%0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e82727 %T Digital Infrastructure for Antimicrobial Susceptibility Testing and Surveillance: A CLSI and EUCAST-Based Model for Resource-Limited Settings %A Mbarushimana,Djibril %A Adegboyega,Taofeek Tope %A Jean Damascene,Gatera %A Bale,Muritala Issa %A Damascene,Buregeya Jean %A Marie Francoise,Kayitesi %A Innocent,Itangishaka %A Alexis,Rugamba %A Adeyemo,Rasheed Omotayo %A Issa,Bagirinshuti %A Akinola,Saheed Adekunle %A Adedeji,Ahmed Adebowale %A Evariste,Mushuru %A Albert,Busumbigabo %A Felicite,Mukamana %A Sylvain,Habarurema %A Habarugira,Felix %A Sinumvayo,Jean Paul %A Noel,Rutambika %A Theogene,Twagirumugabe %A Jules,Ndoli Minega %A Christian,Ngarambe %K antimicrobial susceptibility testing %K CLSI %K EUCAST %K Laboratory Information System %K antimicrobial stewardship %K resource-limited settings %K openClinic GA %K University Teaching Hospital of Butare %K WHONet %D 2026 %7 21.1.2026 %9 %J JMIR Form Res %G English %X Background: Antimicrobial resistance (AMR) poses a significant global health threat, requiring effective antimicrobial susceptibility testing (AST) and surveillance systems. At the University Teaching Hospital of Butare (CHUB) in Rwanda, a baseline Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) identified critical gaps in the Laboratory Information System (LIS), including low capture rates for culture observation (60%) and AST data (25%), no standardization of AST panels (0%), and limited cumulative antibiogram generation (17%). Existing AMR surveillance platforms, such as the Information System for Monitoring Antimicrobial Resistance by the World Health Organization (WHO) Collaborating Center for Surveillance of Resistance to Antimicrobial Agents (WHONET), and the District Health Information System, operate as standalone systems separate from clinical workflows, which limits their real-time clinical utility. Objective: This study aimed to develop an enhanced, web-based LIS integrated within routine clinical care to improve AST reliability, enable real-time AMR surveillance at CHUB, and provide a scalable model for subnational and national surveillance networks in resource-limited settings, supporting antimicrobial stewardship. Methods: We developed an enhanced LIS using the OpenClinic GA, the current open-source hospital information system at CHUB, integrating Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines, and leveraging metadata from the AMR for R package, WHONET resources, and EUCAST Expert Rules. An agile development approach was used, incorporating a custom database schema, Java-based application programming interfaces (APIs), and web-based user interfaces. The system was designed to support minimum inhibitory concentration (MIC) and disk diffusion (DD) methods, automate result interpretation with color-coded outputs, WHO Access, Watch, Reserve (AWaRe)–based cascade reporting, and enable data export to WHONET for global surveillance. Results: The enhanced LIS improved AST data capture and standardization, providing reliable, automated result interpretation and real-time AMR surveillance capabilities. The system’s web-based architecture enables scalability through centralized deployment, allowing multiple facilities simultaneous access. Unlike standalone surveillance tools, the enhanced LIS integrates AST within electronic medical records, maintaining clinical information continuity from specimen registration through result reporting. The system supports immediate clinical decision through AWaRe–based cascade reporting, and automated resistance phenotype detection, followed by standardized WHONET-compatible exports for public health surveillance. Conclusions: This scalable, LIS model demonstrates the feasibility of implementing standards-based AMR informatics in resource-limited settings. By embedding surveillance within clinical workflows rather than treating it as a separate downstream activity, the system maximizes data quality and clinical relevance while minimizing staff burden. The centralized web-based architecture provides inherent scalability from facility to national levels, eliminating data fragmentation and ensuring metadata consistency across networks. Long-term sustainability requires continuous user training, designated personnel for metadata maintenance, local IT capacity building, and funding mechanisms beyond donor dependency. This model provides a practical roadmap for national digital stewardship programs, supporting both immediate patient care and long-term public health surveillance goals. %R 10.2196/82727 %U https://formative.jmir.org/2026/1/e82727 %U https://doi.org/10.2196/82727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e80721 %T Adapted Virtual Reality Exergaming Using Off-the-Shelf Supplies for Poststroke Hemiparetic Arm Rehabilitation: Case Study %A Hare,Sadie %A Vice,Jason %A Bowman,Mary H %A Wright,Ashley %A Young,Raven %A Ahmad,Mahmoud %A Logan,Maggie %A Lai,Byron %+ Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 701 20th Street South, Birmingham, AL, 35233, United States, 1 1 205 638 9790 ext 8, byronlai@uab.edu %K active video game %K augmented reality %K disability %K exercise %K extended reality %K physical activity %K rehabilitation %D 2025 %7 24.12.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual reality (VR) can supplement exercise therapy for poststroke upper-arm hemiparesis, but treatments have been largely limited by specialized or costly equipment, hindering replicability and generalizability. Objective: This study examined the feasibility of using a commercially available bundle of VR supplies to improve hemiparetic arm function before and after an exergaming program in an individual post stroke. Methods: We conducted a pre-post case study (male, aged 72 years, chronic stroke) of a 20-day VR exergaming program (1-hour session per day) using a head-mounted display (Meta Quest 2), with adaptive software (WalkinVR) to boost and adjust in-game movements. Measures of upper-arm function were performed at preintervention (day 0), midintervention (day 10), and postintervention (day 21) and included the Wolf Motor Function Test (WMFT) and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). Data were descriptively analyzed. Results: The participant demonstrated improvement in the mean time to complete tasks of the WMFT by 70.5% (δ=11.73 s; preintervention mean time 16.63, SD 31 s; effect size=0.54) from preintervention to midintervention and 78% (δ=12.96 s; effect size=0.59) from preintervention to postintervention. WMFT mean functional ability score demonstrated an improvement of 18% (δ=0.46 points; preintervention mean score 2.67, SD 0.87 points; effect size=0.59) from preintervention to midintervention and 23% (δ=0.6 points; effect size=0.79) from preintervention to postintervention. Range of motion improved in all joints by an average of 35.64% (SD 20%) from preintervention to postintervention. DASH scores demonstrated minimal improvements across the intervention. Conclusions: VR exergaming with adaptive software could be an easy-to-adopt method for improving the functional ability of the hemiparetic arm among people post stroke. Improvements were potentially meaningful but warrant confirmation in more rigorous study designs. %M 41442699 %R 10.2196/80721 %U https://formative.jmir.org/2025/1/e80721 %U https://doi.org/10.2196/80721 %U http://www.ncbi.nlm.nih.gov/pubmed/41442699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68780 %T Enhancing Parenting Using AI: Exploratory Hackathon %A Woods,Peter %A Donohoe,Stephanie %A Turtle,Louise %A Agrawal,Udit %A Humphriss,Joshua %A Cordes,Niel %A Hodson,Nathan %+ Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, England, CV4 7AL, United Kingdom, 44 2476 574 ext 880, peter.woods@warwick.ac.uk %K hackathon %K mental health %K parenting %K psychiatry %K large language models %D 2025 %7 17.12.2025 %9 Case Report %J JMIR Form Res %G English %X Background: Parenting skills programs are the primary intervention for conduct disorders in children. The Pause app enhances these programs by providing digital microinterventions that reinforce learning between sessions and after program completion. The potential of artificial intelligence (AI) in this context remains untapped. Hackathons have proven effective for health care innovation and can facilitate collaborative development in this space. Objective: We aimed to rapidly build AI-powered features in the Pause app to enhance parenting skills. Methods: We undertook a 1-day hackathon that included an ideation phase drawing on the Design Council’s double diamond framework and a development phase using microsprints based on agile and scrum approaches. The interdisciplinary participants included medical professionals, developers, and product managers. Results: Participants identified 3 core problems: generating age-appropriate distractions, receiving feedback on parenting efforts, and effectively using the journal function. During the solution phase, a wide range of options were explored, resulting in 3 key solutions: AI-assisted idea generation, a tool for summarizing parenting interactions, and a weekly journal roundup. During the development phase, participants completed 4 microsprints. Teams focused on 3 workstreams: building a “weekly roundup” module, creating an AI-based distraction generator, and developing a summarizer for active play sessions. These prototypes were integrated into the preproduction environment, with each workstream producing a functional component. Participant feedback (n=4) was unanimously positive, with all participants rating the event as “excellent” and highlighting the value of in-person collaboration. Conclusions: This 1-day hackathon used the double diamond approach to develop AI-powered features for parenting programs. Three solutions were explored across workstreams, resulting in 2 fully functioning and 1 near-functioning app component. The rapid problem-solving approach mirrors other health technology hackathons and highlights the untapped potential of AI in digital parenting support, surpassing traditional e-learning or video-based methods. This work suggests broader applications of AI-driven coaching in fields like social care. Despite a small team, the hackathon was focused and productive, generating relevant solutions based on prior engagement with parents and practitioners. Future research will assess the impact of the app’s AI-powered features on parenting outcomes. %M 41406472 %R 10.2196/68780 %U https://formative.jmir.org/2025/1/e68780 %U https://doi.org/10.2196/68780 %U http://www.ncbi.nlm.nih.gov/pubmed/41406472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e77237 %T Development and Health System Deployment of an Electronic Health Record–Integrated Chatbot Intervention for Connecting Fall Risk Screening to Community Resources After Emergency Department Visits: Implementation Study %A Keleman,Audrey %A Bounds,Megan %A Lunt,Maxwell %A Portz,Jennifer %A Ferozan,Bucky %A Gomez Picazo,Jonathan %A Bookman,Kelly %A Lum,Hillary D %A Goldberg,Elizabeth M %+ Emergency Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Ave, Campus Box B-215, Aurora, CO, 80045, United States, 1 720 848 6777, elizabeth.goldberg@cuanschutz.edu %K falls %K older adults %K digital health %K referral pathway %K high fall risk screening %K fall prevention %K emergency department %D 2025 %7 18.11.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments (EDs) routinely screen for fall risk, but patients are rarely notified of their results or referred to preventive resources. There is a critical need for an intervention that notifies patients when they are at risk for falls and automates referrals to fall prevention programs without increasing clinician workload. Chatbots can be used to provide patient education and community resources in a conversational, friendly manner. We developed and implemented an automated intervention using our health system's electronic health record (EHR) and an artificial intelligence chatbot, Livi, to address this gap in fall prevention across 17 EDs. Objective: This study aimed to share how we developed our fall risk notification and referral intervention and iteratively improved it based on end-user feedback. Methods: We collaborated with the EHR and ED operations teams to automate patient notification of fall risk and referral. First, we leveraged existing fall risk screening questions in nursing documentation to identify patients at risk for falls. We then developed an EHR workflow that delivers a QR code in the after-visit summary for all high-risk patients at ED discharge. Scanning the QR code launches a conversation with Livi, guiding users to physician-vetted, evidence-based, free or low-cost fall prevention resources in their area. In this workflow, only ED patients who are screened as high risk receive linkage to Livi, and clinicians do not need to manually place referrals or enter specific fall prevention resources at discharge. We conducted rapid, iterative usability testing of the Livi falls chatbot with 93 community members during the development process at 3 community fairs in distinct settings. Results: Rapid iterative testing led to enhancements in the intervention, such as increased font size, an option for Spanish language, additional geographic locations for fall prevention resources, home modification resources, the ability to self-assess for fall risk, fall prevention tips, and the ability for patients to leave feedback on the Livi chatbot. Because all EDs in the health system use the same instance of Epic, the EHR workflow was instantaneously deployed system-wide. The use of a QR code linked to the Livi chatbot also allows for the rapid updating of prevention resources. Conclusions: This study describes the formative development and system-wide implementation of the intervention. This scalable, EHR-integrated intervention demonstrates a novel and pragmatic approach to improving population health by capitalizing on existing clinical workflows and automating both risk notification and personalized resource referral for older adults without increasing clinician burden. The next steps include conducting a randomized controlled trial to assess the impact of the screening and referral tool on recurrent fall-related health care use compared with routine care in the ED. Formal evaluation of the implementation outcomes will be conducted in the planned trial. %M 41252184 %R 10.2196/77237 %U https://formative.jmir.org/2025/1/e77237 %U https://doi.org/10.2196/77237 %U http://www.ncbi.nlm.nih.gov/pubmed/41252184 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e79708 %T A Brief Technique to Reduce Flashbacks of Sexual Trauma in an Adolescent: Proof-of-Concept Case Study Using Imagery Interference %A Lau-Zhu,Alex %A Chan,Carmen %K adolescent %K trauma %K PTSD %K flashback %K intrusive memories %K intrusions %K imagery %K posttraumatic stress disorder %D 2025 %7 12.11.2025 %9 %J JMIR Form Res %G English %X Background: Trauma exposure, including sexual harm, is prevalent in adolescents. A key resulting symptom relates to reexperiencing mental images of trauma, such as intrusive memories and flashbacks. Established treatments are used to address flashback memories but are hard to access, often leave remaining symptoms, and require extensive exposure to traumatic materials. An emerging approach with adult populations suggests intrusive imagery symptoms can be precisely targeted with simple cognitive tasks. Objective: We describe a first proof-of-concept demonstration of an imagery interference technique in a 15-year-old to target residual flashback symptoms after a course of treatment for posttraumatic stress disorder (PTSD) following sexual trauma, to lay the groundwork for further evaluations. Methods: A case study (Mia) was presented, drawing from routine clinical practice within the United Kingdom’s National Health Service. After 23 sessions of trauma-focused cognitive behavioral therapy, Mia received the imagery interference technique at session 24 and returned a month later for session 25 (the final session). The technique involved playing Tetris within a wider protocol informed by the science of memory malleability (eg, including brief memory recall and working memory taxation). Memory ratings (frequency, vividness, and distress) were assessed before and immediately after training on the technique and a month later. Symptoms of PTSD, anxiety, and depression were gathered at the first and final sessions. Views from Mia and her parents were also obtained. Results: For the specific flashback targeted by Mia, vividness reduced within the session (40% to 15%), distress reduced within the session (40% to 15%) and a month later (then to 10%), and frequency reduced a month later (once to zero times per week; 100% reduction). Nontargeted flashbacks also reduced in frequency (from 4 times to 1 time per month; 75% reduction). Mia described the memories as more “distant.” Symptoms of PTSD, depression, and anxiety reduced overall. Conclusions: Pending further rigorous testing beyond this single case, the imagery interference approach has potential as a low-intensity and early intervention for adolescents to address intrusive imagery of trauma, such as sexual harm, and also in other clinical contexts (eg, anxiety). %R 10.2196/79708 %U https://formative.jmir.org/2025/1/e79708 %U https://doi.org/10.2196/79708 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64440 %T Sprint-Intensity Arm Interval Training May Improve Cardiorespiratory Fitness and Cardiometabolic Health Among Children With Mobility Disabilities: Case Report %A Dean,Natalie %A Sinha,Tanvee %A Bright,Larsen %A Ellison,Katie M %A Sayer,Drew %A Young,Raven %A Davis,Drew %A Rimmer,James H %A Lai,Byron %K adapted physical activity %K high-intensity interval training %K telehealth %K teleexercise %K cerebral palsy %K pediatric rehabilitation %K cardiorespiratory fitness %K cardiometabolic %K case report %K aerobic exercise %K cerebral palsy %K physical disabilities %D 2025 %7 8.10.2025 %9 %J JMIR Form Res %G English %X Background: There are limited options for aerobic exercise options that improve cardiorespiratory fitness and manage cardiometabolic health that are also age-appropriate and suitable for children with mobility disabilities. Children with disabilities require exercise programs that incorporate adapted movements to meet various functional needs, which offer brief training durations to accommodate busy schedules and use remote training methods at home to bypass logistical transportation barriers. Objective: The aim of this study is to test the potential effects and safety of a sprint-intensity arm-exercise interval training program, combined with music and telehealth, on cardiorespiratory fitness and cardiometabolic health in a child with cerebral palsy. Methods: This study was a 12-week exercise intervention from pretrial to posttrial for a single child with cerebral palsy (male, age 17 y). The intervention was conducted at the participant’s homes. The participant exercised 3 times per week while following along with YouTube exercise videos. Videos included 4-second maximal sprint bouts followed by periods of rest, which were repeated 30 times during a single exercise session (total of ~2 minutes of maximal exercise). Exercise sessions were supervised by research staff using videoconferencing. Cardiorespiratory fitness was indicated by peak oxygen consumption (pVO2), which was measured by a portable metabolic cart during a graded exercise test. Cardiometabolic health outcomes included body composition by dual-energy x-ray absorptiometry scan and a cardiometabolic blood profile by a dried blood spot test. Outcomes were descriptively analyzed. Results: The participant achieved a 33.6% increase in pVO2 (14.6 to 19.5 mL/kg−1/min–1), a 37.8% improvement in blood triglycerides (82 to 51 mg/dL), and a 15.4% improvement in the total cholesterol to high-density lipoprotein ratio (6.5 to 5.5). Additionally, he had a 5.9% reduction in body weight (171 to 161 lbs) and a 9.6% reduction in total body fat (61.35 to 55.48 lbs) from the arms, legs, and trunk. The participant experienced no adverse events or problems during the intervention. After completing the program, the participant elicited a maximal intensity of exercise using armbands, as demonstrated through pVO2. Conclusions: Sprint-intensity interval training that uses the arms may be safe and potentially effective for enhancing cardiorespiratory fitness and cardiometabolic health in children with physical disabilities. Further research is needed to verify the outcomes of this case report. %R 10.2196/64440 %U https://formative.jmir.org/2025/1/e64440 %U https://doi.org/10.2196/64440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56272 %T Implementing a Cross-Border Next-Generation Personal Health Record in the Philippines and Taiwan: An Implementation Case Report Using Health Level 7 International Fast Healthcare Interoperability Resources %A Lee,Hsiu-An %A Huang,Jui-Chun %A Huang,Shih-Wun %A Chen,Wei-Han %A Marcelo,Alvin B %A Aljibe,Miguel Sandino O %A Hsu,Chien-Yeh %K health insurance %K personal health records %K international patient summary %K HL7 FHIR %K cross-border healthcare %K implementation study %D 2025 %7 2.7.2025 %9 %J JMIR Form Res %G English %X Background: Disparities in electronic health record systems hinder cross-border continuity of care, particularly where labor mobility and tourism intersect (eg, between the Philippines and Taiwan). Both nations collect claim data, yet neither fully aligns with international standards such as the Health Level 7 International, International Patient Summary (IPS). Objective: This implementation report aimed to convert health insurance data from Taiwan’s My Health Bank (MHB) and the Philippine Health Insurance Corporation’s Claim Form 4 (CF4) into a cross-border personal health record (PHR) aligned with the IPS using (Fast Healthcare Interoperability Resources) FHIR standards. Methods: We mapped each data element from CF4 (n=7 main sections) and MHB (n=12 major data items) to 17 sections of the IPS. We analyzed whether these elements matched IPS requirements (required or recommended or optional) and identified missing fields (eg, device use, social history, and advanced directives). We also designed a FHIR-based integration architecture, addressing system security with OAuth 2.0/SMART on FHIR and proposing a national uptake strategy for accelerating cross-border PHR implementation. Results: Of the 17 IPS sections, MHB covered 14 sections (82.4%), while CF4 covered 12 sections (70.6%). Both systems lacked sufficient data elements for medical devices, social history (eg, alcohol or tobacco), and advanced directives. We developed an implementation plan focusing on data interoperability, standardization, and privacy or security protocols. We propose a multiphase approach—beginning with the stakeholder engagement and pilot testing in both countries. Conclusions: Aligning CF4 and MHB data with IPS standards via FHIR can facilitate a robust cross-border next-generation PHR ecosystem. This approach may enhance patient safety, continuity of care, and policy development for the Philippines and Taiwan. Further collaboration, regulatory updates, and public awareness are vital to sustain integration and maximize patient benefits. %R 10.2196/56272 %U https://formative.jmir.org/2025/1/e56272 %U https://doi.org/10.2196/56272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e73811 %T Development of an Eco-Friendly Smartphone-Assisted Nystagmus Recording System for Recording Vertigo Attacks Anytime, Anywhere: Pilot App Development Study %A Dobashi,Yumi %A Noda,Masao %A Kuroda,Tatsuaki %A Miyata,Noriaki %A Ito,Makoto %A Tsunoda,Reiko %A Fushiki,Hiroaki %K dizziness %K telemedicine %K vertigo %K “iCapNYS” system %K mobile health %K smartphone %D 2025 %7 18.6.2025 %9 %J JMIR Form Res %G English %X Background: The widespread adoption of smartphones and tablet devices, along with advancements in data communication technology, has resulted in a paradigm shift in the treatment of dizziness. External factors, such as the spread of COVID-19, have accelerated this transformation in recent years. We have been pursuing telemedicine and web-based medical care to treat dizziness and have developed different products and services necessary for each treatment process stage. Several patients face difficulties in accessing medical facilities during severe vertigo episodes. Furthermore, clinical findings, such as nystagmus or other symptoms, may be absent when symptoms subside by the time of their appointment. Objective: This study aimed to develop a smartphone app for capturing eye movements and head positions during vertigo attacks, enabling recordings anywhere, even at home or work. Methods: We developed an app named “iCapNYS” that uses the iPhone’s front camera and gyro sensor to record eye movements and head positions. The app incorporates features designed to encourage spontaneous eye movements, minimizing nystagmus suppression caused by fixation. Additionally, we designed lightweight, recyclable cardboard goggles to securely hold the smartphone and block visual stimuli from the surrounding environment, optimizing the recording conditions. Results: The “iCapNYS” system successfully captured subtle peripheral vestibular nystagmus in a patient with vertigo. The recorded nystagmus characteristics are comparable to those obtained using traditional infrared CCD (charge-coupled device) cameras. Conclusions: This app is an effective tool for treating vertigo and is easy for older adults to use, as it can be recorded with only 3 taps. We expect that the introduction of this nystagmus-monitoring system will improve vertigo treatment quality, promote medical collaboration, and provide patients with peace of mind in their care. %R 10.2196/73811 %U https://formative.jmir.org/2025/1/e73811 %U https://doi.org/10.2196/73811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67398 %T Applying the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework to Adapt the CHAMP App for Pediatric Feeding Tube Weaning: Application and Case Report %A Bakula,Dana M %A Zax,Alexandra %A Edwards,Sarah %A Nash,Kristina %A Escobar,April %A Graham,Rachel %A Ricketts,Amy %A Thompson,Ryan %A Bullard,Sarah %A Brogren,Julianne %A Shimmens,Leah %A Erickson,Lori A %K gastric feeding tubes %K mobile applications %K interdisciplinary communication %K feeding and eating disorders of childhood %K case report %D 2025 %7 16.6.2025 %9 %J JMIR Form Res %G English %X Background: Evidence-based tube feeding (TF) weaning involves reducing the volume of tube feeds to induce hunger, with interdisciplinary monitoring to allow for proactive medical, nutritional, and behavioral intervention as needed. This can be done outpatient; however, the current standard of care requires a high degree of medical monitoring and care coordination, which can be challenging to implement. The CHAMP App is a mobile app designed for remote patient monitoring of children born with congenital heart conditions who are at high risk for medical morbidity and mortality. The CHAMP App remote patient monitoring program would be ideally suited to improve medical monitoring and care coordination. Objective: This study aims to determine the feasibility of adapting the CHAMP App for children ready to wean from TF. Methods: We used the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as a formative tool and conducted a case study beta test. Results: The level of complexity for the digital innovation’s adaptation supported a high likelihood of success for the TF population. Most issues were simple, such as expanding the types of data that could be entered into the app, and some were more complicated, for instance, training all relevant staff to use and maintain the technology. The case study beta test was conducted with “Greyson”, a 10-month old child weaning from TF (name changed for confidentiality). Once a week, the team reviewed the parent-entered data and communicated with Greyson’s parents, recommending a 25% reduction in tube feeding each week. With the CHAMP App facilitating 2-way communication between the family and the team, Greyson successfully transitioned from receiving 30% of his feeds orally and 70% via tube feeding to 100% oral feedings over the course of 1 month in a home setting. Conclusions: The CHAMP App is likely to be incredibly valuable in TF weaning. The NASSS framework helped identify key considerations for adapting the CHAMP App for TF weaning at a Midwestern children’s hospital. Interviews with the health care team highlighted issues like data entry expansion and staff training. The framework confirmed TF weaning as a suitable application with no major barriers. The CHAMP App successfully supported a test patient, Greyson, in weaning from his feeding tube. It may improve access, communication efficiency, and satisfaction among families and health care teams while reducing costs and enhancing safety monitoring. The app could also make TF weaning more accessible to families with lower health literacy. %R 10.2196/67398 %U https://formative.jmir.org/2025/1/e67398 %U https://doi.org/10.2196/67398 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e72872 %T Concurrent Treatment of Opioid and Tobacco Use Disorder in a Telemedicine Clinic: Case Report of Breaking Through Barriers %A Michero,Darcy %A Monico,Laura %A Pielsticker,Peyton %A Mooney,Larissa J %A Glasner,Suzette %+ Department of Clinical Affairs, Digital Therapeutics, 276 Fifth Avenue, Suite 608, New York, NY, 10001, United States, 1 (518) 545 5428, darcy@pelagohealth.com %K opioid use disorder %K tobacco use disorder %K buprenorphine %K nicotine replacement therapy %K case report %D 2025 %7 15.5.2025 %9 Case Report %J JMIR Form Res %G English %X There are a myriad of obstacles faced by individuals who take medication for opioid use disorder, including high out-of-pocket costs, stigma, logistical challenges associated with traveling to treatment facilities, and negative experiences with treatment providers. The proliferation of illicit fentanyl use and associated overdose risk underscores the urgent need to broaden access to lifesaving pharmacotherapy for opioid use disorder. This case report describes the safe and effective induction of a 32-year-old male onto sublingual buprenorphine in a digital care setting, with integrated, counselor-facilitated psychosocial treatment delivered via a smartphone app targeting relapse prevention. The digital care modality enabled this patient to overcome 2 major treatment barriers: limited access to evidence-based treatment given his residence in a rural area, and heightened overdose risk given his use of fentanyl, a potent synthetic opioid. In addition, we describe tobacco cessation treatment delivered digitally concurrently with opioid use disorder care, combining pharmacotherapy and behavioral skills training. Given the disproportionately high rate of co-occurring opioid use disorder and tobacco use and associated mortality rates, the effective treatment of these conditions simultaneously in this case advances our knowledge of potentially efficacious treatment approaches for underserved individuals with opioid use disorder who present with polysubstance use.International Registered Report Identifier (IRRID): RR2-10.1177/20552076241258400 %M 40372777 %R 10.2196/72872 %U https://formative.jmir.org/2025/1/e72872 %U https://doi.org/10.2196/72872 %U http://www.ncbi.nlm.nih.gov/pubmed/40372777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70015 %T Monitoring Nystagmus in a Patient With Vertigo Using a Commercial Mini-Infrared Camera and 3D Printer: Cost-Effectiveness Evaluation and Case Report %A Sakazaki,Hiroyuki %A Noda,Masao %A Dobashi,Yumi %A Kuroda,Tatsuaki %A Tsunoda,Reiko %A Fushiki,Hiroaki %K dizziness %K vertigo %K smartphone %K BPPV %K telemedicine %K 3D-printer %D 2025 %7 27.2.2025 %9 %J JMIR Form Res %G English %X Background: Observing eye movements during episodic vertigo attacks is crucial for accurately diagnosing vestibular disorders. In clinical practice, many cases lack observable symptoms or clear findings during outpatient examinations, leading to diagnostic challenges. An accurate diagnosis is essential for timely treatment, as conditions such as benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine require different therapeutic approaches. Objective: This study aimed to develop and evaluate a cost-effective diagnostic tool that integrates a mini-infrared camera with 3D-printed goggles, enabling at-home recording of nystagmus during vertigo attacks. Methods: A commercially available mini-infrared camera (US $25) was combined with 3D-printed goggles (US $13) to create a system for recording eye movements in dark conditions. A case study was conducted on a male patient in his 40s who experienced recurrent episodic vertigo. Results: Initial outpatient evaluations, including oculomotor and vestibular tests using infrared Frenzel glasses, revealed no spontaneous or positional nystagmus. However, with the proposed system, the patient successfully recorded geotropic direction-changing positional nystagmus during a vertigo attack at home. The nystagmus was beating distinctly stronger on the left side down with 2.0 beats/second than the right side down with 1.2 beats/second. Based on the recorded videos, a diagnosis of lateral semicircular canal-type BPPV was made. Treatment with the Gufoni maneuver effectively alleviated the patient’s symptoms, confirming the diagnosis. The affordability and practicality of the device make it particularly suitable for telemedicine and emergency care applications, enabling patients in remote or underserved areas to receive accurate diagnoses. Conclusions: The proposed system demonstrates the feasibility and utility of using affordable, accessible technology for diagnosing vestibular disorders outside of clinical settings. By addressing key challenges, such as the absence of symptoms during clinical visits and the high costs associated with traditional diagnostic tools, this device offers a practical solution for real-time monitoring and accurate diagnosis. Its potential applications extend to telemedicine, emergency settings, and resource-limited environments. Future iterations that incorporate higher-resolution imaging and automated analysis could further enhance its diagnostic capabilities and usability across diverse patient populations. %R 10.2196/70015 %U https://formative.jmir.org/2025/1/e70015 %U https://doi.org/10.2196/70015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56598 %T High-Frequency Cognitive Control Training for Depression: Case Report %A Vander Zwalmen,Yannick %A Hoorelbeke,Kristof %A Demeester,David %A Koster,Ernst H W %+ Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 92649107, y.vander.zwalmen@ugent.be %K cognitive control training %K CCT %K cognitive function %K depression %K recurrence %K relapse %K prevention %K case report %K working memory %K memory training %K task performance %K digital health %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive control training (CCT) has gained attention in recent years as a preventative intervention in the context of major depressive disorder. To date, uncertainty exists around the working mechanisms of CCT and how its effects unfold overtime. Objective: This study aimed to examine cognitive and affective transfer effects following an unusually high number of training sessions. Methods: This case report presents data of a participant completing a large amount of training sessions (n=55) over the course of 1 year in 2 training phases: 10 initial sessions, followed by 45 additional sessions. Reliable change indices were calculated for several self-report questionnaires, measuring cognitive and affective functioning. Results: Cognitive task performance suggests improved cognitive functioning after training (accuracy scores increased from 43/181, 24% at baseline to 110/181, 61% shortly after training), which was maintained at follow-up (accuracy scores around 50%). Reliable change indices suggest a decrease in depressive symptoms (Beck Depression Inventory-II score decreased from 23 at baseline to 3 following initial training). Similarly, burnout symptoms following CCT showed a similar decrease. Maladaptive emotion regulation strategies displayed high variability, decreasing after periods of training but increasing when no training was performed. However, no changes in repetitive negative thinking were observed. Thematic analysis from an in-depth interview focusing on CCT adherence and user experience pointed to the importance of independency and accessibility of CCT in perceived agency, as well as the need for clear feedback mechanisms following training. Conclusions: Training task performance indicates further increases in performance beyond typical amounts of training sessions (10-20 sessions), hinting that more sessions could be beneficial for continued improvement in cognitive functioning. In line with previous research, CCT decreased depressive symptomatology. However, its effects on emotion regulation remain unclear. Further mechanistic studies into the temporal unfolding of CCT effects are necessary to investigate potential working mechanisms. Trial Registration: ClinicalTrials.gov NCT05166798; https://clinicaltrials.gov/study/NCT05166798 %M 39612206 %R 10.2196/56598 %U https://formative.jmir.org/2024/1/e56598 %U https://doi.org/10.2196/56598 %U http://www.ncbi.nlm.nih.gov/pubmed/39612206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57588 %T Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study %A Gehringer,James E %A Woodruff Jameson,Anne %A Boyer,Hailey %A Konieczny,Jennifer %A Thomas,Ryan %A Pierce III,James %A Cunha,Andrea B %A Willett,Sandra %+ Virtual Reality Laboratory, Munroe-Meyer Insitute, University of Nebraska Medical Center, 985450 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025592562, james.gehringer@unmc.edu %K cerebral palsy %K HABIT %K home intervention %K virtual reality %K rehabilitation %K VR %K case study %K hand %K hands %K arm %K arms %K intensive training %K feasibility %K game %K games %K gaming %K hand arm bimanual intensive training %K motor %K movement %K home setting %K home-based %K child %K children %K male %K males %K men %K quasi-experimental %K parent %K parents %K intervention %K interventions %D 2024 %7 6.9.2024 %9 Case Report %J JMIR Form Res %G English %X This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting. %M 39241226 %R 10.2196/57588 %U https://formative.jmir.org/2024/1/e57588 %U https://doi.org/10.2196/57588 %U http://www.ncbi.nlm.nih.gov/pubmed/39241226 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58653 %T A Chatbot (Juno) Prototype to Deploy a Behavioral Activation Intervention to Pregnant Women: Qualitative Evaluation Using a Multiple Case Study %A Mancinelli,Elisa %A Magnolini,Simone %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K chatbot prototype %K co-design %K pregnancy %K prevention %K behavioral activation %K multiple case study %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increasing focus on perinatal care, preventive digital interventions are still scarce. Furthermore, the literature suggests that the design and development of these interventions are mainly conducted through a top-down approach that limitedly accounts for direct end user perspectives. Objective: Building from a previous co-design study, this study aimed to qualitatively evaluate pregnant women’s experiences with a chatbot (Juno) prototype designed to deploy a preventive behavioral activation intervention. Methods: Using a multiple–case study design, the research aims to uncover similarities and differences in participants’ perceptions of the chatbot while also exploring women’s desires for improvement and technological advancements in chatbot-based interventions in perinatal mental health. Five pregnant women interacted weekly with the chatbot, operationalized in Telegram, following a 6-week intervention. Self-report questionnaires were administered at baseline and postintervention time points. About 10-14 days after concluding interactions with Juno, women participated in a semistructured interview focused on (1) their personal experience with Juno, (2) user experience and user engagement, and (3) their opinions on future technological advancements. Interview transcripts, comprising 15 questions, were qualitatively evaluated and compared. Finally, a text-mining analysis of transcripts was performed. Results: Similarities and differences have emerged regarding women’s experiences with Juno, appreciating its esthetic but highlighting technical issues and desiring clearer guidance. They found the content useful and pertinent to pregnancy but differed on when they deemed it most helpful. Women expressed interest in receiving increasingly personalized responses and in future integration with existing health care systems for better support. Accordingly, they generally viewed Juno as an effective momentary support but emphasized the need for human interaction in mental health care, particularly if increasingly personalized. Further concerns included overreliance on chatbots when seeking psychological support and the importance of clearly educating users on the chatbot’s limitations. Conclusions: Overall, the results highlighted both the positive aspects and the shortcomings of the chatbot-based intervention, providing insight into its refinement and future developments. However, women stressed the need to balance technological support with human interactions, particularly when the intervention involves beyond preventive mental health context, to favor a greater and more reliable monitoring. %M 39140593 %R 10.2196/58653 %U https://formative.jmir.org/2024/1/e58653 %U https://doi.org/10.2196/58653 %U http://www.ncbi.nlm.nih.gov/pubmed/39140593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55408 %T Assessing the Impact of the Mindfulness-Based Body Scan Technique on Sleep Quality in Multiple Sclerosis Using Objective and Subjective Assessment Tools: Single-Case Study %A Iliakis,Ioannis %A Anagnostouli,Maria %A Chrousos,George %+ Medical School, University of Athens, National and Kapodistrian University of Athens, Omiriou 22, Athens, 16122, Greece, 30 6948531978, kiko_sympa@hotmail.com %K multiple sclerosis %K MS %K sleep problems %K electronic portable device %K EPD %K mindfulness-based body scan technique %K sleep quality %K neurodegenerative disease %K quality of life %K anxiety %K pain %K nocturia %K assessment tools %K single-case study %K effectiveness %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system, often leading to poor sleep quality and diminished quality of life (QoL) for affected patients. Sleep disturbances in MS do not always correlate linearly with other symptoms such as anxiety, depression, fatigue, or pain. Various approaches, including stress reduction techniques such as mindfulness-based interventions, have been proposed to manage MS-related sleep issues. Objective: The aim of this study was to evaluate the effects of the mindfulness-based body scan technique on sleep quality and QoL in patients with MS using both subjective (questionnaires) and objective (electronic portable device) measures. Methods: A single-case study was performed involving a 31-year-old woman diagnosed with relapsing-remitting MS. The patient practiced the mindfulness-based body scan technique daily before bedtime and outcomes were compared to measures evaluated at baseline. Results: The mindfulness-based body scan intervention demonstrated positive effects on both sleep quality and overall QoL. Biometric data revealed a notable dissociation between daily stress levels and sleep quality during the intervention period. Although self-report instruments indicated significant improvement, potential biases were noted. Conclusions: While this study is limited to a single patient, the promising outcomes suggest the need for further investigation on a larger scale. These findings underscore the potential benefits of the mindfulness-based body scan technique in managing sleep disturbances and enhancing QoL among patients with MS. %M 39052996 %R 10.2196/55408 %U https://formative.jmir.org/2024/1/e55408 %U https://doi.org/10.2196/55408 %U http://www.ncbi.nlm.nih.gov/pubmed/39052996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55999 %T Examining Passively Collected Smartphone-Based Data in the Days Prior to Psychiatric Hospitalization for a Suicidal Crisis: Comparative Case Analysis %A Jacobucci,Ross %A Ammerman,Brooke %A Ram,Nilam %+ Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN, 46556, United States, 1 574 631 6650, rjacobuc@nd.edu %K screenomics %K digital phenotyping %K passive assessment %K intensive time sampling %K suicide risk %K suicidal behaviors %K risk detection %K Comparative Analysis %K suicide %K suicidal %K risk %K risks %K behavior %K behaviors %K detection %K prediction %K Smartphone-Based %K screenomic %K case review %K participant %K participants %K smartphone %K smartphones %K suicidal ideation %D 2024 %7 20.3.2024 %9 Case Report %J JMIR Form Res %G English %X Background: Digital phenotyping has seen a broad increase in application across clinical research; however, little research has implemented passive assessment approaches for suicide risk detection. There is a significant potential for a novel form of digital phenotyping, termed screenomics, which captures smartphone activity via screenshots. Objective: This paper focuses on a comprehensive case review of 2 participants who reported past 1-month active suicidal ideation, detailing their passive (ie, obtained via screenomics screenshot capture) and active (ie, obtained via ecological momentary assessment [EMA]) risk profiles that culminated in suicidal crises and subsequent psychiatric hospitalizations. Through this analysis, we shed light on the timescale of risk processes as they unfold before hospitalization, as well as introduce the novel application of screenomics within the field of suicide research. Methods: To underscore the potential benefits of screenomics in comprehending suicide risk, the analysis concentrates on a specific type of data gleaned from screenshots—text—captured prior to hospitalization, alongside self-reported EMA responses. Following a comprehensive baseline assessment, participants completed an intensive time sampling period. During this period, screenshots were collected every 5 seconds while one’s phone was in use for 35 days, and EMA data were collected 6 times a day for 28 days. In our analysis, we focus on the following: suicide-related content (obtained via screenshots and EMA), risk factors theoretically and empirically relevant to suicide risk (obtained via screenshots and EMA), and social content (obtained via screenshots). Results: Our analysis revealed several key findings. First, there was a notable decrease in EMA compliance during suicidal crises, with both participants completing fewer EMAs in the days prior to hospitalization. This contrasted with an overall increase in phone usage leading up to hospitalization, which was particularly marked by heightened social use. Screenomics also captured prominent precipitating factors in each instance of suicidal crisis that were not well detected via self-report, specifically physical pain and loneliness. Conclusions: Our preliminary findings underscore the potential of passively collected data in understanding and predicting suicidal crises. The vast number of screenshots from each participant offers a granular look into their daily digital interactions, shedding light on novel risks not captured via self-report alone. When combined with EMA assessments, screenomics provides a more comprehensive view of an individual’s psychological processes in the time leading up to a suicidal crisis. %M 38506916 %R 10.2196/55999 %U https://formative.jmir.org/2024/1/e55999 %U https://doi.org/10.2196/55999 %U http://www.ncbi.nlm.nih.gov/pubmed/38506916