 50.51 (p<.001). These findings were similar for the KCCCQ12 sub-scales: Physical Limitations (47.09 and 69.43, p<0.001), Quality of Life (43.75 and 62.91, p<0.001), Symptom Frequency (60.40 and 91.70; p<0.001) and Social Limitation (50.0 and 82.50; p<0.001). The PHQ-4 measure of psychological health was completed by n=32 (80%). The median scores at baseline and follow-up for Total Distress (1.50 and 0.0; p<0.02), and the Anxiety sub-scale (1.0 and 0.0; p <0.02) reduced over time. Six hospital admissions were recorded for five patients (10.2% of n=49) within 30 days of commencement of the VHHHFP. Nine patient interviews were informed by the Value Based Healthcare (VBHC) Capability Comfort and Calm (CCC) Framework. Three themes were identified 1) Enhanced patient capability, 2) Improved patient comfort and 3) Positive influences on Calm. Six healthcare professionals shared experiences and perceptions of the VHHHFP, with three emerging themes- 1) Improved patient capability through shared decision making, 2) Improving Capability through care practices and 3) Promoting Comfort and Calm through virtual coordination and collaboration. Conclusions: The use of technologies to support the management of HF is an area of growth and development. This study contributes to the understanding of how remote patient monitoring with interdisciplinary chronic disease support integrated into an existing system can improve clinical outcomes for patients.
Background: Depression is a prevalent comorbidity in patients with pancreatic cancer, negatively impacting their quality of life, treatment adherence, and survival. Inflammation is a key biological pr...
Background: Depression is a prevalent comorbidity in patients with pancreatic cancer, negatively impacting their quality of life, treatment adherence, and survival. Inflammation is a key biological process that may link pancreatic cancer and depression, with inflammatory markers like C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) playing significant roles. Machine learning (ML) provides a novel approach to predicting depression based on these biomarkers, potentially enabling early intervention and improved patient outcomes. Objective: This study aimed to investigate the clinical associations between depression, inflammation, and pancreatic cancer, and to utilize machine learning to predict depression using biomarker levels and clinical data. Methods: A prospective cohort study was conducted between May 2021 and November 2023, including 328 patients diagnosed with pancreatic cancer. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Generalized estimating equations (GEE) were used to explore relationships between depression and inflammatory markers, with significant variables from univariate analyses included in multivariate models. Various ML algorithms, including Random Forest, K-Nearest Neighbors (KNN), and Extreme Gradient Boosting (XGBoost), were employed to predict depression, evaluated using classification metrics such as accuracy, precision, recall, and F1-score. Results: The cohort had a mean age of 65 years, with most patients diagnosed at stage IV. Clinically significant depression (PHQ-9 ≥10) was observed in 35% of patients at baseline, decreasing over time. Univariate analyses indicated associations between depression and factors such as lack of surgical resection and metastatic disease; however, these were not significant in multivariate models. Only log-transformed CRP and NLR remained significant inflammatory markers in multivariate analyses. Among the ML models, XGBoost achieved the highest performance, with an accuracy of 81%, precision of 84%, recall of 91%, and an F1-score of 86%. CRP, NLR, and platelet-lymphocyte ratio (PLR) emerged as the strongest predictors of depression. Conclusions: Depression is prevalent among pancreatic cancer patients and is likely linked to inflammation. Machine learning models, particularly XGBoost, effectively predicted depression using inflammatory markers. Integrating ML-based predictions into mental health care within cancer treatment protocols may improve patient outcomes. Future research should focus on refining these predictive models and exploring their clinical implementation for early depression detection and intervention in pancreatic cancer care.
Background: Technology has transformed the access to information and our learning landscape. During the COVID-19 crisis the accessible and affordable information with appropriate use of technology for...
Background: Technology has transformed the access to information and our learning landscape. During the COVID-19 crisis the accessible and affordable information with appropriate use of technology for healthcare became critical to train health professionals and fight with misinformation. This online based training is gaining increased attention during the last couple of decades both in developed and developing country. The mobile and internet coverage and speed of the internet has significantly improved, and this network coverage opens the opportunity to use the online based training programs for the huge grass root health care service providers. Though the health care providers receive some sort of training specifically for maternal and child health, contraceptives and other common physical illness, they hardly have any opportunity to receive the mental health training. Online based mental health training program for the community health care provider and volunteers can be good option for Bangladesh to reduce its’ wide mental health treatment gap. Objective: This study aimed to find out the potential barrier of the online based mental health trainings for the volunteers who are working in the community to promote mental health and well-being and reduce the mental health stigma in Bangladesh. We also attempted to find out the approaches those might minimize the barriers. The findings of this study will help to develop a realistic expectation and also will provide the insight to predict and prepare to mitigate the challenges of the training implementation. Methods: To understand the complexity of the online based training for mental health we conducted two batches of training with the students who are the mental health volunteers working in the community. We conducted Focus Group Discussions at the end of the 3 days long training of each batch and In-depth Interviews were conducted with also the trainers to find out the barriers of these online training program. The interviews were conducted in Bangla those were recorded transcribed, translated and thematically analyzed. Results: We found the most common barriers to online mental health training was the lack of physical presence, technical issues (e.g., network disturbances, device integration problems), cost of internet, electricity issues, and privacy concern. Moreover, participants reported physical strain of siting in front of desktop and laptop for the training and many of them were concerned about the about privacy breaches, accidental content sharing, and maintaining constant vigilance online. Conclusions: The online based training opened the window to help millions of people at a time however we to be careful about the barriers those threatens the successful implementation of this programs.
Background: Roughly 40% of Alzheimer’s disease (AD) and AD related dementias (ADRD) and up to 20% of AD/ADRD deaths are preventable by addressing modifiable risk factors like physical inactivity. Pa...
Background: Roughly 40% of Alzheimer’s disease (AD) and AD related dementias (ADRD) and up to 20% of AD/ADRD deaths are preventable by addressing modifiable risk factors like physical inactivity. Past programs and technologies to promote and measure physical activity often overlook the voices of the end-user in minoritized groups living with AD/ADRD, or memory challenges. Objective: We apply a human-centered design framework as a call to action to address these gaps and provide a use case. Methods: We applied a human-centered design based on our published Innovation Biodesign framework, to identify clinical needs and map solutions, including gaps in the design and usability testing of technology to measure and monitor physical activity in dementia care. We illustrated the implementation of the framework utilizing a needs assessment and secondary data from the co-design process of a Green Activity Program that tailors nature or “green” activities to improve well-being measuring sleep, activity, and heart rate using the ActiGraph LEAP activity tracker. The program was designed in collaboration with multiple partners, including Hispanic/Latino individuals living with memory challenges in the Bronx, New York. Results: The framework involved problem and solution spaces with an iterative refinement process and highlighted a need to utilize human-centered approaches to select, monitor, and assess desired outcomes of well-being, activity, and sleep for Hispanic/Latino people living with memory challenges. The framework enabled us to conduct a needs assessment and an iterative co-design process to design the program and a future pilot study utilizing the ActiGraph LEAP. Conclusions: The framework empowered us to identify and characterize a clinical problem and gaps in the use of technology to measure and monitor physical activity and advance towards a solution space when designing the Green Activity Program to address the unique social needs of older Hispanic/Latino people living with memory challenges. Application of the framework serves as a call to action to apply human-centered approaches to address the clinical needs of minoritized groups with memory challenges. Clinical Trial: ClinicalTrials.gov NCT06403345.
Background: The increasing prevalence of paediatric obesity presents a major challenge for healthcare services. In England, Complications of Excess Weight (CEW) clinics provide specialist multidiscipl...
Background: The increasing prevalence of paediatric obesity presents a major challenge for healthcare services. In England, Complications of Excess Weight (CEW) clinics provide specialist multidisciplinary care for children presenting with co-morbidities of severe obesity. Positive treatment outcomes require the young person and their family to make behavioural changes to improve the child’s health. However, there are many barriers to health behaviour change, particularly for adolescents. Digital technology could be used to enhance the support offered by CEW clinics to adolescent patients to increase the likelihood of successful behavioural change, but little is known about their and their families’ views of this. Objective: We aimed to explore the views of adolescent patients and their families on how digital technology could be utilised by CEW clinics to support health behaviour change. Methods: The study took a participatory design approach. Four focus groups and co-design workshops were facilitated by a cross-disciplinary team of clinicians, academics and technology innovators. Participants were adolescent CEW clinic patients (aged 10-16 years) and their adult family members. Focus groups and workshops explored young people’s health priorities, the barriers and facilitators of health behaviour change, and co-designed ways in which technology could be used to support young people in overcoming these barriers to achieve their health goals. Focus group data were analysed using inductive content analysis, with findings integrated with key co-design workshop outputs. Results: 37 individuals (19 adolescents, 18 family members) participated across the focus groups and workshops. Participants were in favour of the increased use of digital technology by CEW clinics as an adjunct to in-person support. Weight was not mentioned by participants as an important aspect of their health. Instead, mental health, sleep and peer support were identified as the domains in which adolescent CEW patients felt they would most benefit from additional support and participants reported that technology could be helpful in providing this support. Participants expressed a preference for technology able to individually tailor content to the young person’s needs, including relatable peer-produced content. The need for support for both the young person themselves and their family members was highlighted, as well as the need to integrate strategies to maintain engagement with any technological offering. Conclusions: There is clear potential for digital technology to be used to support the holistic health priorities of young people receiving specialist care for co-morbidities related to excess weight. We plan to use the findings of this study as the basis to begin developing innovative approaches to the use of technology to support this high-need group.
Background: Despite high prevalence of chronic hepatitis B virus (HBV) infection in adults in Lao People’s Democratic Republic (PDR), Lao healthcare workers (HCWs) were previously been shown to have...
Background: Despite high prevalence of chronic hepatitis B virus (HBV) infection in adults in Lao People’s Democratic Republic (PDR), Lao healthcare workers (HCWs) were previously been shown to have low levels of protection against infection. Furthermore, the prevalence of hepatitis D virus (HDV; which increases disease severity in HBV infected individuals) is not known in Lao PDR. Objective: To investigate the exposure, vaccination status and seroprotection against HBV as well as exposure to HDV in Lao healthcare workers from five provinces Methods: In 2020, 666 HCWs aged 20-65 years old from five provinces of the Lao PDR were recruited and sera were tested by Enzyme-linked immunosorbent assay (ELISA) to determine their HBV and HDV co-infection status. Results: HBV exposure, as indicated by the presence of anti-HB core (anti-HBc) antibodies, was 40% overall and significantly higher for HCWs from Oudomxay province (67.7%, P=.001). The seroprevalence of HBsAg was 5.4% overall and increased with age from 3.6% in those aged ≤ 30 years to 6.8% in those aged ≥ 50 years. Only 28.7% of participants had serological indication of immunization. We could find no evidence for HDV exposure in the current study. Conclusions: We recommend strengthening the national vaccination program for HCWs and implementing pre-employment testing.
Background: Psychedelic substances are increasingly studied for their therapeutic potential in modern and precision medicine. Online forums like Erowid offer valuable users' insights into these effect...
Background: Psychedelic substances are increasingly studied for their therapeutic potential in modern and precision medicine. Online forums like Erowid offer valuable users' insights into these effects, yet few studies have used natural language processing (NLP) to analyze these subjective experiences. Objective: This study aims to use NLP models to analyze and interpret user experiences with psilocybin mushrooms and LSD from the Erowid forum, providing insights into user sentiments. Although this methodology focuses on two specific psychoactive substances, it can be applied to any drug to evaluate adverse drug events (ADEs), detect pharmacovigilance signals, and assess potential therapeutic benefits. Methods: Data was collected from Erowid using automated web scraping with XPath expressions, CSS selectors, and Selenium WebDriver from 2,188 users (1,161 psilocybin mushrooms, 1,027 LSD). The compiled dataset included report titles, substance types, and demographics. Sentiment analysis was conducted using three NLP models: BERT, RoBERTa, and VADER. Data pre-processing included tokenization, lemmatization, part-of-speech tagging, and stopword filtering. Results: User demographics revealed comparable ages for psilocybin (23.8±0.9 years) and LSD users (20.0±0.6 years), with a predominance of males. The BERT model predominantly labeled experiences as negative (unfavorable), particularly for psilocybin users (p=0.001). VADER indicated more positive experiences for psilocybin users (p<0.001), while RoBERTa mainly classified experiences as negative or neutral. These differences had small effect sizes and limited practical significance. Models' agreement was weak (Cohen's κ<0.15), with the highest observed agreement between BERT and RoBERTa (LSD=41.58%; psilocybin=38.24%). VADER produced more polarized results, while RoBERTa's "cautious" classifications suggest it may be better suited for analyzing lengthy and complex psychedelic reports. Further, significant gender differences were found only with VADER, where more males expressed positive opinions about psilocybin (74.09% vs. 65.52%, p<0.021). Conclusions: VADER generated more polarized sentiment analyses, whereas RoBERTa offered more "careful" classifications. This study underscores the utility of NLP in analyzing experiences with psychedelics, providing valuable insights despite potential biases and technical challenges. Our findings enhance the understanding of psychedelic users' subjective experiences, informing harm reduction strategies, future research, and policy-making.
Background: Augmented Reality (AR) as an interactive communication tool has matured to the point that it can be used in the classroom to engage medical students. Objective: We assess a state-of-the-ar...
Background: Augmented Reality (AR) as an interactive communication tool has matured to the point that it can be used in the classroom to engage medical students. Objective: We assess a state-of-the-art AR game published together with a modern cell atlas on cells of the oral cavity to investigate the trade-offs of the new technology to convey medical knowledge. Methods: A serious game is designed and created to represent state-of-the-art knowledge on osteoclasts for the classroom. The game is evaluated for its usability and a vignette experiment is conducted comparing the topic of Osteoclasts in the AR game and a textbook option conveying the same information. Participants are randomly assigned and their learning success is measured after the treatment, one week later and one month later. We also assess the use of the game in the app store to gain general insights. Results: A serious game elicits strong interest in the topic and motivates students. The learning outcomes are comparable to text-based self-learning but with higher engagement. Furthermore, curious students benefit more from interactive learning methods compared to text-only methods and have higher learning success. Conclusions: Introducing new technology like AR into teaching curricula requires technological investment, updated curricula and careful application of learning paradigms. AR-based learning may serve especially curious students that usually learn less in text-heavy teaching. In addition, a new generation of students is soon entering the classroom that is very used to short and entertaining information exchanges and our methods repertoire needs to adapt to these new realities.
Background: Black/African American and Hispanic/Latina cisgender women in the United States continue to bear disproportionate incidence of HIV related to sexual transmission and injection drug use. Sp...
Background: Black/African American and Hispanic/Latina cisgender women in the United States continue to bear disproportionate incidence of HIV related to sexual transmission and injection drug use. Specifically, women with substance use disorders (SUD) are more likely to engage in vaginal or anal condomless sex associated with HIV transmission. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool but is not widely used by racial/ethnic minority women. Effective interventions for engaging women with SUD in HIV prevention interventions that are culturally tailored and, therefore, more appealing to racial/ethnic minority women with SUD are critically needed. Objective: This study will assess the initial efficacy, feasibility, and acceptability of an integrated SUD treatment and PrEP services intervention to increase the uptake and adherence to PrEP among racial/ethnic minority cisgender women. Methods: A three-phased mixed methods research design will involve formative qualitative methods to design the intervention (Phase 1), theatre testing to adapt and refine the intervention (Phase 2), and randomized controlled trial (RCT) methods to pilot test the intervention for efficacy, feasibility, and acceptability (Phase 3). The pilot RCT will enroll and randomize 60 women to either the standard SUD treatment program or SUD treatment integrated with PrEP services. The integrated intervention will include four motivational counseling sessions guided by the Information-Motivation-Behavioral (IMB) Skills Model to increase the uptake of PrEP. A mobile health app will be used to engage participants with the intention of motivating PrEP initiation and supporting adherence to PrEP. Results: Findings from individual qualitative interviews informed the development of the integrated intervention. Study recruitment for the randomized pilot (Phase 3) launched in May 2024. Additional statistical analyses will be performed upon completion of the study. Conclusions: This addiction-clinic based behavioral intervention aims to increase PrEP uptake and adherence among racial/ethnic minority cisgender women who engage in sexual and substance use behaviors associated with increased susceptibility to HIV transmission. The integrated intervention has the potential to reduce HIV-related disparities among Black and Hispanic/Latina cisgender women with SUD. Findings from this study will provide a foundation for future HIV prevention interventions for racial/ethnic minority cisgender women with SUD. Clinical Trial: This study is registered on ClinicalTrials.gov (NCT06158607).
You may have come across the term “personalized medicine” before, but what is it? Genetic testing has become commonplace for investigating ancestry and disease risk. There are a myriad of genetic...
You may have come across the term “personalized medicine” before, but what is it? Genetic testing has become commonplace for investigating ancestry and disease risk. There are a myriad of genetic tests available for sale online claiming to offer meal plans and exercise routines tailored to your genetic code. After all, what could be more personalized than DNA? As health information has become more accessible online, another question arises: what information is reliable and what is not? This open educational resource explores 6 questions that can be used by anyone to evaluate the trustworthiness of online health information: Who runs the website? What is the website about? Where are the sources of health information? When was the website last updated? Why was the website made? How is the website funded? Asking these questions is key for the public and medical professionals alike.
Background: Neurological development in children aged 3-11 is highly sensitive and variable. Critical skills for daily and professional
life depend on the development of executive functions, and diff...
Background: Neurological development in children aged 3-11 is highly sensitive and variable. Critical skills for daily and professional
life depend on the development of executive functions, and difficulties in this process can manifest as learning disorders
such as ADHD, Dyslexia, and Dysgraphia, affecting 5-10% of children worldwide. Early screening is crucial to ensure
timely intervention and enhance the quality of life for affected individuals. However, challenges include high costs,
lengthy wait times, and logistical barriers, leading to underdiagnosis and delayed intervention. Objective: To systematically review technological solutions for early screening and improve diagnosis and intervention strategies
for neurodevelopmental disorders in children Methods: Relevant studies were selected using specific inclusion and exclusion criteria to assess the effectiveness of various
technologies and methodologies. Technologies evaluated included gamified eye-tracking tests and machine learning
algorithms. The review employed quality appraisal tools such as the MMAT table and PRISMA flow chart to synthesize
findings from the included studies. Results: The review highlights the efficacy of technologies such as gamified eye-tracking tests and machine learning algorithms
in screening for learning disorders. Despite promising results documented in the literature, there is a significant gap in
translating these technologies into clinical practice. Current practices rely heavily on paper-based tests, which are
inefficient for continuous monitoring and vary widely across regions. No specific sample sizes, response rates, P values,
or Confidence Intervals were detailed in the abstract. Conclusions: Integrating advanced technologies into clinical settings could significantly enhance early diagnosis and intervention for
learning disorders. This aligns with the UK NHS Long Term Plan, advocating for digital and personalized healthcare
solutions to improve access to services, enhance patient experiences, support clinical decision-making, and optimize care
delivery. Future research should focus on bridging the gap between technological advancements and clinical application. Clinical Trial: Not applicable (No RCTs involved).
Background: Emerging evidence supports that women with histories of abuse have heightened levels of stress and immune dysregulation. Few studies have examined the biological plausibility of this assoc...
Background: Emerging evidence supports that women with histories of abuse have heightened levels of stress and immune dysregulation. Few studies have examined the biological plausibility of this association in U.S. Black women– a population disproportionately affected by gender-based violence, health disparities, and generally under-represented in research. Biomarkers of stress and immune health can be difficult to study due to issues in participant recruitment, retention, and protocol adherence. This study documents the process of an at-home, self-collected and minimally invasive salivary cortisol collection protocol among a sample of Black women with histories of abuse in Baltimore City, Maryland, U.S. Objective: The paper's aims are two-fold. First, we describe the at-home, self-collection protocol that we developed for use among a large sample of under-represented racial and ethnic minority women with histories of abuse. Secondly, we share the best practices for our experimental, minimally invasive salivary CAR self-collection procedure that spanned three consecutive days for the ESSENCE project participants. Our paper addresses several issues and gaps in salivary CAR research, including the following: study sample sizes have been limited and lack statistical power, study samples have lacked racial and ethnic diversity, factors that could improve saliva self-collection protocol adherence are unknown, use of phone technology in facilitating protocol adherence is unknown, the feasibility and acceptability of saliva self-collection protocol among vulnerable populations (including women with experiences of violence) and the supports needed for protocol adherence is unknown. The establishment of this protocol and the markers gathered are foundational to understanding the effect of violence and toxic stress on women’s health. Methods: Black women (n=310) were recruited from November 2015 to May 2018 from Baltimore City STD clinics. Participants received in-person instruction and demonstration of how to self-collect saliva samples at home via the passive drool method and were given study-issued cell phones for reminders and to document protocol adherence. At home, participants collected saliva samples upon waking and 30 minutes post-waking on three consecutive weekdays (cortisol awakening response – 2 samples/day for 3 days). Study staff then retrieved saliva samples from participants’ residences, administered a short survey assessing their understanding and adherence to the saliva collection protocol, and documented the retrieval process. Results: Overall, the results report on our saliva collection protocol results, and demonstrate the feasibility of saliva cortisol awakening response among Black women with histories of abuse. Of the 305 women who completed the survey, 224 completed the saliva specimen collection protocol. Of the women who completed the saliva specimen collection protocol, 92 (41%) had a history of forced sex since age 18 (exposed women) and 132 (59%) had no history of forced sex in adulthood (non-exposed women). Women who completed the saliva protocol were similar in demographic characteristics to those of the full study sample (n=305) in terms of age, level of education, employment status, annual individual income, currently in a relationship, and having at least one child living in the household. The high adherence rate and successful collection of salivary cortisol samples support the feasibility of at-home self-collection protocols in this population. Conclusions: This study demonstrates the feasibility and acceptability of self-collection of salivary cortisol for cortisol awakening response among a hard-to-reach sample of U.S. Black women with experiences of trauma and abuse. Research implications include the facilitation of the collection of salivary biomarkers (including stress and inflammation measures) to promote research that examines the physiological and health repercussions of gender-based violence within the context of women’s everyday lives. Clinical Trial: N/A
Background: Generative artificial intelligence (AI), particularly in the form of large language models (LLMs), has rapidly developed. The LLM by Meta AI (LLaMA) series are popular and recently updated...
Background: Generative artificial intelligence (AI), particularly in the form of large language models (LLMs), has rapidly developed. The LLM by Meta AI (LLaMA) series are popular and recently updated from LLaMA2 to LLaMA3. However, impacts of the update in diagnostic performance have not been well documented. Objective: We conducted a comparative evaluation of the diagnostic performance in differential diagnosis lists generated by LLaMA3 and LLaMA2 for case reports. Methods: We analyzed case reports published in the American Journal of Case Reports from 2022 to 2023. After excluding non-diagnostic and pediatric cases, we input the remaining cases into LLaMA3 and LLaMA2 using the same prompt and the same adjustable parameters. Diagnostic performance was defined by whether the differential diagnosis lists included the final diagnosis. Multiple physicians independently evaluated whether the final diagnosis was included in the top 10 differentials generated by LLaMA3 and LLaMA2. Results: In our comparative evaluation of the diagnostic performance between LLaMA3 and LLaMA2, we analyzed differential diagnosis lists for 392 case reports. The final diagnosis was included in the top 10 differentials generated by LLaMA3 in 79.6% (312/392) of the cases, compared to 49.7% (195/392) for LLaMA2, indicating a statistically significant improvement (P <.001). Additionally, LLaMA3 showed higher performance in including the final diagnosis in the top 5 differentials, observed in 63.0% (247/392) of cases, compared to LLaMA2’s 38.0% (149/392, P <.001). Furthermore, the top diagnosis was accurately identified by LLaMA3 in 33.9% (133/392) of cases, significantly higher than the 22.7% (89/392) achieved by LLaMA2 (P <.001). The analysis across various medical specialties revealed variations in diagnostic performance with LLaMA3 consistently outperforming LLaMA2. Conclusions: The results reveal that the LLaMA3 model significantly outperforms LLaMA2 in terms of diagnostic performance, with a higher percentage of case reports having the final diagnosis listed within the top 10, top 5, and as the top diagnosis. Overall dDiagnostic performance improved almost 1.5 times from LLaMA2 to LLaMA3. These findings support the rapid development and continuous refinement of generative AI systems to enhance diagnostic processes in medicine. However, these findings should be carefully interpreted for clinical application, as generative AI, including the LLaMA series, has not been approved for medical applications such as AI-enhanced diagnostics. Clinical Trial: Not applicable
Background: Older adults with cognitive deficits face difficulties recalling daily obstacles and lack self-awareness, amplifying the challenges for homecare clinicians to obtain reliable information o...
Background: Older adults with cognitive deficits face difficulties recalling daily obstacles and lack self-awareness, amplifying the challenges for homecare clinicians to obtain reliable information on functional decline and homecare needs. The result may be suboptimal service delivery. Telemonitoring of ADL has emerged as a tool to optimize ADL homecare needs evaluation. Utilizing ambient sensors, telemonitoring of ADL gathers information about an individual's ADL behaviors within the home, such as preparing meals and sleeping. However, there is a significant gap in the comprehension of how ADL telemonitoring data can be integrated into clinical reasoning to better target homecare services. Objective: The current paper aimed to describe 1) how ADL telemonitoring data is used by clinicians in the process of maintaining care recipients with cognitive deficits at home as well as 2) the impact of ADL telemonitoring on homecare service delivery. Methods: We used an embedded mixed-methods multiple-case study design in which our cases of interest were three health institutions located in the greater Montreal region and offering public homecare services. An ADL telemonitoring system, named NEARS-SAPA, was deployed within those three health institutions for 4 years. Within each case were embedded sub-cases (care recipient, informal caregiver, clinician(s)). For the objectives of the present paper, we used the data collected during 45-60 min interviews with clinicians only. Quantitative metadata were also collected on each service provided to care recipients before and after the implementation of NEARS-SAPA to triangulate the qualitative data. Results: We analyzed 27 sub-cases, comprising 23 clinicians, that completed a total of 57 post-implementation interviews concerning 147 telemonitoring reports. Data analysis showed a 4-step decision-making process used by clinicians 1) Extraction of relevant telemonitoring data, 2) Comparison of telemonitoring data with other sources of information, 3) Risk assessment of the care recipient’s ADL performance and ability to remain at home, and 4) Maintenance or modification of the intervention plan. Quantitative data reporting the number of services received allowed to triangulate qualitative data pertaining to step 4. Overall, the results suggest a stabilization in monthly services following the introduction of the ADL telemonitoring system, particularly in cases where services were increasing prior to its implementation. This is consistent with qualitative data indicating that, in light of the telemonitoring data, most HSCP decided to maintain the current intervention plan rather than increasing or reducing services. Conclusions: Results suggest that ADL telemonitoring contributed to service optimization on a case-to-case basis. ADL telemonitoring may have an important role in reassuring clinicians about their risk management and the appropriateness of services delivery, especially when questions remain as to the relevance of services. Future studies may further explore the benefits of ADL telemonitoring for public healthcare systems with larger-scale implementation studies.
Background: Almost a third of Australian adults are living with obesity, yet most cannot access medical nutrition therapy from dietitians i.e., the health professionals trained in dietary weight manag...
Background: Almost a third of Australian adults are living with obesity, yet most cannot access medical nutrition therapy from dietitians i.e., the health professionals trained in dietary weight management services. Across the health system, primary care doctors readily identify people who may benefit from weight management services but there are limited referral options in the community. Dietitians are trained to provide evidence informed dietary treatment of overweight and obesity but are underutilized and under-resourced. The chat2 (Connecting Health and Technology 2) trial will test combining new technologies for dietary assessment with behavior change techniques to improve outcomes for people living with obesity. Objective: To compare the effectiveness of a one-year digital dietary intervention with standard care on body weight reduction and improved diet quality, in adults living with obesity delivered by dietitians in a primary care setting. Methods: This randomized controlled trial (RCT) will compare a 1-year digital tailored feedback dietary intervention with a control group in 430 adults living with obesity (body mass index (BMI) ≥30 to ≤ 45 kg/m2). The primary outcomes measured at a baseline, six and 12 months, are changes in body weight and diet quality score (DQS). A four-day image-based dietary assessment tool (mobile Food Record; mFR) will be used to measure DQS. Secondary outcomes include dual-energy absorptiometry (DXA) body composition, total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glycated hemoglobin (HbA1c) and fasting glucose. The intervention group will receive eight video counselling sessions with a trained dietitian delivered over 12 months to support dietary behavior change and relapse prevention. Both groups will receive feedback on their clinical chemistry and DXA scans at each timepoint. Results: Participant recruitment commenced in July 2023 and will end in August 2024. Data analysis will commence in 2025, with the anticipated publication of results in 2026. Conclusions: If found to be effective, the results of this RCT will support the delivery of effective evidence-based weight management advice using new technologies. By improving community access to high quality dietetic services, it will ensure more effective utilization of the dietetic workforce to improve outcomes for people living with obesity. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12622000803796.
Background: The increasing use of direct-to-consumer AI-enabled mHealth (AI-mHealth) applications presents an opportunity for more effective health management and monitoring and expanded mHealth capab...
Background: The increasing use of direct-to-consumer AI-enabled mHealth (AI-mHealth) applications presents an opportunity for more effective health management and monitoring and expanded mHealth capabilities. However, AI’s early developmental stage has prompted ethical concerns related to privacy, informed consent, and bias, among others. While some of these concerns have been explored in early stakeholder research related to AI-mHealth, the limited literature suggests that the broader landscape of considerations that hold ethical significance to users may remain underexplored. Objective: Our aim was to document and explore the ethical perspectives of users of mHealth regarding AI-mHealth applications. Methods: We conducted semi-structured interviews with users of mHealth applications (N=21) and employed a qualitative descriptive design to document and describe their ethical perspectives. Results: Through qualitative analysis, three major categories and nine subcategories describing users’ perspectives were identified. Users described attitudes toward the impact of AI-mHealth on their health and data (i.e., influences on health awareness and management, value for mental versus physical health, and the inevitability of data sharing); influences on their trust in AI-mHealth (i.e., expert recommendations, attitudes toward technology companies, and AI explainability); and their preferences relating to information sharing in AI-mHealth (i.e., the type of data that is collected, future uses of their data, and the accessibility of information). Conclusions: This paper provides additional context relating to a number of ethical concerns previously posited or identified in the AI-mHealth literature, including trust, explainability, and information sharing, and revealed additional considerations that have not been previously documented, i.e., users’ differentiation between the value of AI-mHealth for physical and mental health use cases, and their willingness to extend empathy to non-explainable AI. To our best knowledge, this study is the first to apply an open-ended, qualitative descriptive approach to explore the perspectives of end users of direct-to-consumer AI-mHealth applications. Clinical Trial: This study addressed a supplemental aim to an ongoing study about the ethics of AI use in medicine (NCATS R01-TR-003505). This study obtained human subjects research approval from the Institutional Review Board of Stanford University on June 21, 2022 (#58118).
Background: Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological interventions and non-pharmacologic...
Background: Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological interventions and non-pharmacological interventions are used to reduce children’s anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. As a consequence, many different approaches exist. Objective: To increase understanding of the current anxiety management practices, we conducted a public survey via social media platforms, aiming to compare anesthesia providers from an “expert” group and a “social media” group in terms of pediatric anesthesia expertise and to identify differences in preoperative anxiety management between the two groups. Methods: Two surveys were conducted: The first survey targeted attendees of the Scientific Working Group on Pediatric Anesthesia in June 2023 forming the ‘Expert Group’ (EG), and the second survey targeted followers of a pediatric anesthesia platform on social media forming the ‘Social Media Group’ (SG). Both surveys with 24 items were conducted using the same online platform. Questions were grouped into five categories: Pediatric Anesthesia Expertise, Representativity, Structural Conditions, Practices of Pharmacological Management and Practices in Non-Pharmacological Management. The primary objective was to assess the pediatric anesthesia expertise of the SG compared to the EG. Secondary objectives were the differences in the clustered categories with regards to preoperative anxiety management. Results: The study included 198 respondents, with 194 analyzed after excluding 4 due to prior participation or missing data (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs. 10 years, p<0.001), higher specialist status (97.6% vs. 64.6%, p<0.001), and a greater pediatric anesthesia volume (43.9% vs. 12.0% with more than 500 cases per year, p<0.001). Regarding the representativity, two items out of four were statistically significant (level of care of institution, annual case load of institution). Regarding the overall anxiety management practices used, there is a heterogeneous response pattern within both groups, with only five out of 17 items showing statistical significance (feasibility of parental presence during induction, known anxiety measurement tools, induction-based prescription of drugs, minimum age and use of non-pharmacological interventions). Conclusions: Although the respondents do not reflect the level of expertise as a survey of a scientific working group, social media surveys on pediatric anesthesia may be feasible to get an overview of a specific topic when there is great heterogeneity overall. In our case, both cohorts showed little difference in the management of preoperative anxiety in daily practice with very heterogeneous approaches. Evidence-based recommendations could help to standardize preoperative anxiety management and improve anxiety levels in children. Clinical Trial: not necessary
Background: People with disabilities are a priority population for health services research. People who are blind/low vision (B/LV) are a segment of this priority population, who experience difficulty...
Background: People with disabilities are a priority population for health services research. People who are blind/low vision (B/LV) are a segment of this priority population, who experience difficulty to accessing healthcare facilities due to architectural and navigational barriers. These barriers persist despite disability civil rights law in the U.S. Objective: The purpose of this manuscript is to report on a program that was developed to train way finders in human guide technique for people who are B/LV. Methods: This study took place at Michigan Medicine, an academic medical center in southeast Michigan. We conducted a needs assessment through cohort discovery and soliciting expert feedback. The human guide training program was developed using the PRECEDE-PROEED health promotion program development model, and targeted healthcare volunteers and staff. The intended components included in-person training, an online module, and tip sheets. Due to COVID-19, the in-person training was not implemented. We report findings from a process evaluation, measuring reach, knowledge, behavioral capability, and satisfaction pre- and post-program. Results: 87 participants completed the training, most of them were Michigan Medicine volunteers. There were significant improves in behavioral capability related to human guide technique. Participants were satisfied with the training, and provided recommendations for more detailed demonstrations and scenarios in future training sessions. Conclusions: The training improve participants’ knowledge and confidence in providing wayfinding assistance to patients who are B/LV. However, further in-person training is recommended to provide hands-on experience and detailed feedback. Addressing architectural barriers and providing accessible patient education materials is crucial for improving healthcare accessibility for patients who are B/LV.
Background: Artificial intelligence (AI) is revolutionizing various sectors, including healthcare, by enhancing administration, diagnostics, treatment planning, medical education, and more. However, i...
Background: Artificial intelligence (AI) is revolutionizing various sectors, including healthcare, by enhancing administration, diagnostics, treatment planning, medical education, and more. However, its adoption in developing countries like Nigeria is limited. This study investigates the knowledge and attitude of medical students at the University of Ilorin towards AI in medicine. Objective: 1. To assess the knowledge level of artificial intelligence among medical students and doctors
2. To determine the attitude of medical students and doctors to artificial intelligence
3. To assess the perception of respondents on their willingness to apply AI in the near future. Methods: A cross-sectional study was conducted at the University of Ilorin and its teaching hospital, involving 343 medical students. Data were collected using a self-administered questionnaire distributed via social media and class representatives. The questionnaire assessed demographics, knowledge, and attitudes towards AI. Descriptive statistics and chi-square tests were used to analyze the data, with significance set at p < 0.05. Results: The majority (98.8%) of students had heard of AI, but only 76.4% could define it. Most (90.4%) learned about AI through media, and a small percentage (24.1%) from university lectures. Only 9.3% had received AI training. While 63% believed AI would play an important role in healthcare, 63.9% felt it would not render doctors expendable. Almost half (46.3%) felt AI would influence their specialty choice. A significant portion (87.1%) supported including AI in medical education, though 84% acknowledged it would pose new ethical challenges. Gender significantly influenced knowledge of AI (p < 0.05), but level of training did not. Conclusions: Despite limited formal education on AI, medical students at the University of Ilorin exhibit a positive attitude towards its integration into healthcare and education. There is a strong interest in learning more about AI, highlighting the need for its inclusion in the medical curriculum to prepare future doctors for technological advancements in healthcare.
Background: Cancer prevention holds significant importance in modern healthcare. Artificial intelligence (AI) chatbots have simplified public queries on cancer prevention and increased the effectivene...
Background: Cancer prevention holds significant importance in modern healthcare. Artificial intelligence (AI) chatbots have simplified public queries on cancer prevention and increased the effectiveness of prevention strategies. However, further assessment is essential to determine the accuracy and professionalism of the responses provided by these chatbots. Objective: We aimed to investigate the accuracy and consistency of ChatGPT and NewBing in providing cancer prevention advice, and to establish an evaluation framework to support the enhancement of cancer prevention strategies. Methods: We followed guidelines from the American Cancer Society and the National Comprehensive Cancer Network to develop 25 questions after consultations with oncologists. These questions cover four modules on cancer lesions, screening, prevention, and risk. ChatGPT 3.5 and NewBing were utilized for generating responses, with questions reiterated to evaluate model answer stability and reliability. 28 specialists from diverse regions rated the model answers on a 1-5 scale based on clinical experience and guidelines. The scores were statistically analyzed by Excel and SPSS to evaluate their accuracy and consistency with the medical community's consensus. Results: In the four modules, the median total scores for ChatGPT and NewBing were 73 and 71.5 (p > 0.05), respectively. For specific questions such as "What is a nodule?" and “What are the early symptoms of cancer in the body?” in the "cancer lesion-related" module, and certain questions in the "cancer screening" and "cancer risk" modules, ChatGPT scores higher than NewBing (p < 0.05). Subgroup analyses were conducted between clinicians' and non-clinicians' scores (p < 0.05). Conclusions: Both ChatGPT and NewBing exhibited high accuracy and stability when offering cancer prevention advice, showcasing proficiency in handling intricate medical data. Overall, ChatGPT outperformed NewBing, especially on several specific areas. As AI advances, its role in personalized health services will become more significant. It is essential to consistently enhance model performance, guarantee response accuracy, and address ethical concerns.
Background: Compelling evidence shows screening detects colorectal cancer (CRC) at earlier stages and prevents the development of CRC through removal of pre-cancerous polyps. For average risk patients...
Background: Compelling evidence shows screening detects colorectal cancer (CRC) at earlier stages and prevents the development of CRC through removal of pre-cancerous polyps. For average risk patients, there are three commonly used screening tests used in the United States—two types of stool tests collected at home (FIT/FOBT and FIT-DNA) and colonoscopy completed at procedural centers. Objective: This study’s purpose is to examine variation by month for the three types of CRC testing to evaluate consistent patient care by clinical staff. Methods: Data from 31 federally qualified health center (FQHC) clinics in Missouri from 2011-2023 were analyzed. A sample of 37,994 unique eligible patients were identified. Simple statistics characterize the sample, while bivariate analyses assess differences in screening types by month. Results: In the post COVID-19 era, from 2021 to 2023, colonoscopy testing remained stable with about one third of patients (38%) completing this test. Whereas FIT-DNA increased (16% to 26%) and FIT/FOBT decreased (46% to 35%). Completion of CRC screening yielded statistically significant differences for patients completing the different types of CRC screening by month. For patients who received a colonoscopy (n=7,850), October – January were the highest months for screening, while February-April was the lowest. For FIT/FOBT (n=6,818), March-August was higher whereas December-February were the lowest screening months. For FIT-DNA (n=2,663), March was the most popular month followed by April, May and November, with January the lowest month of testing. Conclusions: Home-based tests are more popular than the gold standard, colonoscopy. However, variation of screening over the course of a year suggests under-utilized CRC screening efforts and therefore less than ideal patient care. Months with lower rates of screening for each type of CRC test represent opportunities for improving CRC screening.
Background: The United States population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of heal...
Background: The United States population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care. Objective: The aim of this pilot study was to assess the feasibility of the cinematic virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program. Methods: We conducted a single arm, pre-test and post-test pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in one of four cine-VR trainings. Participants completed three surveys before and after the cine-VR training. We performed paired t-tests to examine changes in these constructs before and after the training. Results: A total of 65 health professional students participated in and completed the full cine-VR training for 100% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Of the 65 participants, 48 completed the pre- and post-assessments. We observed an increase in awareness of discrimination towards people with disability (t.05,47= -3.967, P<.001). Additionally, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t.05,47= -3.364, P=.002). Lastly, we observed an increase in participants’ empathy (t.05,47= -2.329, P=.024). Conclusions: We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research utilizing a randomized control trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training. Clinical Trial: Not applicable
Background: Experimentation is a cornerstone of chemistry education, serving as the bridge between theoretical concepts and practical understanding. However, conducting experiments in real laborato...
Background: Experimentation is a cornerstone of chemistry education, serving as the bridge between theoretical concepts and practical understanding. However, conducting experiments in real laboratory requires reagents and instruments, which can be challenging to access consistently. Virtual technologies provide valuable alternative which provides simulate real-world chemical experiments using computer software. Objective: This study aimed to investigate the effect of virtual laboratories on undergraduate students' academic achievement in practical chemistry, addressing issues in conventional university labs. Methods: A quasi-experimental design with a quantitative approach was used. The study included a purposive sample of 60 Bachelor of Science chemistry students. Teaching methods included real laboratories, virtual laboratory simulations, and lecture-only. Data were analyzed using descriptive and inferential statistics, including mean, standard deviation, one-way analysis of variance (ANNOVA), Tukey's honest significance test as well as independent sample test, and a p-value of .05 determined as the level of significance. Results: The findings showed no significant differences in achievement among the groups before the intervention (P=0.995). After the intervention, significant differences were observed (P=0.000) in one-way ANOVA analysis, with the real lab group having the highest mean score. However, the Pairwise comparisons revealed no statistically significant difference between the real and virtual lab groups (P=0.109), but the virtual lab group significantly outperformed the lecture-only group (P=0.001). Gender did not influence achievement in the virtual lab group Conclusions: These results suggest that universities should prioritize virtual labs for practical courses due to their effectiveness in enhancing student achievement and providing a viable alternative when real labs are unavailable.
Background: Evolving societal trends mean that fathers are having an increasing influence on the health-related behaviours that children develop. Research shows that most fathers are committed to thei...
Background: Evolving societal trends mean that fathers are having an increasing influence on the health-related behaviours that children develop. Research shows that most fathers are committed to their role and when equipped with knowledge, can have a positive impact on their child’s health. However, parenting resources typically target mothers, with fathers invariably excluded. While evolving mobile phone technology provides an efficient means for delivering parenting resources, many fathers find mHealth technology does not provide material they can engage with. Objective: The aim of this study is to explore how to make parenting apps more engaging and useful for fathers using an existing parenting mHealth resource; the My Baby Now app (MBN), as a case study. Methods: Fourteen, purposefully selected, Australian fathers of 7 months to 5-year-old children took part in a qualitative study, comprising either focus groups or interviews. Recorded focus groups/ interviews were transcribed verbatim, then coded and analysed for themes using thematic analysis. Results: Current parenting apps, including MBN, provide parenting information that can be unappealing for fathers. For fathers to engage in mHealth resources, the information needs to be father specific, there should be positive imagery and descriptives of fathers in their parenting role, there should be father exclusive domains such as forums, and there should also be push notifications/ messages to support fathers in times where they may be under stress. Conclusions: Smartphone technology has the capacity to deliver father-specific information when needed. This reduces the risks of fathers becoming frustrated and disengaged from parenting. Future research will be benefited by understanding possible differences in mHealth app usage by fathers of differing SEP, cultural backgrounds and family status, such as single fathers and same sex couples.
Background: Musculoskeletal disorders are the leading cause of disability in people, and managing them can be challenging. Virtual reality (VR) technology has been recognized as a promising simulation...
Background: Musculoskeletal disorders are the leading cause of disability in people, and managing them can be challenging. Virtual reality (VR) technology has been recognized as a promising simulation tool in the field of medicine and rehabilitation, and is an important part of the rehabilitation care of patients in the field of orthopedics. The efficacy of VR interventions for musculoskeletal disorders remains to be determined. Objective: To analyze the impact of the virtual reality on musculoskeletal diseases rehabilitation and assess the consistency of evidence from existing systematic reviews and meta-analyses. Methods: The PubMed/Medline, Embase, and Cochrane Library databases were searched for relevant articles published up to April 2024. Literature screening, quality evaluation, and data extraction were performed based on predefined inclusion and exclusion criteria. The Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 was used to evaluate the methodological quality of the included meta-analyses. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to rate the evidence level for each outcome as high, moderate, low, or very low. Furthermore, the ratings were classified into four categories based on the evidence classification criteria: I (convincing); II (highly suggestive); III (suggestive); IV (weak); and non-significant. Results: Results from 15 meta-analyses were synthesized. Seven meta-analyses had high, eight had moderate, and the remaining had low AMSTAR 2 ratings. Virtual reality (VR) shows promising results in musculoskeletal rehabilitation, significantly reducing knee pain (MD=-1.38, 95%CI: -2.32, -0.44, P=.004, I²=94%) and enhancing balance. In Fibromyalgia Syndrome, VR effectively decreases pain (SMD=-0.45, 95%CI: -0.70, -0.20, P<.01), fatigue (SMD=-0.58, 95%CI: -1.01, -0.14, P=.01), anxiety (SMD=0.50, 95%CI: -0.908, -0.029, P=.04), and depression (SMD=0.02, 95%CI: -0.76, -0.15, P=.003), also improving life quality. For back pain sufferers, VR lessens pain-related fears (MD=-5.46, 95%CI: -9.40, -1.52, P=.007, I²=90%) and pain itself (MD=-1.43, 95%CI: -1.86, -1.00, P<.01, I²=95%). Post-arthroplasty, it positively impacts knee functionality (MD=8.30, 95%CI: 6.92, 9.67, P<.01, I²=24%) and lowers anxiety (MD=-3.95, 95%CI: -7.76, -0.13, P=.04, I²=0%). Conclusions: Virtual reality has shown potential value in rehabilitating various musculoskeletal conditions. It can reduce pain, improve psychological state, and promote patient motor function recovery.
Background: Emotion regulation problems are a common contributor for delinquent behavior in adolescence. These adolescents show difficulties in recognizing, comprehending and controlling emotions, whi...
Background: Emotion regulation problems are a common contributor for delinquent behavior in adolescence. These adolescents show difficulties in recognizing, comprehending and controlling emotions, which impedes the effectiveness of current forensic treatments. In addition, forensic care often faces challenges regarding treatment engagement due to a lack of motivation and difficulties building an alliance between clients and caregivers. The use of Feelee, an app that collects and displays active and passive data, is promising to support adolescents in obtaining more insight in their emotion regulation abilities. Furthermore, the integration of smartphone applications, like Feelee, offers new perspectives to increase adolescents’ engagement and adherence in treatment. Objective: This study aims to describe the research protocol to evaluate the initial effects of the Feelee app in enhancing emotion regulation skills among adolescents in the forensic outpatient setting. The Feelee app, the addition of Feelee to treatment as usual (TAU), as well as the study design, a repeated Single Case Experimental Design (SCED), are discussed in detail. Methods: A repeated ABA-design will be applied to examine the initial effectiveness of Feelee. Both quantitative and qualitive methods will be used. In total 24 participants will be recruited from different forensic outpatient care centers. Participants will follow a 2-week baseline (phase A1), 4-week intervention (phase B) and a 2-week follow-up (phase A2) in which daily measurement on emotion regulation will be conducted. Results: Data-collection has started in June 2023 and is planned to be completed in December 2024. Study results will be published in peer-reviewed journals and presented at national and international conferences. Conclusions: This study aims to evaluate the effectiveness of the Feelee app in enhancing emotion regulation skills. By using a repeated ABA-design, we will get a first insight about the addition of Feelee to TAU in the forensic outpatient setting. Study strengths include the low-threshold addition, ecological validity and the use of both quantitively and qualitative research methods. Further implications for clinical practice are discussed. Clinical Trial: Central Committee on Research Involving Human Subjects NL78889.029.21, Internation Registration for Clinical Trials: ClinicalTrials.gov NCT06509360
Social media is an integral part of adolescent’s daily lives, but the significant time adolescents invest in social media has raised concern about the effect on their mental health. Bans on social m...
Social media is an integral part of adolescent’s daily lives, but the significant time adolescents invest in social media has raised concern about the effect on their mental health. Bans on social media use are quickly emerging as an attempt to regulate social media use, however evidence supporting their effectiveness is limited, and adolescents experience several benefits from social media. Rather than enforcing bans, emotion regulation should be leveraged to help adolescents navigate the online social environment. This viewpoint paper proposes a nuanced approach towards regulating adolescent social media use by 1) discontinuing the use of ineffective bans, 2) recognizing the benefits social media use can have, and 3) fostering emotion regulation skills in adolescents to encourage the development of self-regulation.
This study investigates the most frequently asked questions regarding systemic treatments for psoriasis vulgaris using Google Trends and People Also Asked (PAA) tools, focusing on traditional DMARDs,...
This study investigates the most frequently asked questions regarding systemic treatments for psoriasis vulgaris using Google Trends and People Also Asked (PAA) tools, focusing on traditional DMARDs, biologics, and small-molecule inhibitors. Analyzing data from January 31, 2019, to January 31, 2024, Adalimumab was found to have the highest search volume, followed by Apremilast and Methotrexate in their respective categories. Based on Rothwell’s Question Classification Criteria, questions about Adalimumab predominantly centered around their technical, factual details and cost of the medication. The study highlights significant public interest in these factors over their safety profile and it is likely influenced by Adalimumab’s high direct-to-consumer marketing. Moreover, evaluation of 782 websites showed that potential patients were seeking commercial and government-based websites to learn more about systemic psoriasis treatment. According to the JAMA benchmark criteria, these source types also scored the highest in terms of information quality, while medical practice websites scored the lowest. The findings suggest the need for dermatologists to address factual details such as medication administration scheduling, dietary restrictions, and cost during patient consultations, and to guide patients towards high-quality online resources. Limitations include potential comprehensiveness of questions and evolving medication concerns.
Background: Hypertension is the single most significant modifiable risk factor for all-cause morbidity and mortality worldwide.Lifestylechanges are the cornerstone of prevention and treatment of hyper...
Background: Hypertension is the single most significant modifiable risk factor for all-cause morbidity and mortality worldwide.Lifestylechanges are the cornerstone of prevention and treatment of hypertension，Traditional lifestyle intervention depends on the hospital visit follow-up, patients with poor execution and poor compliance.However, the therapeutic effect of LIAN digital therapy with Internet technology in patients with mild hypertension is not yet established. Objective: We aim to evaluate the therapeutic efficacy of LIAN digital therapeutics in patients with new-onset mild hypertension who did not receive antihypertensive medication. Methods: This randomized controlled clinical trial included 1525 individuals with new-onset mild hypertension who were admitted to our Health Management Medicine Center between January 2022 and March 2023. They were randomly assigned 1:1 to the digital therapeutics group (n=756) or the control group (n = 769). The primary efficacy endpoint was the mean change in office blood pressure (BP) from baseline to 12 weeks. The key secondary efficacy endpoints were the mean changes in lipoprotein indices and lifestyle factors from baseline to 12 weeks. Results: The mean office BP decreased from 142.03 (SD 8.05)/90.39 (SD 5.69) to 136.19 (SD 10.60)/85.44 (SD 7.62) mmHg in the digital therapeutics group and from 141.91 (SD 7.25)/90.28 (SD 5.57) to 139.78 (SD12.33)/89.00 (SD 8.84) mmHg in the control group, with a mean difference in systolic BP and diastolic BP of –5.85 mmHg (95% CI –6.64 to –5.05 mmHg; P<0.001) and –4.95 mmHg (95% CI –5.50 to –4.40 mmHg; P<0.001), respectively. From baseline to 12 weeks, office BP control (<140/90 mmHg) was achieved in 423 (56.0%) patients in the digital therapeutics group and 308 (40.1%) patients in the control group (P<0.001). At 12 weeks, no group differences existed in high-density lipoprotein cholesterol (P=0.082), total cholesterol (P=0.055) or low-density lipoprotein (P=0.222) concentrations. However, changes in the total cholesterol/high-density lipoprotein cholesterol ratio and lifestyle factors were statistically significant (P<0.001). At 12 weeks, there were significant differences in lifestyle factors, including limiting oil consumption (P<0.001), limiting salt consumption (P<0.001), smoking status (P<0.001), drinking status (P<0.001), and exercise status (P<0.001), between the digital therapeutics group and the control group. Conclusions: Our study confirmed the superiority of digital therapeutics for improving BP and lifestyle factors in people with new-onset mild hypertension without antihypertensive medications.
Background: Over the last decade, the healthcare technology landscape has expanded significantly, introducing new and innovative solutions to address healthcare needs. The implications of cybersecurit...
Background: Over the last decade, the healthcare technology landscape has expanded significantly, introducing new and innovative solutions to address healthcare needs. The implications of cybersecurity incidents in the healthcare context extend beyond data breaches to potentially harming individuals' health and safety. Risk perception is influenced by various contextual factors, contributing to cybersecurity concerns that technological safeguards alone cannot address. Thus, it is imperative to study risk perceptions, contextual factors, and technological benefits to guide policy development, risk management, education, and implementation strategies. Objective: To investigate the differences in cybersecurity risk perception among various stakeholders in the healthcare sector in Norway and British Columbia (BC), Canada, and identify specific contextual factors that shape these perceptions. We expect to identify differences in risk perceptions for the explored healthcare technologies. Methods: Using a mixed-methods approach comprising surveys and interviews, we sampled healthcare-related wearable technology stakeholders, including healthcare workers, patients (adults and adolescents) and their families, health authorities and hospital staff (biomedical engineers, IT support, research), and device vendors/industry professionals in both Norway and BC.
Surveys explored information security scenarios based on the Behavioural Cognitive Internet Security Questionnaire (BCISQ), risk perception, and contextualizing variables. We analyzed both survey datasets to summarize participants’ characteristics and responses to questions related to the BCISQ (behaviour and attitude) and risk perception. Interviews were analyzed thematically using an inductive-deductive approach to explore risk perception and contextual factors. Results: Data from 274 survey respondents were available for analysis: 185 from Norway, including 139 (75%) females, and 89 from BC, including 57 (64%) females. Forty-five respondents (31 in Norway and 14 in BC) participated in interviews. The BCISQ showed minor differences between locations; respondents demonstrated generally low-risk behaviour and robust information security awareness. However, password simulation demonstrated discrepancies between self-assessed and “real” behaviour by sharing or willingness to share passwords. Perceived risk is generally considered low, yet consequences of cybersecurity risks were evaluated as major but unlikely. Risk perception was stronger for assisted living and diabetes technologies than for smartwatches. The most important contextual factors shaping risk perceptions are human factors encompassing knowledge, competence, familiarity, feelings of dread, perceived benefit, and trust, as well as the technological factor of device functionality. Organizational and technological factors had lesser effects. Conclusions: We found minimal differences in behaviour and risk perception among Norwegian and BC participants. Human factors and device functionality were most influential in shaping cybersecurity risk perceptions. Considering the rising need for assisted living technologies and wearables, insight into risk perceptions can strengthen risk management, awareness, and competence building. Further, it can address potential concerns amongst stakeholders to enable quicker technology adoption.
Background: Background: The emergence of generative artificial intelligence (GenAI) presents unprecedented opportunities to redefine conceptions of personhood and cognitive disability, potentially enh...
Background: Background: The emergence of generative artificial intelligence (GenAI) presents unprecedented opportunities to redefine conceptions of personhood and cognitive disability, potentially enhancing the inclusion and participation of individuals with cognitive disabilities in society. Objective: Objective: Explore the transformative potential of GenAI in reshaping perceptions of cognitive disability, dismantling societal barriers, and promoting social participation for individuals with cognitive disabilities. Methods: Method: Critical review of current literature in disability studies, artificial intelligence (AI) ethics, and computer science, integrating insights from disability theories and the philosophy of technology. The analysis focused on two key aspects: GenAI as a social mirror reflecting societal values and biases, and GenAI as a cognitive partner for individuals with cognitive disabilities. Results: Results: The article proposes a theoretical framework for understanding the impact of GenAI on perceptions of cognitive disability. It introduces the concepts of GenAI as a "social mirror" that reflects and potentially amplifies societal biases, and as a "cognitive co-pilot" providing personalized assistance in daily tasks, social interactions, and environmental navigation. The article also presents a novel protocol for developing AI systems tailored to the needs of individuals with cognitive disabilities, emphasizing user involvement, ethical considerations, and the need to address both the opportunities and challenges posed by GenAI. Conclusions: Conclusions: Although GenAI has great potential for promoting the inclusion and empowerment of individuals with cognitive disabilities, realizing this potential requires a change in societal attitudes and development practices. The article calls for interdisciplinary collaboration and close partnership with the disability community in the development and implementation of GenAI technologies.
Implications: Realizing the potential of GenAI for promoting the inclusion and empowerment of individuals with cognitive disabilities requires a multi-faceted approach. This involves a shift in societal attitudes, inclusive AI development practices that prioritize the needs and perspectives of the disability community, and ongoing interdisciplinary collaboration. The article emphasizes the importance of proceeding with caution, recognizing the ethical complexities and potential risks alongside the transformative possibilities of GenAI technology.
Background: Gamification refers to using game design elements in nongame contexts. Using gamification to promote physical activity is a novel and promising avenue for improving lifestyle and mitigatin...
Background: Gamification refers to using game design elements in nongame contexts. Using gamification to promote physical activity is a novel and promising avenue for improving lifestyle and mitigating the advancement of cardiovascular diseases. However, the literature provides mixed results regarding the effectiveness of gamification interventions for people with cardiovascular diseases. Objective: This systematic review and meta-analysis aim to evaluate the efficacy of gamification interventions in short-term and follow-up periods of physical activity in people with cardiovascular diseases and to explore the most effective game design elements. Methods: A comprehensive search was conducted across seven electronic databases for randomized controlled trials published in English from January 1st, 2010, to February 3rd, 2024. The studies were included when they used mobile health-based gamification interventions in people with cardiovascular diseases with control groups with or without gamification to promote physical activity or break a sedentary lifestyle and when they assessed relevant outcomes. Two independent reviewers screened the retrieved records for title, abstract, and full text, assessed the risk of bias, and extracted data. We conducted meta-analyses using a random-effects model approach. Sensitivity analysis and influence analysis were performed to examine the robustness of our results. All statistical analysis was performed using R Version 4.3.2. Results: A total of six randomized controlled trials were included. The meta-analysis of five studies revealed a small effect of gamification interventions on short-term physical activity (after sensitivity analysis: Hedges g = 0.32, 95% CI 0.19-0.45, 95% PI 0.02-0.62). The meta-analysis of four studies found the maintenance effect (measured with follow-up averaging 2.5 months after the end of the intervention) was small (Hedges g = 0.24, 95% CI 0.14-0.34, 95% PI -0.01-0.41). The meta-analysis of three studies with participants taking 696.96 more steps per day than the control group (95% CI 327.80-1066.12, 95% PI -121.39-1515.31). “Feedback” and “Avatar” are more important predictors. Conclusions: This meta-analysis provides evidence that gamification interventions effectively promote physical activity in people with cardiovascular disease. Importantly, this effect persists after intervention, indicating that this is not just a novel effect caused by the game nature of gamification. The 95% PI suggests that future implementation of gamification interventions in the same study population will lead to actual effects in promoting physical activity in the vast majority of cases. Clinical Trial: CRD42024518795 (PROSPERO).
Background: The use of extended reality (XR) technologies in healthcare can potentially address some of the significant resource and time constraints related to delivering training for healthcare prof...
Background: The use of extended reality (XR) technologies in healthcare can potentially address some of the significant resource and time constraints related to delivering training for healthcare professionals. While substantial progress in realising this potential has been made across several domains including surgery, anatomy, and rehabilitation, the implementation of XR in mental health training, where nuanced humanistic interactions are central, has lagged. Objective: Given the growing societal and healthcare service need for trained mental health and care workers, coupled with the heterogeneity of exposure during training and the shortage of placement opportunities, we explored the feasibility and utility of a novel XR tool for mental health consultation training. Specifically, we set out to evaluate a training simulation created through a collaboration between software developers, clinicians and learning technologists, in which users interact with a virtual patient, ‘Stacey’, through a virtual reality or augmented reality head-mounted display. The tool was designed to provide trainee healthcare professionals with an immersive experience of a consultation with a patient presenting with perinatal mental health symptoms. Users verbally interacted with the patient, and a human instructor selected responses from a repository of pre-recorded voice-acted clips. Methods: In a Pilot Experiment, we confirmed the face validity and usability of this platform for perinatal and primary care training with subject-matter experts. In our follow-up experiment, we delivered personalised one-hour training sessions to 123 participants, comprising Mental Health Nursing trainees, General Practitioner Doctors in Training, and students in psychology and medicine. This phase involved a comprehensive evaluation focusing on usability, validity, and both cognitive and affective learning outcomes. Results: We found significant enhancements in learning metrics across all participant groups. Notably, there was a marked increase in understanding (p<.001) and motivation (p<.001), coupled with decreased anxiety related to mental health consultations (p<.001). There were also significant improvements to considerations towards careers in perinatal mental health (p<.001). Conclusions: These findings show, for the first time, that XR can be used to provide an effective, standardised, and reproducible tool for trainees to develop their mental health consultation skills. We suggest that XR could provide a solution to overcoming the current resource challenges associated with equipping current and future healthcare professionals, which are likely to be exacerbated by workforce expansion plans.
Background: The link between atrial fibrillation (AF) and stroke has gained attention due to AF's significant impact on stroke risk. Detecting AF, especially paroxysmal AF, presents challenges, highli...
Background: The link between atrial fibrillation (AF) and stroke has gained attention due to AF's significant impact on stroke risk. Detecting AF, especially paroxysmal AF, presents challenges, highlighting the necessity for continuous Holter monitoring. Objective: In our investigation, we utilized commercial data archives to examine AF prevalence and associated cardiac arrhythmias among stroke patients and controls. We also analyzed various factors, such as age, gender, symptoms, test duration, and duration post-stroke, to identify predictors of arrhythmias and enhance paroxysmal detection rates. Methods: We included 98 stroke patients and 98 controls for comparing AF prevalence within 72 hours post-stroke and analyzed 779 stroke patients within 4 days to 10 weeks post-stroke. Results: Our findings revealed a higher AF detection rate in stroke patients compared to controls, with AF being the most prevalent arrhythmia observed. Older age and symptom presence were associated with significant findings, particularly AF. Temporal analysis showed a negative correlation between AF and complete heart block occurrence over time, while ventricular tachycardia exhibited a positive correlation. Paroxysmal fibrillation detection rates were highest within the initial month, with the optimal duration of Holter monitoring being 10 days, underscoring the importance of extended monitoring for detecting paroxysmal atrial fibrillation. Conclusions: Detecting paroxysmal atrial fibrillation could influence stroke management. Furthermore, our study suggests the potential utility of commercial data in yielding comparable outcomes to research data.
Background: Congestive heart failure (CHF) is a common cause of hospital admissions. Medical records contain valuable information about CHF, but manual chart review is time-consuming. Claims databases...
Background: Congestive heart failure (CHF) is a common cause of hospital admissions. Medical records contain valuable information about CHF, but manual chart review is time-consuming. Claims databases (ICD codes) provide a scalable alternative but are less accurate. Automated analysis of medical records through natural language processing (NLP) enables more efficient adjudication but has not yet been validated across multiple sites. Objective: We seek to accurately classify patients in whether they have CHF based on structured and unstructured data from each patient including medication, ICD codes, and information extracted through NLP of notes left by providers by comparing effectiveness of several machine learning models. Methods: We developed a NLP model to identify CHF from medical records using Electronic Health Record (EHR) from two hospitals (Mass General Hospital and Beth Israel Deaconess Medical Center from 2010 to 2023), using 2800 clinical visit notes from 1821 patients. We trained and compared the performance of logistic regression, random forest, and RoBERTa models. We measured model performance using areas under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC). These models were also externally validated by training the data on one hospital sample and testing on the other as well as an overall estimated error from a completely random sample from both hospitals was used. Results: Average age was 67.3 years old; 54.3% were female. The logistic regression model achieved the best performance using a combination of ICD codes, medications, and notes with an AUROC at 0.968 (0.940 – 0.982) and AUPRC at 0.921 (0.835 – 0.969). The models that only used ICD codes or medications had lower performance. The estimated overall error rate in a random EHR sample is 1.6%. The model also showed high external validitiy from training on MGH and testing on BIDMC (AUROC 0.927) and vise versa (AUROC 0.968). Conclusions: The proposed CHF EHR phenotyping model achieved excellent performance, external validity, and generalized across two institutions. The model enables multiple downstream uses, paving the way for large-scale studies of CHF treatment effectiveness, comorbidities, outcomes, and mechanisms.
Background: Evidence that Artificial Intelligence (AI) may improve melanoma detection has led to calls for increased human-AI collaboration in clinical workflows. However, “AI-based support” may e...
Background: Evidence that Artificial Intelligence (AI) may improve melanoma detection has led to calls for increased human-AI collaboration in clinical workflows. However, “AI-based support” may entail a wide range of precise functions for AI. In order to appropriately integrate AI into decision-making processes, it is therefore crucial to understand the precise role that clinicians see AI playing within their clinical deliberations. Objective: This study sought to provide an in-depth understanding of how a range of clinicians involved in melanoma screening and diagnosis conceptualise the role of AI within their decision-making, and what these conceptualisations mean for good decision-making. Methods: This qualitative exploration used in-depth individual interviews with 30 clinicians predominantly from Australia/New Zealand (26/30) who engage in melanoma detection (17 dermatologists, 6 General Practitioners with an interest in skin cancer, and 7 melanographers). The vast majority of the sample (83%) had interacted with or used, 2D/3D skin imaging technologies with AI tools for screening or diagnosis of melanoma, either as part of testing, through clinical AI reader studies, or within their clinical work. Results: We constructed five themes to describe how participants conceptualised the role of AI within decision-making when it comes to melanoma detection. Theme 1 (integrative theme): the importance of good clinical judgement; Theme 2: AI as just one tool among many; Theme 3: AI as an adjunct after a clinician’s decision; Theme 4: AI as a second opinion on unresolved decisions; Theme 5: AI as an expert guide before decision-making. Participants articulated a major conundrum - AI may benefit inexperienced clinicians when conceptualised as an “expert guide”, but over-reliance, de-skilling, and a failure to recognise AI errors, may mean only experienced clinicians should use AI “as a tool”. However, experienced clinicians typically relied on their own clinical judgement, and some could be wary of allowing AI to “influence” their deliberations. The benefit of AI was often then to reassure decisions once they had been reached, by conceptualising AI as a kind of “checker”, “validator”, or in a small number of equivocal cases as a genuine “second opinion”. This perhaps raises queries about the extent to which experienced clinicians then truly seek to “collaborate” with AI or use it to inform decisions. Conclusions: Clinicians conceptualised AI-support in an array of potentially disparate ways that potentially impact AI’s incorporation, whilst prioritising the conservation of good clinical acumen. This must be a priority when developing and adopting AI into decision-making process, and our study implores a more focused engagement with users about the precise way, and in what position, they envisage AI being incorporated into their decision-making process for melanoma detection.
Background: Dermoscopy is a non-invasive technology used to examine the skin's invisible microstructures in dermatological practice. It is an established technique for analyzing skin lesions that have...
Background: Dermoscopy is a non-invasive technology used to examine the skin's invisible microstructures in dermatological practice. It is an established technique for analyzing skin lesions that have been in use since the 17th century when Kohlhaus used a microscope to study nail matrix vessels. [1–3]. However, dermoscopy was not widely used until the 20th century, when Goldman created a portable microscope that could magnify up to ten times more than the naked eye [1–6]. Historically, dermoscopy has been used to diagnose pigmented lesions such as naevi, melanomas, and pigmented basal cell carcinomas [7]. Since the 1990s it has been used to diagnose other dermatological disorders, including infections such as scabies, inflammatory lesions, and hair and nail-fold alterations, and it is also used to track lesions’ progress or reactions to topical treatments such as imiquimod or 5-fluorouracil [8–11]. The evidence-based practice associated with dermoscopy use improves the diagnostic accuracy for skin cancer, reduces unnecessary biopsies of benign lesions, increases survival rates, and improves the early identification of skin malignancies [12–14]. A 2002 meta-analysis of 27 studies revealed that dermoscopy increases experienced physicians’ diagnostic accuracy for melanoma compared to unaided inspection [1]. Moreover, it helps distinguish between various kinds of pigmented and non-pigmented skin malignancies in vivo, and it is significant in differentiating between inflammatory and neoplastic lesions. Currently, the vast majority of worldwide guidelines for skin cancer recommend dermoscopy as a critical component of diagnosing and following up with patients facing an increased risk of this disease [15–20]. Dermoscopy is also increasingly accepted as a standard practice around the globe. Multiple studies have revealed that United States dermatologists use dermoscopy. Indeed, 48% of 3,238 American dermatologists surveyed in 2010 said they used dermoscopy [21]. Chamberlain’s study of dermoscopy revealed a 98% utilization rate use in Australia [22–23], while 95% of dermatologists in France use the practice [24]. However, no study has documented the attitudes toward and use of dermoscopy among future dermatologists in Saudi Arabia. In this study, dermoscopy prevalence among dermatology residents in Riyadh was assessed alongside information sources and elements that influence its use, such as residency levels and the frequency of dermoscopy diagnoses. Objective: to know the attitudes toward and use of dermoscopy among future dermatologists in Saudi Arabia. Methods: In January 2024, A validated and published questionnaire was edited to the research needs was sent to all registered dermatology residents in the Dermatology Saudi Board in Riyadh Results: A total of 63 dermatologist residents in Riyadh, Saudi Arabia completed the online questionnaire equivalent to an 87.5% Response rate The study’s sample was predominantly female (54.0%), and the majority (84.1%) was aged between 26 and 30 years. A considerable proportion of the participants (34.9%) were in the last year of residency. More than half of the participants (54.0%) owned a dermoscopy, and a substantial number (36.5%) offered 21–30 clinics per month on average. More than half the participants (57.1%) had received dermoscopy training. A considerable proportion (36.4%) had used dermoscopy for two years. Additionally, most of the participants (45.5%) had used non-polarized immersion-contact dermoscopy, while (43.2%) had used polarized light dermoscopy. The study’s findings revealed that the majority of the participants (50.0%) had used dermoscopy in < 10% of cases involving the examination of patients with inflammatory skin lesions. The results established a statistically significant association between the participants’ ages, residency levels, and practice centers with the use of dermoscopy, p-values < .05 (0.003,* 0.001,* and 0.004,* respectively). Conclusions: This study has revealed a considerably above-average level of dermatoscopy among use dermatology residents in Riyadh, Saudi Arabia. Dermatoscopy use is increasing among dermatologists, given the practice’s evidence-based advantages and benefits in the early detection and diagnosis of skin diseases. The participants’ ages, residency levels, and practice centers were found to be the main factors that affected dermoscopy use in Saudi Arabia. Finally, this study noted a willingness to improve one’s dermoscopy knowledge and skills, particularly among young dermatologists in Saudi Arabia.
Background: Prolonged sitting and lack of moderate to vigorous physical activity represent two independent risk factors for myriad poor health outcomes. The negative effects of prolonged sitting can b...
Background: Prolonged sitting and lack of moderate to vigorous physical activity represent two independent risk factors for myriad poor health outcomes. The negative effects of prolonged sitting can be ameliorated with as little as 2 minutes of large muscle movement. Further, cardiovascular benefits from moderate to vigorous activity can be accumulated throughout the day in short bouts rather than require continuous long bouts. Taken together, “exercise snacks” provide a way to both interrupt prolonged sitting and accumulate moderate to vigorous physical activity during a sedentary work day. Objective: The current protocol describes the feasibility and acceptability pilot of Move Often eVery Day (MOV'D), a fully-remote, peer-supported behavioral intervention to interrupt prolonged bouts of sitting at work with exercise snack breaks. Methods: The MOV’D pilot study aimed to recruit approximately 60-80 participants who work full-time in a sedentary occupation. Using a randomized 2-group design, participants were randomly assigned either to the “Fitbit Control'' or the “MOV’D” experimental group. The pilot study had a 4-week active intervention and a 4-week follow-up with assessments at baseline, 4-weeks, and 8-weeks. The Fitbit control group received a Fitbit to self-monitor their physical activity prior to getting intervention material at the end of the study. In addition to the Fitbit, the MOV’D intervention features included: a private social support group chat seeded with daily experimenter prompts; weekly, 5-minute behavior change technique videos; daily self-monitoring, and daily exercise snack suggestion videos. Results: Study enrollment began in March 2022 and concluded in June 2022. Data collection concluded in October 2022. We enrolled 70 participants and 68 participants completed all study assessments. Conclusions: This protocol integrates findings from education, behavioral sciences, sedentary behavior, and exercise physiology to promote building an exercise snack habit at work: taking short, intense exercise breaks to break up prolonged sitting. Results from this pilot study will assess the feasibility and acceptability of the MOV’D intervention. Clinical Trial: NCT05360485
Background: Sleep disturbance is one of the most common health concerns reported by breast cancer (BC) survivors and is associated with poor quality of life (QoL) and greater mortality after treatment...
Background: Sleep disturbance is one of the most common health concerns reported by breast cancer (BC) survivors and is associated with poor quality of life (QoL) and greater mortality after treatment. Cognitive behavior therapy for insomnia (CBTi) has shown efficacy for improving sleep and quality of life for BC survivors. Considered the gold standard insomnia treatment, CBTi can be delivered remotely, including via digital intervention. Despite the potential for wider dissemination of CBTi via digital means, these modalities have unique challenges, including technology barriers and poor adherence. We developed a conversational agent (CA) to deliver CBTi via short message service (SMS), supported by mobile-ready web content. Named “Cecebot”, this CA delivers sleep education, implements sleep compression, provides just-in-time intervention on sleep-disrupting behaviors, and includes enhanced support for physical activity (PA) beyond what is typically included in CBTi. This represents a novel modality for a CBTi and PA intervention in BC survivors. Objective: We aim to examine the safety and acceptability of the Cecebot intervention for BC survivors with symptoms of insomnia and explore intervention efficacy. Methods: This trial will recruit 60 BC survivors who are experiencing moderate to severe sleep disturbance. Participants will be assigned to the Cecebot intervention or waitlist control group at a 1:1 ratio. The treatment group will receive Cecebot intervention during weeks 1-6 of the study, while the waitlist control condition will receive the Cecebot intervention during weeks 6-12. The Cecebot intervention utilizes SMS technology paired with Fitbit. Participants will be assessed at baseline, week 6, and week 12. Measurements will include feasibility and acceptability, and explore the effect of a Cecebot intervention. Results: Recruitment of participants began in Spring 2024. The completion of data collection is anticipated to be by Winter 2025. Conclusions: The study results will give insight into the potential for an SMS-based conversational agent to improve sleep in BC survivors with sleep disturbances.
Background: Ventricular fibrillation (VF) is a vicious arrhythmia usually generated after removal of the aortic cross-clamp (ACC) in patients undergoing open heart surgery, which could damage cardiomy...
Background: Ventricular fibrillation (VF) is a vicious arrhythmia usually generated after removal of the aortic cross-clamp (ACC) in patients undergoing open heart surgery, which could damage cardiomyocytes, especially in patients with left ventricular hypertrophy (LVH). Amiodarone has the prominent properties of converting VF and restoring sinus rhythm. However, few studies concentrated on the effect of amiodarone before ACC release on reducing VF in patients with LVH. Objective: The study was designed to explore the effectiveness of prophylactic intravenous amiodarone in reducing VF after the release of ACC in patients with LVH. Methods: Fifty-four patients with LVH scheduled for open-heart surgery were enrolled and randomly divided (1:1) into two groups: group A (amiodarone group) and group P (placebo-controlled group). Thirty minutes before removal of the ACC, the trial drugs were administered intravenously. In group A, 150 mg of amiodarone was pumped in 15 minutes. In group P, the same volume of normal saline was pumped in 15 minutes. The primary outcome was the incidence of VF 10 minutes after removal of the ACC. Results: The incidence of VF was lower in group A than in group P (29.6% vs 70.4%, P = 0.003). The duration of VF, the number of defibrillations, and the defibrillation energy were also lower in group A than in group P (P < 0.05). After the end of cardiopulmonary bypass, the heart rate and mean arterial pressure were lower in group A, the mean pulmonary arterial pressure and the dose of vasoactive drugs was higher than those in group P (P < 0.05). However, there were no significant differences in the use of vasoactive-inotropic agents and hemodynamic status between the two groups before the end of surgery (P > 0.05). Conclusions: In patients with LVH who undergo open-heart surgery, amiodarone can be safely used and reduce the incidence of VF, the duration of VF, the frequency of defibrillation and the energy of defibrillation after ACC removal. Clinical Trial: Chinese Clinical Trial Registry, ChiCTR2000035057; https://www.chictr.org.cn/showprojEN.html?proj=57145
Background: The aim of this study was to develop and validate a nomogram for predicting cancer-specific survival (CSS) in individuals suffering from lower limb melanoma (LLM) at 3-, 5-, and 8-year int...
Background: The aim of this study was to develop and validate a nomogram for predicting cancer-specific survival (CSS) in individuals suffering from lower limb melanoma (LLM) at 3-, 5-, and 8-year intervals following diagnosis. Objective: The aim of this study was to develop and validate a nomogram for predicting cancer-specific survival (CSS) in individuals suffering from lower limb melanoma (LLM) at 3-, 5-, and 8-year intervals following diagnosis. Methods: Patient data pertaining to lower limb melanoma (LLM) cases were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. By employing a random selection process, a training cohort consisting of 70% of the patient population and a validation cohort comprising 30% of the patients were established. Utilizing a backward stepwise Cox regression model, independent prognostic factors were identified. These factors were subsequently integrated into the nomogram, enabling the prediction of cancer-specific survival (CSS) rates at 3-, 5-, and 8-year intervals after diagnosis. The nomogram's performance was evaluated through various metrics, including the concordance index (C-index), the area under the time-dependent receiver operating characteristic curve (AUC), the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), calibration curves, and decision-curve analysis (DCA). Results: This study involved a comprehensive cohort comprising 12,580 patients diagnosed with lower limb melanoma (LLM). Through an analysis of the Cox regression model within the training cohort, a total of nine prognostic factors were identified, namely age, RNP (regional node positive), sex, race, AJCC (American Joint Committee on Cancer) stage, surgical status, chemotherapy status, radiation status, and income status. Subsequently, a nomogram was developed and subjected to rigorous internal and external validation procedures. The nomogram demonstrated excellent discriminatory abilities, as reflected by significantly high C-index and AUC values. Calibration curves provided further confirmation of the nomogram's reliability. Notably, the nomogram exhibited superior performance compared to the AJCC model, as evidenced by improved NRI and IDI values. The decision-curve analysis (DCA) curves further validated the clinical utility of the nomogram, underscoring its practical relevance in prognostication for patients with LLM. Conclusions: The current investigation has effectively developed and validated an initial nomogram for prognosticating outcomes in patients with lower limb melanoma (LLM). The nomogram's impressive performance and practical applicability highlight its potential usefulness within clinical settings. However, it is important to note that additional external validation is necessary to further substantiate its reliability and generalizability.
Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these he...
Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them. Objective: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals' intentions to adopt these behaviors. Methods: This study uses data from legacy media in the U.S., Twitter discussions, and a U.S. nationwide longitudinal panel survey from February 2020 to April 2021. We employed Intermedia Agenda Setting Theory and the Protective Action Decision Model to develop the theoretical framework. Results: We found a two-way interactive agenda flow between legacy media and social media platforms, particularly in controversial topics like vaccination (F = 16.39, p < .001 for newspapers; F = 44.46, p < .001 for Twitter). Exposure to media coverage increased individuals' perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals’ media exposure increased perceived benefits of mask-wearing (β=0.057, p<0.001 for household benefits; β=0.049, p<0.001 for community benefits), it was not consistently linked to higher intentions to wear masks (β = -0.026, p < .001). Conclusions: Our study integrates media flow across platforms with national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align.
Background: Cancer care complexity heightens communication challenges between healthcare providers and patients, impacting their treatment adherence. This is especially evident upon hospital discharge...
Background: Cancer care complexity heightens communication challenges between healthcare providers and patients, impacting their treatment adherence. This is especially evident upon hospital discharge in patients undergoing surgical procedures. Digital health tools offer potential solutions to address communication challenges seen in current discharge protocols. Objective: We aim to evaluate the usability and acceptability of an interactive health platform among discharged patients who underwent oncology-related procedures Methods: A four-week observational study was conducted. Following hospital discharge, a tablet equipped with an integrated Personal Virtual Assistant (PVA) system was provided to patients who underwent oncology-related procedures. The PVA encompasses automated features that provide personalized care plans, developed through collaboration among clinicians, researchers, and engineers from various disciplines. These plans include guidance on daily specific assignments that were divided into 4 categories: medication intake, exercise, symptom surveys, and post-procedural specific tasks. The primary aim assessed the feasibility of the PVA by quantification of dropout rate <10%, and adherence to each care plan category throughout the study duration. The secondary aim assessed acceptability of the PVA via a Technology Acceptance Model (TAM) questionnaire that examined ease of use, usefulness, attitude towards use, and privacy concerns. Results: Seventeen patients were enrolled. However, 1/17 (5.8%) patients dropped out from the study after 3 days due to health deterioration, leaving 16/17 (94.2%) completing the study (54.5±12.7 years old, 52% Caucasian, 82% gynecological disease, 18% hepatobiliary disease). At the study endpoint, adherence to care plan categories were: 78% for medications, 81% for exercises, 61% for surveys, and 58% for tasks. There was an 80% patient endorsement (strongly agree + agree/very easy + easy) across all TAM categories. Conclusions: The PVA is a feasible and acceptable tool for discharged patients undergoing oncology-related procedures, showing reproducibility for a future clinical study assessing effectiveness.
Background: Artificial intelligence has been deemed revolutionary in medicine, but very few artificial intelligence solutions have been observed in Danish general practice. General practice in Denmark...
Background: Artificial intelligence has been deemed revolutionary in medicine, but very few artificial intelligence solutions have been observed in Danish general practice. General practice in Denmark has an excellent system of digitization to develop and utilize artificial intelligence. However, a lack of involvement of general practitioners in the development of artificial intelligence exists. The perspectives of general practitioners as end users are essential to facilitate the development and implementation of artificial intelligence in general practice. Objective: This study aimed to characterize the prerequisites that must be met to enable the development and implementation of artificial intelligence in Danish general practice. Methods: This study applied semi-structured interviews and vignettes to gain perspectives on the potential for developing and implementing artificial intelligence among general practitioners. Twelve general practitioners were interviewed, resulting in an exhaustive dataset. The interviews were transcribed, and thematic analysis was conducted to identify the dominant themes throughout the data. Results: Four main themes were identified in the data analysis as prerequisites that general practitioners found important to consider when developing and implementing AI in general practice: ‘AI must begin with the low-hanging fruit’, ‘AI must be meaningful in the GP’s work’, ‘The GP-patient relationship must be maintained despite AI’, and ‘AI must be a free, active, and integrated option in the EHR’. Conclusions: The four themes contributing to defining prerequisites for artificial intelligence can potentially lead the first steps of future development and implementation of artificial intelligence in Danish general practice. The participating general practitioners were positive towards developing and implementing artificial intelligence in their clinics, and it would be valuable to consider the defined prerequisites when considering new artificial intelligence tools for general practice.
Background: Background: There is a notable lack of psychotherapeutic services tailored to the needs of Black, Brown, People of Color (BBPOC) who are Two Spirit, transgender, and nonbinary (2STNB); res...
Background: Background: There is a notable lack of psychotherapeutic services tailored to the needs of Black, Brown, People of Color (BBPOC) who are Two Spirit, transgender, and nonbinary (2STNB); research indicates that 2STNB BBPOC clients report a lack of competence and cultural humility on the part of their therapists. Objective: Objective: The purpose of this study was to report the feasibility and acceptability of the Healing through Ongoing Psychological Empowerment (HOPE) Intervention using deductive content analysis. Methods: Method: At baseline, 51 clients were enrolled in the open clinical trial, with 49 BBPOC 2STNB clients starting and completing HOPE Intervention. Clients completed up to 15 free virtual therapy sessions that were provided by nine BBPOC 2STNB therapists. Feasibility and acceptability interviews were conducted at prior to the intervention, immediately following the intervention, and 6-month after completing the intervention. Results: Results: The HOPE intervention demonstrated high feasibility and acceptability, specifically regarding data collection, psychometric adequacy, interventionist recruitment/training/retention, delivery of the intervention, acceptability of the intervention to clients, and client engagement with the intervention. Conclusions: Conclusion: These findings propose HOPE as a potentially feasible, culturally specific therapeutic approach for the BBPOC 2STNB community. Future randomized controlled trials comparing HOPE to existing evidence-based treatments are needed. Clinical Trial: Trial registration: The registration number for this clinical trial is ClinicalTrials.Gov: NCT 05140174.
Background: The aim of this article is to investigate the impact of two teaching methods, virtual education and small group instruction, on learning outcomes and student satisfaction in the Research M...
Background: The aim of this article is to investigate the impact of two teaching methods, virtual education and small group instruction, on learning outcomes and student satisfaction in the Research Methodology 2 course for dental students at Shiraz University of Medical Sciences. Choosing an appropriate instructional method is fundamental for enhancing meaningful learning, abilities, skills, and competencies. Objective: Determining the effect of training using two methods of virtual training and training in small groups A lesson on research methods
Learning and satisfaction Dental students Shiraz university of medical sciences Methods: The present study was a semi-experimental intervention study. Results: The advancements in science and technology have made it imperative to transform the process of educational activities. One of the most essential transformations in educational systems is the change in teaching methods by instructors and professors. New educational approaches, shifting from teacher-centered to student-centered education, in which students play an important, influential, and active role in their learning process, are expanding. It is necessary to employ various teaching methods with the aim of increasing student learning and retention, promoting deep and conceptual learning, and evaluating the effectiveness of different methods in accordance with educational objectives, the educational context and resources, and time management. Each of these methods can yield different results depending on student conditions, instructor's abilities, educational objectives, and available resources. Understanding the dominant learning style of students, attention to educational objectives and curriculum, the availability of necessary hardware and software for implementing educational processes, instructors' sufficient understanding and familiarity with appropriate methods, time management, and support from the educational system for innovative teaching approaches, along with the collaboration of learners in the implementation of educational processes, are necessary and essential characteristics for the successful and effective implementation of educational interventions.
Limitations:
- However, the diversity of these factors may limit the generalizability of the results, considering the differences in educational objectives in the aforementioned study and the feasibility of implementing similar teaching patterns for other courses.
- Physical space limitations for optimal implementation of the small group teaching method. Conclusions: The advancements in science and technology have made it imperative to transform the process of educational activities. One of the most essential transformations in educational systems is the change in teaching methods by instructors and professors. New educational approaches, shifting from teacher-centered to student-centered education, in which students play an important, influential, and active role in their learning process, are expanding. It is necessary to employ various teaching methods with the aim of increasing student learning and retention, promoting deep and conceptual learning, and evaluating the effectiveness of different methods in accordance with educational objectives, the educational context and resources, and time management. Each of these methods can yield different results depending on student conditions, instructor's abilities, educational objectives, and available resources. Understanding the dominant learning style of students, attention to educational objectives and curriculum, the availability of necessary hardware and software for implementing educational processes, instructors' sufficient understanding and familiarity with appropriate methods, time management, and support from the educational system for innovative teaching approaches, along with the collaboration of learners in the implementation of educational processes, are necessary and essential characteristics for the successful and effective implementation of educational interventions.
Limitations:
- However, the diversity of these factors may limit the generalizability of the results, considering the differences in educational objectives in the aforementioned study and the feasibility of implementing similar teaching patterns for other courses.
- Physical space limitations for optimal implementation of the small group teaching method.
Background: Background: The implementation of digital healthcare innovation was accelerating in China. Some medical large language models (LLM) were applied into different scenarios. The LLM-based ass...
Background: Background: The implementation of digital healthcare innovation was accelerating in China. Some medical large language models (LLM) were applied into different scenarios. The LLM-based assisted diagnostic systems (LLM-ADSs) were a major scenario. Objective: Objective: The purpose of this study is to evaluate the influencing factors of physicians' adoption of the LLM-ADSs in tertiary hospitals in China. Methods: Methods: We developed and evaluated a 25-item measurement scale and used the results from a web-based survey among 250 physicians to test our hypothetical model, who’s from four grade A tertiary hospitals in four provinces in China. We used partial least squares structural equation modeling (PLS-SEM) to analyze the data. Results: Results: The results indicated that physicians' acceptance of LLM-ADSs was moderately influenced by effort expectancy (f2=0.253), and weakly influenced by performance expectancy (f2=0.118), social influence (f2=0.042), and trust in AI (f2=0.028), with the effect size of these factors decreasing in order. Effort expectancy had a strong effect on performance expectancy (f2=0.639). Trust in AI was strongly influenced by performance expectancy (f2=0.404) and weakly influenced by effort expectancy (f2=0.115), respectively. Moreover, personal innovativeness weakly influenced effort expectancy (f2=0.037), and task-technology fit weakly influenced performance expectancy (f2=0.051). The model had explained 68% of physicians' acceptance. Conclusions: The research enhances our understanding of the determinants of physicians’ acceptance of LLM-ADSs. Among these factors, effort expectancy was considered as the top priority. It highlights the importance of optimizing LLM-ADSs to be user-friendly and seamlessly integrated into clinical workflows to increase ease of use.
Background: Maternal mortality remains a persistent public health concern in Sub-Saharan African countries such as Ethiopia. Previous research has shown that when healthcare facilities do not have the...
Background: Maternal mortality remains a persistent public health concern in Sub-Saharan African countries such as Ethiopia. Previous research has shown that when healthcare facilities do not have the necessary supplies to provide basic emergency obstetric care (BEmOC), women experiencing these emergencies can receive delayed diagnosis/treatment or suboptimal care. Health information technology solutions are a flexible and low-cost method for tracking medical supply availability. Furthermore, these solutions can lead to improved health outcomes, and have displayed proven benefits in low-to-middle income country health systems. Objective: The purpose of this study was to develop and evaluate the usability of electronic dashboards to monitor facility-level readiness to manage basic emergency obstetric care (BEmOC) in Amhara, Ethiopia. Methods: The study used three methods to iteratively refine the dashboards: (1) user-centered design sessions with individuals who interact with the BEmOC supply chain; (2) review and feedback from domain and information visualization subject matter experts (SMEs) to refine the dashboards; and (3) usability heuristic evaluations from human-computer interaction (HCI) SMEs. Results: User-centered design sessions resulted in a preliminary version of the dashboards informed by end-user preferences and perceptions. Next, domain and visualization SMEs continued the dashboards’ iterative refinement, by confirming design choices and recommending changes to enhance the dashboards’ navigation. HCI SMEs rated the dashboards as highly usable (0.82 on a scale of 0-4). Conclusions: Dashboards are a novel method for promoting and tracking a facility’s capacity to manage BEmOC. By including targeted end-users and experts in the design process the team was able to tailor the dashboards to meet user needs, fit into the existing government health systems, and ensure that the dashboards follow design best practices. Collectively, the novel, customized BEmOC dashboards can be used to track and improve facility readiness in Amhara, Ethiopia, and similar global BEmOC facilities.
Background: Virtual approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a virtual context ha...
Background: Virtual approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a virtual context has been minimally explored and there is limited information on important psychometric properties of physical assessment measures used in virtual contexts. Objective: The objectives of this feasibility study were to: determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the virtual assessment, time required to complete study assessments, acceptability of virtual assessment to people with brain injuries and clinicians, and to document preliminary results of sensitivity of the virtual assessment when compared to the in-person assessment and to estimate the preliminary inter-rater and intra-rater reliability of the virtual assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended two assessments (one in-person and one virtual) in a randomized order. The measures administered in these assessments included: the finger-to-nose test, balance testing, the Vestibular/Ocular Motor Screening (VOMS) tool including documentation of change in symptoms and distance for near point convergence (NPC), saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Centre. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the virtual assessment. The same second clinician viewed the recording again approximately one month following initial observation. Results: Rate of recruitment was 61% of people approached, with a total of 20 patient-participants included in the feasibility study. Three clinicians participated as assessors. Length of time required to complete the in-person and virtual assessment procedures averaged nine and 13 minutes, respectively. The majority of clinician and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and virtual assessments. Feedback obtained revolved around technology (e.g. screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the virtual assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (NPC: 1.0). Preliminary estimates of reliability of the virtual assessment ranged from poor (balance testing, saccades, and range of motion: Kappa=0.38-0.49) to excellent (VOMS change in symptoms: Kappa=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide confidence intervals due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision.
Background: Advancements in smartphone technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study is...
Background: Advancements in smartphone technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study is to thoroughly assess the feasibility, usability, and acceptability of the MIA, a specifically developed app, in promoting PA among healthy older adults. Methods: Our study utilized a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a "think-aloud" method was used to provided immediate feedback during initial app use. Participants then integrated the app into their daily activities for five weeks. Behavioral patterns, such as user session duration, feature usage frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale (SUS), User Experience Questionnaire (UEQ), Net Promoter Score (NPS) and the Customer Satisfaction Score (CSAT). Qualitative data from focus groups, performed after the five-week intervention, helped gather insights into user experiences. Recruitment targeted healthy, native Dutch-speaking older adults over 65 without severe illnesses. Results: The study involved 30 participants. The app received positive ratings, with a sustainable usability scale of 77.4 and a customer satisfaction score of 86.6%. Analysis showed general satisfaction with the app’s workout videos and broad acceptance of its content. Qualitative feedback suggested improvements in navigation and content relevance. Conclusions: Mobile health apps offer promise for promoting PA in older adults. Tailoring technology that suits individual needs is crucial to ensure user-friendly, relevant, sustainable, and agile solutions. Future enhancements should focus on personalization and integration with wearable devices to provide real-time health data, which can optimize activity recommendations and health monitoring. Furthermore, incorporating robust social networking features and predictive analytics could enhance user engagement. Clinical Trial: The study was preregistered with ClinicalTrials.gov (NCT05650515).
Background: Medication adherence, or how patients take their medication as prescribed, is a global public health issue. Improving medication-taking habit might be an effective way to improve medicatio...
Background: Medication adherence, or how patients take their medication as prescribed, is a global public health issue. Improving medication-taking habit might be an effective way to improve medication adherence. However, habit is difficult to quantify, and conventional habit metrics are self-reported, with recognized limitations. Recently, several objective habit metrics have been proposed, based on objective medication-taking data. Objective: Explore the correlation between objective habit metrics and objective medication adherence on a large dataset. Methods: The MEMS® Adherence Knowledge Center, a database of anonymized electronic medication adherence data from ambulant subjects enrolled in past clinical studies, was used as the data source. Electronic medication adherence data from subjects following a once-daily regimen and monitored for 14 days or more were extracted. Two objective habit metrics were computed from each subject’s medication intake history: standard deviation of the hour of intake and weekly cross-correlation. Objective medication adherence was computed usin15,818 subjects met the criteria. The two objective habit metrics were associated with the two objective adherence metrics (all p < 0.001). A lower daily or weekly variability in the timing of medication intakes is associated with a better medication adherence. However, no variability is not the norm. Among the numerous factors influencing medication adherence, habit strength is an important one.g the proportion of doses taken and the proportion of correct days. Results: 15,818 subjects met the criteria. The two objective habit metrics were associated with the two objective adherence metrics (all p < 0.001). A lower daily or weekly variability in the timing of medication intakes is associated with a better medication adherence. However, no variability is not the norm. Among the numerous factors influencing medication adherence, habit strength is an important one. Conclusions: Objective habit metrics are correlated to objective medication adherence. Such objective habit metrics can be used to monitor patients and identify those who may benefit from habit-building support. Clinical Trial: Not applicable
Background: With the development of informatics in nursing and the advancement of modern technologies, handwriting a schedule on paper has become an obsolete practice. The introduction of electronic t...
Background: With the development of informatics in nursing and the advancement of modern technologies, handwriting a schedule on paper has become an obsolete practice. The introduction of electronic timetables in nursing is a measure of the digitalization of nursing, with many different outcomes for both patients and nurses, which can be either positive or negative. Objective: The purpose of this literature review is to identify the evidence of the outcomes of the digitalization of schedules in nursing. Methods: To find out what are the digital nursing schedule outcomes, we undertook a systematic review study method of the literature in electronic databases. Data was gathered in electronic databases: CINAHL, Medline, Cochrane Library, PubMed, ScienceDirect, JSTOR and SpringerLink. We searched through the literature in electronic databases. Seventy-four relevant literature items were identified according to the aim and objective of the study. Results: Eleven studies published between 2015 and 2024 were evaluated and critically analysed using the JBI Critical Appraisal Checklist: four systematic literature reviews; three case studies; three quasi-experimental methods and one quantitative descriptive method. Conclusions: The literature on electronic schedules in nursing shows a variety of positive and negative impacts on nurses, patients and healthcare organizations. The introduction of electronic schedules in nursing is mainly a positive measure which, if appropriately implemented, leads to better patient health outcomes and increased job satisfaction among nurses. Our study offers an outlook on the outcomes of using digital nursing schedules. The outcomes apply to both patients and nurses and are mostly positive, although more research is needed on that topic. Clinical Trial: -
Background: Sleep games are an emerging topic in the realm of serious health game research. However, designing features that are both enjoyable and effective at engaging users, particularly university...
Background: Sleep games are an emerging topic in the realm of serious health game research. However, designing features that are both enjoyable and effective at engaging users, particularly university students, to develop healthy sleep habits remains a challenge. Objective: This study aimed to investigate user preferences for three sleep game prototypes—Hero’s Sleep Journey (HSJ), Sleep Tamagochi (ST), and Sleepland (SL)—and to explore their popularity and perceived utility in promoting sleep health. Methods: A mixed-method approach was employed in this study. Quantitative and qualitative data were collected through a co-design workshop involving 47 university students. Participants were presented with storyboard cards of game features and were asked to provide an overall rating on each game, as well as ratings for individual features. They were also encouraged to provide free-form comments on the features and suggest improvements. Additionally, participants were asked to express their preferences among the three games regarding which game they would most like to play and which one they found most useful for promoting sleep health. Results: Surprisingly, while HSJ was the most popular choice among participants, ST was perceived as most beneficial for improving sleep health. Relevance emerged as an overarching theme in the qualitative data analysis, with three interconnected dimensions: psychological relevance to users’ personal lives, logical relevance to sleep health, and situational relevance to users’ circumstantial context. We discussed how the three dimensions of relevance address the autonomy and relatedness constructs outlined in the self-determination theory and proposed three design recommendations. Conclusions: Our serious sleep game prototypes demonstrated potential in engaging university students to develop healthy sleep hygiene. Future sleep game designs should aim to create a sense of relevance to users’ personal lives, sleep health goals, and situational contexts. Rather than a one-size-fits-all approach, it is essential to develop a wide range of game genres and features to cater to diverse users. Aligning game features with sleep health goals and educating users on the design rationale through sleep knowledge are also important. Furthermore, allowing users to customize their game experience and manage technology boundaries is necessary to nurture a sense of control and autonomy in the process of forming good sleep hygiene.
Background: Although anthocyanin-rich foods have been associated with health benefits, it is unclear how well these effects extend to older adults and common geriatric syndromes. In addition, many st...
Background: Although anthocyanin-rich foods have been associated with health benefits, it is unclear how well these effects extend to older adults and common geriatric syndromes. In addition, many studies have relied upon supplements or food extracts, and the effects of whole-food supplementation remain uncertain. Objective: To determine the effectiveness of highbush blueberry supplementation, compared with an isocaloric serving of Deglet Noor dates, on blood pressure, physical function, falls, cognition, and other domains relevant to older adults. Methods: We are conducting a single-center randomized controlled trial among older adults residing in the greater Boston, MA region. Eligible participants include women and men aged 70 years and older. The trial was planned for conduct at a single congregate living facility for older adults, but after the COVID-19 pandemic hit, the initial recruitment was moved to an alternate senior congregate living facility and has subsequently been expanded to a second facility and the larger community. Participants are randomized on a 1:1 basis to consume 1 cup of frozen blueberries or 2-3 pitted dates daily for 3 months. Following a one-week wash-out, participants attend a fasting baseline visit that includes phlebotomy, questionnaires, functional assessments, anthropometric measurements and 24-hour electrocardiographic monitoring and ambulatory blood pressure monitoring. Participants return after 3 months for identical measurements. Recruitment was planned for 70 individuals with 15% attrition. Results: Recruitment for the trial began in April 2022 and ended in April 2024, when the originally planned number of completers was reached. The final population included 61 participants with a median age of 76 years (range 70-94 years), 56% women, and 53% assigned to blueberries. The demographic characteristics of enrolled participants demonstrate the tradeoffs of recruitment based in senior congregate living facilities, with unusually advanced ages but limited racial diversity and a fixed pool of potential participants. Conclusions: This randomized trial will test the effectiveness of whole highbush blueberry supplementation, compared with an isocaloric serving of dates, upon physiological and clinical parameters of interest to older adults. With its emphasis on whole foods, its results will add to a growing number of studies that test the effects of anthocyanins on common chronic diseases of aging. Clinical Trial: The trial is registered at clinicaltrials.gov (NCT05358210).
Background: Breast cancer is the second most common type of cancer in women worldwide. Treatments for this disease can cause various side effects, such as pain, fatigue, loss of muscle mass and decrea...
Background: Breast cancer is the second most common type of cancer in women worldwide. Treatments for this disease can cause various side effects, such as pain, fatigue, loss of muscle mass and decreased quality of life. Physical exercise has proven to be an effective tool to reduce these side effects and improve the quality of life of breast cancer patients. Objective: The purpose of this project is to develop a randomized clinical trial to determine the efficacy of a supervised exercise program on pain, physical function and quality of life in female breast cancer survivors. Methods: A randomized, double-blind, clinical trial will be conducted with 325 participants. The intervention group will receive a supervised exercise program for 12 weeks, while the control group will receive no intervention. Participants' pain, physical function and quality of life will be assessed at baseline, post-intervention and 12 weeks post-intervention. Results: The results of the study are not yet available Conclusions: Physical exercise is a promising tool for improving quality of life in female breast cancer survivors. Further research is needed to confirm the efficacy of physical exercise for this population. Clinical Trial: IO/02072024
Background: Discrimination can greatly impact both physical and mental health due to frequent stressors. Younger individuals, particularly those under 17 years old, are more adversely affected by vict...
Background: Discrimination can greatly impact both physical and mental health due to frequent stressors. Younger individuals, particularly those under 17 years old, are more adversely affected by victimization. Within the European Union, Romania exhibits poor rankings concerning LGBT+ inclusion. Notably, half of Romanian respondents aged 15-17 have reported experiencing bullying due to their sexual orientation. Given that much of this discrimination and harassment occurs within schools, schoolteachers and counselors are vital in affecting institutional change. Objective: This study investigates the impact of an intervention on reducing prejudice against the LGBT community in Romanian schoolteachers and counselors. Most prior interventions of this nature target WEIRD (Western, educated, industrialized, rich, and democratic) populations. Methods: In this randomized control trial, we recruited 175 participants via a national closed online user group and assigned them to either the experimental or control condition. Participants in the experimental condition received the intervention first and then completed the web-based outcome measures, while those in the control condition completed the measures first and then received the intervention. The intervention, designed for internet-based delivery, consisted of a one-hour video session led by a pair of researchers. It blended educational information with testimonials of LGBT+ people, perspective-taking tasks, and a self-efficacy exercise. We measured LGBT prejudice using three scales (ATLG, HS, and ATH). As additional outcomes, we looked at behavioral intentions, self-efficacy, perspective taking, intergroup disgust sensitivity, intergroup anxiety, empathy, factual knowledge about LGBT issues, as well as participant’s feelings towards LGB individuals. Results: Participants in the experimental group (N=89) showed significant reductions in prejudice when using the ATLG Scale (F1,173=7.22, P=.008) when compared to the control group (N=86), but not when using the other two attitudinal scales. We also found that the experimental group had warmer feelings (F1,173=4.40, P=.037; d=0.32), were more likely to engage in supportive behaviors (F1,173=13.96, P<.001; d=0.56), displayed more self-efficacy (F1,173=9.14, P=.001; d=0.33), had more factual knowledge (F1,173=11.98, P=.001; d=0.52), and had a higher ability to take the LGBT+ perspective after controlling for contact (F1,172=4.77, P=.030; d=0.28).
We did not observe significant differences in terms of Intergroup Disgust Sensitivity (F1,173=.816, P=.37), Intergroup Anxiety for either positive (F1,173=.383, P=.54) or negative emotions (F1,173=.51, P=.48), or empathy (F1,173=.02, P=.89). Conclusions: The intervention stands as a highly valuable and cost-effective resource for educators and high school counselors, particularly in regions where negative attitudes toward the LGBT+ community are prominent. The results show that a single one-hour online session, integrating blended cognitive (information), affective (indirect contact, perspective taking), and behavioral (self-efficacy, empowerment) recommendations, is sufficient in producing positive outcomes related to LGBT+ issues within the school environment. Clinical Trial: ISRCTN 84290049; https://doi.org/10.1186/ISRCTN84290049
Background: Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are over-represented among those with unintended pregnancies and particularl...
Background: Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are over-represented among those with unintended pregnancies and particularly those seeking abortion. Yet, few resources exist to help healthcare and allied helping professionals provide culturally competent, and gender-affirming abortion care for underserved populations. Objective: This project aimed to redesign and adapt an existing subscription-based medication abortion mentorship platform into a culturally appropriate and gender-affirming open-access website of curated health professional resources to promote equitable, accessible, high-quality abortion care, particularly for underserved populations Methods: We drew on a user-centered design framework to redesign the web platform in five iterative phases. Healthcare and allied helping professionals were engaged in each stage of the development process including the initial design of the platform, curation of the resources, reviewing the content, and evaluation of the wireframes and the end product. Results: This project resulted in an open-access bilingual (English and French) online platform containing comprehensive information and resources on abortion care for healthcare providers (physicians, nurse practitioners, and pharmacists) and allied helping professionals (midwives, medical officers, community workers, and social workers). The website incorporated information on clinical, logistical, and administrative guidance, including culturally competent and gender-affirming toolkits that could equip healthcare professionals with the requisite knowledge to provide abortion care for underserved populations. Conclusions: This platform contains resources that can increase the competencies of healthcare professionals to initiate and sustain culturally and contextually appropriate abortion care for underserved groups while clarifying myths and misconceptions that often militate against initiating abortion. Our resource also has the potential to support equitable access to high-quality abortion care, particularly for those among underserved populations who may have the greatest unmet need for abortion services yet face the greatest barriers to access to care
Background: Health-related data from technological devices are increasingly obtained through smartphone apps and wearable devices. These data can be used to enable physicians and other care providers...
Background: Health-related data from technological devices are increasingly obtained through smartphone apps and wearable devices. These data can be used to enable physicians and other care providers to monitor patients outside the clinic or assist individuals in improving lifestyle factors. However, the use of health technology data might be hampered by the reluctance of patients to share personal health technology data because of the privacy sensitivity of this information. Objective: The present study investigates to what extent psychological factors play a role in people’s willingness to share personal health technology data. Methods: Data for this cross-sectional study were obtained by quota sampling on age and sex in a community-based sample (N= 1013; mean age = 48.6 (SD = 16.6) years; 51.5% women). Willingness to share personal health technology data and related privacy concerns were assessed using an 8-item questionnaire with good psychometric properties (Cronbach’s α = .82). Psychological variables were assessed using validated questionnaires for optimism (LOT-R), psychological flexibility (PFQ), negative affectivity (DS14-NA), social inhibition (DS14-SI), generalized anxiety (GAD-7) and depressive symptoms (PHQ-9). Data were analysed using multiple linear regression analyses and network analysis was used to visualise the associations between the item scores. Results: Higher levels of optimism (β = 0.093, p = .004), psychological flexibility (β = 0.127, p < .001) and lower levels of social inhibition (β = -0.096, p = .002) were significantly associated with higher levels of willingness to share health technology data when adjusting for age, sex and education level in separate regression models. Other associations with psychological variables were not statistically significant. Network analysis revealed that psychological flexibility clustered more towards items that focussed on the benefits of sharing data, while optimism was negatively associated with privacy concerns. Conclusions: The current results suggest that people with higher levels of optimism and psychological flexibility and those with lower social inhibition levels are more likely to share health technology data. Future studies are needed to identify the specific needs of people with these characteristics regarding data sharing such that optimal use of devices in healthcare can be facilitated.
Background: Abstract
Background: The rapidly evolving COVID-19 pandemic has become a global health crisis. However, as the CoVID-19 is a new pandemic infectious disease, how people, particularly youn...
Background: Abstract
Background: The rapidly evolving COVID-19 pandemic has become a global health crisis. However, as the CoVID-19 is a new pandemic infectious disease, how people, particularly young people, perceive self risks to COVID -19 and associated factors is not well understood . Objective: Objective: The general objective of this study was to assess the perceived self -risk perception; health behaviours related to CoVID-19 and associated factors among young people (18-24yrs) in selected Wollega zones Methods: Methods and materials: A community based cross sectional study design was conducted from July to August, 2021. The study was conducted in 10 selected districts of Horo Guduru Wallaga and East Wollega Zones (four from Horo Guduru Wallaga and 6 from East Wallaga Zone) and two zonal capitals, Nekemte and Shambu. The total sample size was 630 young people aged 18-24 years. This sample size was proportionally distributed to the selected study areas based on their population size. Data collection tool was developed from different literature in English and translated to Afan Oromo, the regional language, and was pretested on young people with similar demographic characteristics out of the study areas. Data collectors were recruited from each site and were trained for two days. Data was collected by house–to- house survey. Descriptive, covariate and multivariate analysis was done after data was cleaned for error. Results: Result: Almost all (99.7%) of the respondents have ever heard about corona virus and 97.1 % reported that they know the modes of transmission of corona virus. However, only less than fifty percent (46.6%) of the study participants mentioned droplet as major mode of transmission of corona virus. The majority knew the sign and symptoms of COVID-19 and that it is preventable. Age and awareness level of participants on the cause of CoVID-19 was significantly associated with self-risk perception. Conclusions: Conclusion: Even though, almost all young people have ever heard about corona virus, there is a knowledge gap in the mode of transmission and prevention methods of Corona virus. Age and awareness level on the cause of CoVID-19 disease was positively associated with self-risk perception.
Background: Recent research has explored non-pharmacological digital therapeutic interventions as a means to improve compliance and reduce side effects in medication treatments for children with atten...
Background: Recent research has explored non-pharmacological digital therapeutic interventions as a means to improve compliance and reduce side effects in medication treatments for children with attention-deficit/hyperactivity disorder(ADHD). Objective: This study aims to validate the effects of game-based intervention content designed to enhance working memory and concentration. The study monitored quantitative changes using assessment tools to evaluate improvements in these cognitive areas when digital game-based content was employed as adjunct therapy alongside medication for children with ADHD. Methods: A total of 30 children participated were divided into an experimental group receiving digital therapeutic intervention based on game content alongside medication and a control group receiving conventional treatment methods. Results: The experimental group exhibited a reduction of 8.13±6.71 points on the K-ARS total score, compared to 7.14±8.73 points in the control group. Inattentiveness and hyperactivity-impulsivity decreased by 23.82% and 17.73%, respectively, more in the experimental group than in the control group. Significant reductions in the K-CBCL total problem behavior score, including internalizing and externalizing behaviors, were consistently observed at 28 d compared to baseline. Results from the FAIR attention-concentration test revealed significant differences between the experimental and control groups in Q-percentile and Q-standard scores (p=0.006 for the experimental group, p=0.007 for the control group) based on repeated measures ANOVA. Conclusions: Digital game-based content demonstrates significant potential as a non-pharmacological therapeutic intervention for ADHD. Clinical Trial: Clinical Research Information Service KCT0009326.
Background: Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anti-cancer therapy (SACTs), the crucial life-saving t...
Background: Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anti-cancer therapy (SACTs), the crucial life-saving treatments for many cancers. However, there is still a lack of consensus on the efficacy of those digital interventions. Objective: This systematic review and meta-analysis aimed to investigate the effectiveness of digital interventions in improving adherence to oral SACTs in patients with cancer. Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. The protocol has been registered at PROSPERO (no. CRD42024550203). Fully published, randomized controlled trials (RCTs) in English on adults with cancer assessing digital interventions for improving adherence to oral SACTs were retrieved from MEDLINE, EMBASE, APA PsycInfo, and CINAHL Plus up to May 31 2024. Adherence measures compared between digital intervention users and non-users were extracted. The proportions of poor adherence were synthesized using a random-effects model. The pooled results were reported as odds ratio (OR) and 95% confidence interval (95%CI). The heterogeneity was assessed with the I2 test (%). The mean difference and 95%CI were calculated from the mean adherence score and standard deviation. Results: This study included 13 RCTs on digital interventions for improving adherence to oral SACTs in patients with cancer. The technologies used were mobile applications (n=4), reminder systems (n=4), telephone follow-ups (n=3), and interactive multimedia platforms (n=2). Adherence was measured by surveys (n=8), relative dose intensity (n=2), pill count (n=1), self-reported missed doses (n=1), a smart pill bottle (n=1), and urine aromatase inhibitor metabolite assays (n=1). Pooled results from 11 trials showed digital technology users had a significantly lower risk of poor adherence (OR: 0.60; 95%CI: 0.47-0.77). Two studies reported positive mean differences in adherence scores comparing digital intervention users and non-users. Conclusions: Digital intervention users exhibited a significantly lower risk of poor oral SACTs adherence than non-users. Acknowledging individual variation and tailoring digital technologies to prioritize patient needs is essential. Clinical Trial: The protocol has been registered at PROSPERO (no. CRD42024550203).
Background: Mobile health (m-health) applications (app) have shown promising results in improving patient self-management of several chronic diseases. We have developed a mhealthapp (named Cardiomeds)...
Background: Mobile health (m-health) applications (app) have shown promising results in improving patient self-management of several chronic diseases. We have developed a mhealthapp (named Cardiomeds) dedicated to patients with heart failure (HF). This app which features an interactive medication list, daily self-monitoring of symptoms, weight, blood pressure, and heart rate, as well as HF educational information delivered through text, figures, video clips, and an interactive quiz. Objective: The aim of this study was to perform a mix-methods usability study of Cardiomeds. Methods: Patients with HF who were smartphone users were recruited from the HF outpatient clinic of the University Hospital of Geneva. The usability test was conducted in two stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication with its dosage and time of intake, or finding specific information about HF. Each task was timed; the sessions were recorded, and all data anonymized. After completing the tasks, patients filled out the System Usability Scale (SUS) 10-item questionnaire and answered 5 open questions about their perceptions of the app. Results: Twenty HF patients (75 % men) with a mean age of 55 years were included overall. The average time to complete all 14 tasks was 18 ± 5.7 minutes overall. Manual insertion of medications was the most time-consuming task, taking an average of 154.40 seconds (SD ± 68.08) in the first stage and 103.10 seconds (SD ± 42.76) in the second stage, and 128 ± 63 seconds overall. The average SUS score was 80%, showing a slight increase from 79% in the first stage to 80% in the second stage, which qualifies the app as “good” in terms of usability. Between the two stages, part of the app interface was redesigned to address the most acute issues identified in the first stage. Despite these improvements, guidance problems remained the most frequent issue, occurring in 36% (8/22) of problems in the first stage and in 40% (6/15) in the second stage. In response to open questions, 85% of the participants indicated they would use the app when it becomes available. Conclusions: The usability test indicates that Cardiomeds is a suitable and user-friendly app for HF patients. The app will be further tested in a randomized clinical trial (study identifier: 2022-00731) during the transition phase after an acute HF hospitalization to assess its impact on patients’ knowledge about HF, self-care, and quality of life.
Abnormal bronchus originating from the trachea or main bronchus are rare. Major bronchial abnormalities include accessory cardiac bronchus (ACB) and tracheal bronchus(TB)[1]. Variant TB brings difficu...
Abnormal bronchus originating from the trachea or main bronchus are rare. Major bronchial abnormalities include accessory cardiac bronchus (ACB) and tracheal bronchus(TB)[1]. Variant TB brings difficulty and confusion when this patient undergoing thoracic surgery. Double-lumen tube(DLT) is the preferred method for lung isolation in right lung surgery, but it is an challenge to provide satisfactory lung collapse and lung recruitment with DLT in the process of surgery. Bronchial blocker(BB) is another commonly method for lung isolation during thoracic surgery, but the abnormal bronchus might not be occluded, Therefore, We tried a new unconventional way of dual BB for a patient with variant TB and anesthesia effect was satisfying. Dual BB could be recommended as a backup or even preferred lung isolation strategy in patients with TB.
The COVID-19 pandemic highlighted the crucial role of smartphone applications in managing public health crises, explicitly developed for lockdowns and social distancing. These apps faced challenges of...
The COVID-19 pandemic highlighted the crucial role of smartphone applications in managing public health crises, explicitly developed for lockdowns and social distancing. These apps faced challenges of broad acceptance, public trust, and rapid integration of sensitive medical data. The COMPASS initiative, part of the German government's Network University Medicine (NUM) projects, aimed to establish a modular platform for coordinated development and use of pandemic apps focusing on ease of use, free availability, sustainability, data security, and rapid deployment. The initiative sought to create a collaborative framework leveraging science, technology, and legislative experience to deploy efficient, effective, and research-ready health apps for pandemic scenarios. In this viewpoint, we examine how COMPASS utilized an interdisciplinary approach, combining expertise from nine university hospitals and external partners to develop app components, guidelines, and templates for pandemic management. The project focused on governance, best practices, regulatory and ethical compliance, research compatibility, interoperability, and a technology platform. Data from study apps like the Mainz Gutenberg Study Covid-19 App and SentiSurv App were analyzed to assess user engagement and app effectiveness. COMPASS successfully implemented study-related applications, developed technical components, and applied non-technical findings, generating nearly 1 million data points with over 25,000 participants. Achievements included a questionnaire editor, key component improvements, and contributions to projects like the digital InnovationHub CAEHR. The initiative emphasized data protection, user trust, and open-source solutions for future health crises. COMPASS represents a paradigm shift in utilizing mobile health applications for pandemic management, integrating technology, ethics, and user engagement, setting a precedent for future innovations in healthcare communication and epidemic response.
Background: Background: Visual judgment is susceptible to human errors, such as evaluation item errors and judgment time variations. Automated Urine Test Strip Colorimetric testing may be used by prac...
Background: Background: Visual judgment is susceptible to human errors, such as evaluation item errors and judgment time variations. Automated Urine Test Strip Colorimetric testing may be used by practitioners and small-scale medical check-up facilities to test urine samples. Objective: Objective: We develop an automated urine test strip colorimetric program using images taken with a smartphone camera to judge the color of the urinalysis test strips objectively. Methods: Methods: To verify the program's reliability, we compare urine samples from real patients with the results of an automated urine analyzer. Results: Results: The concordance rate with the automated urine analyzer is 78.6% on average for 12 items. The concordance rate for the ±1 rank test is 95.4%. In addition, determining urinary albumin level results in a sensitivity of 100% and specificity of 58.6%. The area under the curve derived from the ROC curve is 0.907. Conclusions: Conclusions: The results clarified that colorimetric analysis in a fixed imaging environment could be used to determine urine test strips without calibration. This method may be used to screen for microalbuminuria, helping prevent exacerbation of diabetic nephropathy.
Background: During the COVID-19 pandemic in 2020, hospitals encountered numerous challenges that compounded their difficulties. Some of these challenges directly impacted patient care, such as the nee...
Background: During the COVID-19 pandemic in 2020, hospitals encountered numerous challenges that compounded their difficulties. Some of these challenges directly impacted patient care, such as the need to expand capacities, adjust services, and utilize new knowledge to save lives in an ever-evolving situation. Additionally, hospitals faced regulatory challenges. Objective: Objective: This article presents the findings of a qualitative study that compares the effects of reporting requirements on a small independent hospital (SIH) and a large, networked hospital (LNH) during the pandemic. Methods: Methods: We employed both quantitative and qualitative analyses. The researchers conducted a total of 51 interviews, which were thematically analyzed. We quantified the changes in regulatory reporting requirements over the first 14 months of the pandemic. Results: Results: These requirements placed a significant time burden on key clinical personnel at the SIH, consequently reducing the time available for patient care. Conversely, the LNH had dedicated non-clinical staff responsible for reporting duties, and their robust health information system facilitated this work. Conclusions: Conclusions: The discrepancy in health information technology (HIT) capabilities suggests that there may be significant institutional inequities affecting smaller hospitals' ability to respond to a pandemic and adequately support public health efforts. The healthcare policy implications of these findings are discussed. Clinical Trial: NA
The purpose of this paper is to demonstrate how Critical Discourse Analysis (CDA) frameworks can be used in cross-cultural mental health recovery research. CDA is a qualitative approach that criticall...
The purpose of this paper is to demonstrate how Critical Discourse Analysis (CDA) frameworks can be used in cross-cultural mental health recovery research. CDA is a qualitative approach that critically appraises how language contributes to produce and reinforce social inequalities. CDA regards linguistic productions as reflecting, consciously or unconsciously, the narrators' understandings of, or attitudes about, phenomena. Mental health recovery research aims to identify and address power differentials, making CDA a potentially relevant approach. However, CDA frameworks have not been widely applied to mental health recovery research. We adapted established CDA frameworks to our cross-cultural mental health recovery study. The adapted methodology comprises (i) selecting discourses that indicate positive changes, and (ii) considering sociocultural practices informed by relevant cultural characteristics identified in our previous research, without placing value judgments. Our adapted framework can support cross-cultural mental health recovery research that uses CDA.
Background: Over the past decade, health education curricula have emphasized the importance of active learning. Active learning encompasses numerous strategies including case-based learning (CBL) and...
Background: Over the past decade, health education curricula have emphasized the importance of active learning. Active learning encompasses numerous strategies including case-based learning (CBL) and problem-based learning (PBL) and represents a shift from passive lecture-based learning (LBL). Case-based learning and problem-based learning are often considered the leading active learning methods in health education. CBL is results-driven focusing on helping students integrate learned knowledge whereas PBL is driven by problem-solving. Objective: This review aims to evaluate the differences and similarities in learning outcomes of case-based learning and problem-based learning in health education to assess the level of evidence supporting the preference for one of these leading active learning methods. In short, is there enough evidence to support adopting one of these active learning strategies? Methods: An electronic search was conducted in three databases: PubMed, Embase, and Trip Database to identify randomized controlled trials (RCTs) or quasi-randomized controlled trials (qRCTs) published between January 2000 and October 2023 that compared the learning outcomes of case-based learning and problem-based learning in the same study. Results: A total of 77 records were identified. Following the removal of 10 duplicates, a 2-step process was used to identify appropriate studies for inclusion. A PRISMA Flow Diagram was used to apply the inclusion and exclusion criteria followed by a CASP screening to assess the quality of identified records. This stringent screening resulted in the retention of two relevant and high-quality studies. Conclusions: To date, very few published studies aimed at a side-by-side comparison of the learning outcomes of case-based learning and problem-based learning in health education. We truly believe that more research is warranted to clarify the merits and limitations of these leading active learning strategies to help guide their adoption based on reliable evidence.
Background: Affecting millions of people, spinal pain is the leading cause of years lived with disability worldwide since the nineties. Centralization phenomenon (CP) and directional preference (DP) a...
Background: Affecting millions of people, spinal pain is the leading cause of years lived with disability worldwide since the nineties. Centralization phenomenon (CP) and directional preference (DP) are common features in spinal pain patients, indicating a good clinical prognosis. CP is defined as a rapid and lasting migration of distal pain from the limb to the center of the spine after repeated movement tests. DP is a broader concept in which both the migration and decrease of pain are considered. While their detection has still been based on clinician decision, digital tool would provide objective measurements. Objective: We developed and assessed the reliability and validity of a new algorithm to detect CP and DP among spinal pain patients using quantitative a pain mapping software (PRISMAP). Methods: We designed a two-phase retrospective, cross-sectional, double-blinded diagnostic accuracy study. In Phase 1, using PRISMAP, we recorded and analyzed pain variations before and after a CP-focused physiotherapy session with specialized physiotherapy (PT). PTs classified patients as CP+ or CP-. We developed an algorithm to model changes in pain topography and intensity, identifying patients relative to PT classification. In Phase 2, PTs conducted four pain mappings. The initial two maps depicted a three-day overall patient pain profile, from which reliability and agreement were calculated using Intraclass Coefficient Correlation (ICC), Standard Error of Measurement (SEM), Coefficient of Variation (CV), and Bland-Altman analysis (BA). PTs then documented t-time pain mapping pre- and post-repeated movement test, classifying patients into CP-/CP+ and DP-/DP+. Validity parameters (sensitivity, specificity, positive and negative likelihood ratios (LR+/LR-)) were calculated from the latter two maps, using PT classification as the standard reference. Results: Twelve patients were included in Phase 1 and 49 in Phase 2. The algorithm demonstrated good reliability (ICC=0.993 [95%CI 0.988–0.996], SEM=0.211, CV=12.2%, and bias error with the BA of -0.041 representing 2.4% of the sample mean). Validity for CP was 92.0% [95%CI 73.7–99.02], 79.2% [95%CI 57.8–92.9], 4.42 [95%CI 2.01–9.71], 0.1 [95%CI 0.03–0.39] for sensitivity, specificity, LR+, and LR-. Validity for DP was 81.3% [95%CI 63.56–92.79], 88.2% [95%CI 63.6–98.5], 6.91 [1.86–25.66], and 0.21 [95%CI 0.1–0.45] for sensitivity, specificity, LR+, and LR-. Conclusions: The mathematical modeling of CP and DP is reliable and valid. This approach may enhance patient selection for future studies and serve as a clinical aid for practitioners.
Background: Mental health chatbots have emerged as a promising tool for providing accessible and convenient support to individuals in need. Building on our previous research on digital interventions f...
Background: Mental health chatbots have emerged as a promising tool for providing accessible and convenient support to individuals in need. Building on our previous research on digital interventions for loneliness and depression among Korean college students, this study addresses the limitations identified and explores more advanced AI-driven solutions. Objective: This study aimed to develop and evaluate the performance of HoMemeTown Dr. CareSam, an advanced bilingual chatbot implemented in both English and Korean using ChatGPT 4.0. The chatbot was designed to address the need for more personalized and culturally sensitive mental health support identified in our previous work, while providing an accessible and user-friendly interface for Korean young adults. Methods: We conducted a mixed-methods pilot study with 20 Korean young adults aged 18 to 27 years (mean=23.3, SD=1.96). The HoMemeTown Dr. CareSam chatbot was developed using the GPT API, incorporating features such as a gratitude journal and risk detection. User satisfaction and chatbot performance were evaluated using quantitative surveys and qualitative feedback. Comparative analyses were conducted with other LLM chatbots and existing digital therapy tools (Woebot and Happify). Results: Users generally expressed positive views towards the chatbot, with positivity & support receiving the highest score on a 10-point scale (mean=9.0, SD=1.2), followed by empathy (mean=8.7, SD=1.6) and active listening (mean=8.0, SD=1.8). However, areas for improvement were noted in professionalism (mean=7.0, SD=2.0), complexity of content (mean=7.4, SD=2.0), and personalization (mean=7.4, SD=2.4). The chatbot demonstrated statistically significant performance differences compared to other LLM chatbots (F=3.2719, P=.0465), with more pronounced differences compared to Woebot and Happify (F=12.9444, P<.001). Qualitative feedback highlighted the chatbot's strengths in providing empathetic responses and a user-friendly interface, while areas for improvement included response speed and the naturalness of Korean language responses. Conclusions: The HoMemeTown Dr. CareSam chatbot shows potential as a bilingual mental health support tool, achieving high user satisfaction and demonstrating comparative advantages over existing digital interventions. However, the study's limited sample size and short-term nature necessitate further research. Future studies should include larger-scale clinical trials, enhanced risk detection features, and integration with existing healthcare systems to fully realize its potential in supporting mental well-being across different linguistic and cultural contexts.
Background: Abstract (237 words)
The American Civil War has been commemorated with a great variety of monuments,
memorials, and markers. These monuments were erected for a variety of reasons, begi...
Background: Abstract (237 words)
The American Civil War has been commemorated with a great variety of monuments,
memorials, and markers. These monuments were erected for a variety of reasons, beginning with
memorialization of the fallen and later to honor aging veterans, commemoration of significant
anniversaries associated with the conflict, memorialization sites of conflict, and celebration of
the actions of military leaders. Sources reveal that during both the Jim Crow and Civil Rights
eras, many were erected as part of an organized propaganda campaign to terrorize African
American communities and distort the past by promoting a ‘Lost Cause’ narrative. Through
subsequent decades, to this day, complex and emotional narratives have surrounded interpretive
legacies of the Civil War. Instruments of commemoration, through both physical and digital intervention approaches, can be provocative and instructive, as the country deals with a slavery legacy and the commemorated objects and spaces surrounding Confederate inheritances.
Today, all of these potential factors and outcomes, with internationally relevance, are surrounded by swirls of social and political contention and controversy, including the remembering/forgetting dichotomies of cultural heritage. The modern dilemma turns on the question: In today’s new era of social justice, are these monuments primarily symbols of oppression, or can we see them, in select cases, alternatively as sites of conscience and reflection encompassing more inclusive conversations about commemoration? What we save or destroy and assign as the ultimate public value of these monuments rests with how we answer this question. Objective: I describe monuments as symbols in the “Lost Cause” narrative and their place in enduring Confederate legacies. I make the case, and offer documented examples, that remnants of the monuments, such as the “decorated” pedestals, if not the original towering statues themselves, should be left in place as sites of reflection that can be socially useful in public interpretation as disruptions of space, creating disturbances of vision that can be provocative and didactic. I argue that we should see at least some of them as sculptural works of art that invite interpretations of aesthetic and artistic value. I point out how, today, these internationally relevant factors and outcomes of retention vs. removal are engulfed in swirls of social and political contention and controversy within processes of remembering and forgetting and changing public dialogues. Methods: This article addresses several elements within the purview of the Journal: questions of contemporary society, diversity of opinion, recognition of complexity, subject matter of interest to non-specialists, international relevancy, and history. Drawing from the testimony of scholars and artists, I address the contemporary conceptual landscape of approaches to the presentation and evolving participatory narratives of Confederate monuments that range from absolute expungement and removal to more restrained responses such as in situ re-contextualization, removal to museums, and preservation-in-place. In a new era of social justice surrounding the aftermath of dramatic events such as the 2015 Charleston shooting, the 2017 Charlotteville riot, and the murder of George Floyd, should we see them as symbols of oppression, inviting expungement, or selectively as sites of conscience and reflection, inviting various forms of re-interpretation of tangible and intangible relationships?
I describe monuments as symbols in the “Lost Cause” narrative and their place in enduring Confederate legacies. I make the case, and offer documented examples, that remnants of the monuments, such as the “decorated” pedestals, if not the original towering statues themselves, should be left in place as sites of reflection that can be socially useful in public interpretation as disruptions of space, creating disturbances of vision that can be provocative and didactic. I argue that we should see at least some of them as sculptural works of art that invite interpretations of aesthetic and artistic value. I point out how, today, these internationally relevant factors and outcomes of retention vs. removal are engulfed in swirls of social and political contention and controversy within processes of remembering and forgetting and changing public dialogues. Results: I argue that we should see at least some of them as sculptural works of art that invite interpretations of aesthetic and artistic value. I point out how, today, these internationally relevant factors and outcomes of retention vs. removal are engulfed in swirls of social and political contention and controversy within processes of remembering and forgetting and changing public dialogues. Conclusions: Today, all of these potential factors and outcomes, with internationally relevance, are surrounded by swirls of social and political contention and controversy, including the remembering/forgetting dichotomies of cultural heritage. The modern dilemma turns on the question: In today’s new era of social justice, are these monuments primarily symbols of oppression, or can we see them, in select cases, alternatively as sites of conscience and reflection encompassing more inclusive conversations about commemoration? What we save or destroy and assign as the ultimate public value of these monuments rests with how we answer this question.
Background: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedent...
Background: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving the majority of young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative Just-In-Time Adaptive Interventions (JITAI), which provide support based on real-time data. Objective: This study explores young people's experiences with Mello, a JITAI which focused on the transdiagnostic mechanism of Repetitive Negative Thinking, a significant factor contributing to youth depression and anxiety. Methods: Semi-structured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomised controlled trial of Mello. Nine participants identified as female, four as male, and two as non-binary. Interviews focused on participants’ experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyse the data. Results: Three overarching themes were identified during the analysis: 1) Mello as a Tool for Intentional Engagement with Repetitive Negative Thinking, 2) Doing Therapy Your Own Way, and 3) Barriers to Engagement During Moments of Low Mood, Anxiety, and Repetitive Negative Thinking. Conclusions: Our findings underscore the value of Mello in promoting intentional engagement and reflection on Repetitive Negative Thinking, consistent with prior research that emphasises the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalisation features, and gamification techniques.
Background: The background for this study underscores the importance of reliable sources of health information, highlighting the potential influence of personal biases on our understanding of health-r...
Background: The background for this study underscores the importance of reliable sources of health information, highlighting the potential influence of personal biases on our understanding of health-related matters. First aid, crucial in preserving life and preventing deterioration of health conditions before advanced medical care, is essential knowledge for daily life. Seizures, disruptions in brain activity and neurohormonal interactions, can arise from various factors such as changes in ion concentration, drug withdrawal, or hypoglycemia. Definitions of terms like seizures, convulsions, and epilepsy are clarified to avoid confusion. Epilepsy, a common neurological condition, carries stigma, psychological effects, and significant costs. Regardless of seizure type, ensuring the safety of the individual during a seizure is paramount. This study aims to assess medical students' understanding and misconceptions regarding first aid management of convulsions. Objective: To assess the baseline knowledge of Neelain Medical Students regarding first aid management protocols for convulsions.
To evaluate the attitudes of Neelain Medical Students towards providing first aid assistance during convulsive episodes.
To identify prevalent misconceptions among Neelain Medical Students regarding the appropriate management of convulsions Methods: A descriptive cross-sectional survey with stratified random sampling study was conducted among 299 students at the faculty of medicine Neelain University. Data was collected using a self-administered questionnaire which was adapted from several research papers. Data analysis was done through the SPSS v.26 program. Results: The most common source of information on first aid management of convulsions was lectures in the university (26.8%) followed by self-study (22.1%). Most of the population never practiced first aid of convulsions (71.2%). Majority of the population experienced good practice (76.6%). Most of the population showed low level of misconceptions (73.6%).
Good knowledge was significantly higher among older age groups. Arranged as those older than 24 years (100%) followed by (22-24) (79.7%) then (19-21) (54.1%) and finally (16-18) (38.9%) (P<0.001). Year group associated significantly with the level of knowledge as the higher the educational level the more knowledge. (P<0.001). the source of knowledge which related to higher percentage of good knowledge was ward rounds and clinics (90.6%) followed by lectures in the university (80%) (P<0.001). Good Practice was significantly higher among older age groups. Arranged as those older than 24 years (100%) followed by (22-24) (87.0%) then (19-21) (68.1%) and finally (16-18) (50%) (P<0.001). Year group associated significantly with the level of Practice as the higher the educational level the better practice. (P<0.001). Good practice was more evident for those who attend ward rounds and clinics (90.6%) and those who received their information online (90.6%) (P<0.001). Good practice was evident for those who practiced in the street (100%) followed by hospital (75%), training program and then at home (66.7%) (P<0.001). The highest prevalence of misconception was among those who aged (19-21) (34.1%) and the least was among those who aged more than 24 (25%) (P<0.001). The highest prevalence of the level of misconception was among batch 23 (51.4%) while the lowest was among batch 19 (5.2%) (P<0.001). The lowest level of misconception was among those who practiced at hoe (75%) compared to those who practiced in the hospital (50%) (P<0.001). Good practice was associated with lower levels of misconception (77.3%) (P<0.001).
Higher Knowledge scores positively correlated with higher practice scores (r=0.353) (P<0.001) and knowledge score inversely correlated with the level of misconception (r=-0.207) (P<0.001). Positive attitude correlated positively with higher scores of practices indicating good practice (r=0.206) (P<0.001). and it correlated inversely with the level of misconception (r=0.124) (P<0.05). level of practice correlated inversely with the level of misconception (r=-0.123) (P<0.05) Conclusions: This study was conducted to assess level of knowledge, attitudes, practices and misconceptions among medical students. In general, the study shows good level of knowledge about convulsions and positive attitude towards first aid management through all year groups. However, year group associated significantly with the level of knowledge as the higher the year group the more knowledge. This may be due to more exposure on first aid training/lectures/ clinical ward rounds in clinical years. The results also show good level of practice, however, only 33 (11%) have practiced first aid in a convulsing person. This low percentage of practice shows that more training programs should be taught throughout the study years. Although the study did convey low level of misconceptions (73.6%), it only correlates and translates into inadequate practice, knowledge related to practice; i.e. lack of exposure to the situation and simulations of providing first aid to a convulsing patient.
Background: With dementia cases substantially increasing worldwide, adequate treatment tools are urgently needed. Considering the accessibility of cognitive interventions, non-pharmacological treatmen...
Background: With dementia cases substantially increasing worldwide, adequate treatment tools are urgently needed. Considering the accessibility of cognitive interventions, non-pharmacological treatments such as digital cognitive training are gaining popularity. Past studies specifically focus on cognitive training itself which requires digital literacy and easy to use. To enhance digital literacy and facilitate ease of use, it is possible to incorporate a social aspect, provide rewards for app usage, and utilize AI conversational agents. Objective: We developed a 12-week digital cognitive training called ‘Care & Cure’, which consists of a chatbot service called ‘Saemi talk’ and a group chat service called ‘Our Town’. A field study was conducted, to answering two research questions. The primary objective is to determine whether ‘Care&Cure’ program can enhance cognitive function in older adults. The secondary objective is to determine if ‘Our Town,’ which acts as a catalyst to increase ‘Saemi talk’ usage and interaction between AI agent and the user, improves the social aspect element. Methods: A total of 133 participants (age range: 51–83 years; mean age: 64.75 years) who had not been diagnosed with dementia were recruited. All participants received the ‘Care & Cure’ program for three months. The primary outcomes were changes in Korean-Mini Mental State Examination-version 2 (K-MMSE 2) and Cognitive Impairment Screening Test (CIST) scores after 3 months. and the secondary outcomes were the participants' log data, degrees of social support (MOS-SSS), depression scores (SGDS-K), and engagement scores (TWEETS). Results: Overall, the Care & Cure intervention improved cognitive function, as measured by the K-MMSE pre-post score (Hedge’s g = 0.26, p < .001) and CIST pre-post scores (Hedge’s g = 0.35, p < .001). In secondary results, emotional/informational support showed the highest difference before and after use (t = -6.509, p < .001) with a moderate effect size (0.70; Hedge’s g). Willingness to participate was significantly different between the factors of cognition (t = 2.159, p < .05) with a weak effect size (0.43; Hedge’s g) and affect (t = 2.008, p < .05) with a moderate effect size (0.51; Hedge’s g). However, the behaviors did not show significant differences between pre- and post-use. Additionally, depression showed a significant difference between pre- and post-use (t = 3.093, p < .01) with a weak effect size (0.21; Hedge’s g). In addition, both the active user’s group and non-active user’s group showed a significant increase in CIST scores after treatment (paired t-test; p < 0.001 for active user’s group; p < 0.05, active user’s group). In addition, individuals who used ‘Our Town’ tended to use ‘Saemi talk’ more frequently (p < .001). And, those who used ‘Saemi talk’ more frequently had higher social support scores (p < .001), and individuals with higher social support tended to have higher K-MMSE scores (p < .05). Conclusions: Care & Cure successfully improved cognitive function, participation, social support, and emotional relief. We found that improving social support among participants was a key strategy for improving cognitive function.
Background: Clinical Decision Support Systems (CDSS) have the potential to play a crucial role in enhancing healthcare quality by providing evidence-based information to clinicians at the point of car...
Background: Clinical Decision Support Systems (CDSS) have the potential to play a crucial role in enhancing healthcare quality by providing evidence-based information to clinicians at the point of care. Despite their increasing popularity, there is a lack of comprehensive research exploring their design characterisation and trends. This limits our understanding and ability to optimise their functionality, usability, and adoption in healthcare settings. Objective: This systematic review aims to analyse the design characteristics of CDSS, identify design-related challenges, and provide insight on the implications for future design. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations and used a Grounded Theory analytical approach to guide the conduct, data analysis, and synthesis. A search of five major electronic databases (PubMed, Web of Science, Scopus, IEEE Xplore, and the Journal of Decision Systems) was conducted for articles published between 2013 and 2023, using predefined design-focused keywords (design, user experience, implementation, evaluation, usability, and architecture). Out of 1922 initially identified articles, 40 passed screening and eligibility checks (by two researchers) for a full review and analysis. Results: Analysis of the studies revealed that User-Centred Design (UCD) is the most widely adopted approach for designing CDSS, with all design processes incorporating functional or usability evaluation mechanisms. The CDSS reported were mainly clinician-facing and mostly standalone systems, with their design lacking consideration for integration with existing clinical information systems and workflows. Through a UCD lens, four key categories of challenges relevant to CDSS design were identified: 1) usability and user experience, 2) reliability and effectiveness, 3) data access, and 4) context and clinical complexities. Conclusions: While CDSS show promise in enhancing health care delivery, identified challenges have implications for their future design, efficacy, and utilisation. Adopting pragmatic UCD design approaches that actively involve users is essential for enhancing usability and addressing identified user experience challenges. Integrating with clinical systems is crucial for interoperability and presents opportunities for AI-enabled CDSS that rely on large patient data. Incorporating emerging technologies like explainable AI can boost trust and acceptance. Enabling functionality for CDSS to support both clinicians and patients can create opportunities for effective use in virtual care settings.
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are genetically mediated life-threatening reactions that in adults are usually caused by a medication. These genetic ass...
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are genetically mediated life-threatening reactions that in adults are usually caused by a medication. These genetic associations promise an opportunity for pre-prescription screening and prevention. However, the study of genetic risk and long-term sequelae of SJS/TEN across racially diverse populations has been hampered by many factors that include its rarity, social disparities, and trust in healthcare and providers, which impact access to hospital and clinic-based research studies. Objective: To explore the utility of multiple social media and web-based search tools with the goal of increasing numbers, diversity, and inclusivity of study enrollment. Methods: The SJS survivor study is a community-based retrospective cohort study which remotely recruits drug-induced SJS/TEN survivors in the United States to help determine genetic risk and long-term outcomes. Baseline recruitment included advertisements on the SJS Foundation website and American Burn Association newsletter. Social media ads were later introduced by Vanderbilt University Medical Center (VUMC) Facebook and Instagram accounts, where posts were created using flyers and 60-second SJS/TEN survivor video vignettes. Finally, a national Google Ad campaign was launched. We measured the change in registration of both study interest and effectiveness of implementation of specific social media and web-based search tools before and after their implementation. Results: Since the introduction of social media and Google Ads in March 2022, we report a 48.6% increase in enrollment overall and a 289.5% increase in participation interest. We noticed the ads were inclusive to all age groups and saw a more even age distribution of enrolled participants from 18 through 74 years old was seen, with an average of 15% enrolled into each age category. The most significant increase in both enrollment and diversity of responses came from Google Ads with a total of 201 expressions of interest, 33% of which self-identified as non-White and 56 participants enrolled. Conclusions: Social media and web-based search tools differ in their enrollment effectiveness. In this community-based study, social media and web-based strategies increased numbers, diversity, and inclusion of enrollment and show promise as tools to increase both diversity and enrollment in rare diseases such as SJS/TEN.
Background: Managing chronic diseases remains a significant challenge in OECD countries. Digital tools, especially electronic PROMs (ePROMs), have shown potential in improving data collection and heal...
Background: Managing chronic diseases remains a significant challenge in OECD countries. Digital tools, especially electronic PROMs (ePROMs), have shown potential in improving data collection and healthcare delivery but their implementation in primary health care is still scarce. Objective: We aimed to describe the implementation and effectiveness of ePROMs in chronic disease management in primary health care settings and to identify associated barriers and facilitators. Methods: We conducted a mixed-method systematic review following Cochrane Methods and PRISMA guidelines, including studies that implemented ePROMs among adults to manage chronic diseases. We extracted outcomes related to patient health, provider workflow, costs, and implementation factors. We used the RE-AIM Framework to assess the reach, efficacy, adoption, implementation, and maintenance of ePROMs. Results: Our search yielded 12,168 references, from which 22 studies were included after screening and exclusions. These studies, conducted mainly in the United States and Canada, covered various chronic diseases and utilized diverse ePROMs tools, primarily mobile applications. While some studies reported improvements in patient health outcomes and self-management, others indicated no significant change. Barriers included digital literacy and integration into existing workflows, whereas facilitators involved personalized approaches and existing patient-provider relationships. Conclusions: Success in implementing ePROMs in primary health care appears to hinge on addressing digital literacy, ensuring personalization and meaningful patient-provider interactions, carefully integrating technology into clinical workflows, and conducting thorough research on their long-term impacts and cost effectiveness. Future efforts should focus on these areas to fully realize the benefits of digital health technologies for patients, providers, and healthcare systems. Clinical Trial: PROSPERO Systematic Review Registry (ID: CRD42022333513).
Background: Ecological Momentary Assessment (EMA) can capture highly dynamic processes and intense variability patterns suitable to the study of suicidal ideation and behaviors. Artificial Intelligenc...
Background: Ecological Momentary Assessment (EMA) can capture highly dynamic processes and intense variability patterns suitable to the study of suicidal ideation and behaviors. Artificial Intelligence (AI), and in particular Machine Learning (ML) strategies, have increasingly been applied to EMA data in suicide research. Objective: The review aims to (1) synthesize empirical research applying AI strategies to EMA data in the study of suicidal ideation and behaviors, (2) identify methodologies used, data collection procedures employed, suicide outcomes studied, AI applied, results reported, and (3) develop a standardized reporting framework for researchers applying AI to EMA data in future. Methods: PsycINFO, PubMed, SCOPUS and EMBASE were searched for articles published until June 2024. Studies that applied AI to EMA data in the investigation of suicide outcomes (suicidal ideation, suicide attempt, suicide death), collected across devices (Smartphone, Personal Digital Assistant, PC, tablet) and settings (clinical, community), were included. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines were used to identify relevant studies while minimizing bias. Specific EMA data reported included EMA sampling method, monitoring period, prompt latency, compliance, attrition, and treatment of missing data. Quality appraisal was performed using an adapted checklist for reporting EMA studies (CREMAS). Results: 1,201 records were identified across databases. After full text review, 12 articles, comprising 4398 participants were included. Studies were conducted in psychiatric hospitals (n = 5), emergency departments (n = 2), outpatient clinics (n = 2), medical residency programs (n = 1), and university mental health clinics (n = 1), with some conducted across settings. Design features reported (sampling strategy, prompting frequency, response latency, device used, compliance, and treatment of missing data) varied across studies. In the application of AI to EMA data to predict suicidal ideation, studies reported mean AUCs (0.74 to 0.86), sensitivity (0.64 to 0.81), specificity (0.73 to 0.86), and positive predictive values (0.72 to 0.77). Conclusions: The application of AI to EMA data within suicide research is a small but burgeoning area with high heterogeneity apparent in data collection and reporting standards. Findings indicate some promise in the application of ML to self-report EMA data in the prediction of near-term suicidal ideation. The development by the research team of a reporting framework aims to standardize reporting on the application of AI to EMA data in mental health research going forward. Clinical Trial: PROSPERO: CRD42023440218
Open Science Framework: https://doi.org/10.17605/OSF.IO/NZWUJ
Background: Artificial intelligence (AI) tools hold much promise for mental healthcare by increasing the scalability and accessibility of care. However, current development and evaluation practices of...
Background: Artificial intelligence (AI) tools hold much promise for mental healthcare by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools in mental healthcare limit the meaningfulness of their evaluation for healthcare contexts and thereby, the practical usefulness of such tools for professionals and clients alike. Objective: To move towards meaningful evaluation of AI tools in eMental health, this article demonstrates the evaluation of an AI monitoring tool that detects the need for more intensive care in an online grief intervention for older mourners. Methods: We take a three-fold evaluation approach (1) using the F1-metric to evaluate the tool’s capacity to classify user monitoring parameters, including affect, as (a) in need of more intensive support, or (b) recommendable to continue using the online grief intervention as is; (2) using linear regression to assess the predictive value of users’ monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention. Finally, (3) we collect qualitative experience data from eCoaches (N=4) who incorporated the monitoring in their weekly e-mail guidance during the 10-week intervention. Results: (1) Based on N=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. (2) Due to minimal variation in depression and loneliness scores after the 10-week intervention compared to before the intervention, only one linear regression was conducted with the difference score in grief before and after the intervention as dependent variable and participants’ mean score on the monitoring assessment tool, the estimate and slope of growth curves fitted to each participant’s response pattern to the monitoring assessment tool as predictors. Only the mean score exhibited predictive value for the observed change in grief (R2 =1.19, SE 0.33, t(df) = 3.58(16), P=.002). (3) The eCoaches appreciated the monitoring tool as a) an opportunity to confirm their impression about the participant based on a clinical interview prior to the intervention, b) a source for personalizing their e-mail guidance and c) an opportunity to detect when participants’ mental health deteriorated during the intervention. Conclusions: Each evaluation approach used in this article comes with its own set of limitations and challenges, including (a) skewed class distributions in prediction tasks based on real-life mental health data and (b) choosing meaningful statistical analyses based on clinical trial designs not targeted at evaluating AI tools. However, using multiple evaluation methods provides a good basis for drawing clinically meaningful conclusions and recommendations for improving the clinical value of any specific AI monitoring tool for its intended clinical context.
Proposed Article Abstract: In the African context, digital health solutions can leapfrog numerous health systems challenges to delivering effective and high quality care. However, the last 25 years of...
Proposed Article Abstract: In the African context, digital health solutions can leapfrog numerous health systems challenges to delivering effective and high quality care. However, the last 25 years of digital health innovation for Africa has resulted in numerous prototypes with very few implemented and sustained at large scales. In this viewpoint, we discuss opportunities for [HB2] and challenges in developing , evaluating and scaling digital technologies that are context specific to sub-Saharan Africa. We then explore a ‘people, process, tech’ approache to empower stakeholders to effectively navigate this complex landscape: bundling interventions, committing to open source, focusing on systems and technology integration[HB4] , and becoming the platform. We will illustrate these strategic approaches with case studies from the African continent.
Background: Multimorbidity is gaining prominence as a global public health challenge, with demographic and epidemiologic transitions. Epidemiologically, a bi-directional link exists between depression...
Background: Multimorbidity is gaining prominence as a global public health challenge, with demographic and epidemiologic transitions. Epidemiologically, a bi-directional link exists between depression and multimorbidity, and it is influenced by biological, psycho-social and care-related factors. Variations are expected in the different States with differential performances in the NITI Aayog Annual Health Index. Objective: The objective is to study the association of depression with multimorbidity among the older Indian population living in front-runner, achiever and aspirant States. Methods: This is an analytical cross-sectional study, analyzing secondary data collected during the Longitudinal Ageing Study in India (LASI)-1st wave (2017–18). A total of 66,606 Indian participants aged >45 years were included in the analysis. Based on their NITI Aayog Annual Health Index score, the States and UTs are classified into front-runner (top one-third), achiever (middle one-third) and aspirant (lowest one-third). For this study, the Health Index Round IV 2019-20 was used for categorisation of the states. Depression was the outcome variable, classified according to the Composite International Diagnostic Interview-Short Form (CIDISF). Multivariable logistic regeression analysis was conducted to calculate adjusted odds of association between depression and multimorbidity. Association between multimorbidity and depression was stratified according to the categorisation of States into front-runner, achiever and aspirants. Results: Among those with atleast two co-morbidites, depression was reported in 8.74%. Among those with atleast 4 multimorbidities, depression was reported in 15.56%. Depression was found to most commonly occur along with hypertension (35.8%) and musculoskeletal disorders (21.67%), and least commonly along with cancer (1.09%) and chronic renal failure (1.31%). There was a strong association between depression and multimorbidity in front-runner [aOR = 3.77; 95% C.I. 2.02-7.03], achiever [aOR = 2.10; 95% C.I. 1.84-2.45] and aspirant States [aOR = 3.27; 95% C.I. 1.79-5.95]. Conclusions: Strong association between depression and multimorbidity across all three State categories indicates a need for inclusion of mental health care components in the composite annual health index. Incorporation of routine and high risk screening for depression among patients with multimorbidity into the Ayushman Bharat Comprehensive Primary Health Care (CPHC) package needs to be tested with health technology assessment studies as potential future policy change. Clinical Trial: NA
Background: With the continuous evolution of technology, wearable accelerometers have become one of the most popular means of measuring daily physical activity (PA) levels. Despite the conventional us...
Background: With the continuous evolution of technology, wearable accelerometers have become one of the most popular means of measuring daily physical activity (PA) levels. Despite the conventional use of the non-dominant wrist as a device placement in numerous PA studies, the impact of wrist-worn accelerometer placement on PA data outcomes remains uncertain. Objective: The objective of this study was to examine the degree of agreement between accelerometry data collected from ActiGraph CentrePoint Insight Watches (CPIW) worn on the dominant and non-dominant wrists of young adults in free-living conditions. Methods: Twenty-nine participants (Mage 20.2±1.6; 23 females) simultaneously wore an ActiGraph CPIW on both dominant and non-dominant wrists for 7 consecutive days during waking hours. A sampling frequency of 32Hz and Montoye 2020 cut-points were used to categorize the activity intensity based on vector magnitude counts per minutes. Data validity criteria included: (1) ≥600 min/day of monitor wear time, (2) a wear time difference between the dominant and non-dominant wrists of less than 1% of the average wear time, and (3) at least three valid days of monitor wear. Bland Altman plots and intraclass correlation coefficient (ICC) analyses were performed to compare the accelerometry data between the two device placements. Results: Average daily monitor wear time was 789.6±86.1 min/day for dominant and 793.0±91.8 min/day for non-dominant wrists, respectively. All accelerometer variables, including sedentary time, light PA, moderate-to-vigorous PA (MVPA), steps, triaxial counts, and vector magnitude, showed good-to-excellent levels of reliability between the two measurements (ICC > 0.88 for all, p < .001). Bland Altman analysis calculated mean bias and standard deviation between the two device placements as follows: sedentary time (-18.8±27.6 min/day), light PA (2.7±15.9 min/day), MVPA (12.7±26.7 min/day), steps (218.1±476.6 counts/day), X axis (99.4±188.8 counts/min), Y axis (73.9±147.0 counts/min), Z axis (107.6±183.5 counts/min), and vector magnitude (161.2±273.4 counts/min). Bland Altman plots revealed that the upper and lower limits of agreement across most variables were considerably wide and that moderate proportional bias was present for steps (R2 = 0.091) and light PA (R2 = 0.105). Conclusions: Our findings align partially with previous research, demonstrating higher MVPA and step counts on the dominant wrist, while the non-dominant wrist produced a higher level of sedentary time compared to the dominant wrist. Despite the acceptable level of reliability between the two placements based on ICC analyses, the dominant wrist tended to produce greater outcomes as the intensity of PA increased compared to the non-dominant wrist, highlighting the need for careful consideration when determining the wear location of CPIW and interpreting data outcomes. Clinical Trial: N/A
Background: Cognitive training is increasingly being considered and proposed as a solution for a number of pathologies, particularly those associated with aging. However, to be effectively involved in...
Background: Cognitive training is increasingly being considered and proposed as a solution for a number of pathologies, particularly those associated with aging. However, to be effectively involved in cognitive training, it needs to be willing to put in enough mental effort to succeed and make progress. Objective: In this study we explore how gamification could help increasing voluntary mental effort by adding to a cognitive task visual GLE (Game-Like-Elements) within a narrative context. We also conder if this effect could endure while manipulating intrinsic variable of the task (i.e. by increasing cognitive solicitation). Methods: Thus, twenty participants assessed the impact of visual GLE in cognitive tasks on Perceived Playfulness (PP) and Mental Workload (MWL; assessed thanks to NASA-TLX and WP questionnaires). We also considered increased cognitive demand through a playful task. Results: Results showed that PP was more influenced by cognitive solicitation than interface’s playful characteristics. Moreover, visual game-like elements increased MWL regarding attentional resources, while manipulating cognitive solicitation impacted MWL when linked to task requirements. Conclusions: These results offer valuable insights to improve users’ experience during gamified cognitive tasks and serious games.
Background: In recent years, the rapid development of artificial intelligence technology, and the combination of Chinese medicine is becoming increasingly close, artificial intelligence's powerful dat...
Background: In recent years, the rapid development of artificial intelligence technology, and the combination of Chinese medicine is becoming increasingly close, artificial intelligence's powerful data processing capabilities and pattern recognition technology, is widely used in the depth mining of Chinese medicine information. Objective: In order to deeply explore the theoretical knowledge of Chinese medicine contained in Chinese medical cases, this paper explores the named entity recognition technology under the corpus characteristics of Chinese medical cases, and solves the problems of model performance degradation and low classification accuracy caused by sample imbalance. Methods: Introducing data enhancement methods to increase the diversity of the original samples, introducing loss-weighting methods to reduce the weight of the majority class and increase the weight of the minority class; extracting the contextual semantic information of the words using the BERT two-layer bi-directional Transformer structure to feature represent the text, and then connecting the BiLSTM-WCRF model to realise the downstream task of named entity recognition. Results: The experiments show that the Macro-F1 value of the BERT-BiLSTM-CRF(EDA) model is 10.1% higher than that of the BiLSTM-CRF(EDA) model with the introduction of the data enhancement method; and with the introduction of the loss weighting method on top of EDA, the Macro-F1 value of the BERT-BiLSTM-WCRF(EDA) model is 6.8% higher than that of the BiLSTM- WCRF(EDA) model by 6.8%. Conclusions: The introduction of both data augmentation and loss weighting methods can mitigate overfitting while improving the model as a whole as well as entity recognition for individual labels. Clinical Trial: None
Background: Many members of African American/Black communities, faced with the high prevalence of Alzheimer’s Disease and related dementias (ADRD) within their demographic, find themselves taking on...
Background: Many members of African American/Black communities, faced with the high prevalence of Alzheimer’s Disease and related dementias (ADRD) within their demographic, find themselves taking on the role of informal caregivers. Despite being the primary individuals responsible for the care of ADRD patients, these caregivers often lack sufficient knowledge about ADRD-related health literacy and feel ill-prepared for their caregiving responsibilities. Generative AI has become the new promising technological innovation in healthcare domain, particularly in improving health literacy, however some developments of it might lead to increase the biases and the potential harm towards African American/Black communities. Therefore, the development of generative AI tools to support African American/Black community should be done rigorously. Objective: The goal of this study is to test Lola, a multimodal mobile app, which by relying on generative AI, facilitates access to ADRD related health information. Methods: Through a cognitive walk-through with users, we tested the use of Lola with 15 African American /Black informal ADRD caregivers, by having them performed three tasks on the app and record their opinions and impressions. Results: Our findings highlight the user's need for a system which enables interaction with different modalities, as well as a system which can provide personalized and culturally and contextually relevant information, and the role of community and physical spaces for increasing the use of Lola. Conclusions: Our study shows when designing for African American/Black older adults, a multi-modal interaction with the generative AI system can allow individuals to choose their own interaction way and style, based upon their own interaction preferences and their external constrains. This flexibility of interaction modes can guarantee an inclusive and engaging generative AI experience.
Background: The increasing development and spread of artificial and assistive intelligence is opening up new areas of application not only in applied medicine but also in related fields such as contin...
Background: The increasing development and spread of artificial and assistive intelligence is opening up new areas of application not only in applied medicine but also in related fields such as continuing medical education (CME), which is part of the mandatory training program for medical doctors in Germany. Objective: The aim of our study was to determine whether medical laypersons are able to successfully conduct training courses specifically for physicians with the help of a large language model such as ChatGPT4. Methods: We plan to conduct a randomized controlled trial in which high school students use ChatGPT4 to complete special training courses for doctors in the fields of internal medicine, surgery, gynecology, pediatrics, neurology and anesthesiology. Thus, the test is set up with three arms: a) input of full-text and CME questions in ChatGPT4, b) input of CME questions only and c) a solution approach using a keyword search function in the full text. By means of randomization, the participants were evenly distributed among the three arms. The trial was approved by the Ethics Committee of Witten/Herdecke University (No. S-108/2024, date of approval 15 May 2024) and registered on the Open Science Framework (https://doi.org/10.17605/OSF. IO/MZNUF) in advance. Results: not yet applicable. Conclusions: Using this approach, we wanted to test further possible applications of artificial intelligence in the postgraduate medical education setting and obtain results for practical use. Depending on the results, the potential influence of LLMs such as Chat-GPT4 on CME will be discussed, e.g., as part of a SWOT analysis (strengths, weaknesses, opportunities, threats). Clinical Trial: Open Science Framework (https://doi.org/10.17605/OSF. IO/MZNUF)
Background: Human digital twins have the potential to change the practice of personalizing cognitive health diagnosis because these systems can integrate multiple sources of health information and inf...
Background: Human digital twins have the potential to change the practice of personalizing cognitive health diagnosis because these systems can integrate multiple sources of health information and influences into a unified model. Cognitive health is multifaceted, yet researchers and clinical professionals struggle to align diverse sources of information into a single model. Objective: In this paper, we introduce a method called HDTwin, for unifying heterogeneous data using large language models. HDTwin is designed to predict cognitive diagnoses and offer explanations for its inferences. Methods: HDTwin integrates cognitive health data from multiple sources, including demographic, behavioral, EMA, n-back test, speech, and baseline experimenter interview markers. Data are converted into text prompts for a large language model. The system then combines these inputs with relevant external knowledge from the scientific literature to construct a predictive model. The model’s performance is validated using data from three studies involving n=124 participants, comparing its diagnostic accuracy with baseline machine learning classifiers. Results: HDTwin achieves an overall accuracy of 0.81, significantly outperforming baseline classifiers. The experiments also reveal that HDTwin yields superior predictive accuracy when information sources are fused compared to single sources. HDTwin’s chatbot interface provides interactive dialogues, aiding in diagnosis interpretation and allowing further exploration of patient data. Conclusions: HDTwin integrates diverse cognitive health data, enhancing the accuracy and explainability of cognitive diagnoses. This approach outperforms traditional models and provides an interactive interface for navigating patient information. The approach shows promise for improving early detection and intervention strategies in cognitive health. Clinical Trial: digital twin, smartwatch, digital behavior markers, large language models, text analysis, machine learning
Background: The Doctor-to-Doctor (D2D) application is a mobile healthcare learning (m-learning) application that aims to support continuous learning programs, often called continuous medical education...
Background: The Doctor-to-Doctor (D2D) application is a mobile healthcare learning (m-learning) application that aims to support continuous learning programs, often called continuous medical education. One of the metrics of m-learning success is the average amount of time spent each month on the application, which is a component of stickiness, the tendency of users to use applications repeatedly. Stickiness metrics are important because they have a direct effect on user retention. Objective: This study aims to determine the factors that affect user stickiness of D2D. The research framework is built on the stimulus-organism-response theory. Methods: This study uses a mixed methods approach with 520 health worker respondents, including general practitioners, dentists, specialists, and medical students, as users of the D2D application. Quantitative data processing was analyzed using covariance-based structural equation modeling, while qualitative data analysis was conducted using the content analysis method. Results: This study found that cognitive and emotional applications affected health workers’ stickiness in m-learning. On the other hand, factors related to the functionality of the application and health workers’ experience have been proven to affect cognitive and emotional applications. Conclusions: The results of this study will help m-learning service providers increase user stickiness in m-learning.
Background: Tailored text messaging is a low-cost mobile health intervention approach shown to effectively improve self-care behaviors and clinical outcomes for patients with chronic cardiometabolic c...
Background: Tailored text messaging is a low-cost mobile health intervention approach shown to effectively improve self-care behaviors and clinical outcomes for patients with chronic cardiometabolic conditions. Given the ubiquitous nature of mobile phones, text messages have the potential to reach a large audience. However, automating and disseminating tailored text messages to large populations at low cost presents major logistical challenges that serve as barriers to implementation. Objective: This study describes an innovative approach for automating and disseminating personalized and tailored text messages to large populations at risk of cardiovascular events at a low cost using a registry-based tailored text messaging system known as the Heart Health Messages (HHM) program. We discuss the technical requirements, architectural design, automation process, and challenges associated with program implementation. Methods: Patients at high risk of cardiovascular diseases were identified using a statewide population health registry known as the Tennessee Population Data Network (TN-POPnet). Tailored invitation messages and enrollment surveys were sent to eligible patients via Twilio. Upon completion of the consent and enrollment forms, participants receive tailored text messages from a library of generic messages based on participant-selected frequency of message delivery (daily or every other day). Additionally, participants receive monthly text-based check-in survey messages designed to assess intervention adherence and improvement in self-care. Participants are also sent quarterly follow-up surveys to update enrollment information and preferences. All enrolled participants receive tailored text messages for a 12-month intervention period. Results: A total of 18,914 patients from two major health systems met the inclusion criteria and were eligible for the HHM program. Three phases of HHM 1.0 have been implemented so far, reaching 225 eligible patients in phase 1, 5,228 patients in phase 2, and 13,461 patients in phase 3, with enrollment of approximately 2%, 3%, and 3%, respectively, in each phase using recruitment through text message invitation alone. Efforts are underway to implement strategies in collaboration with the health systems to enhance the HHM program rollout and patient participation. The estimated cost of sending a tailored text message per patient per year via Twilio ranges from $1.70 to $3.42. Conclusions: The HHM program is a low-cost tailored text messaging intervention set for broader dissemination and potentials for replication. The program has the capacity to improve outcomes for people with chronic medical conditions. Clinical Trial: N/A
Background: Death in people living with HIV (PLWH) in sub-Saharan Africa (SSA) is highly preventable. However, the lack of inclusive and cost-effective high-performing prognostic tool constitutes a ch...
Background: Death in people living with HIV (PLWH) in sub-Saharan Africa (SSA) is highly preventable. However, the lack of inclusive and cost-effective high-performing prognostic tool constitutes a challenge. Most of the prognostic tools were developed in rich economies. The distinctive cultural dynamics in the epidemiology of HIV-related death makes them unsuitable for the region. In addition, in all the models, there was a lack of systematic stratification of the determinants of deaths based on clinical relevance and some included factors considered expensive for PLWH in SSA. Objective: To create a tailored predictive model that considers the unique context of sub-Saharan Africa, including cultural dynamics, cost-effectiveness, and clinical relevance. Methods: This a two-phase study. In the development phase, we will employ a combination of evidence synthesis namely meta-analysis, application epidemiology, biostatistical and economic paradigms to develop a prognostic model for PLWH in SSA. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses Protocol will be followed in the structuring of the meta-analysis. From their creation to the present, we will search African journals (SABINET), PubMed, Scopus, Medline, Academic Search Complete, Directory of Open Access Repository, Cochrane Library, Web of Science, EMBASE, and the Cumulative Index for Nursing and Allied Health Literature. Only cohort studies with moderate to high quality will be included. The primary outcome variables include the predictors of HIV-related death and their corresponding effect sizes (RR), homogeneity of the predictors vis-a-vis SSA, cost implication, risk weight, clinical minimum important difference (CMID) and critical risk points. A random-effect meta-analysis model will be used to synthesize the unbiased estimate of risk namely the relative risk (RR) per predictor. A combination of risk weight and CMID will be used for risk stratification. The model's constituent items will be selected based on the combination of risk weight, CMID, and cost implications. We apply the emergent model to secondary data obtained from a cohort of PLWH in Eastern and Western Africa during the validation phase, with outcomes including sensitivity, specificity, calibration, discrimination and area under the curve. Results: The result will be presented using narrative and quantitative synthesis. Further, strength of association, temporality, consistency, biological gradient and specificity of the exposure-outcome association will be presented in table. The predictive algorithms will be presented in table. Conclusions: Effective prognostication coupled with intense monitoring and evaluation, and prioritizing of therapeutic targets possess the potential to positively turn around the fate of millions of PLWH at risk death in SSA.
Background: Anxiety disorders are the most common mental disorders worldwide. However, 65% of them do not access services. The high prevalence of anxiety and low intervention uptake indicate a pressi...
Background: Anxiety disorders are the most common mental disorders worldwide. However, 65% of them do not access services. The high prevalence of anxiety and low intervention uptake indicate a pressing need to develop timely, scalable, and potent interventions suitable for adolescents. Objective: Adapting the existing single-session interventions (SSIs), the study further developed SSI on growth mindset about negative emotion for adolescent mental health. This study aimed to compare the effectiveness of four SSIs: Single-session Intervention of Growth Mindset for Anxiety (SIGMA), SIGMA with boosters, SSI of Growth Mindset of Personality (SSI-GP) and active control (ST, support therapy), in reducing adolescent anxiety. Methods: Classes were randomised to one of four intervention conditions: the SIGMA, SIGMA with boosters, SSI-GP, or ST. Each intervention took approximately 45 minutes online. Participants reported anxiety symptoms (primary outcome), depressive symptoms, suicidal/self-hurting thoughts, perceived control, hopelessness, attitude toward help-seeking and psychological well-being (secondary outcomes) at pre-intervention, the 2-week and 8-week follow-up. Participants also filled out the feedback scale at post-intervention. Generalized Estimating Equations (GEE) was used to examine the effectiveness of the SSIs. Results: 731 adolescents from seven secondary schools were randomised. The intent-to-treat analysis found a significant decrease in anxiety symptoms (the mean and 95% confidence interval(CI) at baseline: SIGMA-Booster: 6.8 [6.0, 7.6], SIGMA: 6.5 [5.8, 7.3], SSIGP: 7.0 [6.2, 7.7], ST: 6.9 [6.1, 7.7]) in two-week (the mean and 95%CI at two-week follow-up: SIGMA-Booster: 5.9 [5.1, 6.7], SIGMA: 5.7 [4.9, 6.5], SSIGP: 5.4 [4.6, 6.2], ST: 5.7 [4.9, 6.4]) and eight-week follow-ups (the mean and 95%CI at eight-week follow-up: SIGMA-Booster: 5.9 [5.1, 6.7], SIGMA: 5.3 [4.5, 6.0], SSIGP: 5.6 [4.8, 6.4], ST: 5.8 [5.1, 6.6]) in all four groups. Moderation analysis found participants with higher motivation for change and higher baseline anxiety scores and fixed mindsets had more improvements in anxiety symptoms. More than 70% of participants were positive about the feasibility and acceptability of the SSIs. Conclusions: The single-session interventions were effective at reducing anxiety and depression among adolescents over 8 weeks. Our data revealed the potential benefits of brief web-based intervention for adolescents, which may be scalable destigmatized and cost-effective alternative to school-based programs. Clinical Trial: ClinicalTrials.gov NCT05027880;
https://clinicaltrials.gov/ct2/show/NCT05027880
Background: Inconsistencies in survey-type assessments (e.g., questionnaires) data collection across biomedical, clinical, behavioral, and social sciences pose challenges to research reproducibility....
Background: Inconsistencies in survey-type assessments (e.g., questionnaires) data collection across biomedical, clinical, behavioral, and social sciences pose challenges to research reproducibility. ReproSchema offers a schema-centric framework and comprehensive tools to standardize survey (e.g., assessment) design and facilitate reproducible data collection in multiple scenarios. Objective: This study illustrates ReproSchema’s impact on enhancing research reproducibility and reliability. We first introduce ReproSchema’s conceptual and practical foundations, then compare it against twelve platforms, assessing its contributions in resolving inconsistencies in data collection. Three use cases detail ReproSchema’s application in standardizing required mental health common data elements, tracking changes in longitudinal data collection, and creating interactive checklists for neuroimaging research. Methods: We describe ReproSchema’s foundation and practical implementation before selecting twelve platforms for comparison, including CEDAR, former, Kobo Toolbox, LORIS, MindLogger, OpenClinica, Pavlovia.org, PsyToolkit, Qualtrics, REDCap, SurveyCTO, SurveyMonkey. Our comparison focuses on adapted FAIR principles (i.e., Findability, Accessibility, Interoperability, and Reusability) and survey-platform-generic functions (i.e., shared assessment, multilingual, multimedia, validation, branch logic, scoring logic, adaptability, and non-code). We then present three use cases of survey design—NIMH-Minimal, the Adolescent Brain Cognitive Development (ABCD) and HEALthy Brain and Child Development Study (HBCD), and the Committee on Best Practices in Data Analysis and Sharing Checklist (eCOBIDAS)—to demonstration ReproSchema’s versatile applications. Results: ReproSchema standardizes survey-based data collection through a central schema and other synergistic components (e.g., a library of assessments, a toolkit for format conversion and schema validation, a user interface for data collection, and a template for multi-assessment research protocol creation). In the platform comparisons, ReproSchema is one of the few platforms that meet all criteria related to the adapted FAIR principles and six out of eight functionalities. Additionally, three use cases highlight ReproSchema’s effectiveness in streamlining data collection, enforcing version control, and facilitating data harmonization post-collection. Conclusions: ReproSchema contributes to reproducible data collection through the standardized creation and usage of assessments in diverse research settings while being equipped with the general functions of other survey platforms. ReproSchema’s existing limitations and plan enhancements, including ontology mappings and semantic search capabilities, demonstrate ongoing refinement in utility for the research community.
Background: Sarcomas are rare cancer with heterogeneous group of tumours. Metastasis is often fatal, and current prognostic methods are limited. Recent findings show that sarcoma cells release small e...
Background: Sarcomas are rare cancer with heterogeneous group of tumours. Metastasis is often fatal, and current prognostic methods are limited. Recent findings show that sarcoma cells release small extracellular vesicles. Studying them can help assess cancer development, progression, and treatment effectiveness. Objective: This study aims to demonstrate the potential of small extracellular vesicles for monitoring the disease and predicting recurrence risk. Methods: A multicentric, prospective pilot study that will include 30 adults’ patients with localized or metastatic sarcoma. Small extracellular vesicles will be isolated from blood samples and protein and miRNA concentration will be determined. Research will last, on average, 6 months for patients with localized sarcoma and 4 months for patients with metastatic sarcoma. The study is sponsored by the Georges-François Leclerc Center and is currently ongoing. Results: Our innovative approach could improve sarcoma patient management through a non-invasive technique to predict treatment response and/or disease progression. Clinical Trial: ClinicalTrials.gov identifier NCT03800121. Registered January 11, 2019, https://clinicaltrials.gov/ct2/show/study/NCT03800121
Keywords: Pilot-study, liquid biopsy, exosomes, sarcoma, cancer monitoring.
Background: The tobacco industry has a history of targeting minority communities, including Hispanics, through social media where vaping is effectively promoted. This marketing increases the risk of v...
Background: The tobacco industry has a history of targeting minority communities, including Hispanics, through social media where vaping is effectively promoted. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Hispanic high school graduates, primarily Mexican Americans, has significantly increased over recent years. However, there is little research on the link between social media and vaping, and the underlying mechanisms/mediators (i.e., outcome expectations, attitudes/beliefs) that explain how vaping-related social media impacts vaping use among Mexican American colleges. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. With Hispanics, particularly Mexican Americans, becoming the largest ethnic group in Texas colleges, it is crucial to understand the impact of social media and acculturation on their vaping use. Objective: This paper outlines the protocol for the mixed methods used in Project VAMoS, a multi-wave study examining social media and e-cigarette use among Mexican American college students. This paper presents descriptive analyses of the participants enrolled in the study, focuses on methodological strengths, and discusses lessons learned during the implementation of the study protocol related to recruitment, data collection, and management. Methods: Project VAMoS is conducted with Mexican American students attending one of six Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, or University of Houston System. This project is conducted in two phases. Phase 1 includes an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (Years 1–2), and Phase 2 includes cognitive interviews and a five-wave, web-based survey study (Years 2-5) with innovative objective assessments of vaping-related social media marketing/messages to which participants are exposed. Descriptive statistics were used to summarize characteristics of participants in the EMA study and web-based survey. Results: The EMA analytic sample comprised 51 participants who were primarily female (72.5%), born in the United States (U.S.; 94.1%), of middle socio-economic status (SES; 74.5 %), and 21 years old on average. The web-based survey cohort comprised 1,492 participants self-identified as Mexican American, Tejano/a/x, or Chicano/a/x heritage, who are primarily female (69.8%), born in the U.S. (91.6%), of middle SES (78.8%), and were on average 20 years old at baseline. Conclusions: The VAMoS project is one of the first longitudinal mixed-method research studies exploring the impact of social media and acculturation on vaping behaviors, specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing vulnerable minority population.
Background: Prevailing childhood obesity in Asia adds risk for future adult burden of obesity and non-communicable diseases. Weak policies across most Asian countries enables unrestricted marketing of...
Background: Prevailing childhood obesity in Asia adds risk for future adult burden of obesity and non-communicable diseases. Weak policies across most Asian countries enables unrestricted marketing of obesogenic foods and beverages directly to children. Television is the common medium for food marketing to reach this audience. Objective: This study aimed to assess the extent and nature of television food and non-alcoholic beverage marketing in nine Asian countries (Bangladesh, China, India, Malaysia, Mongolia, Nepal, Philippines, Sri Lanka and Vietnam) with capacity building from the International Network for Food and Obesity/NCD Research, Monitoring and Action Support who enabled harmonization of data collection method and content analyses. Methods: Advertised foods were categorized as permitted (P) or not permitted (NP) based on the nutrient profile models (NPM) established by the WHO regional offices for South-East Asia (SEARO) and the Western Pacific (WPRO). Data were reported as rate of food advertisements (ads/h/channel) overall and persuasive strategy usage during children’s peak (PVT) and non-peak (non-PVT) viewing times. Results: Cross-country comparisons, irrespective of country income level, indicated NP food advertising dominated children’s popular television channels especially during PVT with rates as per WPRO/ SEARO criteria ranging from 2.40/ 2.29 ads/h/channel (Malaysia) to 9.70/ 9.41 ads/h/channel (Philippines). Persuasive strategy rates were also higher during PVT compared to non-PVT. Sugar-sweetened beverages, sugar-containing solid foods, and high salt and fat-containing snacks and fast foods were frequently advertised. Evaluation of the application of WPRO and SEARO NPMs identified inconsistencies due to regional taste and cuisine variations across Asia. Conclusions: Our study clearly showed unhealthy food marketing through popular children’s television channels is widely occurring in Asia and is a clear breach of child rights. Evidence outcomes will be used to advocate for stronger policy regulations to control unhealthy food marketing and strengthen strategies to promote a healthier food environment for the Asian people. Clinical Trial: Not relevant to this study as this is not a clinical trial.
Background: Global concern for the mental well-being of university students is appropriately on the rise. Prevalence studies worldwide indicate that rates of mental health disorders among young adults...
Background: Global concern for the mental well-being of university students is appropriately on the rise. Prevalence studies worldwide indicate that rates of mental health disorders among young adults attending university have reached 30%, with a staggering 80% of these individuals not receiving proper treatment ((Auerbach et al., 2018)). This not only adversely affects their academic performance but, more crucially, impairs their overall quality of life. In Brazil, where approximately eight million students are enrolled in universities, there exists a noticeable lack of studies addressing their mental health. In response, we created a web-based mental health survey tailored to the context of Brazilian university students. The primary objective of this paper is to outline the methods employed in designing this web-based mental health survey to provide insights into our approach to understanding and addressing mental health issues among university students in Brazil. Objective: The aim of this paper is to describe the methods used in the design of a web-based mental health survey to be administered in a private Brazilian University. Methods: In this web-based mental health survey, undergraduate students (target n = 8028) from two universities in Brazil (UNIFAJ and UNIMAX) will respond to three self-report screening questionnaires: 1) a measure of lifestyle and quality of life (SHORT-SMILE), 2) a screen for mental health disorders (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure Adult) and 3) a summarized version of the Adult Self-Report Scale for Attention Deficit/Hyperactivity Disorder. Students that receive high scores for specific constructs (i.e., depression, mania, generalized anxiety, sleeping disorders, borderline personality disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder and substance use disorders) will be administered more extensive standardized symptomatology scales. The three questionnaires and appropriate follow-up scales will be repeated every year within the same population to evaluate students over time. In addition, each year we will include new incoming students. The data will be analyzed cross-sectionally (with descriptive and association analysis between the different constructs measured) and longitudinally (with trajectory analyses at the level of the individual, area of academic concentration, and institution). Results: This protocol, as stated, has been underway since November 2023. The project is in the first wave of data collection. At this moment, there are 2127 participants, corresponding to more than 25% of the total number of students. Statistical analyzes will begin soon. Conclusions: College and university students have high rates of mental health issues. We have developed and described a web-based mental health survey that will allow us to evaluate and detect these issues with low cost and reasonable response rate in a University in Brazil. These efforts will allow us, in the near future, to monitor and test the efficiency and impact of mental health preventive programs.
This model could be scaled up across other universities in Brazil to easily assess the mental health status of their students and have a significant impact on the mental health of our communities. Clinical Trial: Study registration: This study was registered in the Open Science Framework (OSF) under the https://doi.org/10.17605/OSF.IO/AM5WS
Background: According to International Children’s Continence Society (ICCS), first-line treatment of children with daytime urinary incontinence is standard urotherapy, eventually followed by pharmac...
Background: According to International Children’s Continence Society (ICCS), first-line treatment of children with daytime urinary incontinence is standard urotherapy, eventually followed by pharmacotherapy of anticholinergics. The effect of medical treatment is sparsely investigated and primarily in non-randomized trials. Objective: The primary objective is to evaluate if (1) combination therapy of solifenacin and mirabegron in low doses is superior to monotherapy of solifenacin in high dose and if (2) combination therapy of mirabegron and solifenacin in low doses is superior to monotherapy of mirabegron in high dose in treatment of daytime urinary incontinence among children aged 5 to 14 years who are none complete responders to respectively monotherapy of solifenacin in low dose or monotherapy of mirabegron in low dose.
The secondary objective is to evaluate the treatment response of combination therapy of solifenacin and mirabegron in low doses, monotherapy in high dose and monotherapy in low doses as supplementary comparisons. Additionally, the secondary objective is to evaluate side effects, safety, and tolerability of the medical treatment as well as the effect of treatment on well-being and quality of life. Methods: Children aged 5-14 years diagnosed with daytime urinary incontinence refractory to standard urotherapy will be randomized to four treatment groups, randomization 1:1:1:1. Initially two groups will receive solifenacin 5 mg and two groups will receive mirabegron 25 mg. After 6 weeks, non-complete respondsers will receive add-on treatment according to their primary randomization group; group 1A will reviece solifenacin 5 mg and add-on solifenacin 5 mg, group 1B will receive solifenacin 5 mg and add-on mirabegron 25 mg, group 2A will receive mirabegron 25 mg and add-on mirabegron 25 mg, group 2B will receive mirabegron 25 mg and add-on solifenacin 5 mg. Total treatment period will be 18 weeks.
The primary endpoint measure is treatment response assessed by change from visit 2 to end of study, according to number of wet days pr. 7 days by DryPie. Results: Participants will be included from June 2024 to December 2027. Conclusions: The trial has the potential to optimize medical treatment of children with daytime urinary incontinence, to shorten the treatment period, diminish side effects and minimized unnecessary medical expenses. Clinical Trial: EU CT 2023-510187-13-00
Background: The COVID19 pandemic has caused a large number of infections and fatalities, causing administrations
at various levels to limit public mobility. This paper analyzes the complex associatio...
Background: The COVID19 pandemic has caused a large number of infections and fatalities, causing administrations
at various levels to limit public mobility. This paper analyzes the complex association between the
stringency of restrictions, public mobility, and reproduction rate (R-value) on a national level for Germany. Objective: The goals were to analyze; a) the correlation between government restrictions and public mobility and b)
the association between public mobilities and virus reproduction. Methods: In addition to correlations, a Gaussian
Process Regression Technique is used to fit the interaction between mobility and R-value. Results: The main
findings are that: (i) Government restrictions has a high association with reduced public mobilities,
especially for non-food stores and public transport, (ii) Out of six measured public mobilities, retail,
recreation, and transit station activities have the most significant impact on COVID19 reproduction rates. Conclusions: A mobility reduction of 30% is required to have a critical negative impact on case number dynamics,
preventing further spread.
This paper discusses the specific characteristics of any hypothetical cognitive space that may be modelled in
order to automate (or partially automate) the kind of mental health clinical reasoning -...
This paper discusses the specific characteristics of any hypothetical cognitive space that may be modelled in
order to automate (or partially automate) the kind of mental health clinical reasoning - clinical or psychological
case formulation - that is used by mental health professionals. It argues that work into the use of generative
artificial intelligence (AI) in the field of mental health needs to consider three components of this kind of
clinical reasoning. Firstly, heterotopy. When mental health clinical reasoning statements are made, parsing them
does not result in the same representation when the same words are used, due to the fact that mental health
ontologies contain multiple meanings for the same words. Secondly, orthogonality. Variables relevant to mental
health may not causally intersect but may both be relevant for clinical case formulation and treatment
determination. Thirdly, veridicality. The truth of a clinical case formulation may not be determined by any
testable observations. Even treatment response may not allow for a determination of truth., The truth status of a
clinical case formulation may hinge principally on the degree to which it confers meaning or understanding of a
mental state on the person who is experiencing that mental state, and that truth may be different to the truth
judgements of a mental healthcare clinician. Automated clinical case formulation models need to accommodate
for these features of the cognitive space of mental health clinical case formulation.
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 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: 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.
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
