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The leading peer-reviewed journal for digital medicine, and health & healthcare in the Internet age
The Journal of Medical Internet Research (JMIR), now in its 20th year, is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications. It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2017: 4.671, ranked #1 out of 22 journals) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As leading high-impact journal in its' disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals, which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals.
As open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).
We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.
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Background: The potential for machine learning to disrupt the medical professions is the subject of ongoing debate within biomedical informatics and related fields. Objective: To explore GPs’ opinio...
Background: The potential for machine learning to disrupt the medical professions is the subject of ongoing debate within biomedical informatics and related fields. Objective: To explore GPs’ opinions about the potential impact of future technology on key tasks in primary care. Methods: Context and Setting: A web-based survey of 720 UK GPs’ opinions about the likelihood of future technology to fully replace GPs in performing six key primary care tasks; and if respondents considered replacement for a particular task likely, to estimate how soon the technological capacity might emerge. Qualitative descriptive analysis of written responses (‘comments’) to an open-ended question. Results: Comments were classified into three major categories in relation to primary care: (i) limitations of future technology; (ii) potential benefits of future technology; and (iii) social and ethical concerns. Perceived limitations included the beliefs that communication and empathy are exclusively human competencies; many GPs also considered clinical reasoning, and the ability to provide value-based care as necessitating physicians’ judgements. Perceived benefits of technology included expectations about improved efficiencies in particular with respect to the reduction of administrative burdens on physicians. Social and ethical concerns encompassed multiple, divergent themes including the need to train more doctors to overcome workforce shortfalls, and misgivings about the acceptability of future technology to patients. However, some GPs believed that the failure to adopt technological innovations could incur harms to both patients and physicians. Conclusions: This study presents timely information on physicians’ views about the scope of artificial intelligence in primary care. Overwhelmingly, GPs considered the potential of artificial intelligence to be limited. These views differ from the predictions of biomedical informaticians. More extensive, stand-alone qualitative work would provide a more in-depth understanding of GPs’ views. Clinical Trial: (Not applicable)
Background: The telehealth program is diverse with mixed results. A comprehensive and integrated approach is needed to evaluate who gets benefits from the program to improve clinical outcomes. Objecti...
Background: The telehealth program is diverse with mixed results. A comprehensive and integrated approach is needed to evaluate who gets benefits from the program to improve clinical outcomes. Objective: The CHA2DS2-VASc score has been widely used for the prediction of stroke in patients with atrial fibrillation. This study adopts the predictive concept of the CHA2DS2-VASc score and investigated this score for risk stratification in hospital admission in patients with cardiovascular diseases receiving a fourth-generation synchronous telehealth program. Methods: This was a retrospective cohort study. We recruited patients with cardiovascular disease who received the fourth-generation synchronous telehealth program at the National Taiwan University Hospital between October 2012 and June 2015. We enrolled 431 patients who had joined a telehealth program and compared them with 1549 control patients. Cardiovascular hospitalization was estimated with Kaplan-Meier curves. The CHA2DS2-VASc score was used as the composite parameter to stratify the severity of the patients. The association between baseline characteristics and the clinical outcomes was assessed via the Cox proportional hazard model. Results: The mean follow-up duration was 886.1 ± 531.0 days in patients receiving the fourth-generation synchronous telehealth program and 707.1 ± 431.4 days in the control group. (p<0.0001). The telehealth group had more comorbidities at baseline than the control group. Patients with higher CHA2DS2-VASc score (≥ 4) were associated with a lower estimated rate of free from cardiovascular hospitalization (46.5% vs. 54.8%, log-rank test p = 0.0028). Patients receiving the telehealth program with CHA2DS2-VASc score ≥ 4 were less likely to be admitted for cardiovascular disease (61.5% vs. 41.8%, log-rank test p = 0.010). The telehealth program remains a significant prognostic factor after multivariable Cox analysis in patients with CHA2DS2-VASc score ≥ 4 (HR=0.36 [CI: 0.22 -0.62], p < 0.0001) Conclusions: A higher CHA2DS2-VASc score is associated with higher cardiovascular admission. Patients with CHA2DS2-VASc ≥4 benefits most for free from cardiovascular hospitalization after accepting the fourth-generation telehealth program. Clinical Trial: N/A
Background: The amount of medical and clinical-related information on the Web is increasing. Among the various types of information on the Web, social media-based data obtained directly from people ar...
Background: The amount of medical and clinical-related information on the Web is increasing. Among the various types of information on the Web, social media-based data obtained directly from people are particularly valuable and garnering much attention. To encourage medical natural language processing research exploiting social media data, the NTCIR-13 MedWeb (Medical Natural Language Processing for Web Document) provides pseudo-Twitter messages in a cross-language and multi-label corpus, covering three languages (Japanese, English, and Chinese), and annotated with eight symptom labels (e.g., cold, fever, flu, and so on). Then, participants classify each tweet into one of two categories: those containing a patient’s symptom, and those that do not. Objective: We aim to present the results of groups participated in the Japanese subtask, the English subtask, and the Chinese subtask along with discussions, in order to clarify the issues that need to be resolved in the field of medical natural language processing. Methods: The performance of participant systems is assessed using the exact match accuracy, F-measure based on precision and recall, and Hamming loss. Results: In all, eight groups (19 systems) participated in the Japanese subtask, four groups (12 systems) participated in the English subtask, and two groups (six systems) participated in the Chinese subtask. The best system achieved .880 in exact match accuracy, .920 in F-measure, and .019 in Hamming loss. Conclusions: This paper presented and discussed the performance of systems participated in the NTCIR-13 MedWeb task. Because the MedWeb task settings can be formalized as the factualization of text, the achievement of this task could be applied directly to practical clinical applications.
Background: In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning (FP) and repr...
Background: In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning (FP) and reproductive health. However, little is known regarding the role of SMS-based FP communication on the utilisation of modern contraception and maternal healthcare services in low-resource settings. Objective: The objectives of this study were to 1) measure the coverage of SMS-based family planning (FP) communication, and 2) its association with modern contraception and maternal healthcare services (MHS) among mothers. Methods: Cross-sectional data on 94,675 mothers (15-49 years) were collected from the latest Demographic and Health Surveys on 14 low-and-middle-income countries. The outcome variables were self-reported use of modern contraception and basic MHS (timely and adequate use of antenatal care, and of facility delivery services). Data were analysed using multivariate regression and random effect meta-analyses. Results: The coverage of SMS-based FP communication for the pooled sample was 5.4% (95%CI=3.71, 7.21), and was slightly higher in Africa (6.04, 95%CI=3.38, 8.70) compared with Asia (5.23, 95%CI=1.60, 8.86). Among the countries from sub-Saharan Africa, Malawi (11.92, 95%CI=11.17, 12.70) had the highest percent of receiving SMS while Senegal (1.24, 95%CI=1.00, 1.53) had the lowest. In the multivariate analysis, SMS communication shown significant association with the use of facility delivery only (2.22 (95%CI=1.95, 2.83). The strength of the association was highest for Senegal (OR=4.70, 95%CI=1.14, 7.33) and lowest for Burundi (OR=1.5; 95%CI=1.01, 2.74). Meta analyses revealed moderate heterogeneity both in the prevalence and the association between SMS communication and the utilisation of facility delivery. Conclusions: Although positively associated with using facility delivery services, receiving SMS on FP does not appear to affect modern contraceptive use and other components of MHS such as timely and adequate utilisation of antenatal care.
Background: Internet interventions are able to easily generate objective data about program usage. Increasingly, more studies are exploring the relationship between usage and outcomes but they often r...
Background: Internet interventions are able to easily generate objective data about program usage. Increasingly, more studies are exploring the relationship between usage and outcomes but they often report different metrics of use and the findings are mixed. Thus, current evaluations fail to demonstrate which metrics should be considered and if it is possible to determine an optimal dose-response relationship which can inform thresholds for adherence and clinically meaningful change. Objective: This study aimed to explore the relationship between several usage metrics and outcomes; and determine an optimal dose of usage of an internet intervention for depression. Methods: This is a secondary analysis of data from a Randomized Controlled Trial that examined the efficacy of an internet-based Cognitive-Behavioral Therapy (iCBT) program for depression (Space from Depression) in an adult community sample. Space from Depression is a seven-module, supported intervention delivered over a period of 8 weeks. Supporters were trained volunteers who provided feedback to participants on a weekly basis. Different usage metrics (i.e. time spent, modules and activities completed, percentage of program completion) were automatically collected by the platform and composite variables from these (e.g. activities per session) were computed. A breakdown of the usage metrics was obtained by weeks. For the analysis, the sample was divided into those who obtained a reliable change (RC) (Beck Depression Inventory [BDI-II] change >8) and those who did not. Results: Data from 216 users who used the intervention and completed pre and post-treatment outcomes were included in the analyses. 89 participants obtained a RC and 127 did not. Those in the RC group significantly spent more time, had more logins, used more tools, viewed a higher percentage of the program and got more reviews from the supporter compared to those who did not obtain a RC. Differences between groups in usage was observed from first week in advance across the different metrics although they vanished over time. In the RC group, the usage was higher during the first four weeks and then a significant decrease was observed. ROC Curve analyses showed that the optimal cut-points for different usage metrics were 7 hours total time spent, 15 sessions, 30 tools used and 50% of program completion. Conclusions: Overall, the results showed that those individuals who obtained RC after the intervention had higher levels of exposure to the platform. The usage during the first half of the intervention was higher and differences between groups were observed from the first week. This study also suggests that it is possible to determine an optimal dose and this can be used to inform the minimal usage to establish adherence. These results will help to better understand how to use internet interventions and what optimal level of engagement can most affect outcomes. Clinical Trial: The trial is registered as a controlled trial with ISRCTN (ISRCTN03704676).
Background: 16 years of working in Digital Health Objective: Improve health outcomes through harnessing of digital technologies. Methods: Accumulating experience with current trends in Digital Health...
Background: 16 years of working in Digital Health Objective: Improve health outcomes through harnessing of digital technologies. Methods: Accumulating experience with current trends in Digital Health Results: The paper Conclusions: Guidelines on EHR integrated implementation should be considered part of healthcare policy.