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The leading peer-reviewed journal for digital medicine, and health & healthcare in the Internet age
The Journal of Medical Internet Research (JMIR), now in its 20th year, is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications. It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2016: 5.175, ranked #1 out of 22 journals) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As leading high-impact journal in its' disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals, which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals.
As open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).
We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.
Be a widely cited leader in the digitial health revolution and submit your paper today!
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Background: Smoking is one of the most significant factors contributing to low life expectancy, health inequalities, and illness at the worldwide sacle. Smoking cessation attempts benefit from social...
Background: Smoking is one of the most significant factors contributing to low life expectancy, health inequalities, and illness at the worldwide sacle. Smoking cessation attempts benefit from social support. Mobile phones have changed the way we communicate through the use of freely available message-oriented applications. Mobile application-based interventions for smoking cessation programs can provide interactive, supportive, and individually tailored interventions. Objective: To describe the emotions, coping strategies, beliefs, values, and cognitive evaluations of smokers who are in the process of quitting, and to analyze online social support provided through the analysis of messages posted to a chat function integrated into a mobile application (app). Methods: Descriptive qualitative research. Informants were smokers who participated in the chat of Tobbstop. The technique to generate information was documentary through messages collected from September 2014 through June 2016, specifically designed to support a smoking cessation intervention. A thematic content analysis of the messages applied two models: the Lazarus model to assess participant experiences and perceptions and the Cutrona model to evaluate online social support. Results: During the study period, 11,788 text messages were posted to the chat by 101 users. The most frequent messages offered information and emotional support, and all of the basic emotions were reported in the chat. The three most frequent coping strategies identified were: increased physical activity, different types of treatment such as nicotine replacement, and humor. Beliefs included the inevitability of weight gain and the notion that not using any type of medications is better for smoking cessation. Health and family were the values more frequently described, followed by freedom. A smoke-free environment was perceived as important to successful smoking cessation. The social support group that was developed with the app offered mainly emotional and informational support. Conclusions: Our analysis suggests that a chat integrated into a mobile application focused on supporting smoking cessation provides a useful tool for smokers who are in the process of quitting, by offering social support and a space to share concerns, information, or strategies. Clinical Trial: Trial Registration NCT01734421 https://clinicaltrials.gov/ct2/show/NCT01734421?term=NCT01734421&rank=1
Background: Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue,...
Background: Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many healthcare systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists via a secure platform to facilitate discussion of patients’ care. Objective: In this article, we examine the different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different healthcare contexts worldwide. Methods: We conducted an environmental scan comprised of three stages: a literature review, a grey literature search, and targeted, semi-structured key informant interviews. We searched Medline and EMBASE (literature review) and Google (grey literature search). Upon completing the searches, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, physicians, and decision-makers. Maximum variation sampling was employed to ensure sufficient breadth of participant experience. We conducted semi-structured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach. Results: A total of 53 services emerged from the published and grey literature. Respondents from 10 services participated in telephone interviews. Four major themes emerged from the analysis: service structure, benefits of eConsult, implementation challenges, and implementation enablers. Conclusions: eConsult services have emerged in a variety of countries and health system contexts worldwide. Despite differences in structure, platform, and delivery of their services, respondents described similar barriers and enablers to implementation and growth, and reported improved access and high levels of satisfaction.
Background: During the past two decades Internet has become an accepted way to purchase products and services. Apparently, buying medications online is no exception. Beside it’s benefits several pat...
Background: During the past two decades Internet has become an accepted way to purchase products and services. Apparently, buying medications online is no exception. Beside it’s benefits several patient safety risks are linked to the purchase of medicines outside the traditional supply chain. Although ten thousands of Internet pharmacies are accessible on the web, the actual size of the market is unknown. Further, limited data is available on the use of Internet pharmacies, the number and attitude of people obtaining medications and other health products from the Internet. Objective: The authors aimed to gather information on the frequency and attitudes of patients purchasing medications online in a nationally representative sample of outpatients. Attitudes towards main supply chain channels, perceived benefits and disadvantages influencing online medication purchase are evaluated. Methods: A cross sectional explorative study using a personally administered survey was conducted in a representative sample of Hungarian outpatients in 2018. Results: A total of 1055 outpatients completed the survey (response rate 77.2%). Mean age was 45 years and 43.2% reported to have chronic health conditions. Majority (82.7%) of the respondents were aware of that medications can be obtained online, but only 4.17% (n=44) used the Internet for medication purchase previously. Attitudes towards the different pharmaceutical supply chain retail channels showed significant differences (p<0,01), respondents accepted retail pharmacy units as the most appropriate source of medications while rejected Internet pharmacies. Respondents were asked to evaluate nine statements regarding the potential benefits and disadvantages about the online medicine purchase, and based on the computed relative attitude rate there is a weak still significant tendency toward rejection (p<0,01). Correspondence of demographic factors, internet usage behavior and prospective online drug purchase attitude was evaluated. Respondents who use the internet more and purchase goods online will more likely to buy medications online. Further, younger age and higher educational level will determine the medication purchase behavior. Conclusions: Reasonable number of patients will purchase medications on the Internet in the near future. As illegitimate actors dominate the global online pharmacy market, there is an increased risk of patients buying products from illegal actors. Consequently, improved patient-provider communication and promotion campaigns are needed to inform the public on the safe use of Internet pharmacies, as these initiatives can directly prevent patient safety threats.
Objective The aim of this study was to evaluate the effectiveness of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or chronic obstructive pulmonary disease...
Objective The aim of this study was to evaluate the effectiveness of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or chronic obstructive pulmonary disease (COPD). Design The study was a retrospective observational study with a pre-post research design and a follow-up duration of up to 3 years, based on hospital data collected in the period 2012-2016. Setting Data was collected at the Slingeland Hospital in Doetinchem, The Netherlands. Participants In 2012 the Slingeland Hospital in The Netherlands started a telemonitoring program for patients with COPD or heart failure as part of their usual care. Patients were eligible for the telemonitoring program if they were in an advanced disease stage (New York Heart Association (NYHA) functional class 3 or 4; COPD gold stage 3 or 4), received treatment for their condition by a cardiologist or pulmonary specialist at the Slingeland Hospital, were proficient in Dutch and capable of providing informed consent. Exclusion criteria were absence of the cognitive, physical or logistical ability required to fully participate in the program. Hundred seventy-seven patients with heart failure and 83 patients with COPD enrolled the program between 2012 and 2016. Intervention Using a touchscreen, participants with heart failure recorded their weight (daily), blood pressure and heart rate (once a week) through connected instruments, and completed a questionnaire about their symptoms (once a week). Symptoms in patients with COPD were monitored via the Clinical COPD Questionnaire (CCQ), which participants were asked to complete twice per week. All home registrations were sent via a telemonitoring application (cVitals, FocusCura, Driebergen-Rijssenburg) on the iPad to a medical service center were a trained nurse monitored the data and contacted the patient by video chat or a specialised nurse in the hospital in case of abnormal results, such as deviations from a preset threshold or alterations in symptom score. Outcome measures The primary outcome was the number of hospitalisations; the secondary outcomes were total number of hospitalisation days and healthcare costs during the follow-up period. Generalised Estimating Equations were applied to account for repeated measurements, adjusting for sex, age and length of follow-up. Results In heart failure patients (N=177), after initiation of home telemonitoring both the number of hospitalisations and the total number of hospitalisation days significantly decreased (incidence rate ratio of 0.35 (95% CI: 0.26-0.48) and 0.35 (95% CI: 0.24-0.51), respectively), as did the total healthcare costs (exp(B) = 0.11 (95% CI: 0.08-0.17)), all p < 0.001. In COPD patients (N=83) neither the number of hospitalisations nor the number of hospitalisation days changed compared to the pre-intervention period. However, the average healthcare costs were about 54% lower in COPD patients after the start of the home telemonitoring intervention (exp(B) = 0.46, 95% CI 0.25-0.84, p = 0.011). Conclusion Integrated telemonitoring significantly reduced the number of hospital admissions and days spent in hospital in patients with heart failure, but not in patients with COPD. Importantly, in both patients with heart failure and COPD the intervention substantially reduced the total healthcare costs.
Background: Artificial intelligence（AI）is developing quickly in the medical field, which gives convenience to both medical staff and patients. The AI CDSS Watson for Oncology (WFO) is an outstandi...
Background: Artificial intelligence（AI）is developing quickly in the medical field, which gives convenience to both medical staff and patients. The AI CDSS Watson for Oncology (WFO) is an outstanding representative of AI in medical field, it can give prompt treatment recommendations to cancer patients, just as an excellent oncologist. It is more and more widely used in China, but there is no report about whether it suits Chinese patients. Here we report a retrospective study about the consistency of WFO's recommendations and commendations of the same patient given by our multi-disciplinary team board（MDT） at our center on lung cancer patients’ treatment. Objective: Our objective was to explore practicability of the WFO to the lung cancer cases in China and how to make it more suitable for Chinese patients with lung cancer. Methods: We selected all the lung cancer patients who were hospitalized and received antitumor treatment in the 2nd Xiangya hospital cancer center for the first time from September to December in 2017. WFO gave treatment recommendations to all qualified cases. If our actual therapeutic regimen (which was given by our MDT) was “recommended” or “for consideration” in WFO, we thought it was of consistency, if it was “not recommended” or WFO didn’t have this option, we thought it was of no consistency. Blind second round reviews were made by our MDT to reassess the incongruent cases. Results: WFO didn’t support 18% of all the cases (n=182). Of the 149 cases (82%) supported, 66% were consistent with our MDT recommendations. Subgroup analysis showed that pathological type and staging had a significant effect on consistency (p=0.004, p=0, respectively). Age, gender, whether there was gene mutation or not had no effect on consistency. In 81% of the inconsistent cases, our MDT gave two treatments with Chinese characteristics , which were different from recommendations given by WFO but were also with excellent effect. If WFO can bring the two alternative treatments into the recommended or considered range, the overall consistency can be elevated from 66% to 93%. Conclusions: In China, the majority of the treatment recommendations of WFO are consistent with the recommendation of the expert group, but there is still a relative high proportion of cases which are not supported by WFO. WFO cannot substitute our oncologists currently. As doctors’ assistant, it can improve the efficiency of our work, and it needs to learn local characteristics of patients to become a better assistant. Clinical Trial: none
Background: Randomized trials of web-based decision aids for prostate specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do...
Background: Randomized trials of web-based decision aids for prostate specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet. Objective: 1) Determine the impact of publicly available web-based PSA Option Grid patient decision aids on preference shift, knowledge, and decisional conflict; 2) identify which frequently asked questions (FAQs) are associated with preference shift; 3) explore the possible relationships between these outcomes. Methods: Data were collected between January 1, 2016 and December 30, 2017. Users who accessed the online, interactive PSA Option Grid were provided with three options – have a PSA test, no PSA test, unsure. Users first declared their initial preference, completed five knowledge questions, and a four-item (yes or no) validated decisional conflict scale (SURE). Next, users were presented with ten FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t-tests were employed to compare before-and-after knowledge and decisional conflict scores. A multinomial regression analysis was conducted to determine which FAQs were associated with a shift in screening preference. Results: Of the 467 people who accessed the PSA Option Grid, 186 (40%) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to ‘not having the PSA test’ (26% vs 71%; P <.01), had higher levels of knowledge (68% vs 89%, P < .01), and lower decisional conflict (57% vs 11%, P < .01). Three FAQs were associated with preference shift: What does the test involve? If my PSA level is high, what are the chances that I have prostate cancer? What are the risks? No relationships were present between knowledge, decisional conflict, and preference shift. Conclusions: Unprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict which confirms the ability of these tools to influence decision-making, even when used outside clinical encounters.