Open Peer-Review: Effectiveness of a web-based tailored Interactive Health Communication Application for patients with type 2 diabetes or chronic low back pain: randomized controlled trial, and other submissions


 

JMIR has been a leader in applying openness, participation, collaboration and other "2.0" ideas to scholarly publishing, and since December 2009 offers open peer review articles, allowing JMIR users to sign themselves up as peer reviewers for specific articles currently considered by the Journal (in addition to author- and editor-selected reviewers). Note that this is a not a complete list of submissions as authors can opt-out. The list below shows recently submitted articles where submitting authors have not opted-out of open peer-review and where the editor has not made a decision yet. (Note that this feature is for reviewing specific articles - if you just want to sign up as reviewer (and wait for the editor to contact you if articles match your interests), please sign up as reviewer using your profile).
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The standard turnaround time for reviews is currently 2 weeks, and the general aim is to give constructive feedback to the authors and/or to prevent publication of uninteresting or fatally flawed articles. Reviewers will be acknowledged by name if the article is published, but remain anonymous if the article is declined.

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JMIR Submissions under Open Peer Review

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Titles/Abstracts of Articles Currently Open for Review


Effectiveness of a web-based tailored Interactive Health Communication Application for patients with type 2 diabetes or chronic low back pain: randomized controlled trial

Background: Prevalence of chronic conditions like type 2 diabetes (T2D) and chronic low back pain (CLBP) is rising. Patient involvement and self-management are key strategies in their management. Engaging patients can be fostered by web-based Interactive Health Communication Applications (IHCAs) combining health information with decision support, social support and/or behavior change support. They can reach great numbers of patients at low cost and provide high-quality information and support at the time, place and learning speed patients prefer. Still, online tools often suffer from high attrition. Tailoring content and tone of IHCAs to the individual patient´s needs might improve their effectiveness. Objective: This study aimed to test the effectiveness of a web-based tailored, fully automated IHCA combining health information with decision support and behavior change support for patients with T2D or CLBP. Methods: The effectiveness of the IHCA was tested against a standard website (SW) with identical content in a blinded randomized trial with a parallel design. The content covers information on T2D and CLBP and their treatment options. In the intervention group the content was delivered in dialogue form, tailored to relevant patient characteristics. In the control group the sections of the text were presented in a content tree, without any tailoring. Participants were recruited online and offline and blinded to group assignment. Measurements were at baseline, directly after the first visit, and at 3-month follow-up. The primary hypothesis was that the tailored IHCA has larger effects on knowledge and patient empowerment (primary outcomes) than the SW. Secondary outcomes were decisional conflict and preparation for decision making. All measurements were online self-report questionnaires. Intention-to-treat analysis (ITT) and available cases analysis (AC) were performed for all outcomes. Results: N = 561 users agreed to participate in the study. Of these, n = 179 (31.9%) had T2D and n = 382 (68.1%) had CLBP. System usage was significantly higher in the IHCA (M = 51.2 minutes) than in the SW group (M = 37.6 minutes; p < 0.001). Three months after system use, 52.4% of the sample was retained. There was no significant intervention effect in ITT analysis. In the AC analysis the IHCA group displayed significantly more knowledge at t1 (p = 0.02) and more emotional wellbeing (subscale of empowerment) at t2 (p = 0.009). The estimated mean difference between groups was 3.9 [95%CI: 0.5-7.3] points for knowledge and 25.4 [95%CI: 6.3-44.5] points for emotional wellbeing on a 0 to 100 points scale. Conclusions: The primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative affect in persons who use IHCAs. There were no intervention main effects on other dimensions of patient empowerment or decision-related outcomes. This might be due to our IHCA being, at its core, an educational intervention providing health information in a personalized, empathic fashion, not a decision aid. Or tailoring and interactivity do not make a difference with regard to these outcomes. Clinical Trial: International Clinical Trials Registry DRKS00003322
 
Date Submitted: Sep 30, 2014
Open Peer Review Period: Sep 30, 2014 - Nov 25, 2014
 
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Blog Posting after Lung Cancer Notification: Content Analysis of Blogs Written by Patients or their Families

Background: The advent and spread of the internet has changed the way societies communicate. A portion of information on the internet may constitute an important source of information concerning the experiences and thoughts of patients and their families. Patients and their families use blogs to obtain updated information, search for alternative treatments, facilitate communication with other patients, and receive emotional support. However, much of this information has yet to be actively utilized by health care professionals. Objective: We analyse health-related information in blogs from Japan, focusing on the feelings and satisfaction levels of lung cancer patients or their family members after being notified of their disease. Methods: We collected 100 blogs written in Japanese by patients (or their families) who had been diagnosed with lung cancer by a physician. These 100 blogs posts were searchable between June 1 and June 30, 2013. We focused on blog posts that addressed the lung cancer notification event. We analyzed the data using 2 different approaches. Analysis A, which was blog content analysis. We analyzed the content addressing the disease notification event in each blog. And Analysis B, which was subject dissatisfaction and anxiety analysis. Detailed blog content regarding subject dissatisfaction and anxiety at the individual sentence level was coded and analyzed. Results: Analysis A: the 100 blog posts were written by 48 men, 46 women, and 6 persons whose sex was undisclosed. The average age of the blog authors was 52.4 years. With regard to cancer staging, there were 5 patients at Stage I, 3 patients at Stage II, 14 patients at Stage III, 21 patients at Stage IV, and 57 patients without a disclosed cancer stage. The results showed that the proportion of patients who were dissatisfied with the level of health care exceeded that of satisfied patients (Satisfied: 8%; Dissatisfied: 22%). Analysis B: from the 2,499 sentences in the 100 blog posts analyzed, we identified expressions of dissatisfaction and anxiety in 495 sentences. Our results showed that there were substantially more posts concerning “Way of living, reasons for living, set of values” and “Relationships with medical staff (own hospital)” than in previous studies. Conclusions: This study provides insight into the feelings of dissatisfaction and anxieties held by lung cancer patients and their families, including those regarding the “Way of living, reasons for living, set of values” and “Relationship with medical staff (own hospital)”, which were inaccessible in previous survey analyses. When comparing information obtained from patients’ voluntary records and those from previous surveys conducted by health care institutions, it is likely that the former would be more indicative of patients’ actual opinions and feelings. Therefore important to utilize such records as an information resource.
 
Date Submitted: Sep 30, 2014
Open Peer Review Period: Sep 30, 2014 - Nov 25, 2014
 
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The potential role of social media platforms in community awareness of antibiotic use in the Gulf Cooperation Council States: luxury or necessity?

The increasing emergence and spread of multidrug-resistant bacteria is a serious public health issue. Increasing the awareness of the general public about appropriate antibiotic use is a key factor for combating this issue. Several public media campaigns worldwide have been launched; however, such campaigns can be costly, and the outcomes are variable and difficult to assess. Social media platforms, including Twitter, Facebook, and YouTube, are now frequently utilized to address health-related issues. In many geographical locations such as the countries of the Gulf Cooperation Council (GCC) States, namely, Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain, these platforms are becoming increasingly popular. The socioeconomic status of the GCC states and their reliable communication and networking infrastructure has allowed the penetration and scalability of these platforms in the region. This might explain why the Saudi Ministry of Health is using social media platforms alongside various other media platforms in a large-scale public awareness campaign to educate at-risk communities about the recently emerged Middle East Respiratory Syndrome Coronavirus (MERS-CoV). This article discusses the potential for using social media tools as cost-efficient and mass education platforms to raise awareness of appropriate antibiotic use in the general public and in the medical communities of the Arabian Peninsula.
 
Date Submitted: Sep 24, 2014
Open Peer Review Period: Sep 24, 2014 - Nov 19, 2014
 
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TeleOphthalmology for First Nations Clients at Risk of Diabetic Retinopathy: A Mixed Methods Evaluation

Background: Access to health services is a particular challenge for individuals living in remote or underserviced areas. TeleOphthalmology can provide remote populations with the same level of retinal screening services provided to those in urban centres. This screening can lead to the identification of high-risk individuals who can then be monitored and receive treatment related to their diabetes or other health issues. Objective: To develop and implement a service delivery model for TeleOphthalmology screening and follow-up for at-risk diabetic and diabetic First Nations clients on Vancouver Island. Methods: A highly consultative, culturally appropriate and collaborative approach was used to develop and deploy a TeleOphthalmology service delivery model across First Nations communities. The project was evaluated with regard to utilization and volume of services and referrals. Clinicians involved in the TeleOphthalmology project provided assessments of the TeleOphthalmology quality, productivity, and access. Health providers in First Nations communities provided their perceptions of areas of improvements for the remote retinal screening services, areas where expansion of services could be offered, and opportunities to increase client education and health promotion. Results: All 51 communities expressed interest in receiving TeleOphthalmology services. During the one-year project, TeleOphthalmology clinics were held in 43 of 51 communities on Vancouver Island. During these clinics, 524 clients were screened, and 140 of those clients were referred to a general ophthalmologist, family doctor, retinal specialist, optometrist, or other provider. Satisfaction with the TeleOphthalmology project was high among clinicians involved with the project. Satisfaction was also high among health providers in First Nations communities, with clinic scheduling identified as a potential area of improvement moving forward. The average cost savings per client was calculated to be $65.82, which was largely due to the elimination of client travel costs. Conclusions: TeleOphthalmology was a welcome addition to health services by the First Nations communities on Vancouver Island as evidenced by the 100% rate of interest from those communities. There was no evidence of dissatisfaction by clinicians involved in the TeleOphthalmology project, or by First Nations community health providers. The now-operational TeleOphthalmology program is a testament to the early success of the TeleOphthalmology project.
 
Date Submitted: Sep 17, 2014
Open Peer Review Period: Sep 19, 2014 - Nov 14, 2014
 
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Innovative Teaching using Smartphone and Web Technologies

Over the past decade, there have been massive developments in Web-based and Internet technologies. In addition, there have been even greater advances in terms of mobile phone based technologies, with the introduction of and the ever-increasing popularity of Smartphones. Smartphones are a new generation of mobile technology that has created much of a revolution in the current telecommunications market. Given the rapid advances in technology and the high rates of adoption by clinicians, it is timely to have a general overview of the evidence base of web-based and smartphone technologies in teaching and education. A brief overview of the interventions in paediatrics, Ophthalmology, nephrology, plastic surgery, orthopaedics, pharmacology and urology will be discussed. It should be noted that there are other disciplines that might not have tapped onto these new innovations. It is thus hoped that the existing letter would raise awareness of what has been done; and hopefully similar methodologies could be applied for other disciplines.
 
Date Submitted: Sep 17, 2014
Open Peer Review Period: Sep 17, 2014 - Nov 12, 2014
 
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Learning clinical procedures through Internet digital objects: Experience of undergraduate students across clinical faculties

Background: Various digital learning objects (DLOs) are available in the worldwide web, showing the flow of clinical procedures. It’s unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective: This study aimed to understand the experience of undergraduate students across clinical disciplines (medicine, dentistry, and nursing) in using openly accessible Internet DLOs and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods: A junior year and a senior year were selected from each undergraduate clinical degree program (MBBS, BDS, and BNurs) of the University of Hong Kong. All students were invited to complete a questionnaire on their personal and educational backgrounds and their experience and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by findings of six focus groups. Results: Among 439 respondents, 428 (97.5%) learnt a variety of clinical procedures through Internet DLOs. Most nursing students (87.8%) learnt preventive measures through Internet DLOs, with a lower percentage in medical students (46.3%) and dental students (45.4%) (both p<0.001). Three quarters of students accessed DLOs through public search engines, whereas 93.2% watched YouTube videos. Students often shared DLOs with classmates (63.7%), but rarely discussed with teachers (12.4%). The accuracy, usefulness, and importance of Internet DLOs was rated as 6.85, 7.27, and 7.13, respectively, out of a highest score of 10. Conclusions: Self-exploration of DLOs in the unrestricted Internet environment is extremely common among the current e-generation learners and was regarded by students across clinical faculties as an important supplement to their formal learning in planned curriculum. This trend calls for a transformation of educators’ role from dispensing knowledge to guidance and support.
 
Date Submitted: Sep 16, 2014
Open Peer Review Period: Sep 17, 2014 - Nov 12, 2014
 
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Content analysis of tweets, social media and online news during the measles outbreak in the Netherlands in 2013

Background: In May 2013, a measles outbreak began in the Netherlands among orthodox Protestants, who often refuse vaccination for religious reasons. Objective: This outbreak provided a good opportunity to examine public opinions shared on Twitter and social media during this event. We also compared reported measles cases with online (social) media coverage, to assess whether media followed the epidemiological curve of the measles outbreak. Methods: We analyzed measles-related tweets, social media and online news over a 7-month period (15th of April 2013 to 11th of November 2013). Measles-related tweets, social media, and online news were coded with regard to topic and sentiment. Results: Our findings showed that Twitter and social media followed the online news, rather than the epidemiological curve of the outbreak. All data sources showed three large peaks, possibly triggered by announcements about the measles outbreak by the Dutch National Institute for Public Health and the Environment (RIVM) and statements made by politicians. Most messages were informing the public about the measles outbreak (i.e., about the incidence of measles) and the leading opinion was frustration regarding unvaccinated orthodox Protestants. Conclusions: The monitoring of online (social) media might be useful for the RIVM in deciding how best to respond to the public in relation to disease outbreaks. Additionally, the data extracted from online (social) media provide insight about the opinions of the public towards disease outbreaks, which could enable the RIVM to respond appropriately to public concerns. We suggest monitoring of tweets and social media, since differences were observed between the topics and sentiments of these data sources. Publicly available data contains a vast dearth of information; however, analysis of social media and tweets is laborious. Therefore, further research is required to develop an automatic coding system that captures content most relevant to outbreak situations.
 
Date Submitted: Sep 15, 2014
Open Peer Review Period: Sep 15, 2014 - Nov 10, 2014
 
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Know Your Audience: Predictors of success for a patient-centered SMS application to augment HIV linkage to care in rural Uganda

Background: Despite investments in infrastructure, and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to: 1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda, and 2) evaluate the efficacy of various SMS formats to optimize the balance between confidentiality and accessibility. Methods: We report results from a randomized clinical trial of a short messaging service (SMS) application to notify PLWH of their laboratory results and request return to care for those with abnormal results. Participants with a normal laboratory result received a single SMS indicating results were normal and requesting return as scheduled. Participants with an abnormal result were randomized to one of three message formats which requested early return to clinic and were designed to evaluate trade-offs between clarity and privacy: 1) an SMS that stated results were abnormal and requested return to clinic (“direct”); 2) the same message protected by a 4-digit PIN-code (“PIN”); and 3) the message “ABCDEFG”, explained at enrollment to indicate abnormal results (“coded”). Outcomes of interest were 1) self-reported receipt of the SMS-message; 2) accurate identification of the message; and 3) return to care within seven days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit univariable and adjusted regression models for each outcome with the following explanatory variables: sociodemographic characteristics, CD4 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of SMS messages. Results: We enrolled 385 participants, 68% of whom successfully read a complete sentence on enrollment. Among the entire cohort, 73% self-reported successfully receiving a message, 88% correctly identified the message format, and 61% returned to clinic at the requested time. Among participants with abnormal tests results (n=138, 36%) the strongest predictors of reported message receipt were the ability to read a complete sentence and access a test message on enrollment. Participants with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, P=0.011) and return to clinic appropriately (AOR 3.81, P=0.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, P=0.002) or return within 7 days (AOR 0.26, P=0.005). Gender, age, and socioeconomic characteristics did not predict any outcomes, and there were no differences between those receiving direct or coded messages. Conclusions: Confirmed literacy at the time of enrollment was a robust predictor of SMS receipt, identification, and appropriate clinic return for an SMS result messaging application for PLWH in rural Uganda. Whereas PIN-protected messages reduced odds of clinic return, coded messages were as effective as direct messages, and might augment privacy. Careful attention should be paid to end-user characteristics during design and implementation of mHealth applications in resource-limited settings. Clinical Trial: Clinicaltrials.gov NCT 01579214
 
Date Submitted: Sep 12, 2014
Open Peer Review Period: Sep 15, 2014 - Nov 10, 2014
 
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Development of a theory driven and user-centred healthy eating app targeting parents for childhood weight management

Background: Current interventions to support parents with childhood weight management have had limited success due to a number of factors including physical barriers to families attending weight management programmes, lack of direct measures to involve parents in managing their children’s eating habits and addressing too many target behaviours at once. The proliferation of health promotion apps along with their array of features supporting health behaviour change, offer researchers a new and innovative approach to childhood weight management. However, research on the content of current industry led apps reveals they lack a basis in behaviour change theory and evidence. In addition, few apps aimed at childhood weight management target parents. Objective: To design and develop a user-centred and theory driven healthy eating app targeting parents for childhood weight management. Methods: The Behaviour Change Wheel framework, a theoretically-based approach, along with a user-centred design philosophy, guided the development process. Current evidence along with a series of nine focus groups (N=46) comprised of weight management case workers, parents with overweight and healthy weight children aged 5-11 years, and consultation with experts provided data to inform the app development. Thematic analysis of focus groups was conducted to extract information related to relevant theoretical, user-centred and technological components to underpin the design and development of the app. Results: Stakeholders inputs led to identification of the main target behaviour: to help parents provide appropriate food portion sizes for their children. The behavioural analysis revealed the need for eliciting change in parents’ capability, motivation and opportunity to enact the target behaviour. Seven out of the nine possible intervention functions were selected to bring about this change which guided the selection of fifteen behaviour change techniques. Users’ preferences for healthy eating app features resulted in four themes (app features, usability, aesthetics, and gamification) whereupon a criterion was applied to guide the selection on which preferences should be integrated into the design of the app. Collaboration with industry resulted in drawing on elements of gamification such as points, quizzes and badges to help engage users. Conclusions: The Behaviour Change Wheel combined with the user-centred design approach and collaboration with industry (integrating gamification practices) can be successfully applied for the development of a user-centred theory driven healthy eating app targeting parents for childhood weight management.
 
Date Submitted: Sep 11, 2014
Open Peer Review Period: Sep 11, 2014 - Nov 6, 2014
 
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Interchangeability of the Wii Balance Board™ for bipedal balance assessment

Background: Since 2010, an increasing interest in more portable and flexible hardware for balance and posture assessment led to previously-published studies that have been conducted in order to determine whether or not the Wii Balance Board (WBB) could be used to assess balance and posture scientifically and clinically. However, no previous study aimed to compare results obtained from different WBBs for clinical balance evaluation. Objective: In order to assess the WBB interchangeability a crossover study was designed. Methods: Six subjects participated in this study and their balance was assessed using four different WBBs. Trials were recorded simultaneously with WBBs and with laboratory Force Plate (FP). Nine relevant clinical parameters were derived from center of pressure displacement data obtained from WBB and FP systems. ICC, F-tests and Friedman tests were computed to assess agreement between trials and to compare WBB and FP results. Results: Excellent correlations were found between WBB and FP (mean R=0.83). At the exception of two parameters, strong to excellent agreements were found for the 7 remaining parameters (ICC=0.96). No significative difference was found between each trials recorded with different WBB. Conclusions: Our results indicate for most analyzed parameters that balance and posture assessed with one WBB are statistically similar to results obtained from another WBB. Further, the good correlation between WBB and FP results show WBB can be reliably used for scientific assessment using most of the parameters analyzed in this study. These results also seem to suggest that WBB could be used within multicentric studies and therefore would allow the creation of larger populations for clinical studies. Clinical Trial: CCB: B406201215142
 
Date Submitted: Sep 2, 2014
Open Peer Review Period: Sep 9, 2014 - Nov 4, 2014
 
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Technological Innovations for the MRCPsych Clinical Assessment of Skills and Competencies (CASC) Examination: Feasibility Study

Background: The Clinical Assessment of Skills and Competencies (CASC) is the relatively new clinical exam at the end of the Membership of the Royal College of Psychiatrists (MRCPsych) process. However the CASC has a notoriously low pass rate of approximately 40%, which indicates that large numbers of candidates are struggling with the exam every year. What the authors feel is relevant but being overlooked is that in addition to acquiring knowledge for CASC, it is also important to revise the necessary skills by consistent practice. It is also worth noting that candidates who practice amongst themselves might be lacking external, objective critique. Technological advances, both in online and smartphone technologies, have opened up new dimensions for preparation for the College examinations. Objective: Our research objectives are: Are trainees receptive towards having a smartphone application with mock stations and instructional videos; and are trainees receptive towards having an online peer-review portal, to provide them with external, objective critique? Methods: The CASC Feedback Portal and the Déjà vu CASC application was developed between January to April 2014. The developmental approach involved 4 developmental phases, which included that of: a) Understanding trainee’s requirements, b) System development, c) System evaluation and d) System deployment. The deployment of the smartphone application was done via a commonly accessed online forum, known as the “Revise Now” forum. Results: To date, there have been a cumulative total of 57 downloads of the mobile smartphone application from the web-link that was provided to them. In addition, there was a cumulative total of 225 views of all the videos that were deployed within the smartphone application. Since the inception of the online CASC feedback portal, there have been a cumulative total of 65 visitors to the site, with the majority of the visitors from the United Kingdom (n=36) and Singapore (n=18). Conclusions: This is one of the initial studies that has demonstrated the usefulness of a smartphone application specifically catered to the needs of a postgraduate examination. It is hoped that more rigorous analysis could be done in the near future, to obtain more qualitative and quantitative feedback from trainees.
 
Date Submitted: Sep 5, 2014
Open Peer Review Period: Sep 9, 2014 - Nov 4, 2014
 
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A Search Engine to Access PubMed Monolingual Subsets: Proof of Concept - Evaluation in French

Background: PubMed contains numerous articles in languages other than English. However, existing solutions to access these articles in the language in which they were written remain unconvincing. Objective: The aim of this study was: to propose a practical search engine, MLPubMedln, which will permit access to a PubMed subset in one language, and to evaluate the precision and coverage for the French version. Methods: In order to create this tool, translations of MeSH were enriched (e.g. adding synonyms and translations in French) and integrated into a terminology portal. PubMed subsets in several European languages were also added to our database, using a dedicated parser. The response time for the generic semantic search engine was evaluated for simple queries. BabelMeSH, MLPubMedfr and three different PubMed strategies were compared, to search for literature in French. Precision and coverage were measured for 20 randomly selected queries. The results were evaluated as relevant to title and abstract, the evaluator being blind to search strategy. Results: More than 650,000 PubMed citations in French were integrated into MLPubMedFr information system. The response times were all below the threshold defined for usability (2 seconds). Two search strategies (MLPubMedfr and one strategy with PubMed) showed high precision (respectively 0.93 and 0.97) but coverage was four times higher for MLPubMedfr. Conclusions: It is now possible to freely access biomedical literature using a practical search tool in French. This tool will be of particular interest for health professionals and other end-users who do not read or query sufficiently in English. The information system is theoretically well suited to expand the approach to other European languages such as German, Spanish, Norwegian and Portuguese.
 
Date Submitted: Sep 3, 2014
Open Peer Review Period: Sep 5, 2014 - Oct 31, 2014
 
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Computer literacy, adhesion and attitude towards study demands among participants of a web-based cohort: results from the NutriNet-Santé study

Background: Information about computer skills, adhesion and attitude towards study demands of participants involved in web-based cohorts is largely lacking, despite the worldwide expansion of e-epidemiology. Objective: We aimed to assess computer and Internet skills of participants in a web-based cohort study, and to compare their attitude towards study demands according to sociodemographic background and computer literacy. Methods: Data were collected in 2013 by self-administered web-based questionnaires among 43,028 participants to the NutriNet-santé cohort. Comparisons were performed by unconditional logistic and linear regression analyses. Results: About one quarter of the subjects (23.79%, 10,235/43,028) reported being inexperienced or novice in computer use. Women tended to be more “positive” than men towards the study, whereas better educated participants less likely to accept constraints regarding the frequency (P < .0001) or completion time (P < .0001) of the questionnaires. This study provides useful information for optimizing future web-based research investigations. Conclusions: A substantial proportion of the participants had low perceived computer/Internet skills, suggesting that this does not represent a barrier to participation in web-based cohorts. This study further suggested that several categories of subjects with lower computer skills (e.g., women, or participants with lower educational level) were more positive towards the study and less reluctant to comply with its demands.
 
Date Submitted: Sep 2, 2014
Open Peer Review Period: Sep 3, 2014 - Oct 29, 2014
 
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Quality of Publicly Available Information Websites About Congenital Heart Defects Following a Prenatal Diagnosis: Exploration of Central Subjects of Content and Systematic Assessment of Accessibility, Usability, Reliability and the Quality of Written Information

Background: Pregnant women and their partners use the Internet to search for information following a prenatal diagnosis of congenital heart defect. Objective: To explore central subjects of content and to assess the accessibility, reliability, usability and quality of written information on publicly available information websites about congenital heart defects following a prenatal diagnosis. Methods: Following searches in Bing.com and Google.com, websites containing patient information in English were included. Hits ranged from 340 000 – 67 500 000 and the first 50 hits from each search were screened for inclusion (N=600). Thirty-nine percent (236/600) of the hits were irrelevant. A manifest content analysis was performed to explore central subjects of content. The DISCERN instrument was used to assess the quality of information and the LIDA tool was used to assess accessibility, usability and reliability of the included websites. Results: A total of 67 websites were included, of which 37% (25/67) were affiliated to independent information websites, 25% (17/67) charity/private organizations, 25% (17/67) hospitals/clinics, and 13% (8/67) other affiliations. The majority of the websites (76%, 51/67) could not be attributed to an author. The content on the majority of the websites included care and treatment of children with congenital heart defects (88%, 59/67), causes of congenital heart defects (88%, 59/67), symptoms of congenital heart defects (85%, 57/67), prevalence of congenital heart defects (81%, 54/67), potential complications of congenital heart defects (75%, 50/67), prenatal diagnostics/screening methods (72%, 48/67), and specific congenital heart defects (72%, 48/67), whereas <10% included information about termination of pregnancy (6%, 4/67), care during pregnancy (5%, 3/67), and information specifically directed to partners (1%, 1/67). The mean of the total DISCERN score was 27.9 (SD=9.7, Range=16-53). According to the instrument a majority of the websites were categorized as very poor regarding information about effects of no treatment (88%, 59/67), support for shared decision-making (85%, 57/67), achievement of its aims (84%, 56/67), explicit aims (82%, 55/67), risks of each treatment (82%, 55/67), how treatment choices affect overall quality of life (76%, 51/67), and areas of uncertainty (76%, 51/67). The mean of the total LIDA score was 92.3 (SD=13.1, Range=61-127). According to the tool a majority of the websites were categorized as good with regard to registration (97%, 65/67) and browser test (75%, 50/67), whereas a majority were categorized as poor with regard to currency (87%, 58/67), content production (84%, 56/67), and engagability (75%, 50/67). Conclusions: Difficulties in finding relevant information sources using Web search engines and quality deficits on websites are an incentive for health professionals to take an active part in providing adequate and reliable information online about congenital heart defects.
 
Date Submitted: Aug 30, 2014
Open Peer Review Period: Sep 2, 2014 - Oct 28, 2014
 
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Despite the many biases, reputation of homeopathy is yet grounded on expanding popular, not scientific debate

Comment to: de Barra M, Eriksson K, Strimling P. How feedback biases give ineffective medical treatments a good reputation. J Med Internet Res. 2014 Aug 21;16(8):e193
 
Date Submitted: Aug 26, 2014
Open Peer Review Period: Aug 29, 2014 - Oct 24, 2014
 
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Twitter Sentiment Predicts Affordable Care Act Marketplace Enrollment

Background: The impact of the Affordable Care Act (ACA) and health insurance marketplaces have been measured with factors including public opinion and marketplace enrollment---both of which are published with a lag of weeks to months following implementation. Objective: We sought to evaluate Twitter’s role as a real-time barometer of public sentiment on the ACA and to determine if Twitter sentiment (the positivity or negativity of tweets) could be predictive of state-level marketplace enrollment. Methods: We prospectively collected 977,303 ACA-related tweets in March 2014 and then tested a correlation of Twitter sentiment with marketplace enrollment by state. Results: A 0.10 increase in the sentiment score was associated with an 8.7% increase in enrollment at the state level (95% confidence interval 1.32-16.13; p=.02), a correlation that remained significant when adjusting for state Medicaid expansion (p=.02) or use of a state-based marketplace (p=.03). Conclusions: This correlation indicates the potential for Twitter as a real-time monitoring strategy for future marketplace enrollment periods in which marketplaces could systematically track Twitter sentiment to more rapidly identify enrollment changes, including emerging issues. As a repository of free and accessible consumer-generated opinions, this study reveals a novel role for Twitter in the health policy landscape.
 
Date Submitted: Aug 26, 2014
Open Peer Review Period: Aug 29, 2014 - Oct 24, 2014
 
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The Effects of Self-Feedback Function on Continued Use of Mobile Personal Health Record Application

Background: With dramatic growth in the healthcare industry, innovation and development in information technology (IT) have driven patient-centric care service. Especially, the advent of smartphones brought health information much closer to patients. In spite of all of the effort and attention to implement mobile personal health record (mPHR) applications (apps), little is known about the adoption of mobile technology in the healthcare realm. Objective: The main goal of this study is to determine which aspects of mPHR apps attract patients and how such aspects alter their application usage patterns. Methods: We collected 1,727 patients’ individual log data of an mPHR application provided by the Asan Medical Center in Korea and their demographic and hospital records. This app provides four types of functions; Health management, Chart, Medication, and Outpatient support. Exploiting the function usage data, we measured the effectiveness of these functions to successfully hold patients’ use of the app in two different settings; panel analysis and survival analysis. Results: The results of the panel analysis using 20,872 samples suggest that all of the function types increase the amount of use. However, only the patient’s own health management features enabling them to measure and store personal health information positively influences patients to sustain the use of the mPHR app. Moreover, the results of the survival analysis show that the likelihood to sustain the use of mPHR app is associative with the intensive use of this self-feedback features. Conclusions: Developing personal IT devices and services to promote health supports is still at an immature stage. There are gaps between as-is and to-be models of the devices, thus various attempts have been made to fill this gap. The efficacy of the self-feedback validated in this study may enlighten a way to encourage patients’ behavior change through mobile devices and move one step ahead toward the future model.
 
Date Submitted: Aug 11, 2014
Open Peer Review Period: Aug 26, 2014 - Oct 21, 2014
 
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The use of Chinese-language Internet information about cancer by Chinese health consumers

Background: There is evidence that Internet health information is able to empower consumers and has a positive impact on the outcome of cancer patients. However, there is little research on Chinese-language Internet cancer information. Due to the differences in the information content and cultural background of Chinese and English Internet, research in Chinese-language settings may reveal different usage patterns and issues as compared to the more widely studied English-language Internet. Objective: This study investigates the use of Chinese-language Internet information about cancer by Chinese health consumers, as well as its impact on their cancer care. Methods: This study applied a grounded theory approach in data collection and analysis to construct a theoretical framework for understanding the pattern of use and impact of cancer information from the Chinese-language Internet. Semi-structured interviews were carried out with 20 participants in the People’s Republic of China (PRC) to learn their experience of using the Internet for cancer information as a patient themselves or, more typically, for a family member with cancer or possible cancer. Thematic analysis was undertaken on the interview data applying methods such as open coding, axial coding and constant comparison. Results: Three major themes were identified from the analysis process: (1) information needs evolve during the treatment journey; (2) Traditional Chinese Medicine (TCM) and adverse effects of treatment are the topics of greatest interest for participants; and (3) most participants have encountered Internet health information with questionable quality. Conclusions: The Internet has great potential to empower Chinese cancer patients and their family members through the cancer care journey. However, the quality issues around Internet cancer information, cultural considerations and current health care paradigm constrain this potential. Efforts should be done in order to improve cancer care in China, including establishing online support groups for Chinese cancer patients and care givers, educating consumers to raise awareness of side effects of TCM and to identify high quality Internet information, Engaging customers into decision making.
 
Date Submitted: Aug 23, 2014
Open Peer Review Period: Aug 25, 2014 - Oct 20, 2014
 
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Acute Medical Exacerbations and Engagement with Web-based Health Informatio

Background: The internet is an increasingly important resource for individuals, who seek information from both health professionals and peers. While the demographic and health characteristics of persons who use health information technology has been well described, less is known about the relationship between these health characteristics and level of engagement with health information technology. Even less is known about whether persons who produce web-based health information differ in health status from persons who consume such content. Objective: We explored the health characteristics of persons who engage with the internet for the purposes of consuming or producing web-based health information, and specifically, whether healthier versus sicker persons engage with health information technology in different ways. Methods: We analyzed data from the 2012 Pew Health survey, a landline and cellphone survey of 3,104 adults in the United States. Using multiple logistic regression with sampling weights, we examined the association between sociodemographic and health characteristics and the consumption or production of web-based health information. Sociodemographic variables included age, sex, race and education. Health characteristics included self-reported health status, presence of chronic condition(s), and having an acute medical exacerbation. Acute medical exacerbations were defined as an Emergency Department visit, hospitalization, or other serious medical emergency in the last 12 months. Results: The majority of the sample reported good or excellent health (80%), although 50% reported having at least one chronic condition. Approximately 20% of the sample experienced an acute medical exacerbation in the past year. Education was the sociodemographic characteristic most strongly associated with consuming web-based health information. The strongest health-related predictors of consuming web-based health information were an acute medical exacerbation (OR 2.39, p < .0001) and having a chronic condition (OR 1.54, p = .007). Having an acute medical exacerbation was the only predictor of producing web-based health information (OR 1.97, p = .003). All respondents, regardless of health status, were most interested in web-based health information regarding diseases or medical problems. However, persons with acute medical exacerbations were more likely to seek web-based health information regarding medical tests, procedures and drugs compared to persons without acute medical exacerbations. Conclusions: Producers of web-based health information differ from consumers of this information in important health characteristics that could skew the content of peer-generated web-based health information and over-represent the experiences of persons with acute medical exacerbations. Having an acute medical exacerbation may represent a “window of opportunity” during which patient engagement with health information technology changes. The health care visit for the acute medical exacerbation may represent an opportune time for providers to point patients towards high-quality, easy-to-understand web-based information, especially regarding treatments and procedures.
 
Date Submitted: Aug 21, 2014
Open Peer Review Period: Aug 21, 2014 - Oct 16, 2014
 
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Prioritization of free-text clinical documents: a novel use of a Bayesian classifier

Background: The amount of incoming data into physicians’ offices is increasing, thereby making it difficult to process information efficiently and accurately to maximize positive patient outcomes. Current manual processes of screening for individual terms within long free-text documents are tedious and error-prone. This paper explores the use of statistical methods and computer systems to assist clinical data management. Objective: To verify and validate the use of a naive Bayesian classifier as a means of properly prioritizing important clinical data, specifically that of free text radiology reports. Methods: Fifty reports were first used to train the algorithm based on physicians’ categorization of clinical reports as high-priority or low-priority. Then, the algorithm was used to evaluate 354 reports. Additional beautification procedures such as section extractors, text pre-processors, and negation detection were performed. Results: The algorithm evaluated the 354 reports with discrimination between high-priority and low-priority reports, resulting in a bimodal probability distribution. In all scenarios tested, the false negative rates were below 1.1% and the recall rates ranged from 95.65% to 98.91%. In the case of 50% prior probability and 80% threshold probability, the accuracy of this Bayesian was 93.50%, with a positive predictive value (precision) of 80.54%. It also showed a sensitivity (recall) of 98.91% and a F-measure of 88.78%. Conclusions: The results showed that the algorithm was able to be trained to detect abnormal radiology results by accurately screening clinical reports. Such a technique can potentially be used to enable automatic flagging of critical results. In addition to accuracy, the algorithm was able to minimize false negatives, which is important for clinical applications. We conclude that a Bayesian statistical classifier, by flagging reports with abnormal findings, can assist a physician in reviewing radiology reports more efficiently. This higher level of prioritization allows physicians to address important radiologic findings in a timelier manner and may also aid in minimizing errors of omission.
 
Date Submitted: Aug 19, 2014
Open Peer Review Period: Aug 21, 2014 - Oct 16, 2014
 
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Developing a healthy online cookbook for pediatric cancer patients and survivors

Background: Obesity has been a growing problem among children and adolescents in the United States for a number of decades. Childhood cancer survivors (CCS) are more susceptible to the downstream health consequences of obesity such as cardiovascular disease, endocrine issues and risk of cancer recurrence due to late effects of treatment and suboptimal dietary and physical activity habits. Objective: To document the development of an online cookbook of healthy recipes and nutrition resources to help enable pediatric cancer patients and survivors to lead healthier lifestyles. Methods: At the Table was created by a committee of staff members, community leaders, donors, patients and family members. Recipes were collected from several sources and through contests on social media. We incorporated advice from MDACCH’s Family Advisory and Adolescent/Young Adult Advisory Council members, which included current patients, parents and CCS. Results: Over 400 recipes, searchable by several categories and with accompanying nutritional information, are currently available on the At The Table site. In addition to healthy recipes, social media functionality and cooking videos are built into the site. At the Table is also a nutrition information resource with nutrition and cooking tip sheets available on several subjects. Conclusions: At the Table is a unique resource for promoting healthy lifestyles spanning pediatric oncology prevention, treatment and survivorship. Through evaluations of At the Table’s current and future use, as well as incorporation of the website into interventions designed to promote energy balance, we will continue to adapt and build this unique resource to serve cancer patients, survivors and the general public.
 
Date Submitted: Aug 19, 2014
Open Peer Review Period: Aug 21, 2014 - Oct 16, 2014
 
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Are Parents Getting it Right? A Survey of Parents’ Internet Use for Children’s Healthcare Information.

Background: The use of the Internet to search for medical and health related information is increasing and associated with concerns around quality and safety. We investigated the current use and perceptions of reliable websites for children’s health information by parents. Methods: Following institutional ethics approval we conducted a survey of parents/guardians of children presenting for day surgery. A 20-item survey instrument developed and tested by the investigators was administered. Results: Ninety-eight percent of respondents reported that they used the Internet to search for information around their child’s health. Eighty percent reported using public began their search using public search engines while less than 20% reported starting their search by using university/hospital-based websites. Common conditions such as colds/flu, skin conditions and fever were the most frequently searched and unique conditions directly affecting the child were second. Despite low usage levels of university/hospital-based websites for health information, the majority of respondents (74%) regarded these as providing safe, accurate and reliable information. In contrast, only 24% of respondents regarded public search engines as providing safe and reliable information. Fifty percent of respondents reported that they cross-checked information found on the internet with a family physician. Conclusions: An unprecedented majority of parents/guardians is using the Internet for their child’s health information. Of concern is that parents/guardians are currently not using reliable and safe sources of information. Health care providers should begin to focus on improving access to safe, accurate and reliable information for parents/guardians through various modalities including education, design for multiplatform, and better search engine optimization.
 
Date Submitted: Aug 18, 2014
Open Peer Review Period: Aug 18, 2014 - Oct 13, 2014
 
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E-health, participatory medicine and ethical care: A focus group study of patients and health care providers use of health technologies

Background: The rapid explosion in ehealth is claimed as transformational, accelerating the shift from traditional passive patient to patients as partners and altering the patient-clinician relationship. Epatients are engaged, equipped, enabled and empowered to take part in shared decision-making, and take responsibility for self-managing their illness. In this paper we use e-health and e-health technologies to refer to information and communication technologies used for health and wellness purposes. This includes a vast range of resources such as online applications, tools, information sources and social media. The widespread and rapid adoption of e-health technologies can enable immediacy and convenience in patient-clinician communications, provide patients with extensive and up-to-date information and connect people with similar conditions and have the potential to improve health outcomes. Objective: The objective of our study is to examine how people with chronic illness use ehealth in their daily lives, investigate how it affects patient-provider relationships, and explore the ethical and practical ramifications for patients, providers, and service provision. We apply a relational ethics approach to make explicit the implications and emerging ethical issues of ehealth and associated shifts in terms of patient-clinician relationships, self-management and shared decision-making. Methods: We purposively sampled participants in British Columbia, Canada to participate in focus groups. To be eligible, patient participants self-reported a diagnosis of arthritis and at least one other chronic health condition; health care providers (HCPs) reported a caseload of patients with arthritis and multi-morbidity (>25%). Results: We recruited 32 participants (18 patients, 14 HCPs) for focus group discussions. The participants attended 7 focus groups (FGs), 4 with patients and 3 with rehabilitation professionals and physicians. We used a semi-structured, but flexible, discussion guide. All discussions were audiotaped and transcribed verbatim. Elements of grounded theory guided our constant comparison thematic analytic approach. A relational ethics conceptual lens was applied to the data to identify emergent ethical issues. Predominant themes to emerge were how ehealth use influenced: 1) Changing roles; 2) Partnerships; 3) Tensions and burdens. Conclusions: The knowledge gained through e-health resources supports self-management and changes the medical encounter, supporting pertinent discussion and shared decision-making for patients and clinicians. Our findings emphasize the interactive process of making medical decisions; the negotiations that take place in clinical encounters; the patient work in terms of preparation; and the associated importance of trust, in order to feel able to share and negotiate in a more equitable partnership model. We also revealed the vulnerabilities of both patients and clinicians when facing the tensions and burdens around Internet use, in particular regarding negotiations, of time and evolving roles which nurture shared and informed discussions. Relational ethics brings attention to the moral space of medical encounters in which e-health care occurs.
 
Date Submitted: Aug 17, 2014
Open Peer Review Period: Aug 18, 2014 - Oct 13, 2014
 
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Smartphone-Connected Wearable Motion Sensors to Assess Post-operative Mobilization

Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation. Objective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility. Methods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on 4 activity sensors positioned at different body locations. Results: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recoded by the devices and were remotely available for the investigator to analyze. Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (R=.640, r2=.397) that reached statistical significance on the multivariate model (p=.034). Although increased gait speed also correlated with increased ankle sensor accuracy (r2=.197). Accuracy was also affected by several specific measures of a patient’s level of physical assistance, for which we generated a model to mathematically adjust for systematic under-estimation as well as disease severity. Conclusions: For the first time, we assessed the accuracy and utility of widely-available and wirelessly-connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient’s mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients.
 
Date Submitted: Aug 14, 2014
Open Peer Review Period: Aug 18, 2014 - Oct 13, 2014
 
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Barriers to meaningful use of personal health records by patients: A structured review

Background: An increasing focus on personal electronic health records (PHRs) offers healthcare benefits for patients, particularly those in undeserved and marginalised populations, at risk of receiving less effective healthcare and worse health outcomes. However, PHRs are likely to favour text, technical and health literate users, and be less suitable for disadvantaged patients. These individuals may be less likely to access an online record or contribute to the EHR Incentive Programs ‘meaningful use’ Measure #2 (5% of patients accessing their record). These concerns have prompted this review of the literature, which seeks evidence about barriers to the adoption and continued use of PHRs, the nature of the evidence for those barriers, and the stage of PHR implementation where particular barriers apply. Methods: Searches in PubMed, Embase, CINAHL and ProQuest databases were used to retrieve articles published in English after 2003 in a refereed journal or presented in a refereed conference or scientific meeting. After screening to remove items which were out of scope, the phase of the PHR implementation, the type of investigation, and PHR barriers were categorised using thematic coding. Results: The search retrieved 439 items; screening identified 40 in-scope publications, which provided evidence of 21 barriers to patient adoption and continued use of PHRs, categorised here as Individual, Demographic, Capability, Health-related, PHR or Attitudinal factors. Barriers were identified in most phases of PHR implementation, and in most types of study. A secondary outcome identified that eleven of the publications may have introduced a bias by excluding participants who were less affluent, less capable, or marginalised. Conclusions: PHR barriers can interfere with the decision to start using a PHR, with the adoption process, and with continued use, and the impact of particular barriers may vary at different phases of PHR adoption. The complex interrelationships which exist between many of the barriers is suggested in some publications, and emerges more clearly from this review. Many PHR barriers appear to be related to low socioeconomic status. The 5% meaningful use criterion will measure the activities of more capable PHR users, for whom the barriers are not insurmountable, but is less likely to include online activity by disadvantaged patients. A better understanding is needed of how the effect of barriers is manifested, how that that effect can be countered, and how planning and implementation of PHR initiatives can make allowance for patient level barriers to PHR adoption and use, with appropriate actions to mitigate the effect of those barriers for more disadvantaged patients.
 
Date Submitted: Aug 14, 2014
Open Peer Review Period: Aug 14, 2014 - Oct 9, 2014
 
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The essential evil! A viewpoint of family physicians on educational email alerts

Background: Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians (FPs) become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search online resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective: To understand participants’ knowledge, attitudes, and behaviour in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods: We conducted a qualitative descriptive study using the ‘Knowledge Attitude Behaviour’ model. Participants and data collection: Semi-structured face-to-face interviews with 15 FPs. Analysis: Inductive-deductive thematic qualitative data analysis. Results: As expressed by one FP, email is “the essential evil”. All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (i) advantages of educational email alerts such as saving time, convenience and valid information, and (ii) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions: The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by FPs can help to improve educational email alerts.
 
Date Submitted: Aug 11, 2014
Open Peer Review Period: Aug 12, 2014 - Oct 7, 2014
 
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An Observational Study of Social/Emotional Support in Smoking Cessation Twitter Accounts

Background: Smoking continues to remain the number one preventable cause of premature death in the United States. While evidence for the effectiveness of smoking cessation interventions has increased rapidly, questions remain on how to effectively disseminate these findings. Twitter, the second largest online social network, provides a natural way of disseminating information. Health communicators can use Twitter to inform smokers, provide social support, and attract them to other interventions. A key challenge for health researchers is how to frame their communications to maximize the engagement of smokers. Objective: To examine current Twitter activity for smoking cessation. Methods: Active smoking cessation related Twitter accounts (N=18) were identified. Their 50 most recent tweets were content coded using a schema adapted from the Roter Interaction Analysis System (RIAS), a theory-based, validated coding method. Using negative binomial regression, the association of number of followers and frequency of individual tweet content at baseline was assessed. The difference in followership at six-months (compared to baseline) to the frequency of tweet content was compared using linear regression. Both analyses were adjusted by account type (organizational or not organizational). Results: The 18 accounts had 60,609 followers at baseline and 68,167 at six months. Twenty four percent of tweets were socio-emotional support (mean 11.8, SD 9.8), 14% (mean 7, SD=8.4) were encouraging/engagement, and 62% (mean 31.2, SD 15.2) were informational. At baseline, higher frequency of socio-emotional support and encouraging/engaging tweets was significantly associated with higher number of followers (socio-emotional: IRR 1.09, 95% CI=1.02, 1.20; encouraging/engaging: IRR 1.06, 95% CI=1.00, 1.12). Conversely, higher frequency of informational tweets was significantly associated with lower number of followers (IRR 0.95, 95% CI=0.92, 0.98). At six months, for every increase by 1 in socio-emotional tweets, the change in followership significantly increased by 43.94 (P=0.027); the association was slightly attenuated after adjusting by account type and not significant (P=0.064)). Conclusions: Smoking cessation activity exists on Twitter. Preliminary findings suggest that certain content strategies can be used to encourage followership, and this needs to be further investigated.
 
Date Submitted: Aug 8, 2014
Open Peer Review Period: Aug 11, 2014 - Oct 6, 2014
 
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Telepathology Impacts and Implementation Challenges: A Scoping Review

Background: Telepathology is a particular form of telemedicine which fundamentally alters the way pathology services are delivered. The global digital pathology market is expected to grow at a compound annual growth rate of 15% from $2.2 billion in 2013 to nearly $4.5 billion in 2018. Prior telepathology research has mostly focused on two themes, namely, technical feasibility issues and diagnosis accuracy. Objective: As a complement to prior research conducted in this domain, we aim to synthesize the extant literature on telepathology implementation challenges and broader organizational/societal impacts and to propose a research agenda to guide future efforts in this domain. Methods: To achieve our goals, a scoping review was conducted.Two complementary databases were systematically searched: MEDLINE (Pubmed) and ABI/INFORM (ProQuest). Only peer-reviewed articles and conference proceedings were considered. The final sample consisted of 159 papers published between 1992 and 2013. Results: Our review highlights the diversity of telepathology networks and the importance of considering these distinctions when interpreting findings. For one thing, various network structures are associated with different benefits. While the dominant rationale in single site projects is financial, with telepathology being considered as an equal quality substitute to more costly solutions such as having a resident or roaming pathologist, larger centralized and decentralized networks are targeting a more diverse set of benefits, including extending access to pathology to a whole region, achieving substantial economies of scale in workforce and equipment and improving quality by standardizing care. Overall, our findings reveals that solid and rigorous evaluation studies remain rare as of today. As potential benefits are a key motivator leading to individual and organizational adoption, rigorously evaluating their nature and extent represents an important endeavor for future research. Further, our synthesis of the extant literature reveals that the nature and scale of encountered implementation challenges vary depending on the project structure. In smaller telepathology networks, organizational concerns are less prominent, and implementers are more focused on usability issues. As the project scope widens, organizational and legal issues gain prominence. Conclusions: Researchers should strive to assess telepathology impacts through more rigorous methodologies, leverage more existing theories and frameworks to explain telepathology implementation challenges and success, and ponder the form of telepathology networks when investigating these issues.
 
Date Submitted: Aug 6, 2014
Open Peer Review Period: Aug 8, 2014 - Oct 3, 2014
 
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