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Latest Submissions Open for Peer Review

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).

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JMIR Submissions under Open Peer Review

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Titles/Abstracts of Articles Currently Open for Review:

  • Postural Influence on Cognitive Dynamics during Esports Play: A Randomized Crossover Study

    Date Submitted: Apr 30, 2024
    Open Peer Review Period: May 3, 2024 - Jun 28, 2024

    Background: Humans have evolved to sit in a squatting position, whereas in the digitally integrated era epitomized by esports, prolonged sitting on a chair, namely seated position, is a widespread habit linked to body and mind issues. Although standing position promotes health and cognitive performance, the postural influence on cognitive benefits and risks during esports play remains unknown. Objective: We aimed to test the hypothesis that a standing position enhances esports performance over short periods compared to a seated position, while prolonged standing can lead to cognitive fatigue. Furthermore, we examined whether the forward leaning seated position promotes cognitive dynamics as a possible alternative to the standing position during esports play. Methods: We recruited 25 collegiate casual esports players. They first performed a crossover session of virtual football gaming for a maximum of 3 hours while standing or seated positions (Experiment 1). During the playing, we measured their subjective sensations, mood, virtual football performance, executive function, heart rate, pupil diameter, and salivary cortisol and testosterone levels. Next, we tested the effect of leaning forward in a seated position during the same virtual football gaming condition through a crossover session with a backward seated position (Experiment 2). Results: In Experiment 1, standing increased vitality and pleasure, executive function assessed by Flanker interference, and shot performance during the initial 30 minutes. Heart rate, pupil size, and salivary cortisol and testosterone were higher in the standing condition. Beyond 60 minutes, standing slowed interference with increased conceded goals, and 50% of the participants retired during play. In Experiment 2, seated in a leaning forward position enhanced vitality and pleasure, interference, and shot and pass performance than seated in a reclining position during the initial 60 minutes, but led to lower interference and cognitive accuracy after 120 minutes. Reclining seated position slowed interference from the early phase, but accuracy remained unchanged throughout playing. Conclusions: Our findings provide evidence that standing position for moderate durations (≤60 minutes) improves mood, executive function, and esports performance, but standing for prolonged durations (>60 minutes) causes cognitive fatigue, leading to lowered esports performance. Furthermore, leaning forward seated position serves as an alternative active sitting mirroring the cognitive dynamics of standing esports play. Reclining seated position supports cognitive endurance with higher accuracy. Ultimately, adopting postures to match cognitive demands could encourage active and healthy lifestyles in today’s co-evolving computer-human society.

  • Background: Rapid systematic reviews are vital tools for providing timely evidence to inform healthcare decisions. Objective: The aim of this study was to assess the reporting quality of rapid review literature against established methodological guidelines to identify areas for improvement. Methods: A cross-sectional study design was used with thorough searches of PubMed, Cochrane Library, and Web of Science until February 28, 2023. An expert guided the search strategy, and the Cochrane RR Evidence-Based Methodology was used to evaluate the reporting quality of rapid reviews. Subgroup and comparative analyses were performed to explore influencing factors on quality. Results: Among 112 Rapid Reviews analyzed, less than 50% fully reported on four key items, while over 50% fully reported on four other items. Reports published after 2021 showed slightly higher overall quality than those published before 2020, with significant differences in specific reporting criteria(P<0.05).The included studies were divided into CRR and RR groups. CRR had 100% reporting rates in several items and higher reporting rates in others compared to RR. Overall reporting rates were low for several items, with significant differences between CRR and RR for some items(P<0.05).The included studies were divided into groups A (IF ≤ 5) and B (IF > 5). Literature with an impact factor greater than 5 demonstrated slightly higher report quality compared to lower impact factor literature. Statistically significant differences were observed in specific criteria(P<0.05), with certain items reaching high reporting rates in both subgroups. Conclusions: This study observes an improvement in report quality. Literature in the Cochrane Library shows better reporting quality. However, overall methodological and report quality still require enhancement.

  • Background: Technology-mediated medication adherence interventions have proven useful, yet implementation in clinical practice is low. The ENABLE COST Action (CA19132) online repository of medication adherence technologies (MATech) aims to provide an open access, searchable knowledge management platform to facilitate innovation and support medication adherence management across health systems. To provide a solid foundation for optimal use and collaboration, the repository requires a shared interdisciplinary terminology. Objective: We consulted stakeholders on their views and level of agreement on the terminology proposed to inform the ENABLE repository structure. Methods: A real-time online Delphi study was conducted with stakeholders from 39 countries, active in research, clinical practice, patient representation, policy making, and technology development. Participants rated terms and definitions of MATech and of 21 attribute clusters on product and provider information, medication adherence descriptors, and evaluation and implementation. Criteria of relevance, clarity and completeness were rated on 9-point scales, and free-text comments provided interactively. Participants had the possibility to reconsider their ratings based on real-time aggregated feedback and revisit the survey throughout the study period. We quantified agreement and process indicators for the complete sample and per stakeholder group, and performed content analysis on comments. Consensus was considered reached for ratings with disagreement index (DI) below 1. Median ratings guided decisions on whether attributes were considered mandatory, optional or not relevant. We used results to improve the terminology and repository structure. Results: Of 250 stakeholders invited, 117 rated the MATech definition, of which 83 rated all attributes. Consensus was reached for all items. The definition was considered appropriate and clear (median ratings 7.02 and 7.26, respectively). Most attributes were considered relevant and mandatory, and sufficiently clear to remain unchanged, except ISO certification (considered optional, median relevance rating 6.34), and medication adherence phase, medication adherence measurement, and medication adherence intervention (candidates for optional changes, median clarity ratings 6.07, 6.37, and 5.67, respectively). Subgroup analyses found several attribute clusters considered moderately clear by some stakeholder groups. Results were consistent across stakeholder groups and across time, yet response variation was found within some stakeholder groups for selected clusters, suggesting targets for further discussion. Comments highlighted issues for further debate and provided suggestions which informed modifications to improve comprehensiveness, relevance, and clarity. Conclusions: By reaching agreement on a comprehensive MATech terminology developed following state-of-the-art methodology, this study represents a key step in the ENABLE initiative to develop an information architecture that has the potential to structure and facilitate the development and implementation of MATech in health systems across Europe. The debates and challenges highlighted in stakeholders’ comments outline a potential roadmap for further development of the terminology and the ENABLE repository.

  • Background: Digital health interventions (DHIs) aim to support health-related knowledge transfer e.g., through websites or mobile applications (apps). They have the potential to either increase health inequalities due to the digital divide or to reduce health inequalities by making healthcare available to those who might not otherwise be able to access it, such as geographically remote populations. They can also overcome language barriers though translated content and enable people to access support and advocacy from family members or friends. However, public health programmes and patient-level healthcare delivered digitally need to consider ways to mitigate the digital divide through DHI design, deployment, and engagement mechanisms, to reach digitally excluded populations. Objective: The objective of this systematic scoping review was to identify the features of DHI design and deployment conducive to improving access to, and engagement with, DHIs by people from demographic groups likely to be affected by the digital divide. The review was conducted during the evolving Covid-19 pandemic, and its findings informed the rapid design, deployment, and evaluation of a post-Covid-19 rehabilitation DHI called ‘Living With Covid Recovery’ (LWCR). LWCR needed to be engaging and usable for patients with a wide range of demographic characteristics, to avoid exacerbating existing health inequalities as far as possible. LWCR was introduced as a service in 33 participating NHS hospital clinics from August 2020, was used by 7,679 patients, and the study ran until 20th December 2022. Methods: This systematic scoping review followed the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidance. The following databases were searched for primary research studies published in English from 1 October 2011 to 1 October 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC) and Trip. In addition, we used OpenGrey and Google Scholar to search for grey literature. We selected publications that met the following inclusion criteria: primary research papers that explored and/or evaluated features of DHI design and deployment intended to enable access to and engagement by adults from demographic groups likely to be affected by the digital divide (e.g., older age; minority ethnic groups; lower income/education level). The data from studies that met the review inclusion criteria were extracted, narratively synthesised, and thematically analyzed. Results: A total of 22 papers were included in the review. Inclusion criteria were met for 19 papers of 1245 hits retrieved by the search and three further papers were added from a search of publications included in relevant reviews. DHIs evaluated in the studies included: telehealth, virtual assistants, text message interventions, decision aids and e-health learning programs. The main themes resulting from analysis of extracted data relating to design considerations included: co-development with end-users and user testing for iterative design cycles to produce DHIs that help improve digital skills and digital health literacy through use; tailoring for low literacy levels through animations, pictures, videos and writing for a low reading age; use of virtual assistants to collect information from patients and guide use of a DHI. For deployment, themes revealed included: provide devices and data, if possible, otherwise use text messages or signpost to sources of cheap/free devices and free WiFi; provide ‘human support’ for implementation / onboarding and troubleshooting; provide tailored digital skills education as part of the intervention; and incorporate peer/family support. Conclusions: Taking these “universal precaution”’ can help reduce the digital divide. The results helped guide the iterative design and successful deployment of the LWCR DHI. They also have wider implications for practitioners, policy makers, and researchers, and will inform best practices in the design and delivery of DHIs for equitable health improvement

  • Shared Decision Making Tools Implemented in the Electronic Health Record: A Scoping Review

    Date Submitted: Apr 26, 2024
    Open Peer Review Period: May 1, 2024 - Jun 26, 2024

    Background: Shared decision making (SDM) is a model of patient-centered care that encourages patients and clinicians to work together to reach medical decisions by weighing the risks and benefits of various options within the context of the values and goals of the patient. Despite the interest in incorporating SDM into routine care, current research studies identify various obstacles that limit SDM adoption. These obstacles include technical integration issues, logistical and workflow challenges, and psychological impediments such as uncertainty and legacy belief systems, which continue to impede progress. Integrating SDM tools and processes into EHR systems is often a complex and challenging problem. Objective: We aimed to understand the integration and implementation characteristics of reported Shared Decision Making (SDM) interventions integrated into an electronic health record (EHR) system. Methods: We conducted a scoping review using Arksey and O’Malleys' methodologic framework with guidance from the Joanna Briggs Institute. Results: A total of 19 studies of 2153 were included in the final review. There is a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that target established healthcare processes promoted use. Integrating SDM templates and tools into an EHR appeared to improve the outcomes for most studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were not included in several studies. The two most common study outcome measures were patient satisfaction and SDM tool use. Conclusions: Understanding the approaches for presenting SDM tools directly into a clinician’s workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes is needed for consistency across SDM studies. Targeting accepted clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized control trials are needed to expand the quality of the evidence base. Keeping the goals and values of the patient at the center of shared decision making interactions is a key area for future studies.

  • Implications of the European Union's New Regulation on Artificial Intelligence (2024) on its Clinical Implementation

    Date Submitted: Apr 22, 2024
    Open Peer Review Period: May 1, 2024 - Jun 26, 2024

    On March 13, 2024, the Parliament sanctioned the inaugural comprehensive artificial intelligence (AI) statute globally. The European Union deems the governance of this technology as crucial, in light of potential infringements upon fundamental rights and public freedoms, detrimental impacts on the environment, and the integrity of democratic frameworks. Conversely, the undeniable advances in the medical domain necessitate the regulation of such technology to bolster investments and research, thereby providing the requisite legal certainty for users/patients, professionals, enterprises, and investors. The Regulation acknowledges the potential perils certain AI applications pose to fundamental rights, enacting prohibitions on practices such as biometric categorization, emotion recognition, and social scoring, among others. Nevertheless, the Regulation does not neglect the significance of medical research and, recognizing the imperative for support of new technologies and innovation, permits research with fewer constraints compared to the commercial use of AI algorithms in healthcare.

  • A Decade of Health Information Technology and the Impact on Health Care in the U.S.: Systematic Review

    Date Submitted: Apr 25, 2024
    Open Peer Review Period: Apr 30, 2024 - Jun 25, 2024

    Background: In 2004, the Office of the National Coordinator for Health Information Technology (ONC) was established to facilitate the nationwide adoption and use of health information technology (health IT). Since its inception, the health IT landscape has evolved with a diverse array of federal investments, programs, and policies to advance its use. Previous systematic reviews of literature related to health IT focused on assessing the adoption and use of technology. As health IT has evolved, research has pivoted from tracking adoption of specific health IT features to assessing the impact of these technologies and tools. Objective: This paper provides a comprehensive review of peer-reviewed publications published over the past decade to closely examine the impacts of health IT including the impact of federal policies, changing priorities, and how the expanded use of EHR features, and effect of health IT on people, processes, and outcomes. Methods: All health IT-related peer-reviewed published between January 2013 and June 2023 were evaluated to identify articles that focused on the impact of health IT. Articles and studies were extracted through a review of PubMed. A stepwise process was used to identify articles that met the inclusion criteria, focused on the impact of health IT, and demonstrated sufficient scientific rigor. Results: The resulting 408 articles were coded based on their primary focus (provider-facing or patient-facing technology), or based on topics that pertained to the systemwide use of health IT. Within each of these categories, articles were organized around key themes. Overwhelmingly, research studies reported that health IT generated a positive impact. More than half of all articles focused on provider-facing technology with a focus on measurable outcomes including quality, safety, and costs. A number of studies evaluated the increased use of patient portals and other tools to support engagement. Studies on interoperability highlighted the value of increased health information exchange. An emerging area of study included a focus on the role of health IT in advancing public and population health. Over three-quarters of the published literature concluded that health IT generated a positive, mixed, or neutral impact. These effects were consistent across the different categories of health IT that were examined whether provider-facing, patient-facing, or systemwide impact of health IT. Conclusions: Over the past decade, the focus of studies on the impact of health IT has evolved, transitioning from a concentration on health IT adoption to optimizing its potential. This includes assessing the effectiveness of EHR functions as well as increasing information exchange. As the landscape evolved with broader acceptance of health IT, the focus shifted with greater interest in technology’s impact on patient engagement, and opportunities to use data to advance health care including population and public health. Clinical Trial: N/A

  • Background: There is growing interest in the real-time assessment of physical activity and physiological variables. Acceleration, particularly those collected through wearable sensors, has been increasingly adopted as an objective measure of physical activity. However, sensor-based measures often pose challenges for large-scale studies due to their associated costs, inability to capture contextual information, and restricted user populations. Smartphone-delivered Ecological Momentary Assessment (EMA) offers an unobtrusive and undemanding means to measure physical activity to address these limitations. Objective: To evaluate the usability of EMA by comparing its measurement outcomes with two self-report assessments of physical activity: Global Physical Activity Questionnaire (GPAQ) and a modified version of Bouchard’s Physical Activity Record (BAR). Methods: 235 participants (137 females, 98 males, 94 repeated) participated in one or more 7-day study. Waist-worn sensors provided by Actigraph™ captured accelerometer data while participants completed three self-report measures of physical activity. The multilevel modeling method was used with EMA, GPAQ, and BAR as separate measures, with eight sub-domains of physiological activity (overall physical activity; overall excluding occupational; move; moderate and vigorous exercise; moderate and vigorous occupational; sedentary) to model accelerometer data. Results: Among the three measurement outcomes, EMA (β = .185, p = .005) and BAR (β = .270, p < .001) exhibited higher overall performance over GPAQ (β = .140, p = .019). EMA also showed a more balanced performance, compared to other measurement tools, in modeling various physical activity domains, including occupational, leisure, and sedentary behaviour. Conclusions: Multilevel modeling on three self-report assessments of physical activity indicates that smartphone-delivered EMA is a valid and efficient method for assessing physical activity.telemedicine; smartphone; wearable electronic devices; physical activity

  • Effectiveness of a Digital Therapy System for Rehabilitation Following Anterior Cervical Discectomy and Fusion: A Randomized Controlled Trial

    Date Submitted: Apr 23, 2024
    Open Peer Review Period: Apr 29, 2024 - Jun 24, 2024

    Abstract Objective: This investigation purposed to assess the effectiveness of an innovative digital therapy system in improving neck pain, quality of life, and function in patients outcomes among individuals post Anterior Cervical Discectomy and Fusion (ACDF) surgery. Method: The system integrates computer vision exercise, cognitive-behavioral therapy, and sensor-based posture monitoring system to provide a comprehensive intervention program. A total of 105 post-ACDF patients were enrolled and randomly assigned to three treatment groups: Digital Therapy Group (DTG), Hospital Rehabilitation Group (HRG), and Conventional Treatment Group (CTG). A comprehensive evaluation was conducted before surgery, at 12 weeks, and 24 weeks post-surgery. The assessments included Cervical Spine Mobility, Muscle Endurance Testing, Visual Analog Scale (VAS), Neck Disability Index (NDI), SF-36 Mental Component Summary (SF-36 MCS), and Patient Satisfaction Questionnaire (PSQ). Results: The study found that both the DTG and the HRG showed significant improvements in cervical mobility, muscle endurance, pain reduction, and mental health, with no significant differences between the two groups (p > 0.05). Conclusion: The digital therapy system effectively improves neck pain, NDI score, cervical spine function, and mental health. Its efficacy is comparable to hospital rehabilitation and superior to conventional therapy methods.

  • Artificial Intelligence for Diagnosing Acute Stroke: A 25-Year Retrospective

    Date Submitted: Apr 20, 2024
    Open Peer Review Period: Apr 29, 2024 - Jun 24, 2024

    Background: Background: Stroke is a leading cause of death and disability in the world. Rapid and accurate diagnosis is crucial for minimizing brain damage and optimize treatment plans. Objective: Objective: This review aims to summarize the methods of artificial intelligence (AI) assisted diagnosis of acute stroke and the assessment of stroke prognosis over the past 25 years, providing an overview of common performance metrics and the development trends of algorithms. It also delves into existing issues and future prospects, intending to provide a comprehensive reference for clinical practice. Methods: Method: A total of 33 representative articles published between 1999 and 2024 on utilizing AI technology for acute stroke diagnosis were systematically selected and analyzed in detail. Results: Results: The segmentation of acute stroke lesions from 1999 to 2024 can be divided into three stages. Prior to 2012, research mainly focused on brain white matter segmentation using thresholding techniques. From 2012 to 2016, the focus shifted to stroke lesion segmentation based on machine learning (ML). After 2016, the emphasis was on deep learning (DL) based stroke lesion segmentation, with a significant improvement in accuracy observed. For the classification and prognosis assessment of strokes, both ML and DL have their advantages, achieving a high level of accuracy. Conclusions: Conclusion: Over the past 25 years, AI technology has shown promising performance in segmenting, classifying, and assessing the prognosis of acute stroke lesion.

  • The First Look at Code-Free Custom GPTs in Medicine: An Ophthalmology Perspective

    Date Submitted: Apr 23, 2024
    Open Peer Review Period: Apr 29, 2024 - Jun 24, 2024

    Background: OpenAI recently introduced the ability to create custom GPTs in its advanced model (GPT-4). They do not need any coding knowledge; therefore, clinicians can easily create them without any programming experience. Since they have plain text customization functionality and information expansion capabilities with file upload, they can overcome some drawbacks of the standard GPT-4. Objective: Our aim was to use ophthalmologic GPTs as a base and examine their general properties, advantages and disadvantages, and potential practical uses in detail. Methods: Data collection took place on January 20 and 21, 2024, and custom GPTs were found by entering ophthalmology keywords into the “Explore GPTS” section of the website. General and specific features of custom GPTs were recorded, such as knowledge other than GPT-4 training data. The instruction and description sections, where users can get the most information about a custom GPT, were analyzed for compatibility using the Likert scale. We analyzed two custom GPTs with the highest Likert score in detail. We attempted to create a malicious GPT to test security features. Results: We analyzed 22 ophthalmic custom GPTs, of which 55% were for general use and the most common subspecialty was glaucoma (18%). Over half (55%) contained knowledge other than GPT-4 training data. The representation of the instructions through the description was between “Moderately representative” and “Very representative” with a median Likert score of 3.5 (IQR 3.0 – 4.0). The instruction word count was significantly associated with Likert scores (P = 0.03, 95% CI, 0.050-0.739). Instruction length for high Likert score description was generally between 241 and 338 words. Tested custom GPTs demonstrated potential for specific conversational tone, information, retrieval and combining knowledge from an uploaded source. With these security settings creating a malicious GPT was possible. Conclusions: This is the first study to examine the GPT store for a medical field. Publicly available custom GPTs for ophthalmology are available in the GPT store. Studies are needed to see their use in other medical areas. Custom GPTs can be put into practice immediately. Reliable GPTs can be more useful for a specific aim than classical GPT-4. However, more detailed studies are needed to test their capabilities. The security features currently appear to be rather limited. It may be helpful for the user to review the instruction section before using a custom GPT. Clinical Trial: this is not a trial study

  • The CeHRes Roadmap 2.0: an update of a holistic framework for development, implementation, and evaluation of eHealth technologies

    Date Submitted: Apr 17, 2024
    Open Peer Review Period: Apr 22, 2024 - Jun 17, 2024

    Background: To ensure that an eHealth technology fits with its intended users, other stakeholders, and the context within which it will be used, thorough development, implementation, and evaluation processes are necessary. The CeHRes (Centre for eHealth Research & Wellbeing) Roadmap is a framework that can help shape these processes. While it has been successfully used in research and practice, new developments and insights have arisen since the Roadmap’s first publication in 2011 – not just within the domain of eHealth, but also within the different disciplines in which the Roadmap is grounded. Because of these new developments and insights, a revision of the Roadmap was imperative. Objective: The objective of this viewpoint paper is to present the updated pillars and phases of the CeHRes Roadmap 2.0. Methods: The Roadmap was updated based on four types of sources: (1) experiences with its application in research, (2) literature reviews on eHealth development, implementation and evaluation, (3) discussions with eHealth researchers, and (4) new insights and updates from relevant frameworks and theories. Results: The updated pillars state that eHealth development, implementation and evaluation (1) are ongoing and intertwined processes, (2) have a holistic approach in which context, people, and technology are intertwined, (3) consist of continuous evaluation cycles, (4) require active stakeholder involvement from the start, and (5) are based on interdisciplinary collaboration. The CeHres Roadmap 2.0 consists of five interrelated phases, of which the first is the contextual inquiry, in which an overview of the involved stakeholders, the current situation, and points of improvement is created. The findings from the contextual inquiry are specified in the value specification, in which the foundation for the to-be-developed eHealth-technology is created by means of formulating values and requirements, preliminarily selecting behaviour change techniques and persuasive features, and initiating a business model. In de Design phase, the requirements are translated into several lo- and hi-fi prototypes that are iteratively tested with end-users and/or other stakeholders. A version of the technology is rolled out in the operationalization phase, using the business model and an implementation plan. In the summative evaluation phase, the impact, uptake and working mechanisms are evaluated using a multi-method approach. All phases are interrelated by continuous formative evaluation cycles that ensure coherence between outcomes of phases and alignment with stakeholder needs. Conclusions: While the CeHRes Roadmap 2.0 consists of the same phases as the first version, the objectives and pillars have been updated and adapted, reflecting the increased emphasis on behaviour change, implementation, and evaluation as a process. There is a need for more empirical studies that apply and reflect on the CeHRes Roadmap 2.0 to provide points of improvement, because just as any eHealth technology, the Roadmap has to be constantly improved based on input of its users.

  • Background: Background: Governments and policymakers struggle to achieve a balance between hierarchical steering and horizontal governance in systems characterized by fragmented decision authority and multiple interests. To realize its “One Citizen – One Journal” eHealth policy vision, the Norwegian government established a special eHealth board of stakeholders to ensure eHealth policy development. The aim was to create an inclusive governance model that aligned stakeholders’ interests with government ambitions through coordination and consensus. Little empirical knowledge exists on how countries realize such governance models. Objective: The objective of this study was to investigate how the Norwegian inclusive eHealth governance model developed as a tool to align the government’s policy ambitions with stakeholders’ concerns from January 2012 to December 2022. Objective: Objective: The objective of this study was to investigate how the Norwegian inclusive eHealth governance model developed as a tool to align the government’s policy ambitions with stakeholders’ concerns from January 2012 to December 2022. Methods: Methods: In a longitudinal case study we analyzed 16 policy documents and 175 consultation documents issued between January 2012 and December 2022 related to the Norwegian “One Citizen – One Journal” policy implementation process. We used a qualitative approach and employed thematic analysis. Results: Results: (1) The national policy implementation process progressed through three phases, with changes in stakeholder inclusion and perceived influence on the decision-making process characterizing transitions from phase to phase. (2) Tension developed between two contrasting views regarding stakeholders’ autonomy and top-down government authority. Regional health trusts, municipalities, healthcare professional organizations, and industry actors became increasingly concerned about the model’s ability to balance stakeholders’ autonomy concerns with top-down government authority. On the other hand, patient organizations wanted a hierarchical model to ensure equal access to care and quality of care through coherent digital solutions. (3) Governmental insensitivity to participation, lack of transparency, and decreasing trust between the government and stakeholder groups challenged the legitimacy of the inclusive horizontal governance model. As a response, the government changed its approach and adjusted the model to an inclusive bottom-up network model that combined horizontal and hierarchical decision-making. Conclusions: Conclusions: We conclude that Norway’s “One citizen – one Journal” policy trajectory was characterized by a process that unfolded across three distinct phases. Furthermore, the process was characterized by two contrasting stakeholder perspectives: one concerning the extent of justifiable top-down governance to realize a national journal and the other regarding the impact of top-down governance on stakeholders’ autonomy and freedom to govern their own electronic health record implementation process. Finally, it was characterized by diminishing trust in the inclusive governance model. The National eHealth Governance Board faced challenges in establishing legitimacy as a top-down defined horizontal inclusive governance model, primarily attributed to its handling of dilemmas related to participation, transparency, and trust. These dilemmas represent significant obstacles to inclusive governance models and necessitate ongoing vigilance and responsiveness from governmental entities.

  • Methodological Research on the Adaptation of Patient Decision Support Tools: A Scoping Review

    Date Submitted: Apr 16, 2024
    Open Peer Review Period: Apr 19, 2024 - Jun 14, 2024

    Background: In recent years, there have been many studies on the adaptation of patient decision support tools, but there is a lack of methodological research on the adaptation of patient decision support tools. Objective: This scoping review aims to summarize the steps for adapting patient decision aids (PDAs) based on current research and to explore related methodologies. Methods: A systematic search of the PubMed, Cochrane Library, EMBASE, CINAHL, Web of Science, CNKI, WANFANG, VIP, and SinoMed databases and grey literature was conducted up to January 2024. The search terms focused on patient decision aids and their adaptation. The results were integrated through statistical and thematic analysis. Results: Twenty-five studies were included. Eight steps for adapting PDAs were identified, including defining decision problems and options; assessing local cultural backgrounds; translating; adjusting PDA language style, content, and presentation; creating an initial version of the PDA; conducting acceptability testing; conducting feasibility testing; and PDA revisions. Only a few studies followed a rigorous process for adapting PDAs, and most research did not undertake steps such as local cultural background assessment and feasibility testing due to challenges related to sample size acquisition, cultural diversity, and complexity. Conclusions: This study focused on the steps of language style, content, presentation adjustment, and acceptability testing in the overall process of formulating the steps for adapting decision support tools, adapting these tools, and identifying specific methods for acceptability testing. This study enhanced the quality assessment indicators for PDA language style, content, and presentation adjustments to provide a reference for subsequent research. However, gaps still exist in the evaluation standards for the language style, content, and presentation of PDAs that should be addressed by future research.

  • Measuring the Digital Skills in nursing degree students

    Date Submitted: Apr 15, 2024
    Open Peer Review Period: Apr 18, 2024 - Jun 13, 2024

    Background: In the healthcare field the digital revolution has changed the way in which healthcare is provided through the prevention, diagnosis and monitoring of people's health. In Catalonia, work has been conducted to evaluate the digital competence (DC) of healthcare professionals using a validated test based on the ACTIC (accreditation of competence in information and communication technologies) model. It is therefore important Objective: To determine the DC level of nursing students as future healthcare professionals. Methods: The aim of this study is to analyze the current DC level of students taking the Degree in Nursing at the Terres de l’Ebre Campus, Universitat Rovira i Virgili (URV), Catalonia, Spain. We have used a questionnaire to evaluate the DC level of these students. Results: Our sample comprised 147 students from various modules of the Degree in Nursing. Our results show differences in levels of self-perception and DC but also differences in the competence of students across the various academic years. Conclusions: Evaluating the level of competence of nursing degree students is fundamental for practising and enhancing the most important digital competencies required in the field of professional nursing

  • Background: The ageing population is experiencing more mobility limitations and functional impairments, prompting research into assistive technologies as solutions. These innovations aim to support the health, well-being, and independence of older adults and individuals with mobility challenges. Indoor mobility, vital for daily activities and independence, significantly impacts the lives of these individuals. However, restricted indoor mobility can negatively affect their quality of life and increase the risk of falls. Objective: This study aims to explore the influences of positive ageing perception, quality of life enhancement and social support on indoor assistive technology acceptance and readiness among older adults. Methods: This cross-sectional study was conducted at a gerontechnology laboratory. Participants were required to physically visit the laboratory. The session lasted approximately 60 minutes and consisted of participation in a demonstration of various indoor assistive technologies, as well as the completion of a questionnaire. The demonstrated assistive technologies included a wide range of devices. Participants' positive perceptions of ageing, quality of life enhancement, social support, technology acceptance, and technology readiness were assessed using validated scales. Data analysis was conducted using SPSS 26.0, including descriptive statistics, correlation analysis, and linear regression. Results: A total of 104 older adults aged 60 or above participated and completed the evaluations. The participants' mean age was 67.92 years. Regression analysis revealed that positive ageing perception was positively associated with attitudinal beliefs and gerontechnology confidence. Quality of life enhancement was positively associated with behavioural intention. However, social support showed negative associations with gerontechnology confidence and security. Notably, no significant relationships were found between positive ageing perception and control beliefs, behavioural intention, optimism, innovativeness, comfort, and security. Quality of life enhancement had no significant relationships with attitudinal beliefs, control beliefs, gerontechnology confidence, optimism, innovativeness, comfort, and security. Social support also had no significant associations with attitudinal beliefs, control beliefs, behavioural intention, optimism, innovativeness, and comfort. Conclusions: This study sheds light on the factors influencing older adults' acceptance and readiness to adopt assistive technologies in an indoor setting. The findings underscore the significance of cultivating positive ageing perceptions and emphasising quality of life enhancement through these technologies. It is crucial to address concerns related to gerontechnology confidence, security, and social support to foster greater acceptance and readiness for technology use among older adults. Further research is needed to delve into the underlying mechanisms and develop targeted interventions that promote successful technology adoption in this population. These insights provide valuable guidance for researchers and practitioners seeking to enhance older adults' well-being and quality of life in the digital age. Clinical Trial: N/A

  • Background: With the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: The aim of this study was to investigate the impact of daily use of electronic devices on the risk of neurodegenerative diseases and brain structure. Methods: This longitudinal population-based cohort study analyzed the impact of mobile phone usage duration, weekly usage time, and other electronic device habits on future brain structure and the future risk of various neurodegenerative diseases, including all-cause dementia (ACD), Alzheimer's disease (AD), vascular dementia (VD), all-cause parkinsonism (ACP), and Parkinson's disease (PD). Results: The study included over 277,000 participants for risk analysis, with a mean baseline age of approximately 55.9 years. The average follow-up duration was approximately 13.9 years. Longer years of mobile phone usage were associated with a reduced risk of ACD, AD, and VD compared to rarely using mobile phones. Additionally, longer years of mobile phone usage were linked to a decreased risk of ACP and PD in participants aged older than 60 years. Neuroimaging analysis involved 35,643 participants, with an average duration of approximately 9.0 years between baseline and neuroimaging scans. Longer years of mobile phone usage were correlated with thicker cortex in various areas. Conclusions: Longer years of mobile phone usage were associated with a reduced risk of neurodegenerative diseases and improved brain structure compared to minimal usage. However, higher weekly usage time did not confer additional risk reduction compared to lower weekly usage.

  • Background: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Online health interventions will be the trend to prevent the rising HIV epidemic. Objective: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Online health interventions will be the trend to prevent the rising HIV epidemic. Methods: Four databases were searched and studies from 2008 to January 2023 were screened. Eligible randomized controlled trials (RCTs) were included. Basic study characteristics, intervention strategies and study results were extracted and compared for data analysis. BCTs used were identified according to the definitions from the BCT taxonomy by Michie and Abraham in 2008. Frequencies of BCTs were counted to uncover the commonly used techniques in online HIV prevention programs. Results: A total of 27 RCTs are included in this review. Commonly used BCTs identified include prompt intention formation (100%, 27/27), provide information about behavior-health link (96%, 26/27), provide general encouragement (96%, 26/27), provide information on consequences (89%, 24/27), and provide instruction (85%, 23/27). BCTs with a provision nature are more observed in interventions with significant improvement in HIV knowledge, while more use of BCTs with the nature of initiating actions are observed in studies with significant increase in condom-use self-efficacy. Studies with a significant increase in condom use have used BCTs that manage and maintain behavior the most among the three outcomes. Conclusions: This is the first systematic review that examined the use of BCTs in online HIV prevention interventions for adolescents and young people. Commonly used BCTs found in this review can serve as important references for constructing more effective online interventions in the future. Clinical Trial: N/A

  • Background: Internet gaming disorder (IGD) is a prevalent public health issue among adolescents. Few studies have, however, examined the relationships between IGD symptoms, low self-control, and meaning in life (MIL). Objective: The present study aimed to examine the mediating role of IGD symptoms in the relationships between low self-control and meaning in life and adolescents’ family and school functioning. Methods: A sample of 2,064 adolescents (46.9% females, mean age = 14.6 years) was recruited from five middle schools in Sichuan, China in 2022. Indirect effects of low self-control and MIL on family and school functioning via IGD symptoms were analyzed via structural equation modeling (SEM). Results: All scales showed satisfactory model fit and scalar measurement invariance by gender. Males showed significantly greater IGD symptoms and lower levels of self-control than females. Impulsivity, temper, search for meaning, and lower presence of meaning were significantly associated with greater IGD symptoms. There were significant indirect effects from impulsivity, temper, and presence of meaning to family and school functioning via IGD symptoms. Multigroup SEM across gender found that the positive association between search for meaning and IGD symptoms existed in males but not females. Presence of meaning significantly and negatively moderated the association between impulsivity and IGD symptoms. Conclusions: The findings support a mediating role of IGD symptoms in the relationships between low self-control and MIL and functioning and a buffering role of MIL on the associations between impulsivity and IGD symptoms among the ethnic minority adolescents. The results have implications for targeted interventions to help males with lower self-control and presence of meaning.

  • Background: The monitoring of free-living physical activity by wearable devices can offer real-time assessment of activity features associated with health outcomes or provide suggestions for treatment recommendations and adjustments. The conclusions of studies on physical activity (PA) and health depend crucially on reliable statistical analyses of the digital data. Data analytics, however, are challenging due to the various metrics adopted to measure PA, different aims of studies, and complex temporal variation within variables. The application, interpretation, and appropriateness of these analytical tools have yet to be summarized. Objective: This research reviews studies that adopted analytical methods for analyzing PA monitored by accelerometers. Specifically, this review addresses three questions: (1) What are the metrics used to describe an individual’s free-living daily PA? (2) What are the current analytical tools to analyze PA data, under the aims of classification, association with health outcomes, and prediction of health events? (3) What are the challenges in the analyses and what recommendations for future research are suggested regarding use of statistical methods in response to various tasks? Methods: This scoping review is conducted following the Arksey and O'Malley framework to map research studies by exploring the information about physical activity. Three databases, PubMed, IEEE Xplore, and the ACM Digital Library, were queried in February 2024 to identify related publications. Eligible articles were either classification, association, or prediction studies involving human PA monitored by wearable accelerometers. Results: After screening 1312 articles, 428 eligible studies were identified and categorized into at least one of the three thematic issues: classification (75/428), association (342/428), and prediction (32/428). Most articles (414/428) adopted a PA variable derived from three acceleration dimensions, rather than from a single-dimensional acceleration. All eligible articles considered PA metrics represented in the time domain (428/428); a small fraction also considered PA metrics in the frequency domain (16/428). Studies evaluating the influence of PA on health conditions have increased greatly. Among those in our study, regression-type models were most prevalent (373/428). The machine learning approach for classification research is gaining popularity as well (32/75). In addition to summary statistics of PA, several recent studies utilized tools to incorporate PA trajectories and account for temporal patterns, including longitudinal data analysis with repeated PA measurements or functional data analysis with PA as a continuum for time-varying association (68/428). Conclusions: Summary metrics can quickly provide descriptions of the strength, frequency, and duration of individuals’ overall physical activity. If the distribution and profile of PA are to be evaluated or detected, taking the PA metrics as longitudinal or functional data can bring in more information and improve comprehension of the role PA plays in health. Depending on the research goal, appropriate analytical tools can ensure the reliability of the scientific findings.

  • Background: The aging population in China is becoming increasingly severe, and there is a health inequality phenomenon among urban and rural elderly. With the development of ICT, eHealth has become one of the important factors affecting health. Urban elderly could more conveniently access health information and medical services, while rural elderly may have difficulty enjoying the digital dividends brought by eHealth, highlighting the phenomenon of the “digital health divide”. Objective: This study analyzes the digital health divide and determinants among urban and rural elderly from the perspective of capital theory. Methods: The model for analyzing the digital health divide among urban and rural elderly is constructed based on capital theory. Analysis of variance is used to verify the digital health divide among urban and rural elderly. Structural equation modeling is used to analyze the factors, and the Blinder-Oaxaca decomposition method is used to analyze the main causes. Results: There are three levels of digital health divide among urban and rural elderly, namely digital access divide (F=11.39, P<.01), digital usage divide (F=39.53, P<.001), and digital outcome divide (F=30.20, P<.001). The influence of different levels of divide is transmitted along the digital chain, the impact coefficient of digital access divide on digital usage divide is β=0.060 (P<.05), and digital usage divide on digital outcome divide is β=0.363 (P<.001). The digital usage divide is the most significant level, and cultural capital (β=0.221, P<.001), social support (β=0.361, P<.001), economic capital (β=0.111, P<.01), and habits (β=0.248, P<.001) are most dominant factors contributing to the rural-urban digital usage divide. The Blinder-Oaxaca decomposition results further indicate that cultural capital (33.9%) and social capital (22.5%) are the main factors influencing digital usage divide among urban and rural elderly. Conclusions: here exists digital health divide among urban and rural elderly, and the influence of three level of divide is transmitted along the digital chain. The digital usage divide is the main level, cultural capital and social capital are the main reasons for its formation. To against these divides among urban and rural elderly, interventions in policy, society, technology, and economics are recommended.

  • Assessing the Data Quality Dimensions of Partial and Complete Mastectomy Cohorts in the All of Us Research Program: A Cross-Sectional Study

    Date Submitted: Apr 8, 2024
    Open Peer Review Period: Apr 11, 2024 - Jun 6, 2024

    Background: Breast cancer is prevalent among women in the United States. Non-metastatic disease is treated by partial or complete mastectomy procedures. However, the rates of those procedures vary across practices. Generating real-world evidence on breast cancer surgery could lead to improved and consistent practices. Objective: The paper aims to determine whether All of Us data are fit for use in generating real-world evidence on mastectomy procedures. Methods: Our mastectomy phenotype consisted of adult female participants who had CPT4 or SNOMED codes for a partial or complete mastectomy procedure. We evaluated the phenotype with a novel data quality framework that consisted of five elements: conformance, completeness, concordance, plausibility, and temporality. Also, we used a previously developed adjectival rating matrix with categories of poor (providing little to no data), fair (using only internal EHR data), and good (using internal and external benchmark/data) to evaluate each data quality dimension (DQD). Our subgroup analysis compared partial to complete mastectomy procedure phenotypes. Results: There were 3,704 participants in the partial or complete mastectomy cohort. The geospatial distribution of our cohort varied substantially across states. For example, our cohort consisted of 817 (22.1%) participants from Massachusetts but fewer than 20 participants from multiple other states. We compared the sociodemographics of the partial (n = 2,445) and complete (n = 1,259) mastectomy subgroups. Those groups differed in the distribution of education (P = .02) and income (P < .001) levels using chi-square analysis. The DQD conformance was rated as good. A total of 3,216 (86.7%) participants in our cohort had CPT4 codes for a mastectomy that did not conform to a SNOMED standard. The DQD completeness was rated as fair. The prevalence of breast cancer related concepts was higher in our cohort compared to adult female participants who did not have a mastectomy procedure (P < .001). The DQD concordance was rated as fair. In both the partial and complete mastectomy subgroups, the correlations among concepts were consistent with the clinical management of breast cancer. The DQD plausibility was rated as fair. Although we did not have external benchmark comparisons, the distributions of concepts by age group and time were consistent with expectations. The DQD temporality was rated as fair. The median time between biopsy and mastectomy was seven weeks. Conclusions: Our data quality framework was implemented successfully on a mastectomy phenotype. Moreover, the framework allowed us to differentiate breast-conserving therapy and complete mastectomy subgroups in the All of Us data. The results of our analysis could be informative for future breast cancer studies with the OMOP CDM.

  • Factors Influencing Electronic Health Literacy Among Colorectal Cancer Patients in Lifestyle Medicine

    Date Submitted: Apr 11, 2024
    Open Peer Review Period: Apr 11, 2024 - Jun 6, 2024

    Background: The level and the influence factors of the e-health literacy among colorectal cancer patients are not clear. Objective: Explore the level and the influence factors of e-health literacy among colorectal cancer patients Methods: Colorectal cancer patients were invited to complete a survey on general characteristics, lifestyle and e-health literacy. Lifestyle evaluation include nutrition, exercise, sleep, staying away from risk factors, stress management, and social relationships. Mann-Whitney U test, Kruskal-Wallis test and generalized linear model were employed to explore the influence factor of the e-health literacy of the colorectal cancer patients. Results: A total of 184 individuals were evaluated, The score of the e-health literacy among colorectal cancer patients is 24.00(19.50, 29.00). The generalized linear model demonstrated that younger age, higher level of education attainment, monthly family income, surgical history, higher self-rated health, frequent searching for online health information, owning more electronic devices, perceiving online health resources as helpful, having reading habits, higher frequency of children's social interactions per week, and higher integrative values were associated with higher levels of e-health literacy. Conclusions: The e-health literacy score among colorectal cancer patients was modest, influenced by factors such as age, education attainment, income, surgical history, self-rated health, online health information habits, device ownership, perceived usefulness of online health resources, reading habits, frequency of children's social interactions, and integrative values. Clinicians should consider these factors when designing interventions to improve e-health literacy tailored to individual values and preferences. Clinical Trial: No

  • The development of digital strategies for reducing sedentary behaviour in a hybrid office environment: a modified Delphi study.

    Date Submitted: Apr 24, 2024
    Open Peer Review Period: Apr 11, 2024 - Jun 6, 2024

    Background: Hybrid work has become the new modus operandi for many office workers causing higher levels of sedentary behaviour than working only in the office. Given the potential of digital interventions to reduce sedentary behaviour and the current lack of studies evaluating such interventions for home-office settings, it is crucial to develop digital interventions in such context involving all stakeholders. Objective: The aim of the current study was to reach experts’ consensus on the most feasible work strategies and the most usable digital elements as a delivery method to reduce sedentary behaviour in home-office context. Methods: A modified Delphi study, including 3-survey rounds and focus groups were held to achieve consensus. The first Delphi round consisted of two 9-point Likert scales for assessing the feasibility of work strategies and the potential usability of digital elements to deliver the strategies. The median and mean absolute deviation from the median (MAD-M) for each item were reported. The second round involved two ranking lists with the highly feasible strategies and highly useful digital elements based on round 1 responses to order the list according to experts’ preferences. The weighted average ranking for each item were calculated to determine the most highly ranked work strategy and digital element. The third round encompassed work strategies with a weight above the median from round 2 to be matched with the most useful digital elements to implement each strategy. Four focus groups were additionally conducted to gain a greater understanding of the findings from the Delphi phase. Focus groups were analysed using the principles of Thematic Analysis. Results: Twenty-seven international experts in the field of occupational health participated in the first round, with response rates of 86.2% (n= 25) and 65.5% (n= 19) in round 2 and 3, and 51.7% (n= 15) in the focus groups. Eighteen work strategies and 16 digital elements achieved consensus. Feedback on activity progress and goal achievement, create an action plan and standing while reading, answering phone calls, or performing videoconferences were the most feasible work strategies, while wrist-based activity trackers, combination of media, and application interface in smartphones were the most useful digital elements. Moreover, experts highlighted the requirement of combining multiple levels of strategies such as social support, physical environment, and individual strategies, to enhance their implementation and effectiveness in reducing sedentary behaviour when working from home. Conclusions: This expert consensus provide the foundation for digital interventions development to address sedentary behaviour in desk-based home-office workers. Ongoing interventions should enable evaluation of the feasible strategies delivered by useful digital elements in home-office or hybrid contexts.

  • Smart Contracts and Shared Platforms in Sustainable Healthcare: Systematic Review

    Date Submitted: Apr 5, 2024
    Open Peer Review Period: Apr 9, 2024 - Jun 4, 2024

    Background: The benefits of SC (smart contracts) for sustainable healthcare are a relatively recent topic that has gathered attention given its relationship with trust and the advantages of decentralization, immutability, and traceability that could be introduced in healthcare. Nevertheless, there is a lack of studies exploring the role of SC in this sector based on the frameworks propounded by the literature that reflect the business logic -that has been customized, automatized, and prioritized- and the system trust. This study will address this lacuna Objective: This study aims to provide a comprehensive understanding of SC in healthcare based on reviewing the frameworks propounded by the literature. Methods: A structured literature review based on PRISMA principles was performed. A quantitative assessment of the studies, based on machine learning and data reduction methodologies, is complemented by a qualitative, in-depth, detailed review of the frameworks propounded by the literature. Results: A total of 70 studies, which depicted 19% of studies about this subject, met the selection criteria and were analyzed. Three factors depicted the advances in the topic. Two of them were referred to the leading roles of SC: (a) healthcare process enhancement and (b) assurance of patients’ privacy protection. The first role included six themes, and the second one three themes. The third factor encompassed the technical features that improve systems’ efficiency. The in-depth review of these three factors and the identification of stakeholders allowed us to characterize the system trust in healthcare SC. Conclusions: This comprehensive review allows us to understand the relevance of SC and the potentiality of their use in patient-centric healthcare that considers more than technical aspects. It also provides insights for further research based on specific stakeholders, locations, and behaviors.

  • How to embed a choice experiment in an online decision aid or tool: a scoping review

    Date Submitted: Apr 5, 2024
    Open Peer Review Period: Apr 9, 2024 - Jun 4, 2024

    Background: Decision aids empower patients to understand how treatment options match their preferences. Choice experiments, a valuable method to clarify values used within decision aids, present patients with hypothetical scenarios to reveal their preferences for treatment characteristics. Given the rise in research embedding choice experiments in decision tools and the emergence of novel developments in embedding methodology, a scoping review is warranted. Objective: This scoping review examines how choice experiments are embedded into decision tools and how these tools are evaluated, to identify best practices. Methods: This scoping review was conducted following best practices in line with the PRISMA extension for scoping reviews. The searchers were conducted on MEDLINE, PsycInfo, and Web of Science databases using key search terms. Data were extracted using data charting tables created in Excel. A narrative synthesis was used to summarize the data and illustrations were used to visualise the results using tables and figures. Results: Overall, 22 tools were included in the scoping review. The methodology, development and evaluation details of tools were extracted from 33 papers. These tools were developed for a variety of health conditions including musculoskeletal conditions, oncological conditions, and chronic conditions. Most tools (78%) originated in the USA. The primary purpose (91%) of these tools was to assist patients in comparing or choosing treatments. The most commonly included attributes in the choice tasks were efficacy and side effects. Adaptive conjoint analysis was the most frequent (10 tools) design approach. Conjoint analysis designs used a higher number of tasks (16 -20) while DCEs and adaptive conjoint analysis designs used low (6) to moderate (12) number of tasks. Sawtooth software was commonly used to embed choice tasks in the tools. After completing the choice tasks patients received tailored information in the form of attribute importance scores, highlighting which treatment characteristics mattered most to the patient based on their choices (16 tools), and/or a "best match" treatment recommendation aligned with the patient's preferences (5 tools). A high degree of heterogeneity was observed in the evaluation methodologies and outcome measures used to assess the decision tools. The decisional conflict scale emerged as the most frequently employed outcome measure. Conclusions: This study highlights several methodological challenges that require further investigation. Future research should focus on determining the most effective methods for embedding choice tasks in decision tools, presenting balanced information, and selecting suitable outcome measures to evaluate these tools.

  • A 25-Years Retrospective of Health Information Technologies Infrastructuring: the Example of Catalonia Region

    Date Submitted: Mar 28, 2024
    Open Peer Review Period: Apr 7, 2024 - Jun 2, 2024

    Background: The evolution of healthcare systems has been driven by aging populations, chronic diseases, and rising expectations for quality care. This evolution coincides with significant advancements in information and communication technologies (ICT), which offer the potential to enhance healthcare accessibility, efficiency, and patient outcomes through tools such as telemedicine, electronic health records, and mobile health apps. Objective: This article aims to explore the integration of health information technologies (HIT) in healthcare delivery, focusing on the experiences of Catalonia, a region with universal healthcare coverage and a single public health insurer. It discusses the transition from paper to digital systems, the development of health information registries and platforms, and the challenges and successes encountered over the past twenty-five years. Methods: We systematically analyse the implementation processes of HIT in Catalonia, detailing the architectures and usage trends of these platforms over time. We also provide a qualitative analysis of the organizational, political, and cultural barriers to integrating HIT and evaluate the impact of these technologies on creating more personalized, data-driven care. Results: Catalonia's experience highlights the potential of HIT to facilitate integrated care pathways and improve health outcomes. However, challenges such as organizational resistance, political hurdles, and cultural differences, along with a fragmented approach to health information management, have impeded the full realization of these benefits. Conclusions: The evolution of HIT in Catalonia over the past quarter-century provides valuable insights and lessons for other regions aiming to navigate the complex landscape of digital healthcare transformation. However, the effectiveness of such strategies is contingent on a robust primary care network and a unified healthcare model. The future of healthcare digitalization in Catalonia, and potentially elsewhere, hinges on overcoming legacy data fragmentation and moving towards a genuinely integrated health and social information system that streamlines the strategic use of health data. This transition is not just about adopting new technologies but also about a paradigm shift in healthcare delivery, moving from referrals and transferability of responsibility towards a collaboration emphasizing a holistic approach to patient care for improved health outcomes. Clinical Trial: N/A

  • Background: Electronic Health Records (EHRs) have revolutionized the accessibility and sharing of patient data among healthcare providers, fostering a more coordinated and efficient delivery of care. Over the past 25 years, the evolution of EHRs has significantly contributed to scientific achievements in healthcare, improving the accuracy and efficiency of patient care and supporting better health outcomes. Despite their numerous benefits, EHRs face challenges including interoperability issues, common data models, system compatibility, privacy concerns, and data cleaning complexities. Objective: The objective of our study was to examine the evolution of EHRs over the past 25 years, focusing on their advancements in technology, interoperability, and the impact on healthcare delivery and research. We aimed to identify the challenges and limitations of EHRs in facilitating disease management and understanding, as well as their contribution to epidemiological studies, pragmatic clinical trials, and health economic studies. Methods: We conducted a comprehensive review of literature from PubMed database pertaining to the development and implementation of EHRs over the past quarter-century. Studies from January 2000 to February 2024 were included. Finally, 1,377 studies were selected for the analysis and presentation. Results: Studies that utilized EHR data were for various research purposes, including epidemiological studies, clinical trials, cost-effective studies, and policy studies. We highlighted significant advancements in EHR technology that facilitated improved management and understanding of diseases through comprehensive data collection and analysis over the past 25 years. However, challenges related to data interoperability, privacy, and inconsistencies were also identified. The studies underscored the importance of EHRs in creating more accurate representations of clinical practices and patient populations. We also saw great efforts in incorporating data from different sources and formats with the EHRs, as well as new analytic tools and platforms. Conclusions: EHRs have emerged as a pivotal component of modern healthcare systems, enhancing the efficiency and accuracy of patient care and supporting advanced clinical research. Despite facing interoperability and data management challenges, the benefits of EHRs in improving healthcare delivery and facilitating significant scientific achievements are undeniable. To maximize their potential, there is a critical need for improved resource sharing, collaborations among healthcare providers, and the development of consistent data formats and policies in healthcare networks. Clinical Trial: NA

  • Background: It is reported over 90% of formal smokers in China have achieved quitting without assistance. Social media platforms such as TikTok and Bilibili in China are flooded with a number of short videos related to smoking cessation. However, the quality, usefulness and personal expertise in uploading smoking cessation related content on these platforms have not been evaluated. Objective: This study aims to analyze the usefulness and quality of Chinese Short Video on smoking cessation on TikTok and Bilibili, trying to answer whether social media in China can be a useful source of information for hundreds of millions of smokers to quit smoking. Methods: In October 2023, we searched TikTok and Bilibili for the keywords "quit smoking(戒烟)" and "how to quit smoking on your own(如何自己戒烟)". After eliminating duplicate, unrelated videos, non-Chinese videos, no audio and no video content, we got a total of 400 videos,400 videos were independently reviewed and encoded by 4 reviewers. Video quality and content were assessed using three types of informational appeal(fear, social, and humor),a global quality score(GQS, on a scale of 1-5),and usefulness score (categorizing videos as "useless", "slightly useful", "moderately useful" and "very useful"). Results: Videos on TikTok are more popular than Bilibili. There was no significant difference in GQS and usefulness scores on different platforms (GQS P=0.831, usefulness score P=0.114). The quality and usefulness of videos related to smoking cessation on TikTok and Bilibili were average, with most videos scoring 3(Bilibili 56.5%, TikTok 55.5%) and most of the usefulness scores being slightly useful, lying in the interval 1-4 (Bilibili 53.5%, TikTok 59%).Research shows that videos from Health professionals and Goverment/Professional institutions are better in quality and usefulness than videos from other sources. Videos that are classified as Help from a professional are of higher quality and more useful than videos in other categories. No video variables were significantly correlated with GQS and usefulness of videos on Bilibili; video duration, likes, comments, favorites, and retweets were significantly correlated with GQS and usefulness of videos on TikTok. Conclusions: The overall quality of the videos related to the two platforms is poor, and the quality of the videos uploaded by Health professionals and Goverment/Professional institution is slightly better,which has certain reference value after screening. As an information source of smoking cessation,the platform is not scientific and quality enough. If short videos are to be employed as a new approach for effective health education in the future, it becomes imperative to systematically review the latest findings from smoking cessation intervention research and conduct further research on the characteristics of widely disseminated and influential videos on social media to strike a balance between scientific accuracy and popular appeal.

  • Background: Conventional neuropsychological screening tools for mild cognitive impairment (MCI) have been threatened by their burdensomeness and inaccurate at detecting MCI. From a digital healthcare perspective, smartphone interaction, longitudinally and unobtrusively acquired behavior data in a non-clinical setting, alleviate these limitations. Objective: This study aimed to investigate the discriminant powers of digital biomarkers, drawn from smartphone-derived keystroke dynamics using the Neurokeys keyboard application. Methods: 64 healthy controls (HCs) and 47 patients with MCI producing 3,530 typing sessions within a month, performing the Korean version of the Montreal Cognitive Assessment (MoCA-K), were tested. A total of 2,740 were finally analyzed using the receiving operant curve analysis to investigate sensitivity and specificity. Results: Patients with MCI had significantly higher keystroke latency than controls. In particular, latency between key presses resulted in the highest sensitivity (97.9%) and specificity (96.9%). In addition, keystroke dynamics were significantly correlated with the MoCA-K (hold time: r=-.468, P<0.001; flight time: r=-0.497, P<0.001). Conclusions: The current findings shed new light on the potential of smartphone-derived keystroke dynamics as an ecological surrogate for a laboratory-based conventional screening tool. Clinical Trial: Thaiclinicaltrial.org TCTR20220415002, https:// https://www.thaiclinicaltrials.org/show/TCTR20220415002

  • Background: E-cigarette use has been a public health issue in the US. On June 23, 2022, the FDA issued marketing denial orders (MDOs) to Juul Labs Inc. for all of their products currently marketed in the United States. However, one day later, on June 24, 2022, a federal appeals court granted a temporary reprieve to Juul Labs that allowed it to keep its e-cigarettes on the market. As the conversation around Juul continues to evolve, it is crucial to gain insights into the sentiments and opinions expressed by individuals on social media Objective: To better understand the response of the general public to the policy, and the life-cycle of public health-related policy on social media. Methods: 6,023 tweets and 22,288 reply/retweets were collected from Twitter (rebrand as X) between Jun 2022 and October 2022. We conducted a descriptive analysis, topic modelling utilizing the state-of-the-art BERTopic technique, and sentiment analysis. Results: We found that the life cycle of reactions to the FDA’s ban on Juul lasted no longer than a week on Twitter. Not only the news related to the announcement itself but the surrounding discussions (the 6 topics presented in the study) diminished shortly after June 23rd, 2022—the date when the ban was officially announced. Of the top 50 most retweeted tweets, we found posters responded from neutral (23/45, 51.11%) to more negatively (19/45, 42.22%) on the corresponding topics. Conclusions: We observed a short life-cycle for this news announcement with more negative sentiment toward the FDA’s ban on JUUL. Policymakers could employ tactics such as ongoing updates and reminders about the ban, highlighting its impact on public health, and actively engaging with influential social media users who can help sustain the conversation.

  • Background: Teaching is often characterized as a stressful profession, with a significant proportion of teachers experiencing chronic stress and burnout. Research indicates that teachers’ stress commonly originates upon their entry into workforce, leading to negative effects on their health, occupational well-being and work performance and also impacting students’ outcomes. While meta-analytical evidence shows the efficacy of internet-based stress management interventions (iSMIs) for both experienced employees and university students, there is a gap in research on the efficacy of iSMIs tailored to teachers as well as career starters. We investigated whether an iSMI that was tailored to beginning teachers is effective in reducing their perceived stress. Additionally, this iSMI, developed according to transactional stress theory, explored problem-solving ability and emotion-regulation skills as potential mechanisms of change for the first time. Methods: Participants were 200 highly stressed beginning teachers undergoing German teacher induction, randomized to either an intervention group or a wait-list control group. Outcomes were assessed at baseline, post-intervention, 3- and an extended 6-month follow-up. Results: In the intention-to-treat analysis, the intervention group reported significant, practically meaningful and sustained improvements in perceived stress (d = 0.52) as well as in secondary outcomes. Furthermore, a parallel mediation analysis showed that the iSMI exerted its effect on reduced perceived stress via both improved problem-solving ability and emotion-regulation skills. Conclusions: The present study contributes to the growing evidence on iSMIs for early career teachers during a highly demanding transition phase and advocates for their integration into beginning teachers’ training programs. Furthermore, the results of the mediation analysis highlight the importance of teaching both coping strategies in stress management interventions and strengthening the interventions program theory that is based on transactional stress theory. These results help in further approaching to understand how iSMIs work and lay the groundwork for further exploration of conditions affecting change. Trial registration: This trial was registered in the German Clinical Trials Registry on 23/02/2018 (DRKS00013880).