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Journal Description

The Journal of Medical Internet Research (JMIR), now in its 20th year, is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications. It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2018: 4.945, ranked #1 out of 26 journals in the medical informatics category) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As leading high-impact journal in its' disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals, which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals. 

As open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.

Be a widely cited leader in the digitial health revolution and submit your paper today!

 

Recent Articles:

  • Source: Flickr; Copyright: Léon Talbot; URL: https://www.flickr.com/photos/unleno/165829162/in/photolist-fDVeu-2cPnYwn-6GBqpQ-5qwtfQ-efe4T4-o73FHf-AjoRa-htpVfB-6i4JDc-aNBBQK-jkGxwo-fjVX3M-6CDrGg-e4aGNd-6CDrzF-kKperh-6CHAaU-6hR4Ca-6CDs5R-p5Mbvw-bV9zy6-eMCq5-cDxrz-6Q6gQW-GFWCHF-hkbQwa-57hUiF-8RCm8H-p7; License: Creative Commons Attribution (CC-BY).

    Characterizing Swisher Little Cigar–Related Posts on Twitter in 2018: Text Analysis

    Abstract:

    Background: Little cigars are growing in popularity in the United States, and Swisher is the market leader. The contexts and experiences associated with the use of Swisher-related products is understudied, but such information is available via publicly available posts on Twitter. Objective: This study aimed to analyze Twitter posts to characterize Twitter users’ recent experiences with Swisher-related products. Methods: Twitter posts containing the term “swisher” were analyzed from January 1, 2018, to December 31, 2018. Text classifiers were used to identify topics in posts (n=81,333). Results: The most prevalent topic was Person Tagging (mentioning a Twitter account in a post; 32.77%), followed by Flavors (eg, Grape and Strawberry; 20.96%) and Swisher use (eg, smoke swisher; 17.44%). Additional topics included Cannabis use (eg, blunt, roll, and gut swisher; 6.26%), Appeal (eg, like Swisher; 5.92%), Dislike (eg, posts that showed dissatisfaction with Swisher products; 3.53%), Purchases (eg, buy swisher; 1.90%), and Cigar comparison (eg, mentions of other cigar products including White-owl and Backwoods; 1.64%). Conclusions: This paper describes common contexts and experiences associated with the use of Swisher little cigars from the population posting on Twitter in 2018. These online messages may have offline consequences for tobacco-related behaviors, indicating the need for countering from public health officials. Findings should inform us about targets for surveillance, policy, and interventions addressing Swisher little cigars as well as communication planning and tobacco product counter messaging on Twitter.

  • Patient engagement with the acute care patient portal. Source: Image created by the Authors; Copyright: The Authors; URL: http://www.jmir.org/2019/7/e13336/; License: Creative Commons Attribution (CC-BY).

    Acute Care Patient Portal Intervention: Portal Use and Patient Activation

    Abstract:

    Background: Patient-facing health information technology (HIT) tools, such as patient portals, are recognized as a potential mechanism to facilitate patient engagement and patient-centered care, yet the use of these tools remains limited in the hospital setting. Although research in this area is growing, it is unclear how the use of acute care patient portals might affect outcomes, such as patient activation. Objective: The aim of this study was to describe the use of an acute care patient portal and investigate its association with patient and care partner activation in the hospital setting. Methods: We implemented an acute care patient portal on 6 acute care units over an 18-month period. We investigated the characteristics of the users (patients and their care partners) of the patient portal, as well as their use of the portal. This included the number of visits to each page, the number of days used, the length of the user’s access period, and the average percent of days used during the access period. Patient and care partner activation was assessed using the short form of the patient activation measure (PAM-13) and the caregiver patient activation measure (CG-PAM). Comparisons of the activation scores were performed using propensity weighting and robust weighted linear regression. Results: Of the 2974 randomly sampled patients, 59.01% (1755/2974) agreed to use the acute care patient portal. Acute care patient portal enrollees were younger, less sick, less likely to have Medicare as their insurer, and more likely to use the Partners Healthcare enterprise ambulatory patient portal (Patient Gateway). The most used features of the acute care patient portal were the laboratory test results, care team information, and medication list. Most users accessed the portal between 1 to 4 days during their hospitalization, and the average number of days used (logged in at least once per day) was 1.8 days. On average, users accessed the portal 42.69% of the hospital days during which it was available. There was significant association with patient activation on the neurology service (P<.001) and medicine service (P=.01), after the introduction of HIT tools and the acute care patient portal, but not on the oncology service. Conclusions: Portal users most often accessed the portal to view their clinical information, though portal usage was limited to only the first few days of enrollment. We found an association between the use of the portal and HIT tools with improved levels of patient activation. These tools may help facilitate patient engagement and improve outcomes when fully utilized by patients and care partners. Future study should leverage usage metrics to describe portal use and assess the impact of HIT tools on specific outcome measures in the hospital setting.

  • Source: Freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/young-man-wearing-eyeglasses-using-laptop-kitchen-counter_3421182.htm; License: Licensed by JMIR.

    Patient Attitudes About Viewing Their Radiology Images Online: Preintervention Survey

    Abstract:

    Background: Although patient data is available through electronic portals, little information exists about the benefits and/or challenges of providing patients with online access to their radiology images. Objective: The aims of this quality improvement project were to understand patient attitudes toward being able to view their radiology images online and determine how information should be presented to ensure the images are helpful to the patients, rather than causing confusion and anxiety. Methods: An online survey of consumers was conducted to evaluate attitudes toward online access to personal radiological images. Results: A total of 105 responses were received from 686 community members (15.3%). Of 105 consumers, 94 (89.5%) reported a desire to have access to the radiology images within their online patient portal; 86.7% (91/105) believed it would help them better understand their medical conditions and 81.0% (85/105) said this would help them feel more in control of their care. Most respondents (74/105, 70.5%) said it would help them feel reassured that their doctor was doing the right thing, and 63.8% (67/105) said it would increase their level of trust in their doctor. Among surveyed patients, 78.1% (82/105) valued viewing their radiology images online, while 92.4% (97/105) valued their online radiology reports. Most patients (69/105, 65.7%) wished to discuss their results with their ordering clinician, 29.5% (31/105) wished to discuss with their interpreting radiologist, and 3.8% (4/105) wished to share their images on social media. The biggest potential concern among 23.8% (25/105) was that the images would be confusing. Conclusions: A large majority of surveyed patients desired the ability to view their radiology images online and anticipated many benefits and few risks. Health care organizations with electronic health records and online patient portals should consider augmenting their existing portals with this highly desired feature. To avoid the biggest patient concern, radiology reports should accompany images. Patients wanted to discuss their results with their ordering physician and their interpreting radiologist. Some even would like to share results on social media. Further research on the actual experience with such a tool will be needed.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/man-sitting-chair-suffering-from-backache-while-working-laptop_3706493.htm; License: Licensed by JMIR.

    An Evaluation of the Effectiveness of the Modalities Used to Deliver Electronic Health Interventions for Chronic Pain: Systematic Review With Network...

    Abstract:

    Background: Electronic health (eHealth) is the use of information and communication technology in the context of health care and health research. Recently, there has been a rise in the number of eHealth modalities and the frequency with which they are used to deliver technology-assisted self-management interventions for people living with chronic pain. However, there has been little or no research directly comparing these eHealth modalities. Objective: The aim of this systematic review with a network meta-analysis (NMA) is to compare the effectiveness of eHealth modalities in the context of chronic pain. Methods: Randomized controlled trials (N>20 per arm) that investigated interventions for adults with chronic pain, delivered via an eHealth modality, were included. Included studies were categorized into their primary node of delivery. Data were extracted on the primary outcome, pain interference, and secondary outcomes, pain severity, psychological distress, and health-related quality of life. Pairwise meta-analyses were undertaken where possible, and an NMA was conducted to generate indirect comparisons and rankings of modalities for reducing pain interference. Results: The search returned 18,470 studies with 18,349 being excluded (duplicates=2310; title and abstract=16,039). Of the remaining papers, 30 studies with 5394 randomized participants were included in the review. Rankings tentatively indicated that modern eHealth modalities are the most effective, with a 43% chance that mobile apps delivered the most effective interventions, followed by a 34% chance that interventions delivered via virtual reality were the most effective. Conclusions: This systematic review with an NMA generated comparisons between eHealth modalities previously not compared to determine which delivered the most effective interventions for the reduction of pain interference in chronic pain patients. There are limitations with this review, in particular, the underrepresented nature of some eHealth modalities included in the analysis. However, in the event that the review is regularly updated, a clear ranking of eHealth modalities for the reduction of pain interference will emerge.

  • This picture illustrates the perspective of the participants in this study. An eye tracker confirmed that sharp or foveal vision remained on the central display, while the participants rated patient monitoring scenarios on the monitor to the left with their left peripheral visual field. Source: David W Tscholl; Copyright: David W Tscholl; URL: http://www.jmir.org/2019/7/e13041/; License: Creative Commons Attribution (CC-BY).

    Avatar-Based Patient Monitoring With Peripheral Vision: A Multicenter Comparative Eye-Tracking Study

    Abstract:

    Background: Continuous patient monitoring has been described by the World Health Organization as extremely important and is widely used in anesthesia, intensive care medicine, and emergency medicine. However, current state-of-the-art number- and waveform-based monitoring does not ideally support human users in acquiring quick, confident interpretations with low cognitive effort, and there are additional problematic aspects such as alarm fatigue. We developed a visualization technology (Visual Patient), specifically designed to help caregivers gain situation awareness quickly, which presents vital sign information in the form of an animated avatar of the monitored patient. We suspected that because of the way it displays the information as large, colorful, moving graphic objects, caregivers might be able to perform patient monitoring using their peripheral vision, which may facilitate quicker detection of anomalies, independently of acoustic alarms. Objective: In this study, we tested the hypothesis that avatar-based monitoring, when observed with peripheral vision only, increases the number of perceptible changes in patient status as well as caregivers’ perceived diagnostic confidence compared with a high-fidelity simulation of conventional monitoring, when observed with peripheral vision only. Methods: We conducted a multicenter comparative study with a within-participant design in which anesthesiologists with their peripheral field of vision looked at 2 patient-monitoring scenarios and tried to identify changes in patient status. To ensure the best possible experimental conditions, we used an eye tracker, which recorded the eye movements of the participants and confirmed that they only looked at the monitoring scenarios with their peripheral vision. Results: Overall, 30 participants evaluated 18 different patient status changes with each technology (avatar and conventional patient monitoring). With conventional patient monitoring, participants could only detect those 3 changes in patient status that are associated with a change in the auditory pulse tone display, that is, tachycardia (faster beeping), bradycardia (slower beeping), and desaturation (lower pitch of beeping). With the avatar, the median number of detected vital sign changes quadrupled from 3 to 12 (P<.001) in scenario 1, and more than doubled from 3 to 8 (P<.001) in scenario 2. Median perceived diagnostic confidence was confident for both scenarios with the avatar and unconfident in scenario 1 (P<.001), and very unconfident in scenario 2 (P=.024) with conventional monitoring. Conclusions: This study introduces the concept of peripheral vision monitoring. The test performed showed clearly that an avatar-based display is superior to a standard numeric display for peripheral vision. Avatar-based monitoring could potentially make much more of the patient monitoring information available to caregivers for longer time periods per case. Our results indicate that the optimal information transmission would consist of a combination of auditory and avatar-based monitoring.

  • Source: freepik; Copyright: katemangostar; URL: https://www.freepik.com/free-photo/positive-senior-lady-showing-photos-daughter-laptop_4167026.htm; License: Licensed by JMIR.

    Perceptions of Information and Communication Technology as Support for Family Members of Persons With Heart Failure: Qualitative Study

    Abstract:

    Background: Heart failure (HF) affects not only the person diagnosed with the syndrome but also family members, who often have the role of informal carers. The needs of these carers are not always met, and information and communications technology (ICT) could have the potential to support them in their everyday life. However, knowledge is lacking about how family members perceive ICT and see opportunities for this technology to support them. Objective: The aim of this study was to explore the perceptions of ICT solutions as supportive aids among family members of persons with HF. Methods: A qualitative design was applied. A total of 8 focus groups, comprising 23 family members of persons affected by HF, were conducted between March 2015 and January 2017. Participants were recruited from 1 hospital in Sweden. A purposeful sampling strategy was used to find family members of persons with symptomatic HF from diverse backgrounds. Data were analyzed using qualitative content analysis. Results: The analysis revealed 4 categories and 9 subcategories. The first category, about how ICT could provide relevant support, included descriptions of how ICT could be used for communication with health care personnel, for information and communication retrieval, plus opportunities to interact with persons in similar life situations and to share support with peers and extended family. The second category, about how ICT could provide access, entailed how ICT could offer solutions not bound by time or place and how it could be both timely and adaptable to different life situations. ICT could also provide an arena for family members to which they might not otherwise have had access. The third category concerned how ICT could be too impersonal and how it could entail limited personal interaction and individualization, which could lead to concerns about usability. It was emphasized that ICT could not replace physical meetings. The fourth category considered how ICT could be out of scope, reflecting the fact that some family members were generally uninterested in ICT and had difficulties envisioning how it could be used for support. It was also discussed as more of a solution for the future. Conclusions: Family members described multiple uses for ICT and agreed that ICT could provide access to relevant sources of information from which family members could potentially exchange support. ICT was also considered to have its limitations and was out of scope for some but with expected use in the future. Even though some family members seemed hesitant about ICT solutions in general, this might not mean they are unreceptive to suggestions about their usage in, for example, health care. Thus, a variety of factors should be considered to facilitate future implementations of ICT tools in clinical practice.

  • Person using chat application on laptop. Source: Pexels.com; Copyright: Rawpixel.com; URL: https://www.pexels.com/photo/photography-of-person-using-laptop-1243365/; License: Licensed by JMIR.

    Development and Evaluation of ClientBot: Patient-Like Conversational Agent to Train Basic Counseling Skills

    Abstract:

    Background: Training therapists is both expensive and time-consuming. Degree–based training can require tens of thousands of dollars and hundreds of hours of expert instruction. Counseling skills practice often involves role-plays, standardized patients, or practice with real clients. Performance–based feedback is critical for skill development and expertise, but trainee therapists often receive minimal and subjective feedback, which is distal to their skill practice. Objective: In this study, we developed and evaluated a patient-like neural conversational agent, which provides real-time feedback to trainees via chat–based interaction. Methods: The text–based conversational agent was trained on an archive of 2354 psychotherapy transcripts and provided specific feedback on the use of basic interviewing and counseling skills (ie, open questions and reflections—summary statements of what a client has said). A total of 151 nontherapists were randomized to either (1) immediate feedback on their use of open questions and reflections during practice session with ClientBot or (2) initial education and encouragement on the skills. Results: Participants in the ClientBot condition used 91% (21.4/11.2) more reflections during practice with feedback (P<.001) and 76% (14.1/8) more reflections after feedback was removed (P<.001) relative to the control group. The treatment group used more open questions during training but not after feedback was removed, suggesting that certain skills may not improve with performance–based feedback. Finally, after feedback was removed, the ClientBot group used 31% (32.5/24.7) more listening skills overall (P<.001). Conclusions: This proof-of-concept study demonstrates that practice and feedback can improve trainee use of basic counseling skills.

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/focused-doctor-working-with-ipad_1198167.htm; License: Licensed by JMIR.

    Incorporating Information From Electronic and Social Media Into Psychiatric and Psychotherapeutic Patient Care: Survey Among Clinicians

    Abstract:

    Background: Obtaining collateral information from a patient is an essential component of providing effective psychiatric and psychotherapeutic care. Research indicates that patients’ social and electronic media contains information relevant to their psychotherapy and clinical care. However, it remains unclear to what degree this content is being actively utilized by clinicians as a part of diagnosis or therapy. Moreover, clinicians’ attitudes around this practice have not been well characterized. Objective: This survey aimed to establish the current attitudes and behaviors of outpatient clinicians regarding the incorporation of patients’ social and electronic media into psychotherapy. Methods: A Web-based survey was sent to outpatient psychotherapists associated with McLean Hospital in Belmont, Massachusetts. The survey asked clinicians to indicate to what extent and with which patients they reviewed patients’ social and electronic media content as part of their clinical practice, as well as their reasons for or against doing so. Results: Of the total 115 respondents, 71 (61.7%) indicated that they had viewed at least one patient’s social or electronic media as part of psychotherapy, and 65 of those 71 (92%) endorsed being able to provide more effective treatment as a result of this information. The use of either short message service text messages or email was significantly greater than the use of other electronic media platforms (χ21=24.1, n=115, P<.001). Moreover, the analysis of survey responses found patterns of use associated with clinicians’ years of experience and patient demographics, including age and primary diagnosis. Conclusions: The incorporation of patients’ social and electronic media into therapy is currently common practice among clinicians at a large psychiatric teaching hospital. The results of this survey have informed further questions about whether reviewing patient’s media impacts the quality and efficacy of clinical care.

  • Source: Flickr; Copyright: Make Me Local; URL: https://www.flickr.com/photos/makemelocal/26932391967/in/photolist-H2VxPD-cdkwa-bohPiW-64SDLW-8gH9jG-bBWdRR-7ZbqH5-4GLnUM-6X9V6y-73fwKw-5yYtyK-5x7eh5-7mBYdS-5VfJRr-b33gba-8gDvHe-86XWK5-2evAG5J-2fPAjgK-r9T4a3-H2VxZD-ZD3L-5qwC6k-kwsn2Z-9jbnYG-5qxP9z-SCm9me-; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Influence of Climate on Google Internet Searches for Pruritus Across 16 German Cities: Retrospective Analysis

    Abstract:

    Background: The burden of pruritus is high, especially among patients with dermatologic diseases. Identifying trends in pruritus burden and people’s medical needs is challenging, since not all affected people consult a physician. Objective: The purpose of this study was to investigate pruritus search behavior trends in Germany and identify associations with weather factors. Methods: Google AdWords Keyword Planner was used to quantify pruritus-related search queries in 16 German cities from August 2014 to July 2018. All identified keywords were qualitatively categorized and pruritus-related terms were descriptively analyzed. The number of search queries per 100,000 inhabitants of each city was compared to environmental factors such as temperature, humidity, particulate matter 10 micrometers or less in diameter (PM10), and sunshine duration to investigate potential correlations. Results: We included 1150 pruritus-related keywords, which resulted in 2,851,290 queries. “Pruritus” (n=115,680) and “anal pruritus” (n=102,390) were the most-searched-for keywords. Nearly half of all queries were related to the category localization, with Berlin and Munich having a comparatively high proportion of people that searched for pruritus in the genital and anal areas. People searched more frequently for information on chronic compared to acute pruritus. The most populated cities had the lowest number of queries per 100,000 inhabitants (Berlin, n=13,641; Hamburg, n=18,303; and Munich, n=21,363), while smaller cities (Kiel, n=35,027; and Freiburg, n=39,501) had the highest. Temperature had a greater effect on search query number (beta -7.94, 95% CI -10.74 to -5.15) than did PM10 (beta -5.13, 95% CI -7.04 to -3.22), humidity (beta 4.73, 95% CI 2.70 to 6.75), or sunshine duration (beta 0.66, 95% CI 0.36 to 0.97). The highest relative number of search queries occurred during the winter (ie, December to February). Conclusions: By taking into account the study results, Google data analysis helps to examine people’s search frequency, behavior, and interest across cities and regions. The results indicated a general increase in search queries during the winter as well as differences across cities located in the same region; for example, there was a decline in search volume in Saarbrucken, while there were increases in Cologne, Frankfurt, and Dortmund. In addition, the detected correlation between search volume and weather data seems to be valuable in predicting an increase in pruritus burden, since a significant association with rising humidity and sunshine duration, as well as declining temperature and PM10, was found. Accordingly, this is an unconventional and inexpensive method to identify search behavior trends and respective inhabitants’ needs.

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/young-man-sitting-office-using-laptop_4831029.htm; License: Licensed by JMIR.

    Computerized Quality of Life Assessment: A Randomized Experiment to Determine the Impact of Individualized Feedback on Assessment Experience

    Abstract:

    Background: Quality of life (QoL) assessments, or patient-reported outcome measures (PROMs), are becoming increasingly important in health care and have been associated with improved decision making, higher satisfaction, and better outcomes of care. Some physicians and patients may find questionnaires too burdensome; however, this issue could be addressed by making use of computerized adaptive testing (CAT). In addition, making the questionnaire more interesting, for example by providing graphical and contextualized feedback, may further improve the experience of the users. However, little is known about how shorter assessments and feedback impact user experience. Objective: We conducted a controlled experiment to assess the impact of tailored multimodal feedback and CAT on user experience in QoL assessment using validated PROMs. Methods: We recruited a representative sample from the general population in the United Kingdom using the Oxford Prolific academic Web panel. Participants completed either a CAT version of the World Health Organization Quality of Life assessment (WHOQOL-CAT) or the fixed-length WHOQOL-BREF, an abbreviated version of the WHOQOL-100. We randomly assigned participants to conditions in which they would receive no feedback, graphical feedback only, or graphical and adaptive text-based feedback. Participants rated the assessment in terms of perceived acceptability, engagement, clarity, and accuracy. Results: We included 1386 participants in our analysis. Assessment experience was improved when graphical and tailored text-based feedback was provided along with PROMs (Δ=0.22, P<.001). Providing graphical feedback alone was weakly associated with improvement in overall experience (Δ=0.10, P=.006). Graphical and text-based feedback made the questionnaire more interesting, and users were more likely to report they would share the results with a physician or family member (Δ=0.17, P<.001, and Δ=0.17, P<.001, respectively). No difference was found in perceived accuracy of the graphical feedback scores of the WHOQOL-CAT and WHOQOL-BREF (Δ=0.06, P=.05). CAT (stopping rule [SE<0.45]) resulted in the administration of 25% fewer items than the fixed-length assessment, but it did not result in an improved user experience (P=.21). Conclusions: Using tailored text-based feedback to contextualize numeric scores maximized the acceptability of electronic QoL assessment. Improving user experience may increase response rates and reduce attrition in research and clinical use of PROMs. In this study, CAT administration was associated with a modest decrease in assessment length but did not improve user experience. Patient-perceived accuracy of feedback was equivalent when comparing CAT with fixed-length assessment. Fixed-length forms are already generally acceptable to respondents; however, CAT might have an advantage over longer questionnaires that would be considered burdensome. Further research is warranted to explore the relationship between assessment length, feedback, and response burden in diverse populations.

  • Source: Pexels; Copyright: Christina Morillo; URL: https://www.pexels.com/photo/person-using-silver-macbook-pro-1181467/; License: Licensed by JMIR.

    Artificial Intelligence and the Implementation Challenge

    Abstract:

    Background: Applications of artificial intelligence (AI) in health care have garnered much attention in recent years, but the implementation issues posed by AI have not been substantially addressed. Objective: In this paper, we have focused on machine learning (ML) as a form of AI and have provided a framework for thinking about use cases of ML in health care. We have structured our discussion of challenges in the implementation of ML in comparison with other technologies using the framework of Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS). Methods: After providing an overview of AI technology, we describe use cases of ML as falling into the categories of decision support and automation. We suggest these use cases apply to clinical, operational, and epidemiological tasks and that the primary function of ML in health care in the near term will be decision support. We then outline unique implementation issues posed by ML initiatives in the categories addressed by the NASSS framework, specifically including meaningful decision support, explainability, privacy, consent, algorithmic bias, security, scalability, the role of corporations, and the changing nature of health care work. Results: Ultimately, we suggest that the future of ML in health care remains positive but uncertain, as support from patients, the public, and a wide range of health care stakeholders is necessary to enable its meaningful implementation. Conclusions: If the implementation science community is to facilitate the adoption of ML in ways that stand to generate widespread benefits, the issues raised in this paper will require substantial attention in the coming years.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/serious-guy-studying-with-laptop-desk_1370875.htm#page=4&index=38&query=teenager%20laptop; License: Licensed by JMIR.

    Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study

    Abstract:

    Background: Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. Objective: The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. Methods: At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. Results: The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. Conclusions: In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents.

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    Open Peer Review Period: Jul 19, 2019 - Sep 13, 2019

    Background: Early detection in the prevention of addictive behaviours remains a complex question in practice for most first-line health professionals, despite its importance in terms of public health....

    Background: Early detection in the prevention of addictive behaviours remains a complex question in practice for most first-line health professionals, despite its importance in terms of public health. Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction centre for problematic use. Even though early detection is highly recommended by the WHO, it is not performed in practice. Objective: To assess acceptability and feasibility of a web-based application, “Pulsio Santé”, for health service users and first-line prevention professionals. Methods: A mixed-method prospective pilot study was conducted in 2017 in two departments: The Nantes occupational health department responsible for monitoring the health of salaried personnel across the region, and the university department of preventive medicine with a health unit dedicated to university students. In each department, all health professionals (physicians and nurses) were invited to participate in the study. Subjects 18 or older seen by a health professional from one of the departments were eligible. The study procedure comprised 4 phases: 1) inclusion of participants by health professionals face-to-face, 2) self-automated web-based assessment report filled in by participants on their substance use with “Pulsio Santé” based on ASSIST questionnaire. Participants received a text message on their smartphone or by email, 3) if participants agreed, they could transfer results to their health professional. If not, messages appeared allowing them to get in touch with their general practitioner, should the assessment detect a risk. Two levels of feasibility and acceptability criteria were assessed. Two focus group sessions with health professionals were performed, exploring their points of view on the acceptability and feasibility of the web-based application. A multi-category content analysis was done. Results: 1474 people were eligible and 44 health professionals participated in the study. The first level of acceptability (% of people who agreed to receive a text message or an email) was 79.2% (1167 out of 1474). The second level of acceptability (% of participants who click on the self-assessment link) was 60.2% (703 out of 1167). The first level of feasibility (% of participants who completed their self-evaluation entirely) was 76.2% (536 out of 703). The second level of feasibility (% of participants who shared the results with their health professional) was 79.5% (426 out of 536). Health professionals highlighted obstacles to carry out the recommended interventions for people at risk based on their online screening. Conclusions: Our pilot study on a large sample showed good acceptability and feasibility of “Pulsio Santé” by health service users and professionals. The need for further studies more directly focused on the limitations emerged.

  • A Customized Nutrient-Profiling Approach Lowers Glyecemic-A1C for Type-2 diabetics: A Quasi-Experimental Study

    Date Submitted: Jul 16, 2019

    Open Peer Review Period: Jul 19, 2019 - Sep 13, 2019

    Background: Current dietary management approaches are mostly calorie-counter and diet-tracker tools that draw our attention away from the nutritional value of our food. To improve individuals’ dieta...

    Background: Current dietary management approaches are mostly calorie-counter and diet-tracker tools that draw our attention away from the nutritional value of our food. To improve individuals’ dietary behavior, and primarily type-2 diabetics, we need a simple technique to increase their understanding of the nutritional content of their food. Objective: To this end we designed, developed and evaluated a customized nutrient profiling tool that we call EasyNutrition. EasyNutrition introduces the new concept of Nutrient Profiling (NuVal), by applying the Intelligent Nutrition Engine, an algorithm we developed for ranking different food recipes based on the their nutritional value. The study aims to investigates the efficacy of EasyNutrition for type-2 diabetics in lowering their glycemic-A1C and improving their dietary habits. Methods: We evaluated the utility of EasyNutrition through the lenses of Design-Science in three sequential stages. This paper elaborates on the third stage to investigate Easy Nutrition efficacy in managing type-2 diabetes. A quasi-experimental study was conducted in a diabetes treatment center (n=28). The intervention group utilized EasyNutrition over three months, while participants in the control group utilized the standard-of-care provided by the center. Dietary habits and glycemic-A1C were measured in order to capture any change before and after experimenting with Easy Nutrition. Results: The intervention group (n = 9) exhibited a statistically significant change between the pre-and post-exposure results of their A1C; t (9) = 2.427, p = .041. Their A1C has dropped from 8.13 to 6.72. This provides a preliminary evidence of the efficacy of using a customized nutrient-profiling app in reducing glycemic-A1C for type-2 diabetics. Conclusions: This study adds to the evidence base that nutrient profiling strategy may be a modern adjunct to diabetes dietary management. In conjunction with reliable dietary education provided by a registered dietician, EasyNutrition may have some beneficial effects to improve the dietary habits of type-2 diabetics.

  • Mindfulness Virtual Community for Student’s Mental Health: A Randomized Control Trial

    Date Submitted: Jul 18, 2019

    Open Peer Review Period: Jul 19, 2019 - Jul 26, 2019

    Background: The rising prevalence of mental health problems in university students may be overwhelming traditional university mental health services. Given the demonstrated anxiolytic and antidepressa...

    Background: The rising prevalence of mental health problems in university students may be overwhelming traditional university mental health services. Given the demonstrated anxiolytic and antidepressant benefits of mindfulness, we developed an eight-week online Mindfulness Virtual Community (MVC) intervention. Twelve psycho-educational videos on topics students pre-identified as stressful, prepared the trial participants for subsequent videos that guided them in 10 minutes of topically applied mindfulness practice. All video content was informed by Cognitive Behavior Therapy (CBT) constructs. Optional peer-to-peer text-based discussion and weekly live chat sessions were monitored and led by a mental health professional. Objective: To investigate the efficacy of an online MVC intervention in reducing symptoms of depression, anxiety and stress (primary outcomes) among undergraduate students in Toronto, Canada. The secondary outcomes included quality of life and life satisfaction. Methods: Recruitment for the three-arm randomized trial was undertaken with flyers, university-based listserv announcements, and postings associated with university courses where instructors granted credit for participation. Consenting students (n=119) were randomized to a wait list control group (WLC) or to a full MVC intervention (F-MVC) or to a partial MVC intervention (P-MVC) (which used videos only) (n=40, n=40, n=39). Participants were informed of allocation after consenting. The baseline (T1) and additional assessment sessions at 4 weeks (T2) and 8 weeks (T3) included the Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale. Analyses employed Generalized Estimation Equation (GEE) methods with AR(1) covariance structures and were adjusted for possible confounding variables (i.e. gender, age, country of birth, paid work, unpaid work, vigorous physical activities, and self-rated health). Results: Of the 113 students who provided baseline data, 28 males (24.8%) and 85 females (75.2%) reported a mean age of 24.8 years and were mostly Canadian-born (59.3%). Participants in F-MVC (n=39), P-MVC (n=35) and WLC (n=39) groups were similar in socio-demographic characteristics at baseline. There were no significant between-group differences on any key outcome variable at baseline. At T3 follow-up, per adjusted comparisons, there were statistically significant reductions in depression scores for F-MVC (score change -3.36 points, p=0.001) and P-MVC (score change -3.12, p=0.008) when compared to WLC. At T3 there was statistically significant reduction in anxiety scores only for P-MVC (score change -5.59, p=0.01) when compared to WLC. There was also statistically significant reduction in scores for perceived stress (score change 2.1, p =0.04) but only for P-MVC compared to WLC. No statistically significant changes were found for the quality of life and life satisfaction for F-MVC or P-MVC versus WLC. Conclusions: Internet-based mindfulness-CBT-based interventions, such as F-MVC and P-MVC, can result in significant reductions in depression, anxiety and stress in a student population. Such low-cost interventions can substitute for or supplement traditional, office-based counseling services. Clinical Trial: https://doi.org/10.1186/ISRCTN92827275

  • Acceptability and feasibility of a mental health mobile application to facilitate monitoring and outreach among Veterans

    Date Submitted: Jul 15, 2019

    Open Peer Review Period: Jul 18, 2019 - Sep 12, 2019

    Background: Advances in mobile health (mHealth) technology have made it possible for patients and providers to monitor and track symptoms in real-time. Ideally, mHealth application (apps) would includ...

    Background: Advances in mobile health (mHealth) technology have made it possible for patients and providers to monitor and track symptoms in real-time. Ideally, mHealth application (apps) would include both passive and interactive aspects of symptom monitoring. Objective: Researchers at a Veterans Affairs Medical Center and the Cogito Corporation sought to explore the acceptability and feasibility of such a mHealth app, the Companion System, among Veterans. Methods: A mixed methodological approach was used to investigate acceptability and feasibility. Veterans completed clinical interviews and self-report measures at baseline and a three-month follow-up. Veterans were able to use the Companion System app for three months. Passive data monitoring and outreach also occurred during this time period. Results: Results suggested that use of the Companion System was feasible and acceptable. Veterans were interested in, and used, the app; however, use of the app declined over time. Nonetheless, data was passively collected, and outreach occurred throughout. On the Client Satisfaction Questionnaire, 79% of the sample reported satisfaction (M = 26.2, SD = 4.3) demonstrating acceptability. Many Veterans reported liking the app features and the sense of connection they felt with the study clinicians who monitored their symptoms. Lack of privacy was a relatively minor concern. Conclusions: Feasibility and acceptability of a smartphone app to monitor mental health symptoms and follow-up in a Veteran sample was supported. Clinically, the Companion System app may serve as a useful method to promote symptom monitoring and facilitate early identification of risk and mitigation of negative psychiatric outcomes such as suicide.

  • The addition of the Canadian CT Head Rule, Transient Ischemic Attack Score and Subarachnoid Hemorrhage Rule to The Ottawa Rules App

    Date Submitted: Jul 15, 2019

    Open Peer Review Period: Jul 18, 2019 - Sep 12, 2019

    Background: The Canadian CT Head Rule (CCHR), the Canadian Transient Ischemic Attack (TIA) Score and Subarachnoid Hemorrhage (SAH) Rule have all previously demonstrated the potential to significantly...

    Background: The Canadian CT Head Rule (CCHR), the Canadian Transient Ischemic Attack (TIA) Score and Subarachnoid Hemorrhage (SAH) Rule have all previously demonstrated the potential to significantly standardise care and improve the management of patients in EDs. Based on user feedback, we believe the addition of these rules to The Ottawa Rules App has the potential to increase the app’s usability and user acceptability. Objective: The primary objective of this study was to evaluate the perceived usefulness, acceptability and uptake of the enhanced The Ottawa Rules App (now includes CCHR, TIA and SAH Rules) among ED clinicians (Medical Students, Residents, Nurses and Physicians). Methods: The enhanced The Ottawa Rules App was publicly released for free on iOS and Android operating systems in November 2018. This study was conducted across two tertiary EDs in Ottawa, Canada. Posters, direct enrolment, snowball sampling and emails were used for study recruitment. A 24-question online survey was administered to participants via email, and was used to determine user acceptability of the app and Technology Readiness Index (TRI) scores. In-app user analytics were collected to track user behavior such as number of app sessions, length of app sessions, frequency of rule use, date app was first opened etc. Results: A total of 77 ED clinicians completed the study including 34 nurses, 12 residents, 14 physicians, and 17 medical students completing ED rotations. The median TRI score for this group was 3.38, indicating a higher than average propensity to embrace/adopt new technologies to accomplish goals in their work or daily lives. The majority of respondents agreed or strongly agreed that the app helped participants accurately carry out the clinical rules (56/77,72.7%), and that they would recommend this app to their colleagues (64/77, 83.1%). Feedback from study participants suggested further expansion of the app - more clinical decision rules, and different versions of the app tailored to clinician role. Analysis and comparison of Google Analytics data and in-app data revealed similar usage behavior among study enrolled users and all app users globally. Conclusions: This study provides evidence that the use of The Ottawa Rules App (Version 3.0.2) to improve and guide patient care would be feasible and widely accepted. The ability to verify self-reported user data (via online survey) against server analytics data is a notable strength of this study. Participants’ continued app use and request for the addition of more CDRs warrants the further development of this app and call for additional studies to evaluate its feasibility and usability in different settings as well as assessment of clinical impact.

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