%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e76432 %T The Role of Digital Biomarkers in Physiological Signal-Based Depression Assessment: Systematic Review and Meta-Analysis %A Lee,Hyeongsuk %A Kang,Seung-Gul %A Lee,SeonHeui %K digital biomarkers %K depression %K wearable electronic devices %K sleep quality %K ambulatory monitoring %D 2026 %7 2.4.2026 %9 %J J Med Internet Res %G English %X Background: Digital biomarkers are increasingly being used to support depression assessment by providing objective, continuous, and real-time physiological and behavioral data. However, most existing studies have focused on individual biomarkers, such as sleep or cardiac parameters, while integrative evaluations that capture the multidimensional nature of depression remain limited. Objective: This systematic review evaluated digital biomarkers for depression and synthesized evidence on differences between individuals with depression and controls. Methods: Eligible studies included observational or interventional studies examining digital biomarkers for depression with validated outcome measures. We searched major international and Korean databases, including MEDLINE, PsycINFO, CINAHL, IEEE Xplore, Web of Science, Cochrane Library, KISS, RISS, KMbase, and KoreaMed, from inception to December 28, 2025. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Scottish Intercollegiate Guidelines Network checklist. Meta-analyses were conducted using random-effects models with the Hartung-Knapp-Sidik-Jonkman method, and other outcomes were narratively summarized. Results: The search yielded 39,617 records, of which 132 studies involving 57,852 participants met the inclusion criteria. These studies encompassed various digital biomarkers, including sleep, physical activity, cardiac measures, smartphone-derived data, speech, GPS data, and circadian rhythms. A meta-analysis of 22 studies (6947 participants) revealed that individuals with depression had significantly longer sleep onset latency (5 studies; n=292; +4.75 min, 95% CI 2.46-7.04; P=.005; 95% prediction interval [PI] 0.01-10.27) and time in bed (3 studies; n=236; +31.81 min, 95% CI 18.22-45.39; P=.01; 95% PI 2.28-55.16). Physical activity counts were also significantly lower (5 studies; n=462; standardized mean difference −0.71, 95% CI −1.33 to −0.09; P=.03; 95% PI −2.18 to 0.71). Although individuals with depression showed a lower sleep efficiency, higher mean heart rate, and lower SD of normal-to-normal intervals, these differences were not statistically significant. Other digital markers yielded inconsistent results. Overall, these findings indicate that no single digital biomarker sufficiently captures depression-related changes. Instead, the results support the superiority of personalized, multimodal approaches. However, the generalizability of these findings is limited by the lack of standardized data collection protocols and high clinical heterogeneity across studies, as reflected in wide PIs. Conclusions: Certain digital biomarkers, particularly sleep onset latency and physical activity counts, showed consistent average differences between the depression and control groups. However, wide PIs indicate substantial variability across settings, suggesting that no single marker is sufficient for reliable detection. This study advances the field by providing a comprehensive meta-analysis of multidimensional digital biomarkers, establishing a quantitative foundation for objective depression screening and monitoring. These findings support the use of personalized, multimodal digital phenotyping approaches and highlight the need for standardized, clinically interpretable frameworks for real-world depression monitoring. Trial Registration: PROSPERO CRD42024518136; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024518136 %R 10.2196/76432 %U https://www.jmir.org/2026/1/e76432 %U https://doi.org/10.2196/76432 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e78841 %T Technology-Based Interventions for Prevention of Type 2 Diabetes Following Gestational Diabetes: Systematic Review and Meta-Analysis %A Eades,Claire %A Nguyen-Hoang,Anh %A Hoyle,Louise %A Cameron,Dawn %A Evans,Josie MM %+ Health Sciences, Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling, Stirlingshire, FK9 4LA, United Kingdom, 44 01786466340, c.e.eades@stir.ac.uk %K diabetes prevention %K gestational diabetes %K health behavior change %K mHealth %K type 2 diabetes %D 2026 %7 1.4.2026 %9 Review %J J Med Internet Res %G English %X Background: Previous gestational diabetes incurs an 8-fold risk of developing type 2 diabetes, but lifestyle change can prevent or delay progression. Technology-based interventions may help overcome challenges women face in making postpartum lifestyle changes. Objective: This study aimed to assess whether technology-based diabetes prevention interventions improve outcomes related to the onset of type 2 diabetes among women with a previous diagnosis of gestational diabetes. Methods: Cochrane Central Register of Controlled Trials, CINAHL, Embase, PsycINFO, and Midwives Information and Resource Service were searched to October 2025 using subject headings and free-text terms. Titles and abstracts were independently screened by 2 authors, as were retrieved full-text articles. Studies were eligible if they examined technology-based diabetes prevention interventions delivered between gestational diabetes diagnosis and any time post partum, assessing anthropometric outcomes, glycemic control, health behavior, or psychological outcomes. Risk of bias was assessed by 1 reviewer using the National Institute for Clinical Excellence checklist, and certainty of evidence was assessed by 2 reviewers using the Grading of Recommendations Assessment, Development, and Evaluation. Data were summarized narratively, and results were pooled, where possible, using a random effects model. Results: This review identified 15 studies, including 1257 participants. Pooled analysis of 7 studies showed significantly greater weight loss among those receiving technology-based interventions (mean difference –1.01, SE 0.35, 95% CI –1.86 to –0.16 kg; P=.03). Interventions delivered using technology only showed increased weight loss (mean difference –1.13, 95% CI –3.12 to 0.86 kg) as did those with a longer follow-up (mean difference –1.58, 95% CI –3.93 to 0.76 kg) compared with combined technology and telemedicine approaches (mean difference –0.89, 95% CI –2.51 to 0.73 kg) and studies with shorter follow-up (mean difference –0.7, 95% CI –1.21 to –0.18 kg), but these differences were not significant (mode of delivery: χ21=0.08; P=.78; follow-up: χ21=1.06; P=.30). Meta-analysis showed no significant differences in BMI (mean difference –0.22, SE 0.1, 95% CI –0.4 to –0.01 kg/m2; P=.27; n=2 studies), fasting glucose (mean difference –0.03, SE 0.16, 95% CI –0.49 to 0.49 mmol/L; P=.99; n=4 studies), 2-hour glucose (mean difference 0.12, SE 0.19, 95% CI –0.47 to 0.72 mmol/L; P=.56; n=4 studies), hemoglobin A1c(mean difference –0.01%, SE 0.02%, 95% CI –0.24% to 0.23%; P=.74; n=2 studies), or homeostasis model assessment of insulin resistance (mean difference 0.07, SE 0.02, 95% CI –0.16 to 0.31; P=.16; n=2). Certainty of evidence for all pooled outcomes was very low. Conclusions: Technology-based interventions may help support women in reducing their risk of type 2 diabetes following gestational diabetes mellitus, but substantial heterogeneity, significant risk of bias, and very low certainty in the evidence mean that the findings should be interpreted cautiously. Trials with larger samples and longer follow-up are required to draw firm conclusions. Trial Registration: PROSPERO CRD42024324019; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024324019 %M 41921207 %R 10.2196/78841 %U https://www.jmir.org/2026/1/e78841 %U https://doi.org/10.2196/78841 %U http://www.ncbi.nlm.nih.gov/pubmed/41921207 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 14 %N %P e82017 %T Effectiveness of Gamified Swallowing Exercises in Adults With Dysphagia: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Liu,Jijia %A Ou,Meijun %A Yan,Mengyao %A Xu,Xianghua %A Qin,Li %K deglutition disorders %K gamified %K swallowing exercise %K systematic review %K meta-analysis %D 2026 %7 26.3.2026 %9 %J JMIR Serious Games %G English %X Background: Dysphagia is a prevalent health issue affecting quality of life. Gamified swallowing exercises have the potential to enhance swallowing function and adherence in adults with dysphagia. Nevertheless, such evidence has not yet been systematically synthesized. Objective: This study aimed to systematically evaluate the effects of gamified swallowing exercises and promote their clinical application in swallowing rehabilitation. Methods: Eleven electronic databases were searched from inception to June 25, 2025. Randomized controlled trials (RCTs) that explored gamified swallowing exercises in adults with dysphagia, regardless of etiology, and reported on swallowing function, adherence, nutritional status, or quality of life were included. The Cochrane Risk of Bias tool 2.0 was applied to assess the methodological quality. We employed the Hartung-Knapp-Sidik-Jonkman method for random-effects model analysis to calculate effect sizes and 95% CIs. Subgroup analysis was conducted to explore potential causes of heterogeneity, and the overall quality of evidence was evaluated through GRADEpro GDT software. Results: Of 2400 initially identified records, 6 RCTs met the inclusion criteria, with 2 rated as low risk, 3 as some concerns, and 1 as high risk. These studies, conducted in China, South Korea, and Turkey between 2019 and 2025, enrolled a total of 330 poststroke patients with dysphagia. Interventions involved 1 to 3 games targeting the lips, tongue, and pharynx, with additional equipment. This meta-analysis indicated that gamified swallowing exercises improved swallowing function, as evidenced by enhanced swallowing performance (mean difference [MD]=1.1; 95% CI 0.9 to 1.3; I2=0; prediction interval [PI] 0.3 to 1.6), reduced dysphagia severity (standardized mean difference [SMD]=0.4; 95% CI 0.3 to 0.5; I2=0; PI 0.3 to 0.5), and increased adherence (MD=2.4; 95 % CI 1.8 to 2.9; I2=0; PI 1.2 to 2.7). However, no significant effects were observed on dysphagia screening (SMD=−1.8, 95% CI −5.4 to 1.8; I2=96.5%; PI −8.6 to 4.9) or quality of life (SMD=−2.30, 95% CI −9.6 to 5; I2=97.5%; PI −16.1 to 14.1). Overall, the quality of the included studies ranged from moderate to very low, which limits confidence in the pooled estimates. Conclusions: This study provides the first quantitative synthesis of the effects of gamified swallowing exercises. The results demonstrate that gamified swallowing exercises improve swallowing function and enhance adherence, suggesting that gamified swallowing exercises are a promising method for swallowing rehabilitation. However, the overall risk of bias across included studies and the suboptimal evidence quality reduce the certainty of the current evidence. Therefore, the findings should be interpreted with caution. The small number of high-quality RCTs, reliance on additional equipment, and limited standardization of gamified interventions further limit clinical generalizability. Future research should focus on large-scale, robustly designed RCTs, while designing etiology-specific games and developing more accessible rehabilitation equipment, such as smartphones, could enhance the overall effects and facilitate the widespread adoption of these interventions in remote and home care settings. Trial Registration: PROSPERO CRD42024617169; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024617169 %R 10.2196/82017 %U https://games.jmir.org/2026/1/e82017 %U https://doi.org/10.2196/82017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e79363 %T Robot-Assisted Therapy for Upper Limb Rehabilitation After Stroke: Umbrella Review %A Liu,Sijia %A Zhang,Xianghong %A Zhou,Lijun %A Zhang,Jiashan %A Liu,Jialin %A He,Chengqi %+ West China Hospital of Sichuan University, No.37 Guoxuexiang, Wuhou District, Chengdu, 610041, China, 86 13880982177, hxkfhcq2015@126.com %K robot-assisted rehabilitation %K stroke %K upper limb rehabilitation %K umbrella review %K robot therapy effectiveness %D 2026 %7 25.3.2026 %9 Review %J J Med Internet Res %G English %X Background: Stroke is a leading cause of long-term upper limb disability, severely impacting patients’ independence and quality of life. Robot-assisted therapy (RAT) has emerged as a promising, high-intensity rehabilitation alternative. However, conclusions from existing systematic reviews on its efficacy are inconsistent and often lack a holistic framework, limiting their use for guiding personalized clinical decisions. Objective: This study aims to systematically synthesize recent evidence on RAT for upper limb rehabilitation after stroke. Guided by the International Classification of Functioning, Disability and Health framework, it moves beyond singular outcomes to provide a multidimensional evaluation across body function, activity, and participation levels. The review aims to provide stratified guidance for clinical decision-making based on patient- and intervention-specific characteristics, thereby supporting evidence-based practice and informing future research. Methods: This study included systematic reviews and meta-analyses published from January 1, 2019, to December 26, 2025, comparing RAT with conventional therapy for upper limb rehabilitation after stroke. Overall, 6 databases, including PubMed, Web of Science, and Embase, were searched. Two reviewers (XZ and LZ) independently performed study selection, data extraction, and quality assessment using the AMSTAR 2 tool. The synthesis integrated outcome measures and subgroup analyses derived from the included studies. Results: This umbrella review included 21 meta-analyses encompassing 535 randomized controlled trials and 27,598 patients across acute, subacute, and chronic stroke stages. According to AMSTAR 2, 17 reviews were high quality, 3 moderate, and 1 critically low. The synthesis demonstrated that RAT was superior in improving upper limb motor function, but no statistically significant advantages were observed in activities of daily living compared to conventional therapy. Subgroup analyses revealed that treatment effects were influenced by stroke stage, upper limb motor impairment level, and robot type. Conclusions: RAT is an effective intervention for improving upper limb motor function after stroke. However, its benefits are primarily observed at the level of body function, with limited evidence for long-term maintenance. The current evidence is constrained by significant outcome heterogeneity and methodological limitations inherent to umbrella reviews. Future research should validate these findings in broader clinical practice, focus on translating functional gains into sustained improvements in daily activities and participation, and include cost-effectiveness evaluations. Trial Registration: PROSPERO CRD42024497183; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497183 %M 41879816 %R 10.2196/79363 %U https://www.jmir.org/2026/1/e79363 %U https://doi.org/10.2196/79363 %U http://www.ncbi.nlm.nih.gov/pubmed/41879816 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 12 %N %P e75769 %T Digital Tools’ Effectiveness on Physical Activity Outcomes in Children and Adolescents: Umbrella Review %A Tabacchi,Garden %A Scardina,Antonino %A Amato,Antonella %A Giardina,Marta %A Accardi,Giulia %A Di Liberto,Valentina %A Giglia,Giuseppe %A Vasto,Sonya %A Frinchi,Monica %A Boffetta,Paolo %A Mazzucco,Walter %A Bellafiore,Marianna %K physical activity %K digital %K effectiveness %K children %K adolescents %K mobile phone %D 2026 %7 24.3.2026 %9 %J JMIR Public Health Surveill %G English %X Background: A substantial proportion of children and adolescents worldwide do not meet current physical activity (PA) guidelines. So digital tools interventions have been implemented worldwide. However, evidence regarding the effectiveness of these remains inconsistent, underscoring the need for a comprehensive synthesis of the available literature. Objective: This umbrella review aimed to summarize and critically evaluate the characteristics and effectiveness of digital interventions designed to increase PA in children and adolescents. Methods: An overview of systematic reviews (SRs) and meta-analyses of randomized controlled trials (RCTs) was conducted in accordance with the PRIOR (Preferred Reporting Items for Overviews of Reviews) and the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklists. Reviews published between 2018 and 2025 were searched in SCOPUS, PubMed or MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and SPORTDiscus or EBSCO, using a combination of terms addressing the type of digital tool (eg, apps, wearables, etc) and device-based PA outcomes. Eligible SRs and meta-analyses focused on populations aged 6‐17 years and evaluated digital interventions aimed at increasing PA. Methodological quality was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) for SRs and meta-analyses, and Risk of Bias 2 for RCTs. Intervention characteristics and effectiveness outcomes were summarized as frequencies, and chi-square tests were applied to explore differences in effectiveness across study features. Results: Forty-eight SRs or meta-analyses comprising 62 RCTs were included. The reviews’ quality was moderate to poor, and 7/62 (11.3%) of RCTs were judged to have a high risk of bias. The mainly addressed PA outcomes were moderate-to-vigorous PA and step counts, commonly measured using accelerometers and pedometers. Overall, 45.2% of interventions demonstrated effectiveness for at least 1 PA outcome. Higher effectiveness rates were observed in RCTs that targeted PA as the sole primary outcome (19/32, 59.4%), used wearables as both the digital intervention component (7/11, 63.6%) and delivery device (8/12, 66.7%), and used pedometers for PA outcome measurement (13/16, 81.3%). Significant differences in effectiveness were found for the type of PA assessment device (P=.003) and for interventions targeting low-income populations, which showed lower effectiveness (P=.01). Additional trends were identified for geographic region (P=.06), intervention setting (P=.09), baseline activity level (P=.06), intervention focus (P=.09), and device brand (P=.09). Conclusions: This novel umbrella review provides a comprehensive synthesis of digital PA interventions in youth, foreseeing potential factors that may influence their effectiveness, and highlighting methodological limitations. It offers evidence-based insights for practitioners, educators, and policymakers, helping to identify digital tools most likely to successfully increase PA in youth. Future research should prioritize stronger methodological rigor and more precise intervention designs. This has clear value for the public health practice to reduce long-term disease risk. Trial Registration: PROSPERO CRD42024510602; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024510602 %R 10.2196/75769 %U https://publichealth.jmir.org/2026/1/e75769 %U https://doi.org/10.2196/75769 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e60542 %T Information and Communication Technologies for Chronic Disease Self-Management in Adults Aged 65 Years and Older: Scoping Review %A Murdock,Paul %A Wu,Yiyi %A Senteio,Charles R %K health technology %K self-care %K self-management %K chronic disease %K efficacy %K technology %K older adult %K gerontology %K chronic %K chronic diseases %K systematic review %K behavioral health %K health equity %K Preferred Reporting Items for Systematic reviews and Meta-Analyses %K PRISMA %K medication behavior %K dietary behavior %K physical activity %K physical rehabilitation %K digital health %D 2026 %7 19.3.2026 %9 %J Interact J Med Res %G English %X Background: The increasing number of older adults living with chronic conditions has led to rapid growth in information and communication technologies (ICTs) designed to support chronic disease self-management. Although many technologies target behaviors such as medication adherence, physical activity, dietary management, and follow-up care, the breadth, characteristics, and design considerations of these tools for adults aged 65 years and older have not been comprehensively reported. Objective: This scoping review aims to systematically map the existing literature describing ICTs developed to support chronic disease self-management among adults aged 65 years and older. Specifically, the review seeks to (1) identify the types of ICTs available; (2) characterize the self-management behaviors they target; and (3) examine the extent of older adults’ involvement in the design, adaptation, or evaluation of these technologies. Methods: This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Seven databases (PubMed, CINAHL, Web of Science, Cochrane Library, Compendex, IEEE Xplore, and Computers & Applied Sciences Complete) were searched, with all searches completed on December 15, 2024. Inclusion criteria were peer-reviewed studies published in English between 2007 and 2025 that (1) included adults aged ≥65 years; (2) addressed one or more chronic diseases; and (3) evaluated, described, or tested an ICT intended to support at least 1 chronic disease self-management behavior. Two reviewers independently screened all titles and abstracts and full texts; disagreements were resolved by a third reviewer. Data were charted using a standardized extraction template and synthesized narratively by technology type and self-management domain. Results: Nineteen studies met the inclusion criteria. Technologies were grouped into 4 broad categories: mobile apps, online platforms, wearable or sensor-based tools, and smart home or device-integrated systems. Physical activity and medication management were the most targeted self-management behaviors, whereas follow-up appointment adherence and dietary behaviors were less frequently addressed. Only a small number of studies explicitly involved older adults in the design or development process, and such involvement was often limited to usability testing rather than participatory co-design. Conclusions: The current evidence base is fragmented, with substantial variability in technology types, targeted behaviors, and reported outcomes. Significant gaps remain regarding the participatory design of ICTs with older adults and the development of technologies that address multiple self-management needs simultaneously. Future ICT development should intentionally incorporate older adults and caregivers throughout the design cycle and expand beyond single-behavior interventions to reflect the multimorbidity common in this population. %R 10.2196/60542 %U https://www.i-jmr.org/2026/1/e60542 %U https://doi.org/10.2196/60542 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e83709 %T Global Research Trends and Hotspots in Gene Editing and Stem Cell Therapies for Neurodegenerative Diseases: Bibliometric and Visualization Analysis %A Xiang,Lijun %A Xiao,Yun %A Cai,Ming %A Qin,Jing %A Wang,Ting %A Xiang,Xueming %A Ke,Jun %A Peng,Ganlin %K neurodegenerative diseases %K gene editing technology %K stem cell therapy %K bibliometric analysis %K clinical translation %D 2026 %7 9.3.2026 %9 %J Interact J Med Res %G English %X Background: Neurodegenerative diseases are a major and growing global health burden. Their pathogenesis is complex, and effective therapies remain limited. Gene editing and stem cell–based strategies are reshaping the therapeutic landscape. However, the field has not been systematically examined through bibliometric analysis. Objective: We aimed to define the intellectual landscape of global research on gene editing and stem cell therapy for neurodegenerative diseases from 2005 to 2024, highlight evolving hotspots, track the field’s evolution, and identify major bottlenecks limiting clinical translation. Methods: We retrieved 1821 publications from the Web of Science Core Collection (2005-2024). We performed a multidimensional bibliometric analysis using CiteSpace and VOSviewer. We assessed publication output, country and institutional contributions, key authors and journals, co-cited references, and keyword networks. These analyses were used to track the field’s evolution and pinpoint emerging themes. Results: In total, 9978 researchers from 90 countries and 2515 institutions contributed to this literature. Annual publications increased from 28 in 2005 to 179 in 2024, with stepwise growth over time. The United States ranked first in output (n=780) and in citation impact (total local citation score=2784; total global citation score=40,009). China and India ranked second and fifth in output, respectively, but their average citation impact was lower than that of the leading countries. The University of California, San Francisco, and Johns Hopkins University remained consistently influential. Boulis NM, Bankiewicz KS, and Feldman EL were among the most prominent contributors. Molecular Therapy was the leading journal in this area. Keyword analyses pointed to a growing intersection between genetics and immunology. Major topics included nanotechnology-based delivery, adeno-associated virus vectors, small interfering RNA, intrathecal microsphere injection, autophagy, blood-brain barrier (BBB) targeting, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), and induced pluripotent stem cells. Burst detection highlighted “open label” as a recent hotspot. This likely reflects rising translational activity and early clinical testing. Conclusions: The field is moving from technology development toward clinical translation. Anglo-American countries currently drive both productivity and influence. China and India contribute heavily to volume but need a stronger impact. CRISPR/induced pluripotent stem cell platforms and BBB-focused delivery remain central frontiers. The rise of “open-label” studies suggests accelerating clinical momentum. Future progress will require safer and more efficient delivery, clearer standards, and larger global consortia to harmonize protocols and speed translation. %R 10.2196/83709 %U https://www.i-jmr.org/2026/1/e83709 %U https://doi.org/10.2196/83709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e73812 %T Association Between Digital Biomarkers of Health and Anxiety: Systematic Review and Meta-Analysis %A Lau,Yolanda %A Chemas,Natalia %A Ajeet Gokani,Heema %A Morrell,Rachel %A Phannarus,Harisd %A Cooper,Claudia %A Walker,Zuzana %A Demnitz-King,Harriet %A Marchant,Natalie L %+ Division of Psychiatry, University College London, Division of Psychiatry, 4th Floor Maple House, 149 Tottenham Court Road, London, W1T 5AU, United Kingdom, 44 20 3108 7961, n.marchant@ucl.ac.uk %K anxiety %K digital %K heart rate %K machine learning %K meta-analysis %K physical activity %K sleep %K systematic review %K wearable %D 2026 %7 9.3.2026 %9 Review %J J Med Internet Res %G English %X Background: Digital biomarkers are gaining interest as proxy markers for mental health, as they enable passive and continuous data collection. However, the association between digital biomarkers of health and anxiety, both generalized anxiety disorder and anxiety symptoms, remains unknown. Objective: This systematic review and meta-analysis examined the association between digital biomarkers of health obtained from wrist-worn wearables and anxiety in adults. Methods: Systematic literature searches were conducted across 6 databases, including unpublished gray literature. The final search was done on September 21, 2025. Cross-sectional or longitudinal studies investigating the association between digital biomarkers from wrist-worn wearables and anxiety were eligible. Studies using inferential statistics or machine learning methods were both eligible. Studies were excluded if participants received diagnoses of neurodegenerative disorders or physical health conditions. Two risk-of-bias tools were used: the National Heart, Lung, and Blood Institute assessment tool for inferential statistical studies, and the modified version of the Quality Assessment of Diagnostic Accuracy Studies-2 for machine learning studies. Whenever possible, effect sizes were combined across studies, for each digital biomarker of health separately, using random-effects meta-analyses. Sensitivity analyses were performed to assess whether results differed according to anxiety type (state or trait) and age group. Otherwise, studies were synthesized narratively. Results: A total of 44 studies from 42 articles were eligible. Among these, 36 studies used inferential statistical approaches for analysis (21 reporting sleep characteristics, 8 reporting physical activity, 2 reporting heart rate variability, and 5 reporting more than 1 type), and 8 studies used machine learning approaches. Sample size ranged from 17 to 170,320. Meta-analyses on 4 sleep metrics found no associations: sleep efficiency (Fisher z=–0.07, 95% CI –0.14 to 0.002; P=.06; PI –0.19 to 0.05), wake after sleep onset (Fisher z=0.13, 95% CI –0.04 to 0.30; P=.11; PI –0.15 to 0.41), total sleep time (Fisher z=0.009, 95% CI –0.01 to 0.03; P=.28; PI –0.02 to 0.03), and sleep onset latency (Fisher z=0.04, 95% CI –0.07 to 0.15; P=.08; PI –0.19 to 0.27). Qualitative syntheses revealed that lower physical activity levels and higher heart rate were associated with greater anxiety symptoms. Machine learning studies using wrist-worn wearable data alone showed varied performance, with predictive performance improving when wearable data were combined with other data sources. Conclusions: This is the first review to synthesize evidence from inferential statistical (mostly fair quality) and machine learning studies examining association between wearable-derived digital biomarkers and anxiety. Meta-analyses found no associations between sleep metrics and anxiety. Although based on limited studies, lower physical activity levels and elevated heart rate were associated with greater anxiety symptoms. Digital biomarkers may be more useful when integrated with other data sources (eg, self-report and clinical data) rather than used as stand-alone screening tools. Trial Registration: PROSPERO CRD42023409995; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023409995 %M 41802227 %R 10.2196/73812 %U https://www.jmir.org/2026/1/e73812 %U https://doi.org/10.2196/73812 %U http://www.ncbi.nlm.nih.gov/pubmed/41802227 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e76930 %T Internet Use and Self-Rated Health Among Older Adults: Scoping Review %A AboJabel,Hanan %A Abo-Rass,Fareeda %+ , The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Mount Scopus Campus, Jerusalem, 9190501, Israel, 972 0556810001, hanan.abo-jabel@mail.huji.ac.il %K internet use %K older adults %K scoping review %K self-rated health %K social participation %D 2026 %7 19.2.2026 %9 Review %J Interact J Med Res %G English %X Background: Self-rated health (SRH) is a robust predictor of morbidity, functional decline, and mortality in later life. As internet use becomes increasingly embedded in older adults’ daily routines, clarifying its association with SRH and the pathways through which it may operate is important for research, practice, and policy. Objective: This scoping review aimed to map and characterize the international evidence on the association between internet use and SRH among older adults, synthesize how potential mediators and moderators have been examined, and identify key methodological, theoretical, and population gaps in the literature. Methods: Guided by the Joanna Briggs Institute methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting standards, we conducted a scoping review and searched 5 databases: PubMed, CINAHL, AgeLine, PsycINFO, and Web of Science. The final search was performed on February 5, 2024. Reference lists were screened, and Google Scholar searches were conducted as supplementary search methods. Results: Database searches identified 4294 records; after removing 615 duplicates, 3679 records were screened, and 77 full texts were assessed, resulting in 27 included studies. All included studies were quantitative, and the evidence base was predominantly cross-sectional (25/27). Explicit theoretical frameworks were used in 6 out of 27 studies. Most studies were published between 2019 and 2024 (22/27) and were conducted most frequently in China (11/27) and the United States (7/27). All studies were conducted in high-income countries. SRH was typically assessed using a single-item measure, while internet use was operationalized as access/use (yes/no), frequency, and/or purpose/domain-specific measures. Most studies reported a statistically significant positive association between internet use and better SRH (24/27), with socially oriented uses (eg, communication and social participation) showing the most consistent associations. Mediating pathways were examined in 6 out of 27 studies, and most often suggested social mechanisms such as greater social support, higher social engagement, and lower loneliness. Subgroup heterogeneity was reported in 10 out of 27 studies, including differences by age, gender, residence, and marital status. Conclusions: Overall, internet use, particularly socially oriented use, was most consistently associated with better SRH among older adults. Policy efforts should support digital inclusion by improving access, skills, and ongoing assistance that enable meaningful use for social connection and service access. At the same time, nondigital options are essential to avoid excluding older adults who do not use the internet. In addition, evidence gaps, including limited use of theoretical frameworks and scarce data from low- and middle-income countries, underscore the need for theory-informed longitudinal and intervention studies to strengthen causal inference, expand knowledge on mediating and moderating factors, and assess generalizability across diverse contexts. %M 41712917 %R 10.2196/76930 %U https://www.i-jmr.org/2026/1/e76930 %U https://doi.org/10.2196/76930 %U http://www.ncbi.nlm.nih.gov/pubmed/41712917 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e69676 %T Emerging Technologies and Vulnerabilities in Older Adults Without Cognitive Impairments: Systematic Review of Qualitative Evidence %A Fasoli,Annachiara %A De Luca,Maria %A Beretta,Giorgia %A Gastmans,Chris %A Sanchini,Virginia %K aged care %K emerging technologies %K ethical issues %K older adults %K vulnerability %K impairments %K PRISMA %D 2026 %7 19.2.2026 %9 %J Interact J Med Res %G English %X Background: Aged care has recently undergone major transformations due to demographic aging and the concomitant need to manage health care costs. New emerging technologies (ETs) have started to play central roles in the daily management of older adults. For these transformations to effectively promote successful and active aging, it is essential to understand the opinions of older adults on the impact that technology can have on their vulnerabilities and aging process. Objective: This work aims to study the ethically related impact of ETs on cognitively healthy older adults’ vulnerabilities. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review of empirical (qualitative) evidence exploring the relationship between ETs and older adults’ vulnerabilities as perceived by older adults (older than 65 years) without cognitive impairments. Five major databases (PubMed, Web of Science, Embase, CINAHL, and Philosopher’s Index) were queried on March 1, 2022. After eliminating duplicates, titles, abstracts, and full texts were screened for relevance. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the Qualitative Analysis Guide of Leuven methodology, which involved carefully reading the publications included, identifying significant themes, and constructing conceptual schemes for each paper. The quality of the publications was evaluated by using the Critical Appraisal Skills Program. Results: A total of 11,631 results were obtained. Eventually, 70 articles were included, and of these, 46 articles had a high level of methodological quality. The remaining 24 articles had moderate quality. ETs appeared to have an ambivalent effect, mitigating some already existing vulnerabilities, and at the same time, worsening already existing vulnerabilities or creating new vulnerabilities. For example, unconventional monitoring techniques (eg, wearables) often mitigated relational vulnerability, helping to maintain independence and remain at home and in one’s community. Conversely, these same devices may negatively affect moral vulnerability, threatening older adults’ privacy linked to data confidentiality. Conclusions: This systematic review, which focused on the perceptions of older adults without cognitive impairments, enriches the vast literature about the everyday management and care of seniors by exploring the ethical implications of ETs. This research is complementary to another systematic review of qualitative evidence, which analyzed the views of older people with cognitive disorders on the same topic. Although a certain ambivalence in the use of ETs was identified by both population groups, it is interesting how cognitively healthy older adults give more importance to some dimensions of vulnerability, such as the moral and relational ones, which, in the case of cognitively impaired older adults, are not as significant. Two important aspects identified were the respect of privacy and data security, and the perceived risk of control and surveillance linked to the use of monitoring technologies. %R 10.2196/69676 %U https://www.i-jmr.org/2026/1/e69676 %U https://doi.org/10.2196/69676 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e72281 %T Treatment of Gender in Research on Intervention Programs Targeting Social Isolation and Loneliness Among Older Adults: Scoping Review %A Nomura,Kenta %A Kiguchi,Naoto %A Inomata,Eisuke %A Nakamachi,Takeshi %A Kobayashi,Norikazu %+ , Graduate School of Rehabilitation, Mejiro University, 320 Ukiya, Iwatsuki-ku, Saitama-shi, Saitama, 339-8501, Japan, 81 487972131, nomura@mejiro.ac.jp %K social isolation %K loneliness %K intervention %K program %K gender %K men %K women %K older %K review %K remote %K in-person %K scoping review %D 2026 %7 18.2.2026 %9 Review %J Interact J Med Res %G English %X Background: Social isolation and loneliness have considerable health implications. Research indicates that older men are generally more susceptible to social isolation compared with women, highlighting the need to integrate gender-responsive approaches in the development and implementation of interventions for mitigating social isolation and loneliness in later life. Objective: This study aimed to conduct a review of intervention programs targeting social isolation and loneliness, focusing on gender-specific considerations. Specifically, it aims to examine the gender composition (male-to-female ratio) of participants in intervention programs and identify and analyze intervention strategies that demonstrate gender-sensitive effectiveness. Methods: A scoping review was conducted as per the Joanna Briggs Institute manual for evidence synthesis. A comprehensive literature search, including hand searching, was conducted across 6 English-language databases, PubMed, MEDLINE, Cochrane, CINAHL, ScienceDirect, and Web of Science, for papers and reports published in 2013-2023. The authors, country, subjects, research design, intervention method, results, and mentions of gender for each included document were presented. Results: The study identified 1282 papers and reports, of which 10 were selected for analysis. Only 1 study reported a higher number of male participants compared with female ones; in contrast, all other studies included predominantly female samples. The studies assessed outcomes based on 2 indicators of social isolation, 4 indicators of loneliness, and 29 other indicators. Exercise and workshops proved effective for social isolation and loneliness, while meditation and laughter therapy were effective for loneliness. The intervention with the highest percentage of male participants (264/323, 82%) was a customized meditation program. Conversely, physical activities, social support, and community-based group health classes drew more female participants. In total, 8 studies did not mention gender in the discussion section, and none considered gender-specific issues in formulating research objectives and outcomes. Conclusions: Research on social isolation and loneliness has generally ignored the influence of gender. The review also indicated a gender bias in participant selection, with women markedly overrepresented in study samples. The study found that women tend to prefer interventions emphasizing conversations, shared experiences, and emotional exchange. In contrast, men showed the highest participation in a meditation program focused on self-dialogue, which required minimal interaction. Importantly, interventions aimed at promoting social interaction or participation are unlikely to succeed without consideration of gender-specific issues. Therefore, systematically identifying conditions necessary for effective interventions that target older men is crucial for guiding future research and program development. Trial Registration: Open Science Framework 10.17605/OSF.IO/83JQF; hhttps://osf.io/83jqf/overview %M 41705739 %R 10.2196/72281 %U https://www.i-jmr.org/2026/1/e72281 %U https://doi.org/10.2196/72281 %U http://www.ncbi.nlm.nih.gov/pubmed/41705739 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e75713 %T The Usability of Continuous Monitoring Devices With Deterioration Alerting Systems in Noncritical Care Units: Scoping Review %A Pan,Jo-Fan %A Dowding,Dawn %A Wong,David %A Scott,Ashley %A Zhao,Qimeng %K continuous monitoring %K monitoring %K wearable devices %K early warning score %K vital sign %K alerts %K alarms %K deterioration %D 2026 %7 10.2.2026 %9 %J Interact J Med Res %G English %X Background: Delayed recognition of patient deterioration in a non–intensive care unit (ICU) setting contributes to serious adverse events. Continuous monitoring devices with alerting systems offer real-time data to support early detection, but their effectiveness depends on usability. While prior reviews focus on clinical outcomes, usability—defined by effectiveness, efficiency, and satisfaction—remains underexplored. Objective: This study aims to scope the evidence related to the usability of continuous monitoring devices with deterioration alerting in noncritical adult care units. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of MEDLINE, Embase, Emcare, Web of Science, and IEEE Xplore was performed for studies published up to November 2024. Title and abstract screening, full-text review, and data extraction were independently conducted by 2 reviewers. Studies were included if they (1) evaluated the usability—defined as effectiveness, efficiency, or satisfaction—of continuous monitoring devices; (2) focused on adult patients in non-ICU hospital settings; (3) used primary data; (4) were published in English; and (5) described how clinicians received alerts. Results: The search identified 1284 papers, with 35 included. Most studies focused on postoperative patients in surgical wards, mainly from the United States and the Netherlands. Only 2 studies used mixed methods, and 10 reported clinician characteristics. While effectiveness (71%) and efficiency (74%) were widely studied, satisfaction (46%) and usability barriers (29%) received less attention. Conclusions: Continuous monitoring devices with deterioration alerts may reduce rapid response team calls and ICU transfers, save time, and maintain acceptable alarm frequencies with high user satisfaction. However, usability challenges persist, including technical issues, alarm fatigue, patient discomfort, and limited training or workflow integration. This review mapped current use, usability, and barriers, categorized key usability factors for improvement, and identified the need for further research on clinician perspectives and broader health care settings to enhance generalizability. %R 10.2196/75713 %U https://www.i-jmr.org/2026/1/e75713 %U https://doi.org/10.2196/75713 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e79729 %T Predictive Performance of Artificial Intelligence Algorithms for Gestational Diabetes Mellitus in Pregnant Women: Systematic Review and Meta-Analysis %A Liang,Yingni %A Dai,Anran %A Luo,Meiyan %A Zheng,Zhuolian %A Shen,Jiayu %A Su,Yinhua %A Li,Zhongyu %K gestational diabetes mellitus %K artificial intelligence %K prediction %K meta-analysis %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analysis %D 2026 %7 30.1.2026 %9 %J J Med Internet Res %G English %X Background: Gestational diabetes mellitus (GDM) is a common complication during pregnancy, with its incidence increasing year by year. It poses numerous adverse health effects on both mothers and newborns. Accurate prediction of GDM can significantly improve patient prognosis. In recent years, artificial intelligence (AI) algorithms have been increasingly used in the construction of GDM prediction models. However, there is still no consensus on the most effective algorithm or model. Objective: This study aimed to evaluate and compare the performance of existing GDM prediction models constructed using AI algorithms and propose strategies for enhancing model generalizability and predictive accuracy, thereby providing evidence-based insights for the development of more accurate and effective GDM prediction models. Methods: A comprehensive search was conducted across PubMed, Web of Science, Cochrane Library, EMBASE, Scopus, and OVID, covering publications from the inception of databases to June 1, 2025, to include studies that developed or validated GDM prediction models based on AI algorithms. Study selection, data extraction, and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool were performed independently by 2 reviewers. A bivariate mixed-effects model was used to summarize sensitivity and specificity and to generate a summary receiver operating characteristic (SROC) curve, calculating area under the curve (AUC). The Hartung-Knapp-Sidik-Jonkman method was further used to adjust for the pooled sensitivity and specificity. Between-study standard deviation (τ) and variance (τ²) were extracted from the bivariate model to quantify absolute heterogeneity. The Deek test was used to evaluate small-study effects among included studies. Additionally, subgroup analysis and meta-regression were conducted to compare the performance differences among algorithms and to explore sources of heterogeneity. Results: Fourteen studies reported on the predictive value for AI algorithms for GDM. After adjustment with the Hartung-Knapp-Sidik-Jonkman method, the pooled sensitivity and specificity were 0.78 (95% CI 0.69‐0.86; τ=0.15, τ2=0.02; PI 0.47‐1.09) and 0.85 (95% CI 0.78‐0.92; τ=0.11, τ2=0.01; PI 0.59‐1.11), respectively. The SROC curve showed that the AUC for predicting GDM using AI algorithms was 0.94 (95% CI 0.92‐0.96), indicating a strong predictive capability. Deek test (P=.03) and the funnel plot both showed clear asymmetry, suggesting the presence of small-study effects. Subgroup analysis showed that the random forest algorithm exhibited the highest sensitivity (0.83, 95% CI 0.74‐0.93), while the extreme gradient boosting algorithm exhibited the highest specificity (0.82, 95% CI 0.77‐0.87). Meta-regression further revealed an evaluation in predictive accuracy in prospective study designs (regression coefficient=2.289, P=.001). Conclusions: Unlike previous narrative reviews, this systematic review innovatively provided a comparative and quantitative synthesis of AI algorithms for GDM prediction. This established an evidence-based framework to guide model selection and identified a critical evidence gap. The key implication for real-world application was the demonstrated necessity of local validation before clinical adoption. Therefore, future work should focus on large-scale, prospective validation studies to develop clinically applicable tools. Trial Registration: PROSPERO CRD42025645913; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025645913 %R 10.2196/79729 %U https://www.jmir.org/2026/1/e79729 %U https://doi.org/10.2196/79729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e84617 %T Characterization of Models for Identifying Physical and Cognitive Frailty in Older Adults With Diabetes: Systematic Review and Meta-Analysis %A Wang,Xia %A Meng,Shujie %A Xiao,Xiang %A Lu,Liu %A Chen,Hongyan %A Li,Yong %A Zhang,Rong %A Jiang,Qiwu %A Liu,Shan %A Gao,Ru %K prediction model %K diabetes %K frailty %K systematic review %K meta-analysis %D 2026 %7 29.1.2026 %9 %J J Med Internet Res %G English %X Background: Physical frailty and cognitive frailty are increasingly recognized as critical geriatric syndromes among older adults with diabetes, contributing to adverse outcomes such as disability, hospitalization, and mortality. Early identification of individuals at high risk is therefore essential for timely prevention and intervention. Although a growing number of prediction models have been developed for this population, evidence regarding their methodological rigor, predictive performance, and generalizability remains fragmented. Objective: This study aims to evaluate and characterize existing models for detecting or predicting physical frailty and cognitive frailty in older adults with diabetes. Methods: PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were searched from their inception to December 2025. Retrospective, cross-sectional, and prospective studies that developed or validated models predicting frailty or cognitive frailty in older adults with diabetes were included. The Prediction Model Study Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability. Random effects meta-analyses using the Hartung-Knapp-Sidik-Jonkman method were conducted to synthesize model performance, including the pooled area under the receiver operating characteristic curve (AUC). Heterogeneity was explored through subgroup and sensitivity analyses. Small study effects were evaluated using funnel plots, the Egger test, and the Deeks funnel plot asymmetry test. Results: A total of 24 studies comprising 32 diagnostic models were included. The overall pooled analysis demonstrated an AUC of 0.851 (95% CI 0.820‐0.882) with a 95% prediction interval of 0.710‐0.992, sensitivity of 0.810 (95% CI 0.740‐0.850), and specificity of 0.850 (95% CI 0.810‐0.890). Statistical comparisons in the modeling approach revealed that logistic regression models achieved a significantly higher pooled AUC (0.850) compared with machine learning models (0.785; P=.003). Similarly, retrospective studies demonstrated superior performance, with an AUC of 0.900 compared with 0.843 for cross-sectional studies (P=.03). Conversely, no significant differences were observed across subgroups stratified by data source (P=.42), patient characteristics (P=.77), validation methods (P=.16), or specific outcomes (P=.94). The most common predictors identified were depression, age, and regular exercise; however, all included studies were assessed as having a high risk of bias. Conclusions: To our knowledge, this review provides the first comprehensive synthesis of models for risk stratification of physical frailty and cognitive frailty in older adults with diabetes. The findings indicate that existing models demonstrate satisfactory discrimination; specifically, CIs confirmed a robust average effect, while prediction intervals suggested that performance in future settings, though variable, is likely to remain acceptable. However, clinical utility is currently constrained by high risk of bias and limited external validation. Future research must prioritize rigorous, prospective, multicenter studies adhering to standard reporting guidelines (eg, TRIPOD [Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis]) to establish valid, generalizable, and clinically actionable prognostic instruments. Trial Registration: PROSPERO CRD420251019308; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251019308 %R 10.2196/84617 %U https://www.jmir.org/2026/1/e84617 %U https://doi.org/10.2196/84617 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e80386 %T The Effectiveness, Facilitators, and Barriers of Digital Mental Health Services for First Nations People in Australia: Systematic Scoping Review %A Zhai,Siyu %A Goodman,Andrew %A Smith,Anthony C %A Diminic,Sandra %A Zhou,Xiaoyun %K digital mental health %K Aboriginal and Torres Strait Islander people %K eHealth %K mHealth %K mobile health %K telehealth %K mental health services %D 2026 %7 27.1.2026 %9 %J Interact J Med Res %G English %X Background: First Nations people in Australia experience inequitable mental health outcomes and service access. Digital mental health (DMH) services, which refer to offering mental health services through digital platforms, are considered potential solutions to address such mental health service inequities and improve the mental health outcomes of First Nations Australians. However, evidence on the effectiveness of DMH services for First Nations people in Australia is yet to be synthesized. Objective: This systematic scoping review aims to fill this gap and to identify the facilitators and barriers that influence the implementation of DMH services among First Nations people in Australia. Methods: A systematic search was conducted across 6 academic databases to search for studies related to DMH services for First Nations people in Australia. Search terms relating to First Nations people, geographic terminologies of Australia, mental health, and DMH services were used. Studies were included if they assessed the effectiveness of DMH services or the determinants of the facilitators and barriers of implementing DMH interventions among First Nations people in Australia. Data were extracted based on study design, targeted services, and research findings, and were then synthesized using a thematic analysis framework. Results: In total, 22 studies met the inclusion criteria. DMH services were used to support and treat First Nations Australians and conduct psychological assessments in these individuals. Evidence of effectiveness was stronger for nonsevere mental health conditions. The determinants of the facilitators and barriers of the implementation of DMH services included the following: (1) organizational and administrative factors; (2) cultural appropriateness; (3) accessibility; (4) integration of DMH services in the existing health system; (5) engagement between clients and service providers; (6) coverage of different conditions and clients; (7) acceptability to DMH services; (8) digital literacy; and (9) efficiency. Conclusions: Evidence on the use of DMH services for First Nations Australians remains heterogeneous in terms of study design and outcome measurement. DMH services appear to be most effective for managing nonsevere mental health conditions. Successful implementation requires multilevel structural support, including policy and organizational commitment, enhanced digital infrastructure, workforce training and engagement, and the design of culturally responsive DMH models to improve uptake and equitable access to mental health care among First Nations Australians. Trial Registration: PROSPERO CRD42024612517; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024612517 %R 10.2196/80386 %U https://www.i-jmr.org/2026/1/e80386 %U https://doi.org/10.2196/80386 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e76582 %T Identifying Key Predictors of Appropriate Discharge Destinations for Older Inpatients in Acute Care: Scoping Review %A Leinert,Christoph %A Fotteler,Marina Liselotte %A Kocar,Thomas Derya %A Wolf,Jessica %A Beissel,Lisa %A Grummich,Kathrin %A Dallmeier,Dhayana %A Denkinger,Michael %K CDSS %K clinical decision support system %K continuity of care %K discharge destination %K discharge planning %K feature selection %K geriatrics %K postacute care %K predictor %D 2026 %7 22.1.2026 %9 %J Interact J Med Res %G English %X Background: Postacute care (PAC) services are important to ensure functional recovery and provide adequate care for geriatric inpatients in acute care. The choice between different PAC options can be challenging, and predictors for the most appropriate among diverse discharge options are warranted. Objective: We conducted a scoping review to identify predictors of appropriate discharge destinations for older adults (≥65 y) in acute care transitioning to different PAC settings and extract the most relevant predictors for different PAC settings as well as a generalizable set of predictor domains. Methods: The databases of Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Emcare were systematically searched for English or German literature published until February 25, 2022. A total of 3 researchers screened, extracted, and categorized the data according to domains, discharge destinations, mean age, and health care systems origin, focusing on predictors that increase the likelihood of a discharge destination (positive predictors). The Jaccard index was calculated to compare the similarity between different possible domain combinations and existing literature. Results: Of 22,382 records screened, 171 quantitative and 10 qualitative studies were included. After separating combined discharge destinations, we found 1047 predictors for different discharge destinations including nursing home (n=297, 28%), skilled nursing facility (n=223, 21%), inpatient rehabilitation (n=206, 20%), home with (n=97, 9%) or without (n=74, 7%) support, assisted living (n=63, 6%), and early inpatient rehabilitation (n=21, 2%). Of all positive predictors (n=723), age was the most frequently reported predictor (80/723, 11%). Geriatric syndromes were found more often in patients 80 years or older (121/192, 63%) and in non-US studies (174/285, 61%). The top reported predictors for discharge to nursing homes were diagnosed dementia (9/297, 3%) and deficits in instrumental activities of daily living (ADL; 10/297, 3%); for discharge to rehabilitation, the top predictors were longer length of stay (11/205, 5%) and existent cardiopulmonary disease (10/205, 5%); and for back home without support, the top predictors were good ADL (10/74, 14%) and mobility assessments (9/74, 12%). Among 20 predictor domains, 8 were most concordant with the literature: cognitive impairment, ADL, demographics, social support, hospitalization data, multimorbidity, mobility, and primary diagnosis. Conclusions: This scoping review provides a comprehensive overview of predictors for appropriate discharge decisions in older adults in acute care, stratified by destination, age, study origin, and the predictor domains most concordant with the literature. The results will be valuable to inform the choice of features for clinical decision support systems, including the training of machine learning algorithms. %R 10.2196/76582 %U https://www.i-jmr.org/2026/1/e76582 %U https://doi.org/10.2196/76582 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e70777 %T Exploring Serious Games in Supporting Postnatal Depression: Narrative Review %A Wang,Weijie %A Penney,Erika %A Gay,Valerie %A Garcia,Jaime %K serious game %K postnatal depression %K digital health %K mobile phone %K perinatal education %K mental health %D 2026 %7 16.1.2026 %9 %J Interact J Med Res %G English %X Background: Postnatal depression (PND) is a clinical sign of sadness in certain individuals after childbirth. PND affects the mother, the baby, and the whole family. PND is now recognized as a public health concern worldwide. The global prevalence of PND is approximately 17.22%. However, less than half of those affected seek help, which means over 50% of PND cases are left untreated. Current reviews lack focus on digital interventions targeting parents in late pregnancy or postnatal stages. Existing studies prioritize symptom relief over fostering help-seeking behaviors. Objective: This study aims to identify what serious games have been applied to support the treatment or help-seeking of PND and what gaps are still left. Methods: Eligibility criteria for this review included full-text papers from 2015 to 2024 from conferences or peer-reviewed journals that were relevant to serious games to support help-seeking behaviors for individuals with depression. Seven research databases and publisher repositories were used. The final search was conducted in March 2025, and a thematic analysis was used to identify and organize recurring themes. As this review adopts a narrative approach, predefined eligibility criteria, a structured search strategy, and review by an interprofessional team were used to reduce selection bias. Results: Only 2 studies related to PND were identified. After expanding the search string to depression, 13 studies were included in this review, and the studied games were divided into 3 help-seeking categories: promoting knowledge, reducing stigma, and raising awareness. This review identified that gamification, educational messages, and supportive character interactions could enhance engagement, build coping skills, and promote help-seeking in a practical, parent-friendly format. Nonetheless, this paper is limited by the reliance on depression literature due to scarce PND-specific studies, the quality of included studies, the exclusion of non-English language publications, and the use of common but select academic databases. These factors may affect generalizability but also serve to highlight critical gaps for future research and targeted intervention design. Conclusions: There is a dearth of studies directly related to PND. Existing games commonly use narrative storytelling and interactive scenarios to promote empathy, correct misconceptions, and encourage help-seeking in broad depression. However, few are designed specifically for new parents, whose unique needs—such as time constraints—make mobile platforms the most suitable format for effective engagement. The authors propose that the future interprofessional codevelopment of a mobile serious game tailored to new parents would address the intervention and literature gaps identified in this review. It is argued that key design elements should include an emotionally engaging narrative, meaningful player choices, real-life parenting scenarios, calming visuals, and accessible, low-pressure gameplay. This review contributes to the progression of serious game research, with a focus on addressing the needs of an often underserved and undertreated PND population. %R 10.2196/70777 %U https://www.i-jmr.org/2026/1/e70777 %U https://doi.org/10.2196/70777 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 15 %N %P e76601 %T Machine and Deep Learning for Detection of Moderate-to-Vigorous Physical Activity From Accelerometer Data: Systematic Scoping Review %A Zi,Yahua %A van de Ven,Sjors RB %A de Geus,Eco JC %A Chen,Peijie %+ , School of Exercise and Health, Shanghai University of Sport, No.399 Changhai Rd, Shanghai, 200438, China, 86 21 5125 3145, chenpeijie@sus.edu.cn %K physical activity intensity %K raw accelerometer data %K wearable sensors %K free-living validation %K classification %K estimation %K sensor placement %K machine learning %K deep learning %D 2026 %7 8.1.2026 %9 Review %J Interact J Med Res %G English %X Background: Accurate monitoring of moderate-to-vigorous physical activity (MVPA) is critical for advancing public health research and personalized interventions. Traditional accelerometry methods, reliant on regression-derived intensity cut points, exhibit significant misclassification errors and poor generalizability to the free-living environment. Recent advancements in machine learning (ML) and deep learning (DL) offer promising alternatives for automated MVPA detection. Objective: This scoping review synthesizes evidence on ML and DL techniques for MVPA estimation and prediction using accelerometer data, focusing on performance, algorithm bias, sensor configurations, and translational potential. Methods: Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, we conducted a systematic search across PubMed, IEEE Xplore, and Web of Science (February 1995-April 2025), supplemented by snowball citation tracking. Two independent reviewers screened titles, abstracts, and full texts against predefined inclusion criteria. Data from included studies were charted by one reviewer and verified by the other, extracting details on study characteristics, sensor configuration, ML and DL techniques, validation methods, and performance metrics. A narrative synthesis approach was used, guided by 6 research questions, to collate and summarize the findings. The synthesis process was rigorously reviewed by multiple authors to ensure consistency. Results: Of 1938 screened studies, 40 met the inclusion criteria, with 4 studies added by follow-up manual searches. While traditional ML models (eg, random forest, support vector machine) achieved strong laboratory performance with F1-score of 87.4%-100% and accuracy of 87.9%-100%, their real-world performance declined by 8.0%-13.3% in F1-score and 6.6%-12.2% in accuracy, due to environment noise and device heterogeneity. DL architectures (eg, convolutional neural networks, transformers) achieved robust performance by leveraging raw signal dynamics with an F1-score of 71.9%-79.8% and an accuracy of 87.9%-100% in free-living settings. Hybrid models (eg, convolutional neural networks and long short-term memory) demonstrated state-of-the-art performance (F1-score 91.4%-98.4%, accuracy 97.7%-99.0%). Wrist-worn sensors dominated studies (30/40, 75%) and matched hip/thigh placements in lab settings (mean F1-scores: 86.5%-88.6%), but multisensor configurations (wrist + hip) yielded the highest accuracy (89.7%). Key challenges included algorithmic bias reducing applicability in older adult populations, and impaired reproducibility, with only 42.5% (17/40) of studies sharing code and data. Emerging opportunities are noted for edge computing and hybrid models integrating contextual data. Conclusions: ML and DL significantly enhance MVPA monitoring by automating feature extraction and improving adaptability to free-living variability. However, persistent gaps in generalizability, inconsistent validation protocols, and transparency deficits hinder translation. The findings support the need for future research to prioritize inclusive model training, standardized reporting frameworks, and open science practices to realize the equitable potential of artificial intelligence–driven physical activity assessment. %M 41505746 %R 10.2196/76601 %U https://www.i-jmr.org/2026/1/e76601 %U https://doi.org/10.2196/76601 %U http://www.ncbi.nlm.nih.gov/pubmed/41505746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e82881 %T Digital Health Technologies Applied in Patients With Early Cognitive Change: Scoping Review %A Zhang,Yunhao %A Zhu,Xuejiao %A Yang,Shulan %A Wong,Arkers Kwan Ching %A Chen,Xinming %K digital health technology %K early cognitive change %K Alzheimer disease %K cognition %K scoping review %D 2025 %7 29.12.2025 %9 %J J Med Internet Res %G English %X Background: Digital health technologies (DHTs) have the potential to revolutionize the screening, diagnostic support, monitoring, and intervention for early cognitive change. However, the full spectrum of their application and the existing evidence base in this specific patient population have not been systematically delineated. Objective: This study aimed to review and synthesize the applications, roles, and challenges of DHTs in patients with early cognitive change. Methods: This scoping review was conducted in accordance with established methodological frameworks for scoping reviews and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and PRISMA-S (PRISMA Statement for Reporting Literature Searches in Systematic Reviews) guidelines. A systematic search was conducted across 5 electronic databases: PubMed, Embase, Web of Science, APA PsycINFO, and the Cochrane Library. The search covered the period from each database’s inception until September 30, 2025. Studies were selected, and data were extracted using the population-concept-context framework, focusing on digital health interventions for patients with early cognitive change. Results: This scoping review identified 193 studies (from 8346 initial articles, screened down to 5623 after deduplication) evaluating DHTs for early cognitive change, with a marked publication surge post 2020. Studies predominantly focused on mild cognitive impairment and subjective cognitive decline. Among the 170 studies that reported the age of participants, the mean age of the participants was 74.09 (SD 7.98) years. Furthermore, six categories of DHTs emerged: (1) artificial intelligence or big data, (2) internet of things, (3) virtual reality or augmented reality, (4) robotics, (5) mobile apps or computerized cognitive training, and (6) telemedicine. Outcomes most frequently assessed included cognitive function, mental health, and feasibility. Notably, only 23 studies measured quality of life, with limited long-term (6‐12 months) follow-up. Physiological markers, social support, sleep quality, and self-efficacy were explored but less frequently. Conclusions: DHTs demonstrate significant potential in the management of patients with early cognitive impairment, particularly playing crucial roles in screening, intervention, monitoring, and auxiliary diagnosis. This scoping review underscores that DHTs, through personalized interventions and continuous care, can effectively improve patient outcomes while innovatively incorporating the caregiver perspective. However, their practical application faces challenges in balancing technological complexity with user-friendliness. Future research needs to address five key issues: (1) the lack of long-term efficacy evidence, (2) insufficient coverage of individuals with subjective cognitive decline and caregiver populations, (3) a dearth of empirical evidence on the combined application of multiple DHTs, (4) the failure of personalized programs to fully account for individual differences, and (5) the absence of effective solutions to address data and ethical risks. There is an urgent need to establish a long-term efficacy evaluation system for DHTs through rigorous methodological validation. Trial Registration: OSF Registries osf.io/YBV4E; https://osf.io/YBV4E %R 10.2196/82881 %U https://www.jmir.org/2025/1/e82881 %U https://doi.org/10.2196/82881 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e65538 %T Obesity Prevention and Reduction in China Using the Social Media Platform WeChat: Scoping Review %A Wang,Yinuo %A Zhuang,Xuxiu %A Sundermeir,Samantha %A Gittelsohn,Joel %K obesity %K digital interventions %K mHealth %K WeChat %K scoping review %K prevention %K public health %K Chinese %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %D 2025 %7 11.12.2025 %9 %J Interact J Med Res %G English %X Background: Digital interventions for obesity have demonstrated efficacy in obesity prevention and management. The emergence of smartphones and ubiquitous apps such as WeChat represents potential modality to enhance the reach, sustainability, and cost-effectiveness of such interventions. By the end of the first quarter of 2024, WeChat had approximately 1.36 billion monthly active users, accounting for 96.5% of China’s population. The use of this platform for obesity interventions has been validated in multiple Chinese trials, most published in Chinese language journals. Objective: We aim to synthesize the existing evidence on obesity interventions delivered through WeChat to generate implications for future intervention design and development, thereby reaching an international audience. Methods: We conducted a scoping review of PubMed and China National Knowledge Infrastructure using search terms including “WeChat,” “obesity,” “weight,” “BMI,” “waist circumference,” “hip circumference,” “waist-to-hip ratio,” “body fat,” “skin fold thickness,” and these Chinese equivalents “weixin,” “feipang,” “tizhong,” “tizhongzhishu,” “yaowei,” “tunwei,” “yaotunbi,” “tizhi,” and “pizhehoudu.” We included only original research studies, theses, or dissertations with measurable outcomes that used WeChat functions as intervention strategies. Study quality was assessed using the National Institutes of Health Quality Assessment Tool, with specific tools selected based on study design. Descriptive statistics were applied, with categorical variables summarized as frequencies and percentages (n, %) to report study distribution. Results: Our scoping review based on PubMed and China National Knowledge Infrastructure identified 665 initial records, among which 43 studies met eligibility criteria and were included for data extraction to characterize intervention details. Results indicated effectiveness in 86.0% (37/43) of studies, with WeChat-assisted obesity interventions achieving significant short- and long-term weight loss measured by objective outcomes (body weight, BMI, waist circumference, hip circumference, waist-to-hip ratio, and body fat percentage). However, formative research informing intervention design was insufficient. Common methodological limitations included lack of randomization and blinding (42/43, 97.7%) and unreported intervention compliance metrics (39/43, 92.0%). Functionally, interventions primarily used “WeChat group” and “Official Account”—public accounts that provide health education, diet or physical activity logging, and other features. Conclusions: Overall, WeChat represents a promising platform for obesity interventions; however, current apps fail to leverage its full features (eg, online payment and live streaming). Key limitations include methodological heterogeneity and cultural specificity, which were addressed through narrative synthesis stratified by study types. Future research should incorporate the formative phase and use more rigorous methodologies such as randomized controlled trials to optimize intervention design and delivery via this modality. %R 10.2196/65538 %U https://www.i-jmr.org/2025/1/e65538 %U https://doi.org/10.2196/65538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68688 %T The Effects of Teleinterventions on Pediatric Weight Control: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Wu,Cheng-Tai %A Ng,Jue-Chuan %A Cheng,Yu-Tai %A Chang,Ling-Yin %A Kang,Enoch Y %A Chiu,Hsin-Hui %A Cheng,Ching-Feng %K children %K body weight %K obese %K nonpharmacological treatment %K teleintervention %K PRISMA %D 2025 %7 8.12.2025 %9 %J J Med Internet Res %G English %X Background: Childhood overweight or obesity has become one of the world’s most concerning health problems. Teleinterventions that deliver health information and behavioral strategies through telephone calls, websites, apps, newsletters, or emails can help manage children’s weight-related conditions. Objective: This study aimed to systematically evaluate the effects of teleinterventions versus nonteleinterventions on anthropometric outcomes in children with overweight or obesity. Methods: Randomized controlled trials investigating weight control using teleinterventions in children with overweight or obesity published in the Cochrane Library (including CENTRAL), Embase, PubMed, and Web of Science databases were selected. The outcomes included changes in BMI, BMI z score, body fat, and waist circumference. Two reviewers independently performed evidence selection, data extraction, and risk of bias evaluation. Data were pooled using a random-effects model. Results were presented as the mean difference (MD) with 95% CI. Results: A total of 26 randomized controlled trials involving 2866 children living with overweight or obesity met the eligibility criteria. The pooled results showed that teleinterventions significantly reduced the BMI z score between the fourth and sixth months (MD −0.15, 95% CI −0.23 to −0.08; I2=94%) and between the seventh and twelfth months (MD −0.19, 95% CI −0.34 to −0.03; I2=98%). Similarly, BMI (MD −2.48, 95% CI −4.15 to −0.82; I2=96%) and waist circumference (MD −0.59, 95% CI −1.05 to −0.14; I2=80%) were significantly reduced between the fourth and the sixth months but were nonsignificant between the seventh and twelfth months. Moreover, teleinterventions with family involvement or professional interaction between the fourth and the sixth months provided significant benefits, including reductions in BMI z score (MD −0.16, 95% CI −0.23 to −0.09; I2=96% and MD −0.13, 95% CI −0.20 to −0.05; I2=96%) and BMI (MD −2.50, 95% CI −4.32 to −0.69; I2=96% and MD −2.48, 95% CI −4.15 to −0.82; I2=96%). In addition, teleinterventions with family involvement could significantly reduce waist circumference between the fourth and sixth months (MD −0.75, 95% CI −1.25 to −0.25; I2=52%). Teleinterventions led to a significant reduction in waist circumference in children between the fourth and sixth months (MD −0.88, 95% CI −1.45 to −0.30; I2=75%). However, teleinterventions did not lead to a significant reduction in body fat among children or adolescents with overweight or obesity, even when family members were involved in the intervention. Conclusions: Teleinterventions, particularly when incorporating family engagement and structured professional interaction, yielded significant short- to medium-term improvements in weight control for children and adolescents living with overweight or obesity compared to nonteleinterventions. These findings highlight the promising role of telemedicine as a valuable modality for addressing the public health challenge of childhood obesity. Trial Registration: PROSPERO CRD42022328874; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022328874. %R 10.2196/68688 %U https://www.jmir.org/2025/1/e68688 %U https://doi.org/10.2196/68688 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e78410 %T “It’s Not Only Attention We Need”: Systematic Review of Large Language Models in Mental Health Care %A Bucher,Andreas %A Egger,Sarah %A Vashkite,Inna %A Wu,Wenyuan %A Schwabe,Gerhard %+ Department of Informatics, University of Zurich, Binzmühlestrasse 14, Zurich, 8050, Switzerland, 41 446356690, bucher@ifi.uzh.ch %K AI %K GenAI %K large language models %K LLM %K mental health %K systematic review %D 2025 %7 4.11.2025 %9 Review %J JMIR Ment Health %G English %X Background: Mental health care systems worldwide face critical challenges, including limited access, shortages of clinicians, and stigma-related barriers. In parallel, large language models (LLMs) have emerged as powerful tools capable of supporting therapeutic processes through natural language understanding and generation. While previous research has explored their potential, a comprehensive review assessing how LLMs are integrated into mental health care, particularly beyond technical feasibility, is still lacking. Objective: This systematic literature review investigates and conceptualizes the application of LLMs in mental health care by examining their technical implementation, design characteristics, and situational use across different touchpoints along the patient journey. It introduces a 3-layer morphological framework to structure and analyze how LLMs are applied, with the goal of informing future research and design for more effective mental health interventions. Methods: A systematic literature review was conducted across PubMed, IEEE Xplore, JMIR, ACM, and AIS databases, yielding 807 studies. After multiple evaluation steps, 55 studies were included. These were categorized and analyzed based on the patient journey, design elements, and underlying model characteristics. Results: Most studies assessed technical feasibility, whereas only a few examined the impact of LLMs on therapeutic outcomes. LLMs were used primarily for classification and text generation tasks, with limited evaluation of safety, hallucination risks, or reasoning capabilities. Design aspects, such as user roles, interaction modalities, and interface elements, were often underexplored, despite their significant influence on user experience. Furthermore, most applications focused on single-user contexts, overlooking opportunities for integrated care environments, such as artificial intelligence–blended therapy. The proposed 3-layer framework, which consists of the L1: LLM layer, L2: interface layer, and L3: situation layer, highlights critical design trade-offs and unmet needs in current research. Conclusions: LLMs hold promise for enhancing accessibility, personalization, and efficiency in mental health care. However, current implementations often overlook essential design and contextual factors that influence real-world adoption and outcomes. The review underscores that the self-attention mechanism, a key component of LLMs, alone is not sufficient. Future research must go beyond technical feasibility to explore integrated care models, user experience, and longitudinal treatment outcomes to responsibly embed LLMs into mental health care ecosystems. %M 41186978 %R 10.2196/78410 %U https://mental.jmir.org/2025/1/e78410 %U https://doi.org/10.2196/78410 %U http://www.ncbi.nlm.nih.gov/pubmed/41186978 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e75168 %T Adoption of Telemedicine for Dementia Care in Nigeria: Scoping Review %A Adedeji,Abiodun %A Dogan,Huseyin %A Adedoyin,Festus %A Heward,Michelle %K telemedicine %K dementia care %K Nigeria %K mHealth %K video consultations %K remote monitoring %K caregiver support %K health care accessibility %K national telemedicine strategy %K mobile health %D 2025 %7 27.10.2025 %9 %J Interact J Med Res %G English %X Background: Dementia is a global health challenge, particularly in Nigeria, where limited health care infrastructure, cultural stigmas, and poor awareness hinder its care. Telemedicine can improve patient outcomes, increase health care access, and support caregivers. However, challenges such as poor internet connectivity, digital literacy, and a lack of integrated strategies hinder its adoption, particularly in rural areas. Objective: This scoping review aims to evaluate the adoption of telemedicine for dementia care in Nigeria by highlighting existing interventions, their effectiveness, implementation challenges, and contextual barriers. It also draws on global evidence to propose culturally relevant, sustainable strategies. Methods: A scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework. Peer-reviewed articles were included if they focused on telemedicine or digital health interventions for dementia care in Nigeria or sub-Saharan Africa and published between January 2010 and February 2024. Databases searched included PubMed, Scopus, CINAHL, PsycINFO, Cochrane Library, and Google Scholar. A total of 23 articles met the inclusion criteria. Results: Among the 23 studies, 10 (43.5%) focused on mobile health apps, 8 (34.8%) on video consultations, and 5 (21.7%) on remote monitoring tools. These interventions improved caregiver support, medication adherence, and access to specialist care. Key barriers included limited digital literacy, poor internet access, and a lack of cohesive national telemedicine policy. Conclusions: There is an urgent need for an inclusive national telemedicine policy in Nigeria. Interventions such as mobile health, video consultations, and remote monitoring tools show potential to enhance dementia care, reduce caregiver burden, and improve health outcomes. %R 10.2196/75168 %U https://www.i-jmr.org/2025/1/e75168 %U https://doi.org/10.2196/75168 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e76577 %T Acupuncture and Moxibustion for Poststroke Depression: Systematic Review %A Meng,Lu %A Xu,Chuang-Long %A He,Xiao-Xu %A Tan,Xiao-Chan %K acupuncture %K humans %K poststroke depression %K systematic review %K moxibustion %D 2025 %7 16.10.2025 %9 %J Interact J Med Res %G English %X Background: Poststroke depression (PSD) is a common complication following stroke. In recent years, several systematic reviews have evaluated the effects of moxibustion and acupuncture on PSD; however, their findings have been inconsistent. Objective: This overview of systematic reviews aimed to assess the methodological quality, reporting quality, and strength of evidence of existing systematic reviews on acupuncture and moxibustion for PSD. In addition, this study also analyzed the limitations of previous studies and suggested directions for future research. Methods: Systematic reviews concerning acupuncture and moxibustion for PSD published before August 10, 2024, were identified from 8 databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP Database, and Chinese Biomedical Literature Database. Eligible studies included systematic reviews and meta-analyses of randomized controlled trials comparing moxibustion and acupuncture for the treatment of PSD. The methodological quality, reporting quality, and evidence quality were evaluated using AMSTAR 2 (Assessment of Multiple Systematic Reviews-2), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020, and GRADE (Grading of Recommendations Assessment, Development and Evaluation), respectively. The corrected covered area was calculated to assess overlap among the included primary studies. Results: A total of 24 studies were included. According to the Assessment of Multiple Systematic Reviews-2 assessment, all studies were rated as having “low” or “critically low” methodological quality. Based on PRISMA, 1 study demonstrated seriously inadequate reporting quality, while 21 studies had partially inadequate reporting quality. The quality of evidence in the included reviews ranged from very low to moderate. Most of the primary outcomes exhibited mild to moderate overlap among studies. Conclusions: Most of the included systematic reviews indicated that acupuncture may be beneficial for PSD. Nevertheless, the methodology, reporting, and evidence quality of these reviews require improvement. Stronger evidence will depend on the conduct of larger, multicenter, rigorously designed randomized controlled trials, as well as high-quality systematic reviews. Trial Registration: PROSPERO CRD42024576753; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024576753 %R 10.2196/76577 %U https://www.i-jmr.org/2025/1/e76577 %U https://doi.org/10.2196/76577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e79217 %T Evaluation Strategies for Large Language Model-Based Models in Exercise and Health Coaching: Scoping Review %A Lai,Xiangxun %A Lai,Yue %A Chen,JiaCheng %A Huang,Shengqi %A Gao,Qi %A Huang,Caihua %K large language models (LLMs) %K evaluation metrics %K coaching %K exercise %K movement %K scoping review %D 2025 %7 14.10.2025 %9 %J J Med Internet Res %G English %X Background: Large language model (LLM)-based artificial intelligence (AI) coaches show promise for personalized exercise and health interventions. However, the unique demands of ensuring safety and real-time, multimodal personalized feedback have created a fragmented evaluation landscape lacking standardized frameworks. Objective: This scoping review systematically maps current evaluation strategies for LLM-based AI coaches in exercise and health, identifies strengths and limitations, and proposes directions for robust, standardized validation. Methods: Following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a systematic search across 6 major databases (eg, PubMed, Web of Science) for original research on LLM-based exercise and health coaching. Studies were included if they explicitly reported on evaluation methods. We extracted and synthesized data on model types, application domains, and evaluation strategies and developed a 5-point Evaluation Rigor Score (ERS) to quantitatively assess the methodological depth of the evaluation designs. Results: We included 20 studies, most using proprietary models like ChatGPT (75%). Evaluation strategies were highly heterogeneous, mixing human ratings (80%) and automated metrics (40%). Crucially, the evidence was limited by low methodological rigor: the median ERS was 2.5 out of 5, with 55% of studies classified as having low rigor. Key gaps included limited use of real-world data (40%) and inconsistent reliability reporting (45%). Conclusions: The current evaluation of LLM-based health coaches is fragmented and methodologically weak. Future work must establish multidimensional validation frameworks that integrate technical benchmarks with human-centered methods to ensure safe, effective, and equitable deployment. %R 10.2196/79217 %U https://www.jmir.org/2025/1/e79217 %U https://doi.org/10.2196/79217 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e70323 %T Horizon Scanning Methods for Health Care Technology Innovation Identification: Rapid Scoping Review of Patent Research Studies %A Garcia Gonzalez-Moral,Sonia %A Pennock,Erin %A Ewedairo,Olushola %A Green,Elizabeth %A Elgey,James %A Mkwashi,Andrew %K horizon scanning %K patent analysis %K medtech %K rapid scoping review %K health care innovation %D 2025 %7 11.9.2025 %9 %J Interact J Med Res %G English %X Background: Patents are an early sign of innovation, yet their role in horizon scanning for health care remains unclear. Objective: This study investigates the role of, and methods for, patent analysis in advancing health care technology innovation in a sector that is characterized by diverse health care technologies and significant research investment. Patents are critical early indicators of innovation, supporting horizon scanning and weak signal detection. The study aimed to identify intellectual property sources, evaluate methods for patent retrieval and analysis, and outline objectives for using patent data to anticipate trends and inform health care strategies. Methods: A rapid scoping review was conducted following Cochrane Rapid Review Methods recommendations and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a preregistered protocol on the Open Science Framework. Searches in Embase, IEEE Xplore, and Web of Science targeted records published 2020 onward to capture the most recent sources, methods, and tools. Three independent reviewers screened studies using Rayyan (Qatar Computing Research Institute). We included any study type published since 2020 that provided patent sources data, methods, and tools applied to the study of health care technologies. Our data extraction included bibliographic details, study characteristics, and methodological information. Risk of bias assessments were not undertaken. Narrative and tabular methods, supplemented by visual charts, were used to synthesize findings. Results: Our searches identified 1741 studies, of which 124 were included after title, abstract, and full-text screening, with 54% being original research, 43.5% reviews, and the remainder being conference abstracts (2.5%). Most studies (68%) relied solely on patent databases, while others searched the gray and published literature. Research objectives of the included studies were grouped into 10 themes, with trend analysis (50%) and the provision of recommendations for future research, policy, and strategy development (20%) being the most common. Our review identified up to 47 patent databases, with 27% of studies using multiple sources. Whenever time limits were reported, the mean time horizon for patent searches was 24.6 years, ranging from 1900 to 2019. Automated approaches, used in 33% (n=43) of studies, frequently used tools such as Gephi (Gephi Consortium) for network visualization. Disease mapping based on National Institute for Health and Care Excellence classification indicated that cancer (19%) and respiratory conditions (16%), particularly COVID-19, were key areas. Conclusions: Patent data are valuable for identifying technological trends and informing policy and research strategies. While patents provide crucial insights into emerging technologies, inconsistent deduplication practices across studies pose the risk of data inflation, accentuating the need for transparency and rigor. Finally, this review emphasized the importance of data transformation and visualization in detecting emerging trends, with Python and R being the most commonly used programming languages for developing custom tools. %R 10.2196/70323 %U https://www.i-jmr.org/2025/1/e70323 %U https://doi.org/10.2196/70323 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e68592 %T Evaluation of AI Tools Versus the PRISMA Method for Literature Search, Data Extraction, and Study Composition in Glaucoma Systematic Reviews: Content Analysis %A Meliante,Laura Antonia %A Coco,Giulia %A Rabiolo,Alessandro %A De Cillà,Stefano %A Manni,Gianluca %K artificial intelligence %K systematic literature review %K AI-assisted academic writing %K AI-assisted data analysis %K AI in systematic reviews %K Connected Papers %K Elicit %K JenniAI %K ChatPDF %K AI %K SLR %D 2025 %7 5.9.2025 %9 %J JMIR AI %G English %X Background: Artificial intelligence (AI) is becoming increasingly popular in the scientific field, as it allows for the analysis of extensive datasets, summarizes results, and assists in writing academic papers. Objective: This study investigates the role of AI in the process of conducting a systematic literature review (SLR), focusing on its contributions and limitations at three key stages of its development, study selection, data extraction, and study composition, using glaucoma-related SLRs as case studies and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-based SLRs as benchmarks. Methods: Four AI platforms were tested on their ability to reproduce four PRISMA-based, glaucoma-related SLRs. We used Connected Papers and Elicit to perform research of relevant records; then we assessed Elicit and ChatPDF’s ability to extract and organize information contained in the retrieved records. Finally, we tested Jenni AI’s capacity to compose an SLR. Results: Neither Connected Papers nor Elicit provided the totality of the results found using the PRISMA method. On average, data extracted from Elicit were accurate in 51.40% (SD 31.45%) of cases and imprecise in 13.69% (SD 17.98%); 22.37% (SD 27.54%) of responses were missing, while 12.51% (SD 14.70%) were incorrect. Data extracted from ChatPDF were accurate in 60.33% (SD 30.72%) of cases and imprecise in 7.41% (SD 13.88%); 17.56% (SD 20.02%) of responses were missing, and 14.70% (SD 17.72%) were incorrect. Jenni AI’s generated content exhibited satisfactory language fluency and technical proficiency but was insufficient in defining methods, elaborating results, and stating conclusions. Conclusions: The PRISMA method continues to exhibit clear superiority in terms of reproducibility and accuracy during the literature search, data extraction, and study composition phases of the SLR writing process. While AI can save time and assist with repetitive tasks, the active participation of the researcher throughout the entire process is still crucial to maintain control over the quality, accuracy, and objectivity of their work. %R 10.2196/68592 %U https://ai.jmir.org/2025/1/e68592 %U https://doi.org/10.2196/68592 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e69640 %T eHealth Literacy Interventions: Scoping Review %A Wang,Yan %A Niu,Yutian %A Xu,Rongjing %A Zhang,Qingqing %A Jia,Shoumei %A Wang,Anni %K eHealth literacy %K intervention %K scoping review %K digital health %K health literacy %K eHL %D 2025 %7 22.8.2025 %9 %J Interact J Med Res %G English %X Background: Electronic resources have become a predominant modality for health information dissemination in recent years. eHealth literacy (eHL) means individuals’ competencies to effectively acquire and use health information from electronic sources. Enhancing eHL is thus essential to facilitate individuals’ effective engagement with electronic resources and promote improved health management. Objective: This scoping review aimed to synthesize the characteristics of eHL interventions, thereby providing a reference for future intervention strategies. Methods: A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, ProQuest, CINAHL, CNKI, VIP, Wan Fang Data, and Sino Med limited to Chinese and English-language studies published before August 2024 was conducted. The interventional studies included had the explicit primary objective of enhancing eHL. We also incorporated studies that assessed eHL as a secondary outcome or mediator influencing health behaviors or clinical outcomes. All publications were required to provide publicly accessible complete datasets. We excluded conference abstracts and protocols. Academic theses and dissertations were included if they underwent institutional quality assurance through rigorous academic review processes and met predefined eligibility criteria. Results: A total of 35 studies were included in this review. The most prevalent eHL interventions (12/35, 34%) were delivered via mobile apps and devices in various settings, including educational institutions, public spaces, health care facilities, and community centers. These interventions predominantly focused on enhancing information literacy, health literacy, and computer literacy across the 6 domains of eHL: traditional, health, information, scientific, media, and computer literacy. A majority of the interventions were conducted on a weekly basis (6/13, 46%) and had a duration of 24 weeks (6/35, 17%). However, 77% (27/35) of interventions did not assess long-term effects. The primary outcomes of eHL interventions encompassed perceived eHL, actual eHealth knowledge and skills, health literacy, health behavior, and clinical outcomes, with 86% (30/35) indicating positive effects. The eHealth Literacy Scale was the most frequently used assessment tool. Conclusions: This study synthesizes the characteristics of eHL interventions. Current eHL interventions exhibit limitations in theoretical grounding, longitudinal tracking, and traditional or media literacy components. Overreliance on self-reported metrics constrains validity assessment. Future work should strengthen theoretical frameworks, integrate objective metrics, and enhance longitudinal designs. %R 10.2196/69640 %U https://www.i-jmr.org/2025/1/e69640 %U https://doi.org/10.2196/69640 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e75363 %T Safety and Efficacy of Aspirin and Indobufen in the Treatment of Atherosclerotic Diseases: Systematic Review and Meta-Analysis %A Pan,Wenhao %A Guan,Linger %A Zhang,Haicheng %K atherosclerotic disease %K antiplatelet therapy %K aspirin %K indobufen %K PRISMA %D 2025 %7 20.8.2025 %9 %J Interact J Med Res %G English %X Background: The pathogenesis of atherosclerotic thrombosis primarily involves platelet activation and aggregation, making antiplatelet therapy the cornerstone of treatment for such diseases. Objective: This meta-analysis aimed to compare the safety and efficacy of aspirin and indobufen in antiplatelet therapy for patients with atherosclerotic diseases. Methods: We searched the Cochrane Library, PubMed, Embase, Web of Science, and the Chinese Wanfang databases. The literature was screened according to predefined inclusion and exclusion criteria. Risk ratio (RR) was used to assess the magnitude of risk associated with exposure and our inclusion criteria are as follows: (1) the study population comprised adults (aged 18 years and older) with coronary heart disease caused by coronary artery atherosclerosis or stroke caused by intracranial atherosclerosis; (2) the intervention was represented by indobufen in the study groups versus aspirin in the control groups; (3) the primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events or any bleeding or Bleeding Academic Research Consortium 2/3/5 bleeding; (4) the secondary outcomes were cardiovascular death, myocardial infarction, and ischemic stroke; adverse cardiovascular events such as coronary thrombus reformation, heart failure, myocardial infarction, stroke, angina pectoris, and cardiovascular death; stroke; myocardial infarction; and cardiovascular death; and (5) the studies were randomized clinical trials with either crossover or parallel designs or prospective observational trials. Results: Eighteen trials with a total of 12,981 patients were included in this study. Compared to aspirin, indobufen reduced the risk of (1) bleeding events (RR 0.54, 95% CI 0.41‐0.71; P<.0001), (2) Bleeding Academic Research Consortium 2/3/5 bleeding (RR 0.50, 95% CI 0.26‐0.94; P=.03), (3) adverse cardiovascular events (RR 0.43, 95% CI 0.30‐0.61; P<.00001), and (4) myocardial infarction (RR 0.60, 95% CI 0.41‐0.89; P=.01). However, there were no significant differences between the 2 groups in terms of major adverse cardiovascular and cerebrovascular events, stroke, or cardiovascular mortality. Conclusions: Compared with aspirin, indobufen demonstrated better safety and was not inferior to aspirin in terms of efficacy, with superior results in some aspects (eg, fewer risks of adverse cardiovascular events and myocardial infarction). Further studies with larger sample sizes or longer follow-up periods may provide additional evidence. Trial Registration: PROSPERO CRD42024588250; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024588250 %R 10.2196/75363 %U https://www.i-jmr.org/2025/1/e75363 %U https://doi.org/10.2196/75363 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e65606 %T Developing Requirements for a Standardized System to Return Individual Research Results Back to Study Participants: Narrative Review %A Carr,Rosalyn Leigh %A Chan,Vita %A West,Nicholas C %A Görges,Matthias %K return of results %K research results %K knowledge translation %K system %K researching %K researcher %K research participants %K study participants %K personalization %K data integration %K data visualization %K research ethics %K narrative review %D 2025 %7 18.8.2025 %9 %J Interact J Med Res %G English %X Background: The increasing prevalence of smart devices has created vast amounts of untapped data, presenting new opportunities for data sharing across various fields, such as environmental sciences, health management, and astrophysics. While a significant portion of the public is willing to donate personal data, we need to better understand how to obtain information about which data assets a person may hold and the risks, benefits, and potential uses of this data exchange mechanism. Developing a trusted data-sharing platform may increase participants’ willingness to donate data and researchers’ ability to return personalized results from research findings. Objective: This study aimed to develop a preliminary list of core requirements, which can be used to develop design recommendations for standardizing the return of individual research results to study participants across research disciplines. Methods: We conducted a narrative literature review of existing platforms used to return research results to study participants. The search strategy included English-language articles published between May 2013 and May 2023. Concepts related to returning, disseminating, and sharing research results were searched for in (1) published research reports on Web of Science and MEDLINE, (2) gray literature, and (3) the bibliographies of included articles. Screening and data extraction were performed by 2 independent reviewers using Covidence. Inclusion criteria required that the study (1) included human participants, (2) returned information based on data collected from or by participants, (3) was published in English, and (4) included a description of a results-sharing system. Articles that met all 4 inclusion criteria were included in the review; articles that met the first 3 were also presented as supplementary articles. Results and requirements were synthesized thematically. Results: Overall, 6608 abstracts were screened, and 266 articles underwent full-text review to identify 8 articles describing the development and evaluation of 7 different return of results systems. In total, 7 of the 8 articles reported the use of multimodal dissemination methods, including a combination of physical documents, emails, phone calls, and digital platforms to support text and graphical data representations. One article outlined accessibility features to serve the specific participant population. None of the articles described in detail how results were or were not anonymized. A total of 4 studies relied on an expert or clinician to share results on behalf of the research team. Additional educational or contextual materials were included alongside results in four studies, including specific materials designed for follow-up with experts and clinicians. Participants were not hesitant to receive unfavorable results and instead aimed to incorporate such information into their lives via lifestyle changes, clinical intervention, or seeking community. Conclusions: Return of results systems should support multiple modes of dissemination for text-based results. Additional educational and lay-language materials are helpful for participants to understand and use information gained from receiving results. %R 10.2196/65606 %U https://www.i-jmr.org/2025/1/e65606 %U https://doi.org/10.2196/65606 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e56240 %T Economic Evaluations and Equity in the Use of Artificial Intelligence in Imaging Examinations for Medical Diagnosis in People With Dermatological, Neurological, and Pulmonary Diseases: Systematic Review %A Santana,Giulia Osório %A Couto,Rodrigo de Macedo %A Loureiro,Rafael Maffei %A Furriel,Brunna Carolinne Rocha Silva %A de Paula,Luis Gustavo Nascimento %A Rother,Edna Terezinha %A de Paiva,Joselisa Péres Queiroz %A Correia,Lucas Reis %K machine learning %K ML %K artificial intelligence %K AI %K algorithm %K algorithms %K economic evaluation %K equity %D 2025 %7 13.8.2025 %9 %J Interact J Med Res %G English %X Background: Health care systems around the world face numerous challenges. Recent advances in artificial intelligence (AI) have offered promising solutions, particularly in diagnostic imaging. Objective: This systematic review focused on evaluating the economic feasibility of AI in real-world diagnostic imaging scenarios, specifically for dermatological, neurological, and pulmonary diseases. The central question was whether the use of AI in these diagnostic assessments improves economic outcomes and promotes equity in health care systems. Methods: This systematic review has 2 main components, economic evaluation and equity assessment. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool to ensure adherence to best practices in systematic reviews. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews), and we followed the PRISMA-E (Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Equity Extension) guidelines for equity. Scientific articles reporting on economic evaluations or equity considerations related to the use of AI-based tools in diagnostic imaging in dermatology, neurology, or pulmonology were included in the study. The search was conducted in the PubMed, Embase, Scopus, and Web of Science databases. Methodological quality was assessed using the following checklists, CHEC (Consensus on Health Economic Criteria) for economic evaluations, EPHPP (Effective Public Health Practice Project) for equity evaluation studies, and Welte for transferability. Results: The systematic review identified 9 publications within the scope of the research question, with sample sizes ranging from 122 to over 1.3 million participants. The majority of studies addressed economic evaluation (88.9%), with most studies addressing pulmonary diseases (n=6; 66.6%), followed by neurological diseases (n=2; 22.3%), and only 1 (11.1%) study addressing dermatological diseases. These studies had an average quality access of 87.5% on the CHEC checklist. Only 2 studies were found to be transferable to Brazil and other countries with a similar health context. The economic evaluation revealed that 87.5% of studies highlighted the benefits of using AI in dermatology, neurology, and pulmonology, highlighting significant cost-effectiveness outcomes, with the most advantageous being a negative cost-effectiveness ratio of –US $27,580 per QALY (quality-adjusted life year) for melanoma diagnosis, indicating substantial cost savings in this scenario. The only study assessing equity, based on 129,819 radiographic images, identified AI-assisted underdiagnosis, particularly in certain subgroups defined by gender, ethnicity, and socioeconomic status. Conclusions: This review underscores the importance of transparency in the description of AI tools and the representativeness of population subgroups to mitigate health disparities. As AI is rapidly being integrated into health care, detailed assessments are essential to ensure that benefits reach all patients, regardless of sociodemographic factors. Trial Registration: PROSPERO CRD42023407755; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023407755 International Registered Report Identifier (IRRID): RR2-10.2196/48544 %R 10.2196/56240 %U https://www.i-jmr.org/2025/1/e56240 %U https://doi.org/10.2196/56240 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e72231 %T Digital Interventions for Improving Body Dissatisfaction in Children and Emerging Adults: Systematic Review and Meta-Analysis %A Liu,Li %A Yang,Jianning %A Tan,Fengmei %A Yang,Xia %A Luo,Huan %A Chen,Yanhua %A Zhao,Xiaolei %K body dissatisfaction %K digital intervention %K children %K emerging adults %K systematic review %K meta-analysis %K PRISMA %D 2025 %7 13.8.2025 %9 %J Interact J Med Res %G English %X Background: Body dissatisfaction is a condition where individuals are dissatisfied with their physical appearance. It has become a global issue, especially among children and emerging adults. A growing number of digital interventions have been developed to address body dissatisfaction in children and emerging adults; however, controversies remain regarding their efficacy, underscoring the need for a comprehensive synthesis of current evidence. Objective: This systematic review aimed to explore the effectiveness of digital interventions in improving body image–related outcomes among children and emerging adults. Methods: From inception to April 24, 2024, a literature search was performed across 7 databases—PubMed, Web of Science, MEDLINE, EBSCO (Elton B Stephens Company), Cochrane Library, CNKI (China National Knowledge Infrastructure), and WANFANG—to identify randomized controlled trials (RCTs) with a predefined set of inclusion criteria. This systematic review was reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Study selection, data extraction, and risk of bias assessment using the Cochrane Risk-of-Bias Tool 2.0 were conducted independently by 2 researchers. Standardized mean differences (SMDs) and 95% CIs from the included RCTs were calculated for the meta-analysis. Heterogeneity was assessed with I² values. A fixed-effects model was used when I²≤50%, and a random-effects model was selected when I²>50%. Results: Twenty RCTs with 5251 participants (2610 in intervention groups and 2641 in control groups) met the inclusion criteria. Digital interventions included web pages, mobile apps, computer-based videos, computer-based sessions, internet-based sessions, internet games, chatbots, podcasts, and social media. Our results indicate that digital interventions could significantly improve body dissatisfaction (SMD=0.38, 95% CI −0.63 to −0.13; I2=55%; P=.003), physical appearance comparison (SMD=−0.24, 95% CI −0.45 to −0.03; I2=0%; P=.003), thin-ideal internalization (SMD=−0.28, 95% CI −0.36 to −0.2; I2=41%; P<.001), self-esteem (SMD=0.14, 95% CI 0.07-0.21; I2=21%; P<.001), self-compassion (SMD=0.55, 95% CI 0.33-0.78; I2=35%; P<.001), and depression (SMD=−0.59, 95% CI −0.97 to −0.21; I2=0%; P=.002), with small to medium effect sizes. Conclusions: While digital interventions improved body dissatisfaction among children and emerging adults, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the effectiveness of digital interventions on body dissatisfaction. Trial Registration: PROSPERO CRD42024567594; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567594 %R 10.2196/72231 %U https://www.i-jmr.org/2025/1/e72231 %U https://doi.org/10.2196/72231 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e69686 %T Cross-Platform Availability of Smartphone Sensors for Depression Indication Systems: Mixed-Methods Umbrella Review %A Leimhofer,Johannes %A Petrovic,Milica %A Dominik,Andreas %A Heider,Dominik %A Hegerl,Ulrich %+ , Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, Münster, 48149, Germany, 49 251 830, dominik.heider@uni-muenster.de %K umbrella review %K mobile phone %K smartphone %K sensor data %K digital health %K depression %K cross-platform %K data availability %D 2025 %7 7.8.2025 %9 Review %J Interact J Med Res %G English %X Background: A popular trend in depression forecasting research is the development of machine learning models trained with various types of smartphone sensor data and periodic self-ratings to derive early indications of changes in depression severity. While most works focus on model performance, there is little concern about the universal usability and reliable operation of such systems across smartphone platforms. This review serves as foundational work for the MENTINA clinical trial, which investigates smartphone-based health self-management for depression. The usability and reliability of mobile apps for depression are commonly perceived through the lens of the approaches and interventions offered rather than the reliability of the built-in mobile phone functions to support effortless and exact delivery of intended interventions. Objective: This work aimed to synthesize existing systematic reviews to identify smartphone sensor modalities used in mental health monitoring and, building on this foundation, assess the cross-platform availability of these data streams using PhoneDB to inform the design and implementation of digital depression indication systems. Methods: To identify the already used hardware and software sensors and their purposes in mental health monitoring, an umbrella review was conducted. Three electronic databases, including PubMed, Web of Science Core Collection, and Scopus, were searched using smartphone, sensor data, and depression keyword combination to retrieve relevant literature reviews published within the last 5 years (2019-2024). Once the initial search was completed, the extracted hardware sensors were checked for availability on Android and iOS smartphones by analyzing device specifications in PhoneDB over the last 10 years. Results: The extracted data streams observed across the 9 included studies covered 16 hardware and 3 software data streams. Hardware data streams included accelerometers, barometers, battery levels, Bluetooth, cameras, cellular networks, GPSs, gyroscopes, humidity, light sensors, magnetometers, proximity sensors, sound sensors, step counters, temperature sensors, and Wi-Fi. Software data streams included app usage, call and message logs, and screen status. Hardware component availability on Android and iOS systems showed the changes in component trends from 2014 to 2024 as of September 2024, with the accelerometers, batteries, cameras, and GPSs remaining consistent on Android and iOS, while components such as gyroscopes, step counters, and barometers gradually increased over the years, particularly on Android. Conclusions: Multiple data streams identified in the literature review showed a consistent increase in availability over time, enabling improved use of these outputs for depression forecasting and the training of machine learning models with diverse smartphone data, including sensor-derived information. For more precise and reliable data to be used in the mental health field, particularly in critical areas such as tracking and predicting changes in depression severity, further research is required to streamline smartphone data across varying mobile hardware and software configurations to provide reliable output for digital mental health purposes. %M 40773748 %R 10.2196/69686 %U https://www.i-jmr.org/2025/1/e69686 %U https://doi.org/10.2196/69686 %U http://www.ncbi.nlm.nih.gov/pubmed/40773748 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e73656 %T Guideline-Based Digital Exercise Interventions for Reducing Body Weight and Fat and Promoting Physical Activity in Adults With Overweight and Obesity: Systematic Review and Meta-Analysis %A Motevalli,Mohamad %A Drenowatz,Clemens %A Tanous,Derrick %A Ruedl,Gerhard %A Kirschner,Werner %A Schauer,Markus %A Rosemann,Thomas %A Wirnitzer,Katharina %+ Department of Sport Science, University of Innsbruck, Fürstenweg 185, Innsbruck, 6020, Austria, 43 67763778121, mohamad.motevalli@uibk.ac.at %K technology %K mobile health %K mHealth %K eHealth %K ubiquitous Health %K uHealth %K smartphone %K weight loss %K body composition %K adulthood %K training %K fitness %D 2025 %7 7.8.2025 %9 Review %J Interact J Med Res %G English %X Background: Digitally delivered physical exercise interventions are becoming increasingly popular in addressing the obesity epidemic. However, there remains uncertainty on their efficacy regarding the reduction of body weight (BW) and body fat, which may, at least partly, be due to variations in study designs and inconsistent adherence to international physical activity (PA) guidelines. Objective: This study aimed to evaluate the effectiveness of digital exercise interventions based on PA guidelines in reducing BW and fat in adults with overweight or obesity, as well as their impact on PA-related factors. Methods: This review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Comprehensive searches were performed in October 2024 across PubMed, Cochrane Library, Web of Science, and Ovid MEDLINE databases. Eligible studies included adults (aged ≥18 years) with objectively confirmed overweight or obesity who used digital interventions aligned with international PA guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias (version 2) tool for randomized controlled trials and the Risk of Bias in Nonrandomized Studies of Interventions tool for nonrandomized studies. A random-effects meta-analysis with Hartung-Knapp adjustment was performed using R software. Results: Out of 4948 studies identified, 188 (3.8%) were screened in full and 30 (0.6%) met the eligibility criteria. Intervention durations ranged from 8 weeks to 24 months (average 6.4, SD 5.5 months). Meta-analysis showed that guideline-based digital exercise interventions significantly reduced BW compared to controls (mean difference [MD]=−1.17 kg; P=.003; I2=0.0%), with subgroup analysis revealing greater effects in active (nondigital) controls (MD=−1.23 kg; I2=7.5%) compared to passive (waitlist) controls (MD=−0.52 kg; I2=0.0%). A significant reduction in BMI was observed (MD=−0.50 kg/m2; P=.003), although with substantial heterogeneity (I2=70.0%), and subgroup analysis showed greater effects compared to passive controls (MD=−0.70 kg/m2; I2=43.1%) rather than to active controls (MD=−0.45 kg/m2; I2=74.5%). No significant effect was observed for body fat percentage overall (MD=−0.08%; P=.84; I2=7.4%). Qualitative analysis (including findings from noncomparative studies) showed that guideline-based digital exercise interventions led to significant reductions in BW (22/25, 88% studies; range −1.3 to −8.4 kg); BMI (19/23, 83% of studies; range −0.4 to −3.4 kg/m2); waist circumference (15/16, 94% of studies; range −2.1 to −9.2 cm), body fat percentage (9/9, 100% of studies; range −0.3% to −4.1%); and fat mass (7/7, 100% of studies; range −0.4 to −6.5 kg), while findings for waist-to-hip ratio and PA outcomes were inconsistent. Conclusions: Guideline-based digital PA and exercise interventions show potential in reducing excess BW in adults with overweight or obesity, with stronger effects when compared to nondigital interventions. However, their superiority over traditional methods is uncertain for BMI and body composition. Substantial variations in study designs present challenges in drawing definitive conclusions on specific characteristics of effective digital exercise tools. Trial Registration: PROSPERO CRD42024620020; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024620020 %M 40773286 %R 10.2196/73656 %U https://www.i-jmr.org/2025/1/e73656 %U https://doi.org/10.2196/73656 %U http://www.ncbi.nlm.nih.gov/pubmed/40773286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65443 %T Evaluation of the Aspects of Digital Interventions That Successfully Support Weight Loss: Systematic Review With Component Network Meta-Analysis %A Nunns,Michael %A Febrey,Samantha %A Abbott,Rebecca %A Buckland,Jill %A Whear,Rebecca %A Shaw,Liz %A Bethel,Alison %A Boddy,Kate %A Thompson Coon,Jo %A Melendez-Torres,G.J. %+ Isca Evidence, University of Exeter Medical School, Faculty of Health & Life Sciences, University of Exeter, Exeter, United Kingdom, 44 01392726064, g.j.melendez-torres@exeter.ac.uk %K systematic review %K component network meta-analysis %K obesity %K digital interventions %K digital technology %K weight loss %K PRISMA %D 2025 %7 22.5.2025 %9 Review %J J Med Internet Res %G English %X Background: Obesity is a chronic complex disease associated with increased risks of developing several serious and potentially life-threatening conditions. It is a growing global health issue. Pharmacological treatment is an option for patients living with overweight or obesity. Digital technology may be leveraged to support patients with weight loss in the community, but it is unclear which of the multiple digital options are important for success. Objective: This systematic review and component network meta-analysis aimed to identify components of digital support for weight loss interventions that are most likely to be effective in supporting patients to achieve weight loss goals. Methods: We searched MEDLINE, Embase, APA PsycInfo, and Cochrane Central Register of Controlled Trials from inception to November 2023 for randomized controlled trials using any weight loss intervention with digital components and assessing weight loss outcomes in adults with BMI ≥25 kg/m2 (≥23 kg/m2 for Asian populations). Eligible trials were prioritized for synthesis based on intervention relevance and duration, and the target population. Trial arms with substantial face-to-face elements were deprioritized. Prioritized trials were assessed for quality using the Cochrane Risk of Bias Tool v1. We conducted intervention component analysis to identify key digital intervention features and a coding framework. All prioritized trial arms were coded using this framework and were included in component network meta-analysis. Results: Searches identified 6528 reports, of which 119 were included. After prioritization, 151 trial arms from 68 trials were included in the synthesis. Nine common digital components were identified from the 151 trial arms: provision of information or education, goal setting, provision of feedback, peer support, reminders, challenges or competitions, contact with a specialist, self-monitoring, and incentives or rewards. Of these, 3 components were identified as “best bets” because they were consistently and numerically, but not usually significantly, most likely to be associated with weight loss at 6 and 12 months. These were patient information, contact with a specialist, and incentives or rewards. An exploratory model combining these 3 components was significantly associated with successful weight loss at 6 months (–2.52 kg, 95% CI –4.15 to –0.88) and 12 months (–2.11 kg, 95% CI –4.25 to 0.01). No trial arms used this specific combination of components. Conclusions: Our findings indicate that the design of digital interventions to support weight loss should be carefully crafted around core components. On their own, no single digital component could be considered essential for success, but a combination of information, specialist contact, and incentives warrants further examination. Trial Registration: PROSPERO CRD42023493254; https://tinyurl.com/ysyj8j8s %M 40403296 %R 10.2196/65443 %U https://www.jmir.org/2025/1/e65443 %U https://doi.org/10.2196/65443 %U http://www.ncbi.nlm.nih.gov/pubmed/40403296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62793 %T Smart Home Advancements for Health Care and Beyond: Systematic Review of Two Decades of User-Centric Innovation %A Park,Youna %A Han,Jieun %+ , Graduate School of Technology and Innovation Management, Hanyang University, Multidisciplinary Lecture Hall 709, Wangsimni-ro 222, Seoul, 04763, Republic of Korea, 82 02 2220 2279, juliahanje@hanyang.ac.kr %K smart home %K systematic literature review %K thematic analysis %K health care %K user needs %K ambient intelligent home %K user centric innovation %D 2025 %7 20.5.2025 %9 Review %J J Med Internet Res %G English %X Background: The rapid advancement of Internet of Things and artificial intelligence technologies has driven significant growth in the demand for smart home products, with household penetration projected to increase from 77.6% in 2025 to 92.5% in 2029. Despite this growth, much of the existing research adopts a technology-push approach, focusing primarily on user adoption and acceptance from the perspective of technology providers rather than addressing the evolving needs and experiences of users. Objective: This study seeks to bridge this gap by conducting a comprehensive review of 20 years of smart home literature (2000-2023) using bibliometric and thematic analysis. The objective is to align future research with user needs and market trends by examining technology, user behavior, and service perspectives to inform academic and industry developments. Methods: The analysis was carried out in four steps: (1) collecting 5981 abstracts from the Web of Science database (from 2000 to the first half of 2023), (2) preprocessing and refining the data, (3) applying topic modeling to 1003 selected papers, and (4) combining bibliometric network analysis with qualitative, in-depth interpretation. Results: This study identified 110 key topics across 4 distinct periods, providing insights into 2 decades of advancements in technology, applications, and user-centered research. The findings illustrate the progression of smart home technologies from wireless networks to Internet of Things and artificial intelligence, the expansion of services from basic monitoring to applications such as energy management and health care, and a shift in user profiles from early adopters to underserved populations. The study highlights the limitations of the technology-push approach and underscores the importance of understanding diverse user groups and improving user experiences. It also emphasizes the potential of ambient intelligence environments to intuitively adapt to the health and lifestyle needs of all residents, simplifying and enriching daily life. Conclusions: This research delivers valuable academic and practical insights into the evolution of the smart home domain, showcasing a shift from technology-push strategies to user-centered approaches. By prioritizing user satisfaction and quality of life—especially in health care—the findings open new commercial opportunities and pave the way for innovative, real-world smart home solutions tailored to contemporary user needs. %M 40392590 %R 10.2196/62793 %U https://www.jmir.org/2025/1/e62793 %U https://doi.org/10.2196/62793 %U http://www.ncbi.nlm.nih.gov/pubmed/40392590 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e73517 %T Ethical Challenges and Opportunities of AI in End-of-Life Palliative Care: Integrative Review %A García Abejas,Abel %A Geraldes Santos,David %A Leite Costa,Fabio %A Cordero Botejara,Aida %A Mota-Filipe,Helder %A Salvador Vergés,Àngels %+ Board of Directors, Innohealth.Academy, Magi Casanovas 11, Sitges, Barcelona, 08870, Spain, 34 630887995, angels.salvador@innohealth.academy %K palliative medicine %K artificial intelligence (AI) %K ethical implications %K end-of-life care %K patient-centred care %D 2025 %7 14.5.2025 %9 Review %J Interact J Med Res %G English %X Background: Artificial intelligence (AI) is increasingly integrated into palliative medicine, offering opportunities to improve quality, efficiency, and patient-centeredness in end-of-life care. However, its use raises complex ethical issues, including privacy, equity, dehumanization, and decision-making dilemmas. Objective: We aim to critically analyze the main ethical implications of AI in end-of-life palliative care and examine the benefits and risks. We propose strategies for ethical and responsible implementation. Methods: We conducted an integrative review of studies published from 2020 to 2025 in English, Portuguese, and Spanish, identified through systematic searches in PubMed, Scopus, and Google Scholar. Inclusion criteria were studies addressing AI in palliative medicine focusing on ethical implications or patient experience. Two reviewers independently performed study selection and data extraction, resolving discrepancies by consensus. The quality of the papers was assessed using the Critical Appraisal Skills Programme checklist and the Hawker et al tool. Results: Six key themes emerged: (1) practical applications of AI, (2) communication and AI tools, (3) patient experience and humanization, (4) ethical implications, (5) quality of life perspectives, and (6) challenges and limitations. While AI shows promise for improving efficiency and personalization, consolidated real-world examples of efficiency and equity remain scarce. Key risks include algorithmic bias, cultural insensitivity, and the potential for reduced patient autonomy. Conclusions: AI can transform palliative care, but implementation must be patient-centered and ethically grounded. Robust policies are needed to ensure equity, privacy, and humanization. Future research should address data diversity, social determinants, and culturally sensitive approaches. %M 40302210 %R 10.2196/73517 %U https://www.i-jmr.org/2025/1/e73517 %U https://doi.org/10.2196/73517 %U http://www.ncbi.nlm.nih.gov/pubmed/40302210 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e66336 %T Innovative, Technology-Driven, Digital Tools for Managing Pediatric Urinary Incontinence: Scoping Review %A Bladt,Lola %A Vermeulen,Jiri %A Vermandel,Alexandra %A De Win,Gunter %A Van Campenhout,Lukas %+ Department of Product Development, Faculty of Design Sciences, University of Antwerp, Paardenmarkt 90/94, Antwerp, 2000, Belgium, 32 497848014, lola.bladt@uantwerpen.be %K pediatric urinary incontinence %K nocturnal enuresis %K behavioral therapy %K urotherapy %K patient compliance %K digital health %K serious games %K telehealth %K health technology %K enuresis alarm %K artificial intelligence %K AI %D 2025 %7 5.5.2025 %9 Review %J Interact J Med Res %G English %X Background: Urinary incontinence affects approximately 7% to 10% of children during the day and 9% to 12% of children during the night. Treatment mainly involves lifestyle advice and behavioral methods, but motivation and adherence are low. Traditional tools such as pen-and-paper solutions may feel outdated and no longer meet the needs of today’s “digital native” children. Meanwhile, digital interventions have already shown effectiveness in other pediatric health care areas. Objective: This scoping review aimed to identify and map innovative, technology-driven, digital tools for managing pediatric urinary incontinence. Methods: PubMed, Web of Science, and the Cochrane Library were searched in March 2022 without date restrictions, complemented by cross-referencing. Studies were eligible if they focused on pediatric patients (aged ≤18 years) with bladder and bowel dysfunctions and explored noninvasive, technology-based interventions such as digital health, remote monitoring, and gamification. Studies on adults, invasive treatments, and conventional methods without tangible tools were excluded. Gray literature was considered, but non–English-language, inaccessible, or result-lacking articles were excluded. A formal critical appraisal was not conducted as the focus was on mapping existing tools rather than evaluating effectiveness. Data analysis combined descriptive statistics and qualitative content analysis, categorizing tools through iterative coding and team discussions. Results: In total, 66 articles were included, with nearly one-third (21/66, 32%) focusing on nocturnal enuresis. Our analysis led to the identification of six main categories of tools: (1) digital self-management (7/66, 11%); (2) serious games (7/66, 11%); (3) reminder technology (6/66, 9%); (4) educational media (12/66, 18%), further divided into video (5/12, 42%) and other media (7/12, 58%); (5) telehealth and remote patient monitoring (13/66, 20%), with subcategories of communication (5/13, 38%) and technological advances (8/13, 62%); and (6) enuresis alarm innovations (21/66, 32%), further divided into novel configurations (8/21, 38%) and prevoid alarms (13/21, 62%). Conclusions: The field of pediatric urinary incontinence demonstrates a considerable level of innovation, as evidenced by the inclusion of 66 studies. Many tools identified in this review were described as promising and feasible alternatives to traditional methods. These tools were reported to enhance engagement, improve compliance, and increase patient satisfaction and preference while also having the potential to save time for health care providers. However, this review also identified gaps in research, highlighting the need for more rigorous research to better assess the tools’ effectiveness and address the complex, multifaceted challenges of pediatric urinary incontinence management. Limitations of this review include restricting the search to 3 databases, excluding non–English-language articles, the broad scope, and single-reviewer screening, although frequent team discussions ensured rigor. We propose that future tools should integrate connected, adaptive, and personalized approaches that align with stakeholder needs, guided by a multidisciplinary, human-centered framework combining both qualitative and quantitative insights. %M 40324170 %R 10.2196/66336 %U https://www.i-jmr.org/2025/1/e66336 %U https://doi.org/10.2196/66336 %U http://www.ncbi.nlm.nih.gov/pubmed/40324170 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e57958 %T Reasons for Crown Failures in Primary Teeth: Systematic Review and Meta-Analysis %A Lampl,Stephan %A Gurunathan,Deepa %A Mehta,Deepak %A Jogikalmat,Krithikadatta %K primary teeth %K pediatrics %K children %K biological complications %K technical complications %K survival rates %K dental %K oral %K dentist %K synthesis %K review methods %K search %K systematic %K meta-analysis %K complication %K crown %D 2025 %7 1.5.2025 %9 %J Interact J Med Res %G English %X Background: Understanding long-term retention rates and complications associated with different materials for fabricating pediatric crowns for primary teeth is crucial for material selection and optimizing clinical outcomes. Objectives: This systematic review aimed to descriptively analyze the crown-retention rates and complications associated with crown retention, as well as the biological and technical complications of pediatric crowns, for primary teeth. The meta-analysis reported herein was performed to estimate long-term (3-year and 5-year) retention rates of these pediatric crowns fabricated using various materials. Methods: Using the PICOS (Population, Intervention, Comparison, Outcomes, and Study design) paradigm, a systematic search was conducted between July and August 2023 in the Cochrane, Embase, and PubMed databases to identify randomized controlled trials (RCTs) and clinical (prospective and retrospective) studies reporting retention rates, complications of crown retention, and biological and technical complications. After selecting studies with a predefined set of selection criteria, data from included studies were used for a systematic review aimed at a descriptive analysis of factors associated with the failure of crowns for primary teeth. Data from the included RCTs were used for meta-analysis, wherein 3-year and 5-year crown-retention rates were estimated using Poisson regression models. Results: This systematic review included 13 RCTs and 5 clinical studies on dental crowns for primary teeth, involving 454 children (1172 crowns) in RCTs and 810 children (2667 crowns) in clinical studies. The median follow-up durations were 12 months for RCTs and 20.8 months for clinical studies, with a 10.6% (124/1172) dropout rate in RCTs. Meta-analysis of pooled 5-year retention rates for different crown materials revealed the following retention rates: 88.90% for compomer crowns, 92.18% for composite resin crowns, 90.30% for resin-modified glass ionomer cement (RMGIC) crowns, and 97.88% for stainless steel crowns. Additionally, strip crowns exhibited a retention rate of 83.48%, while zirconia crowns had a retention rate of 97.09%. Poisson regression estimated 3-year and 5-year crown-retention rates, indicating good outcomes across materials. Complications included secondary caries (up to 21.8% in zirconia crowns) and marginal adaptation issues (up to 22.2% in compomer crowns). These findings highlight material-specific considerations necessary for optimizing outcomes in pediatric dental crown treatments. Conclusion: While retentive complications such as chipping, material loss, and fractures do occur across materials, compomer, composite resin, stainless steel, strip, and zirconia crowns all have clinically acceptable retention rates. However, the differences in biological and technical complications between materials may provide insights for selecting appropriate materials for pediatric crowns based on clinical considerations. Trial Registration: PROSPERO CRD42023442266; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023442266 International Registered Report Identifier (IRRID): RR2-10.2196/51505 %R 10.2196/57958 %U https://www.i-jmr.org/2025/1/e57958 %U https://doi.org/10.2196/57958 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67877 %T Evidence of Interventions for the Prevention of Unintentional Injuries: Scoping Review %A Shetty,Sheela %A Nayak,Baby S %A George,Anice %A Shetty,Avinash %A Guddattu,Vasudeva %K prevention %K injury %K education %K health %K child %K children %K unintentional injury %K disability %K youth %K surveillance %K surveillance data %K risk factor %K injury intervention %K literature search %K scoping review %K scoping literature review %K policymaker %K preventative measure %K preventive measure %D 2025 %7 28.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Unintentional injuries are the leading cause of death and disability among young children. Preventive strategies for unintentional injuries are mainly based on surveillance data and identifying risk factors. Objective: This study aimed to review and synthesize published literature that determined the effectiveness of interventions for preventing unintentional injuries among children. Methods: The methodological framework was supported by The Joanna Briggs Institute Reviewer’s Manual – Methodology for JBI Scoping Reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The inclusion criteria to include the studies in the review were unintentional injuries in children, interventions to prevent injuries, a brief description of the intervention and the outcome of the intervention, and articles published in a peer-reviewed journal and written in the English language. Results: In total, 21 articles were included in the review following the systematic search of key databases such as Web of Science, PubMed/MEDLINE, Scopus, ScienceDirect, and gray literature for studies published between July 2013 and May 2023. Of the 21 articles, 16 were randomized controlled trials, 4 were nonrandomized controlled trials, and 1 was a mixed method study. The findings of the review showed that interventions, either as a single measure (video-based teaching, testimonial story-based teaching, health education, storybook reading) or in combination (knowledge quiz and simulation test, module-based teaching along with personal counseling, and teaching with the help of video and poster), have shown a considerable decline in the number and severity of injuries. The studies included various target populations, including children and adolescents between 0 and 19 years old. Conclusions: The review results indicate the need to plan, implement, and reinforce preventive measures and techniques to reduce unintentional injuries among children. They can also serve as a useful indicator for policymakers. %R 10.2196/67877 %U https://pediatrics.jmir.org/2025/1/e67877 %U https://doi.org/10.2196/67877 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e64826 %T Informatics Interventions for Maternal Morbidity: Scoping Review %A Inderstrodt,Jill %A Stumpff,Julia C %A Smollen,Rebecca C %A Sridhar,Shreya %A El-Azab,Sarah A %A Ojo,Opeyemi %A Bowns,Brendan %A Haggstrom,David A %+ Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States, 1 3176903316, ji3@iu.edu %K scoping review %K maternal morbidity %K medical informatics %K clinical informatics %K mother %K pregnant %K perinatal %K GDM %K preeclampsia %K maternity %K gestational diabetes mellitus %D 2025 %7 25.3.2025 %9 Review %J Interact J Med Res %G English %X Background: Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention–defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations. %M 40132184 %R 10.2196/64826 %U https://www.i-jmr.org/2025/1/e64826 %U https://doi.org/10.2196/64826 %U http://www.ncbi.nlm.nih.gov/pubmed/40132184 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e67290 %T Comparison of Outcomes Between Staged and Same-Day Circumferential Spinal Fusion for Adult Spinal Deformity: Systematic Review and Meta-Analysis %A Dagli,Mert Marcel %A Turlip,Ryan William %A Oettl,Felix C %A Emara,Mohamed %A Gujral,Jaskeerat %A Chauhan,Daksh %A Ahmad,Hasan S %A Santangelo,Gabrielle %A Wathen,Connor %A Ghenbot,Yohannes %A Arena,John D %A Golubovsky,Joshua L %A Gu,Ben J %A Shin,John H %A Yoon,Jang Won %A Ozturk,Ali K %A Welch,William C %+ Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 801 Spruce Street, Philadelphia, PA, 19107, United States, 1 2672306493, Marcel.Dagli@Pennmedicine.upenn.edu %K adults %K circumferential fusion %K scoliosis %K spinal curvature %K spinal fusion %K spinal deformity %K intraoperative %K postoperative %K perioperative %K systematic reviews %K meta-analysis %K PRISMA %D 2025 %7 6.3.2025 %9 Review %J Interact J Med Res %G English %X Background: Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as staged or same-day procedures. However, evidence guiding the choice between these approaches is lacking. Objective: This study aims to compare patient outcomes following staged and same-day CF for ASD. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in PubMed, MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus. Eligibility criteria included studies comparing outcomes following staged and same-day CF in adults with ASD. Searches were exported to Covidence, and records were deduplicated automatically. Title and abstract screening, full-text review, and data extraction were performed by two independent reviewers, with all conflicts being resolved by a third reviewer. A meta-analysis was conducted for outcomes reported in 3 or more studies. Results: Seven studies with 741 patients undergoing CF for ASD were included in the review (staged: n=331, 44.7% and same-day: n=410, 55.3%). Four studies that had comparable outcomes were merged for the quantitative meta-analysis and split based on observed measures. The meta-analysis revealed significantly shorter hospital length of stay (mean difference 3.98, 95% CI 2.23-5.72 days; P<.001) for same-day CF. Three studies compared the operative time between staged and same-day CF, with all reporting a lower mean operative time for same-day CF (mean between 291-479, SD 129 minutes) compared to staged CF (mean between 426-541, SD 124 minutes); however, inconsistent reporting of mean and SD made quantitative analyses unattainable. Of the 4 studies that compared estimated blood loss (EBL) in the relevant groups, 3 presented a lower EBL (mean between 412-1127, SD 954 mL) in same-day surgery compared to staged surgery (mean between 642, SD 550 to 1351, SD 869 mL). Both studies that reported intra- and postoperative adverse events showed more intraoperative adverse events in staged CF (10.9% and 13.6%, respectively) compared to same-day CF (9.1% and 3.6%, respectively). Four studies measuring any perioperative adverse events showed a higher incidence of adverse events in staged CF than all studies combined. However, quantitative analysis of EBL, intraoperative adverse events, and perioperative adverse events found no statistically significant difference. Postoperative adverse events, reoperation, infection rates, and readmission rates showed inconsistent findings between studies. Data quality assessment revealed a moderate degree of bias for all included studies. Conclusions: Same-day CF may offer shorter operating time and hospital stay compared to staged CF for ASD. However, there was marked heterogeneity in perioperative outcomes reporting, and continuous variables were inconsistently presented. This underscored the need for standardized reporting of clinical variables and patient-reported outcomes and higher evidence of randomized controlled trials to elucidate the clinical superiority of either approach. Trial Registration: PROSPERO CRD42022339764; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339764 International Registered Report Identifier (IRRID): RR2-10.2196/42331 %M 40053742 %R 10.2196/67290 %U https://www.i-jmr.org/2025/1/e67290 %U https://doi.org/10.2196/67290 %U http://www.ncbi.nlm.nih.gov/pubmed/40053742 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e63959 %T Therapeutic Guidelines for the Self-Management of Major Depressive Disorder: Scoping Review %A de Campos Tibúrcio,Priscila %A Maria Marcheti,Priscila %A Miori Pascon,Daniela %A Montebello Junior,Marco Antônio %A Alzete de Lima,Maria %A Fernandes,Carla Sílvia %A Samarina Vilaça de Brito Santos,Célia %A Socorro de Sousa Nóbrega,Maria do Perpétuo %+ School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, São Paulo, 05403-000, Brazil, 55 19997889041, priscila.campostib13@gmail.com %K major depressive disorder %K nursing %K revision %K self-management %K symptoms %K PRISMA %D 2025 %7 6.3.2025 %9 Review %J Interact J Med Res %G English %X Background: Major depressive disorder contributes to the global burden of mental illness. Therapeutic guidelines promote treatment self-management and support caregivers and family members in this process. Objective: We aimed to identify therapeutic guidelines for the symptoms of major depressive disorder. Methods: This scoping review followed the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) protocol, carried out in 12 databases (LILACS, PubMed, SciELO, Scopus, Web of Science, b-on, BDENF, AgeLine, Cochrane, BVS, IBECS, and CINAHL) and 5 secondary gray literature sources (Google Scholar, Global ETD Search, EBSCO Open Dissertations, CAPES Catalog of Theses and Dissertations, and the Digital Library of Theses and Dissertations of the University of Sao Paulo). The eligibility criteria were based on the population, concept, and context framework: people diagnosed with major depressive disorder aged >18 years (population), therapeutic guidelines for self-management of major depressive disorder symptoms (concept), and symptoms of major depressive disorder (context). Data collection was carried out from March to July 2022 and updated in June 2024. The included studies were experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, or quantitative studies; systematic reviews and meta-analyses; and scoping and literature reviews published in full without time restrictions in English, Spanish, or Portuguese. All the information, as well as the studies captured, was stored in a Microsoft Excel spreadsheet using Rayyan and the JBI Manual for Evidence Synthesis. The titles, abstracts, and full texts were carefully read and classified, extracting the results. After review by 2 independent researchers, 62 studies were selected. The results are presented descriptively, including characterization of the studies and mapping and categorization of groups and subgroups of therapeutic guidelines for self-management of major depressive disorder. Results: In total, 62 studies published between 2011 and 2023 were included, where 44 (71%) came from indexed data sources and 18 (29%) were gray literature indexed on Google Scholar (13/62, 21%), doctoral theses (3/62, 5%), and master’s dissertations (2/62, 3%). Among the therapeutic guidelines identified, mapped, and categorized, 7 major groups were identified for self-management: psychotherapy (32/62, 52%), adoption of healthy habits (25/62, 40%), integrative and complementary practices (17/62, 27%), relaxation techniques (9/62, 14%), consultation with a health professional (14/62, 22%), pharmacological therapy (9/62, 14%), and leisure or pleasurable activities (4/62, 6%). Conclusions: It was possible to identify therapeutic guidelines to promote self-management of major depressive disorder in the adult population. Therapeutic guidance is an important resource for patients, their families, and the community, making patients the protagonists of their own health. For health professionals, therapeutic guidelines become tools that help develop skills and competencies for care among patients, thus ensuring their ability to self-manage major depressive disorder. %M 40053745 %R 10.2196/63959 %U https://www.i-jmr.org/2025/1/e63959 %U https://doi.org/10.2196/63959 %U http://www.ncbi.nlm.nih.gov/pubmed/40053745 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e45367 %T Global Evidence on the Sustainability of Telemedicine in Outpatient and Primary Care During the First 2 Years of the COVID-19 Pandemic: Scoping Review Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework %A Valdes,Daniela %A Shanker,Ankit %A Hijazi,Ghofran %A Mensah,Daniel Opoku %A Bockarie,Tahir %A Lazar,Ioana %A Ibrahim,Siti Aishah %A Zolfagharinia,Hamid %A Procter,Rob %A Spencer,Rachel %A Dale,Jeremy %A Paule,Armina %A Medlin,Liam Jonathon %A Tharuvara Kallottil,Keerthana %+ Department of Computer Science, University of Warwick, 6 Lord Bhattacharyya Way, Coventry, CV4 7AL, United Kingdom, 44 7943058485, daniela.valdes@warwick.ac.uk %K pandemic %K primary care %K outpatients %K telemedicine %K ambulatory care %K global health %K patient experience %K NASSS %K clinician-patient relationship %K health inequalities %K gray literature %K PRISMA %D 2025 %7 28.2.2025 %9 Review %J Interact J Med Res %G English %X Background: The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about the sustainability of this intervention at the global level. Objective: This research examines the patient experience, health inequalities, and clinician-patient relationship in telemedicine during the COVID-19 pandemic’s first 2 years, aiming to identify sustainability factors. Methods: This study was based on a prepublished protocol using the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included academic and gray literature published between March 2020 and March 2022 according to these criteria: (1) population (any group); (2) concepts (patient experience, clinician-patient relationship, health inequalities); (3) context (telemedicine in primary and outpatient care); (4) excluding studies pertaining to surgery, oncology, and (inpatient) psychiatry. We searched Ovid Medline/PubMed (January 1, 2022), Web of Science (March 19, 2022), Google/Google Scholar (February and March 2022), and others. The risk of bias was not assessed as per guidance. We used an analysis table for the studies and color-coded tabular mapping against a health care technology adoption framework to identify sustainability (using double-blind extraction). Results: Of the 134 studies that met our criteria, 49.3% (66/134) reported no specific population group. Regarding the concepts, 41.8% (56/134) combined 2 of the concepts studied. The context analysis identified that 56.0% (75/134) of the studies referred to, according to the definition in the United Kingdom, an outpatient (ambulatory care) setting, and 34.3% (46/134) referred to primary care. The patient experience analysis reflected positive satisfaction and sustained access during lockdowns. The clinician-patient relationship impacts were nuanced, affecting interaction and encounter quality. When mapping to the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, 81.3% (109/134) of the studies referenced the innovation’s sustainability. Although positive overall, there were some concerns about sustainability based on quality, eHealth literacy, and access to health care for vulnerable migrants and the uninsured. Conclusions: We identified confusion between the concepts of patient experience and patient satisfaction; therefore, future research could focus on established frameworks to qualify the patient experience across the whole pathway and not just the remote encounter. As expected, our research found mainly descriptive analyses, so there is a need for more robust evidence methods identifying impacts of changes in treatment pathways. This study illustrates modern methods to decolonize academic research by using gray literature extracts in other languages. We acknowledge that the use of Google to identify gray literature at the global level and in other languages has implications on reproducibility. We did not consider synchronous text-based communication. Trial Registration: Open Science Framework 4z5ut; https://osf.io/4z5ut/ %M 40053716 %R 10.2196/45367 %U https://www.i-jmr.org/2025/1/e45367 %U https://doi.org/10.2196/45367 %U http://www.ncbi.nlm.nih.gov/pubmed/40053716 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e46441 %T Comparing Digital Versus Face-to-Face Delivery of Systemic Psychotherapy Interventions: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Erasmus,Pieter %A Borrmann,Moritz %A Becker,Jule %A Kuchinke,Lars %A Meinlschmidt,Gunther %+ , Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University Berlin, Stromstrasse 3b, Berlin, 10555, Germany, 49 30 300 117 710, gunther.meinlschmidt@ipu-berlin.de %K systemic psychotherapy %K family therapy %K adolescent %K systematic review %K meta-analysis %K face to face %K digital %K remote %K distance %K telehealth %K delivery modality %D 2025 %7 24.2.2025 %9 Review %J Interact J Med Res %G English %X Background: As digital mental health delivery becomes increasingly prominent, a solid evidence base regarding its efficacy is needed. Objective: This study aims to synthesize evidence on the comparative efficacy of systemic psychotherapy interventions provided via digital versus face-to-face delivery modalities. Methods: We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for searching PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and PSYNDEX and conducting a systematic review and meta-analysis. We included randomized controlled trials comparing mental, behavioral, and somatic outcomes of systemic psychotherapy interventions using self- and therapist-guided digital versus face-to-face delivery modalities. The risk of bias was assessed with the revised Cochrane Risk of Bias tool for randomized trials. Where appropriate, we calculated standardized mean differences and risk ratios. We calculated separate mean differences for nonaggregated analysis. Results: We screened 3633 references and included 12 articles reporting on 4 trials (N=754). Participants were youths with poor diabetic control, traumatic brain injuries, increased risk behavior likelihood, and parents of youths with anorexia nervosa. A total of 56 outcomes were identified. Two trials provided digital intervention delivery via videoconferencing: one via an interactive graphic interface and one via a web-based program. In total, 23% (14/60) of risk of bias judgments were high risk, 42% (25/60) were some concerns, and 35% (21/60) were low risk. Due to heterogeneity in the data, meta-analysis was deemed inappropriate for 96% (54/56) of outcomes, which were interpreted qualitatively instead. Nonaggregated analyses of mean differences and CIs between delivery modalities yielded mixed results, with superiority of the digital delivery modality for 18% (10/56) of outcomes, superiority of the face-to-face delivery modality for 5% (3/56) of outcomes, equivalence between delivery modalities for 2% (1/56) of outcomes, and neither superiority of one modality nor equivalence between modalities for 75% (42/56) of outcomes. Consequently, for most outcome measures, no indication of superiority or equivalence regarding the relative efficacy of either delivery modality can be made at this stage. We further meta-analytically compared digital versus face-to-face delivery modalities for attrition (risk ratio 1.03, 95% CI 0.52-2.03; P=.93) and number of sessions attended (standardized mean difference –0.11; 95% CI –1.13 to –0.91; P=.83), finding no significant differences between modalities, while CIs falling outside the range of the minimal important difference indicate that equivalence cannot be determined at this stage. Conclusions: Evidence on digital and face-to-face modalities for systemic psychotherapy interventions is largely heterogeneous, limiting conclusions regarding the differential efficacy of digital and face-to-face delivery. Nonaggregated and meta-analytic analyses did not indicate the superiority of either delivery condition. More research is needed to conclude if digital and face-to-face delivery modalities are generally equivalent or if—and in which contexts—one modality is superior to another. Trial Registration: PROSPERO CRD42022335013; https://tinyurl.com/nprder8h %M 39993307 %R 10.2196/46441 %U https://www.i-jmr.org/2025/1/e46441 %U https://doi.org/10.2196/46441 %U http://www.ncbi.nlm.nih.gov/pubmed/39993307 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e51718 %T Process Evaluations of Interventions for the Prevention of Type 2 Diabetes in Women With Gestational Diabetes Mellitus: Systematic Review %A Sa'id,Iklil Iman Mohd %A Hotung,Natasha %A Benton,Madeleine %A Nadal,Iliatha Papachristou %A Baharom,Anisah %A Prina,Matthew %A Nisak Mohd Yusof,Barakatun %A Goldsmith,Kimberley %A Birts,Samantha %A Siew Mooi,Ching %A Forbes,Angus %A Ismail,Khalida %A Chew,Boon How %+ Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, Denmark Hill Campus, King’s College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 7905985068, khalida.2.ismail@kcl.ac.uk %K gestational diabetes mellitus %K randomized controlled trial %K process evaluation %K implementation %K complex interventions %D 2025 %7 6.2.2025 %9 Review %J Interact J Med Res %G English %X Background: Gestational diabetes mellitus (GDM) is characterized by hyperglycemia in pregnancy and typically resolves after birth. Women with GDM have an increased risk of developing type 2 diabetes mellitus (T2DM) later in life compared to those with normoglycemic pregnancy. While diabetes prevention interventions (DPIs) have been developed to delay or prevent the onset of T2DM, few studies have provided process evaluation (PE) data to assess the mechanisms of impact, quality of implementation, or contextual factors that may influence the effectiveness of the intervention. Objective: This study aims to identify and evaluate PE data and how these link to outcomes of randomized controlled trials (RCTs) of T2DM prevention interventions for women with GDM. Methods: A systematic review was conducted to identify studies published from 2005 to 2020 aiming to capture the most recent DPIs. Five electronic bibliographic databases (Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, Embase, PubMed, and MEDLINE) were searched to identify relevant studies. Inclusion criteria were published (peer-reviewed) RCTs of DPIs in women with a current diagnosis or history of GDM. Exclusion criteria were studies not published in English; studies where the target population was women who had a family history of T2D or women who were menopausal or postmenopausal; and gray literature, including abstracts in conference proceedings. The Medical Research Council’s PE framework of complex interventions was used to identify key PE components. The Mixed Method Appraisal Tool was used to assess the quality of included studies. Results: A total of 24 studies were included; however, only 5 studies explicitly reported a PE theoretical framework. The studies involved 3 methods of intervention delivery, including in person (n=7), digital (n=7), and hybrid (n=9). Two of the studies conducted pilot RCTs assessing the feasibility and acceptability of their interventions, including recruitment, participation, retention, program implementation, adherence, and satisfaction, and 1 study assessed the efficacy of a questionnaire to promote food and vegetable intake. While most studies linked PE data with study outcomes, it was unclear which of the reported PE components were specifically linked to the positive outcomes. Conclusions: While the Medical Research Council’s framework is a valuable source for conducting systematic reviews on PEs, it has been criticized for lacking practical advice on how to conduct them. The lack of information on PE frameworks in our review also made it difficult to categorize individual PE components against the framework. We need clearer guidance and robust frameworks for conducting PEs for the development and reporting of DPIs for women with GDM. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020208212; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=208212 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1177/16094069211034010 %M 39913176 %R 10.2196/51718 %U https://www.i-jmr.org/2025/1/e51718 %U https://doi.org/10.2196/51718 %U http://www.ncbi.nlm.nih.gov/pubmed/39913176 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e55835 %T The Effect of Combining mHealth and Health Professional–Led Intervention for Improving Health-Related Outcomes in Chronic Diseases: Systematic Review and Meta-Analysis %A Kanai,Masashi %A Miki,Takahiro %A Sakoda,Toshiya %A Hagiwara,Yuta %+ PREVENT Inc, IKKO Shinsakae Building 9F, 1 Aoi, Higashi-ku, Aichi, 461-0004, Japan, 81 527157955, miki.takahiro@prevent.co.jp %K mHealth %K systematic reviews %K meta-analysis %K chronic diseases %K global health %K technology %K health care %K interventions %K chronic conditions %K health care professionals %K World Health Organization %K physical activity %K web-based %D 2025 %7 20.1.2025 %9 Review %J Interact J Med Res %G English %X Background: Chronic diseases such as diabetes and cardiovascular disease are global health challenges, affecting millions of people worldwide. Traditional health care often falls short in chronic disease management. This has led to the exploration of innovative solutions, such as mobile health (mHealth) technologies. mHealth, which leverages mobile and wireless technologies, has the potential to transform health care delivery by providing continuous, accessible, and personalized care. However, the effectiveness of mHealth, particularly when integrated with traditional health care interventions delivered by professionals, warrants comprehensive investigation. Understanding the combined impact of mHealth and professional-led interventions is critical to maximizing the potential of mHealth to improve patient outcomes and adherence. Objective: This study aims to investigate the effectiveness of combining mHealth and health professional–led intervention for improving health-related outcomes in chronic diseases Methods: This systematic review and meta-analysis focused on randomized controlled trials. We searched Web of Science, CENTRAL, MEDLINE, and CINAHL through July 17, 2023. The study targeted patients aged 18 years and older, experiencing at least 1 chronic condition. The interventions were a combination of mHealth and the use of a health care professional. The comparison groups consisted of participants receiving either general care and follow-up or those using mHealth devices without any health care professional involvement. The outcomes measured in this review included hemoglobin A1c (HbA1c), quality of life (QoL), and physical activity. Results: The study included 26 research papers, encompassing 7360 individuals. Meta-analysis was conducted for HbA1c, QoL, and physical activity. For HbA1c, short-term improvement was significant (standardized mean difference [SMD] –0.43; 95% CI –0.64 to –0.21; I2=69%) and medium term (SMD –0.49; 95% CI –0.49 to –0.09; I2=21%). However, in the long term, the improvement was not significant (SMD –0.23; 95% CI –0.49 to 0.03; I2=88%). For QoL, significant improvements were observed in the short term (SMD –0.23; 95% CI –0.42 to –0.05; I2=62%), and in the medium term (SMD –0.16; 95% CI –0.24 to –0.07; I2=0%). In the long term, however, the improvement was not significant (SMD –0.12; 95% CI –0.41 to 0.16; I2=71%). For physical activity, both subjective (questionnaire) and objective (number of steps) outcomes were analyzed. In the short term, subjective outcomes showed significant improvement (SMD 0.31; 95% CI 0.12-0.50; I2=0%), while objective outcomes did not (SMD 0.11; 95% CI –0.05 to 0.27; I2=0%). Medium- and long-term subjective outcomes showed no significant improvement. Meta-analysis for objective outcomes in the medium and long term was not possible due to insufficient studies. Conclusions: This study confirmed short- and medium-term benefits of mHealth combined with professional interventions for HbA1c, QoL, and short-term physical activity, supporting effective chronic disease management. %M 39832160 %R 10.2196/55835 %U https://www.i-jmr.org/2025/1/e55835 %U https://doi.org/10.2196/55835 %U http://www.ncbi.nlm.nih.gov/pubmed/39832160 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57271 %T Unveiling the Influence of AI on Advancements in Respiratory Care: Narrative Review %A Alqahtani,Mohammed M %A Alanazi,Abdullah M M %A Algarni,Saleh S %A Aljohani,Hassan %A Alenezi,Faraj K %A F Alotaibi,Tareq %A Alotaibi,Mansour %A K Alqahtani,Mobarak %A Alahmari,Mushabbab %A S Alwadeai,Khalid %A M Alghamdi,Saeed %A Almeshari,Mohammed A %A Alshammari,Turki Faleh %A Mumenah,Noora %A Al Harbi,Ebtihal %A Al Nufaiei,Ziyad F %A Alhuthail,Eyas %A Alzahrani,Esam %A Alahmadi,Husam %A Alarifi,Abdulaziz %A Zaidan,Amal %A T Ismaeil,Taha %+ Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, MC-3129, PO Box 3660, Riyadh, 11481, Saudi Arabia, 966 501407856, Qahtanimoh@ksau-hs.edu.sa %K artificial intelligence %K AI %K respiratory care %K machine learning %K digital health %K narrative review %D 2024 %7 20.12.2024 %9 Review %J Interact J Med Res %G English %X Background: Artificial intelligence is experiencing rapid growth, with continual innovation and advancements in the health care field. Objective: This study aims to evaluate the application of artificial intelligence technologies across various domains of respiratory care. Methods: We conducted a narrative review to examine the latest advancements in the use of artificial intelligence in the field of respiratory care. The search was independently conducted by respiratory care experts, each focusing on their respective scope of practice and area of interest. Results: This review illuminates the diverse applications of artificial intelligence, highlighting its use in areas associated with respiratory care. Artificial intelligence is harnessed across various areas in this field, including pulmonary diagnostics, respiratory care research, critical care or mechanical ventilation, pulmonary rehabilitation, telehealth, public health or health promotion, sleep clinics, home care, smoking or vaping behavior, and neonates and pediatrics. With its multifaceted utility, artificial intelligence can enhance the field of respiratory care, potentially leading to superior health outcomes for individuals under this extensive umbrella. Conclusions: As artificial intelligence advances, elevating academic standards in the respiratory care profession becomes imperative, allowing practitioners to contribute to research and understand artificial intelligence’s impact on respiratory care. The permanent integration of artificial intelligence into respiratory care creates the need for respiratory therapists to positively influence its progression. By participating in artificial intelligence development, respiratory therapists can augment their clinical capabilities, knowledge, and patient outcomes. %M 39705080 %R 10.2196/57271 %U https://www.i-jmr.org/2024/1/e57271 %U https://doi.org/10.2196/57271 %U http://www.ncbi.nlm.nih.gov/pubmed/39705080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55986 %T Accuracy of Machine Learning in Detecting Pediatric Epileptic Seizures: Systematic Review and Meta-Analysis %A Zou,Zhuan %A Chen,Bin %A Xiao,Dongqiong %A Tang,Fajuan %A Li,Xihong %+ Department of Emergency, West China Second University Hospital, Sichuan University, No 20, Section 3, Renmin South Road, Wuhou District, Chengdu, 610000, China, 86 13551089846, lixihonghxey@163.com %K epileptic seizures %K machine learning %K deep learning %K electroencephalogram %K EEG %K children %K pediatrics %K epilepsy %K detection %D 2024 %7 11.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Real-time monitoring of pediatric epileptic seizures poses a significant challenge in clinical practice. In recent years, machine learning (ML) has attracted substantial attention from researchers for diagnosing and treating neurological diseases, leading to its application for detecting pediatric epileptic seizures. However, systematic evidence substantiating its feasibility remains limited. Objective: This systematic review aimed to consolidate the existing evidence regarding the effectiveness of ML in monitoring pediatric epileptic seizures with an effort to provide an evidence-based foundation for the development and enhancement of intelligent tools in the future. Methods: We conducted a systematic search of the PubMed, Cochrane, Embase, and Web of Science databases for original studies focused on the detection of pediatric epileptic seizures using ML, with a cutoff date of August 27, 2023. The risk of bias in eligible studies was assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies–2). Meta-analyses were performed to evaluate the C-index and the diagnostic 4-grid table, using a bivariate mixed-effects model for the latter. We also examined publication bias for the C-index by using funnel plots and the Egger test. Results: This systematic review included 28 original studies, with 15 studies on ML and 13 on deep learning (DL). All these models were based on electroencephalography data of children. The pooled C-index, sensitivity, specificity, and accuracy of ML in the training set were 0.76 (95% CI 0.69-0.82), 0.77 (95% CI 0.73-0.80), 0.74 (95% CI 0.70-0.77), and 0.75 (95% CI 0.72-0.77), respectively. In the validation set, the pooled C-index, sensitivity, specificity, and accuracy of ML were 0.73 (95% CI 0.67-0.79), 0.88 (95% CI 0.83-0.91), 0.83 (95% CI 0.71-0.90), and 0.78 (95% CI 0.73-0.82), respectively. Meanwhile, the pooled C-index of DL in the validation set was 0.91 (95% CI 0.88-0.94), with sensitivity, specificity, and accuracy being 0.89 (95% CI 0.85-0.91), 0.91 (95% CI 0.88-0.93), and 0.89 (95% CI 0.86-0.92), respectively. Conclusions: Our systematic review demonstrates promising accuracy of artificial intelligence methods in epilepsy detection. DL appears to offer higher detection accuracy than ML. These findings support the development of DL-based early-warning tools in future research. Trial Registration: PROSPERO CRD42023467260; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023467260 %M 39661965 %R 10.2196/55986 %U https://www.jmir.org/2024/1/e55986 %U https://doi.org/10.2196/55986 %U http://www.ncbi.nlm.nih.gov/pubmed/39661965 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55925 %T Wearable Devices for Supporting Chronic Disease Self-Management: Scoping Review %A Gagnon,Marie-Pierre %A Ouellet,Steven %A Attisso,Eugène %A Supper,Wilfried %A Amil,Samira %A Rhéaume,Caroline %A Paquette,Jean-Sébastien %A Chabot,Christian %A Laferrière,Marie-Claude %A Sasseville,Maxime %+ Faculty of Nursing Sciences, Université Laval, 1050 Av. de la Médecine, Québec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 407576, marie-pierre.gagnon@fsi.ulaval.ca %K chronic diseases %K self-care %K self-management %K empowerment %K mobile health %K mHealth %K wearable %K devices %K scoping %K review %K mobile phone %K PRISMA %D 2024 %7 9.12.2024 %9 Review %J Interact J Med Res %G English %X Background: People with chronic diseases can benefit from wearable devices in managing their health and encouraging healthy lifestyle habits. Wearables such as activity trackers or blood glucose monitoring devices can lead to positive health impacts, including improved physical activity adherence or better management of type 2 diabetes. Few literature reviews have focused on the intersection of various chronic diseases, the wearable devices used, and the outcomes evaluated in intervention studies, particularly in the context of primary health care. Objective: This study aims to identify and describe (1) the chronic diseases represented in intervention studies, (2) the types or combinations of wearables used, and (3) the health or health care outcomes assessed and measured. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, searching the MEDLINE and Web of Science databases for studies published between 2012 and 2022. Pairs of reviewers independently screened titles and abstracts, applied the selection criteria, and performed full-text screening. We included interventions using wearables that automatically collected and transmitted data to adult populations with at least one chronic disease. We excluded studies with participants with only a predisposition to develop a chronic disease, hospitalized patients, patients with acute diseases, patients with active cancer, and cancer survivors. We included randomized controlled trials and cohort, pretest-posttest, observational, mixed methods, and qualitative studies. Results: After the removal of 1987 duplicates, we screened 4540 titles and abstracts. Of the remaining 304 articles after exclusions, we excluded 215 (70.7%) full texts and included 89 (29.3%). Of these 89 texts, 10 (11%) were related to the same interventions as those in the included studies, resulting in 79 studies being included. We structured the results according to chronic disease clusters: (1) diabetes, (2) heart failure, (3) other cardiovascular conditions, (4) hypertension, (5) multimorbidity and other combinations of chronic conditions, (6) chronic obstructive pulmonary disease, (7) chronic pain, (8) musculoskeletal conditions, and (9) asthma. Diabetes was the most frequent health condition (18/79, 23% of the studies), and wearable activity trackers were the most used (42/79, 53% of the studies). In the 79 included studies, 74 clinical, 73 behavioral, 36 patient technology experience, 28 health care system, and 25 holistic or biopsychosocial outcomes were reported. Conclusions: This scoping review provides an overview of the wearable devices used in chronic disease self-management intervention studies, revealing disparities in both the range of chronic diseases studied and the variety of wearable devices used. These findings offer researchers valuable insights to further explore health care outcomes, validate the impact of concomitant device use, and expand their use to other chronic diseases. Trial Registration: Open Science Framework Registries (OSF) s4wfm; https://osf.io/s4wfm %M 39652850 %R 10.2196/55925 %U https://www.i-jmr.org/2024/1/e55925 %U https://doi.org/10.2196/55925 %U http://www.ncbi.nlm.nih.gov/pubmed/39652850 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57050 %T Relationship Between Depression and Falls Among Nursing Home Residents: Integrative Review %A Matos Queirós,Alcina %A von Gunten,Armin %A Rosselet Amoussou,Joëlle %A Lima,Andreia Maria %A Martins,Maria Manuela %A Verloo,Henk %+ Departement of Health and Social Welfare, Lausanne University Hospital and University of Lausanne, Avenue des Casernes 2, Lausanne, 1014, Switzerland, 41 799134061, alcinaqueiros@hotmail.com %K depression %K falls %K nursing home %K nursing home resident %K cross-sectional study %K cohort study %K integrative review %K fall risk %K older adults %D 2024 %7 28.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Depression is a highly prevalent psychopathological condition among older adults, particularly those institutionalized in nursing homes (NHs). Unfortunately, it is poorly identified and diagnosed. NH residents are twice as likely to fall as community-dwelling older adults. There is a need for more knowledge about the mechanisms and relationships between depression and falls. Objective: This study aims to identify, analyze, and synthesize research on the relationships between depression and falls among NH residents. Methods: A literature search was conducted in October 2023 in the following bibliographic databases: MEDLINE ALL Ovid, Embase, CINAHL with Full Text EBSCO, APA PsycInfo Ovid, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley, and ProQuest Dissertations & Theses A&I. Clinical trials were searched for in the Cochrane Central Register of Controlled Trials Wiley, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. Additional searches were performed using Google Scholar, the DART-Europe E-theses Portal, and backward citation tracking. The Newcastle-Ottawa Scale and the Appraisal tool for Cross-Sectional Studies were used to evaluate study quality. Results: The review included 7 quantitative studies published in 7 different countries from 3 continents; of these, 6 (86%) were cross-sectional studies, and 1 (14%) was a prospective cohort study. Results suggested high frequencies of depressive symptoms and falls among older adults living in NHs, and depressive symptoms were considered a risk factor for falls. The 15-item and 10-item versions of the Geriatric Depression Scale were the most commonly used measurement tools, followed by the Cornell Scale for Depression in Dementia and the Resident Assessment Instrument-Minimum Data Set 2.0. The prevalence of depression was heterogeneous, varying from 21.5% to 47.7% of NH residents. The studies used heterogeneous descriptions of a fall, and some considered the risk of falls, recurrent fallers, and near falls in their data. The prevalence of fallers was disparate, varying from 17.2% to 63.1%. Of the 7 retained studies, 6 (86%) reported a relationship between depression and falls or the risk of falls. Among the 19 other risk factors identified in the review as being associated with falls among NH residents were a history of falls in the last 180 days, >1 fall in the past 12 months, and respiratory illnesses. Conclusions: There is a paucity of research examining falls among older adults with depressive symptoms in NHs. These findings should alert nurses to the need to consider depression as a risk factor in their work to prevent falls. More research is needed to gain a comprehensive understanding of fall risk among NH residents with depressive symptoms. International Registered Report Identifier (IRRID): RR2-10.2196/46995 %M 39608784 %R 10.2196/57050 %U https://www.i-jmr.org/2024/1/e57050 %U https://doi.org/10.2196/57050 %U http://www.ncbi.nlm.nih.gov/pubmed/39608784 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58036 %T Benefits of Clinical Decision Support Systems for the Management of Noncommunicable Chronic Diseases: Targeted Literature Review %A Grechuta,Klaudia %A Shokouh,Pedram %A Alhussein,Ahmad %A Müller-Wieland,Dirk %A Meyerhoff,Juliane %A Gilbert,Jeremy %A Purushotham,Sneha %A Rolland,Catherine %+ Boehringer Ingelheim International GmbH, Binger Strasse 173, Ingelheim am Rhein, 55218, Germany, 49 15143151983, klaudia.grechuta@boehringer-ingelheim.com %K clinical decision support system %K digital health %K chronic disease management %K electronic health records %K noncommunicable diseases %K targeted literature review %K mobile phone %D 2024 %7 27.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Clinical decision support systems (CDSSs) are designed to assist in health care delivery by supporting medical practice with clinical knowledge, patient information, and other relevant types of health information. CDSSs are integral parts of health care technologies assisting in disease management, including diagnosis, treatment, and monitoring. While electronic medical records (EMRs) serve as data repositories, CDSSs are used to assist clinicians in providing personalized, context-specific recommendations derived by comparing individual patient data to evidence-based guidelines. Objective: This targeted literature review (TLR) aimed to identify characteristics and features of both stand-alone and EMR-integrated CDSSs that influence their outcomes and benefits based on published scientific literature. Methods: A TLR was conducted using the Embase, MEDLINE, and Cochrane databases to identify data on CDSSs published in a 10-year frame (2012-2022). Studies on computerized, guideline-based CDSSs used by health care practitioners with a focus on chronic disease areas and reporting outcomes for CDSS utilization were eligible for inclusion. Results: A total of 49 publications were included in the TLR. Studies predominantly reported on EMR-integrated CDSSs (ie, connected to an EMR database; n=32, 65%). The implementation of CDSSs varied globally, with substantial utilization in the United States and within the domain of cardio-renal-metabolic diseases. CDSSs were found to positively impact “quality assurance” (n=35, 69%) and provide “clinical benefits” (n=20, 41%), compared to usual care. Among CDSS features, treatment guidance and flagging were consistently reported as the most frequent elements for enhancing health care, followed by risk level estimation, diagnosis, education, and data export. The effectiveness of a CDSS was evaluated most frequently in primary care settings (n=34, 69%) across cardio-renal-metabolic disease areas (n=32, 65%), especially in diabetes (n=13, 26%). Studies reported CDSSs to be commonly used by a mixed group (n=27, 55%) of users including physicians, specialists, nurses or nurse practitioners, and allied health care professionals. Conclusions: Overall, both EMR-integrated and stand-alone CDSSs showed positive results, suggesting their benefits to health care providers and potential for successful adoption. Flagging and treatment recommendation features were commonly used in CDSSs to improve patient care; other features such as risk level estimation, diagnosis, education, and data export were tailored to specific requirements and collectively contributed to the effectiveness of health care delivery. While this TLR demonstrated that both stand-alone and EMR-integrated CDSSs were successful in achieving clinical outcomes, the heterogeneity of included studies reflects the evolving nature of this research area, underscoring the need for further longitudinal studies to elucidate aspects that may impact their adoption in real-world scenarios. %M 39602213 %R 10.2196/58036 %U https://www.i-jmr.org/2024/1/e58036 %U https://doi.org/10.2196/58036 %U http://www.ncbi.nlm.nih.gov/pubmed/39602213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55897 %T Implementation of Machine Learning Applications in Health Care Organizations: Systematic Review of Empirical Studies %A Preti,Luigi M %A Ardito,Vittoria %A Compagni,Amelia %A Petracca,Francesco %A Cappellaro,Giulia %+ Department of Social and Political Sciences, Bocconi University, Via Sarfatti 25, Milan, 20136, Italy, 39 02 58365267, giulia.cappellaro@unibocconi.it %K artificial intelligence %K machine learning %K implementation %K health care organization %K barriers %K facilitators %D 2024 %7 25.11.2024 %9 Review %J J Med Internet Res %G English %X Background: There is a growing enthusiasm for machine learning (ML) among academics and health care practitioners. Despite the transformative potential of ML-based applications for patient care, their uptake and implementation in health care organizations are sporadic. Numerous challenges currently impede or delay the widespread implementation of ML in clinical practice, and limited knowledge is available regarding how these challenges have been addressed. Objective: This work aimed to (1) examine the characteristics of ML-based applications and the implementation process in clinical practice, using the Consolidated Framework for Implementation Research (CFIR) for theoretical guidance and (2) synthesize the strategies adopted by health care organizations to foster successful implementation of ML. Methods: A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted in PubMed, Scopus, and Web of Science over a 10-year period (2013-2023). The search strategy was built around 4 blocks of keywords (artificial intelligence, implementation, health care, and study type). Only empirical studies documenting the implementation of ML applications in clinical settings were considered. The implementation process was investigated using a thematic analysis and coding procedure. Results: Thirty-four studies were selected for data synthesis. Selected papers were relatively recent, with only 9% (3/34) of records published before 2019. ML-based applications were implemented mostly within hospitals (29/34, 85%). In terms of clinical workflow, ML-based applications supported mostly prognosis (20/34, 59%) and diagnosis (10/34, 29%). The implementation efforts were analyzed using CFIR domains. As for the inner setting domain, access to knowledge and information (12/34, 35%), information technology infrastructure (11/34, 32%), and organizational culture (9/34, 26%) were among the most observed dimensions influencing the success of implementation. As for the ML innovation itself, factors deemed relevant were its design (15/34, 44%), the relative advantage with respect to existing clinical practice (14/34, 41%), and perceived complexity (14/34, 41%). As for the other domains (ie, processes, roles, and outer setting), stakeholder engagement (12/34, 35%), reflecting and evaluating practices (11/34, 32%), and the presence of implementation leaders (9/34, 26%) were the main factors identified as important. Conclusions: This review sheds some light on the factors that are relevant and that should be accounted for in the implementation process of ML-based applications in health care. While the relevance of ML-specific dimensions, like trust, emerges clearly across several implementation domains, the evidence from this review highlighted that relevant implementation factors are not necessarily specific for ML but rather transversal for digital health technologies. More research is needed to further clarify the factors that are relevant to implementing ML-based applications at the organizational level and to support their uptake within health care organizations. Trial Registration: PROSPERO 403873; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403873 International Registered Report Identifier (IRRID): RR2-10.2196/47971 %M 39586084 %R 10.2196/55897 %U https://www.jmir.org/2024/1/e55897 %U https://doi.org/10.2196/55897 %U http://www.ncbi.nlm.nih.gov/pubmed/39586084 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e51214 %T Social Cohesion and COVID-19: Integrative Review %A Ware,Paul %+ Department of Social and Community Health, School of Population Health, University of Auckland, Park Road, Auckland, New Zealand, 64 99236549, paul.ware@auckland.ac.nz %K social cohesion %K social capital %K COVID-19 %K infrastructure %K tool %K social %K economic %K interpersonal %K interpersonal relationship %K emotions %K pandemic %K engagement %K health behaviors %K resilience %K emotional well-being %K well-being %D 2024 %7 21.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Nations of considerable wealth and sophisticated health care infrastructures have experienced high rates of illness and death from COVID-19. Others with limited economic means and less developed health systems have achieved much lower burdens. To build a full understanding, an appraisal of the contribution of social relationships is necessary. Social cohesion represents a promising conceptual tool. Objective: This study aimed to examine scholarship on social cohesion during the COVID-19 pandemic: specifically, the constructions of social cohesion being deployed, the variables chosen for representation, and the effects of and on social cohesion being reported. Methods: The PubMed, Scopus, and JSTOR databases were searched for relevant journal articles and gray literature. A total of 100 studies met the inclusion criteria. Data were extracted and analyzed from these using spreadsheet software. Results: Several constructions of social cohesion were found. These concerned interpersonal relationships, sameness and difference, collective action, perceptions or emotions of group members, structures and institutions of governance, locally or culturally specific versions, and hybrid or multidimensional models. Social cohesion was reported to be influential on health outcomes, health behaviors, resilience, and emotional well-being, but there was some potential for it to drive undesirable outcomes. Scholarship reported increases or decreases in quantitative measures of social cohesion, a temporary “rally round the flag” effect early in the pandemic, the variable impacts of policy on social cohesion, and changing interpersonal relationships due to the pandemic conditions. There are numerous issues with the literature that reflect the well-documented limitations of popular versions of the concept. Conclusions: Social cohesion has been used to express a range of different aspects of relationships during the pandemic. It is claimed to promote better health outcomes, more engagement with positive health behaviors, and greater resilience and emotional well-being. The literature presents a range of ways in which it has been altered by the pandemic conditions. There are significant weaknesses to this body of knowledge that greatly impede its overall quality. %M 39571166 %R 10.2196/51214 %U https://www.i-jmr.org/2024/1/e51214 %U https://doi.org/10.2196/51214 %U http://www.ncbi.nlm.nih.gov/pubmed/39571166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53781 %T Added Value of Medical Subject Headings Terms in Search Strategies of Systematic Reviews: Comparative Study %A Leblanc,Victor %A Hamroun,Aghiles %A Bentegeac,Raphaël %A Le Guellec,Bastien %A Lenain,Rémi %A Chazard,Emmanuel %+ Public Health Department, CHU Lille, Université de Lille, 42 Rue Paul Duez, Lille, 59000, France, 33 637004971, leblancvictor59@gmail.com %K Medical Subject Headings %K MeSH %K MeSH thesaurus %K systematic review %K PubMed %K search strategy %K comparative analysis %K literature review %K positive predictive value %K PPV %K review %K scientific knowledge %K medical knowledge %K utility %K systematic literature review %D 2024 %7 19.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The massive increase in the number of published scientific articles enhances knowledge but makes it more complicated to summarize results. The Medical Subject Headings (MeSH) thesaurus was created in the mid-20th century with the aim of systematizing article indexing and facilitating their retrieval. Despite the advent of search engines, few studies have questioned the relevance of the MeSH thesaurus, and none have done so systematically. Objective: The objective of this study was to estimate the added value of using MeSH terms in PubMed queries for systematic reviews (SRs). Methods: SRs published in 4 high-impact medical journals in general medicine over the past 10 years were selected. Only SRs for which a PubMed query was provided were included. Each query was transformed to obtain 3 versions: the original query (V1), the query with free-text terms only (V2), and the query with MeSH terms only (V3). These 3 queries were compared with each other based on their sensitivity and positive predictive values. Results: In total, 59 SRs were included. The suppression of MeSH terms had an impact on the number of relevant articles retrieved for 24 (41%) out of 59 SRs. The median (IQR) sensitivities of queries V1 and V2 were 77.8% (62.1%-95.2%) and 71.4% (42.6%-90%), respectively. V1 queries provided an average of 2.62 additional relevant papers per SR compared with V2 queries. However, an additional 820.29 papers had to be screened. The cost of screening an additional collected paper was therefore 313.09, which was slightly more than triple the mean reading cost associated with V2 queries (88.67). Conclusions: Our results revealed that removing MeSH terms from a query decreases sensitivity while slightly increasing the positive predictive value. Queries containing both MeSH and free-text terms yielded more relevant articles but required screening many additional papers. Despite this additional workload, MeSH terms remain indispensable for SRs. %M 39561364 %R 10.2196/53781 %U https://www.jmir.org/2024/1/e53781 %U https://doi.org/10.2196/53781 %U http://www.ncbi.nlm.nih.gov/pubmed/39561364 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55865 %T Visual Modeling Languages in Patient Pathways: Scoping Review %A Bogale,Binyam %A Vesinurm,Märt %A Lillrank,Paul %A Celius,Elisabeth Gulowsen %A Halvorsrud,Ragnhild %+ Department of Neurology, Institute of Clinical Medicine, University of Oslo, Bldg 20, Ludvig Kastensvei 15, Oslo, 1064, Norway, 47 96711061, binyadad@gmail.com %K patient pathways %K visual modeling languages %K business process model and notation %K BPMN %K unified modeling language %K UML %K domain-specific modeling languages %K scoping review %D 2024 %7 15.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Patient pathways (PPs) are presented as a panacea solution to enhance health system functions. It is a complex concept that needs to be described and communicated well. Modeling plays a crucial role in promoting communication, fostering a shared understanding, and streamlining processes. Only a few existing systematic reviews have focused on modeling methods and standardized modeling languages. There remains a gap in consolidated knowledge regarding the use of diverse visual modeling languages. Objective: This scoping review aimed to compile visual modeling languages used to represent PPs, including the justifications and the context in which a modeling language was adopted, adapted, combined, or developed. Methods: After initial experimentation with the keywords used to describe the concepts of PPs and visual modeling languages, we developed a search strategy that was further refined and customized to the major databases identified as topically relevant. In addition, we consulted gray literature and conducted hand searches of the referenced articles. Two reviewers independently screened the articles in 2 stages using preset inclusion criteria, and a third reviewer voted on the discordance. Data charting was done using an iteratively developed form in the Covidence software. Descriptive and thematic summaries were presented following rounds of discussion to produce the final report. Results: Of 1838 articles retrieved after deduplication, 22 satisfied our inclusion criteria. Clinical pathway is the most used phrase to represent the PP concept, and most papers discussed the concept without providing their operational definition. We categorized the visual modeling languages into five categories: (1) general purpose–modeling language (GPML) adopted without major extension or modification, (2) GPML used with formal extension recommendations, (3) combination of 2 or more modeling languages, (4) a developed domain-specific modeling language (DSML), and (5) ontological modeling languages. The justifications for adopting, adapting, combining, and developing visual modeling languages varied accordingly and ranged from versatility, expressiveness, tool support, and extensibility of a language to domain needs, integration, and simplification. Conclusions: Various visual modeling languages were used in PP modeling, each with varying levels of abstraction and granularity. The categorization we made could aid in a better understanding of the complex combination of PP and modeling languages. Standardized GPMLs were used with or without any modifications. The rationale to propose any modification to GPMLs evolved as more evidence was presented following requirement analyses to support domain constructs. DSMLs are infrequently used due to their resource-intensive development, often initiated at a project level. The justifications provided and the context where DSMLs were created are paramount. Future studies should assess the merits and demerits of using a visual modeling language to facilitate PP communications among stakeholders and use evaluation frameworks to identify, modify, or develop them, depending on the scope and goal of the modeling need. %M 39546800 %R 10.2196/55865 %U https://www.i-jmr.org/2024/1/e55865 %U https://doi.org/10.2196/55865 %U http://www.ncbi.nlm.nih.gov/pubmed/39546800 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57931 %T Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review %A Sattora,Emily %A Teelin,Karen %A Prendergast,Christopher %A Smith,Abigail %A Evans,James %A Imdad,Aamer %+ Division of Pediatric Gastroenterology, Hepatology, Pancreatology, and Nutrition, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, United States, 1 319 356 2950, aamer-imdad@uiowa.edu %K transgender %K lipid levels %K hormone therapy %K biochemical outcomes %K clinical outcomes %K comprehensive data %K systematic review %K meta-analysis %K adolescent %K adults %K electronic databases %K testosterone %K estrogen %D 2024 %7 12.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective: This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods: We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. Conclusions: This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Trial Registration: PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb International Registered Report Identifier (IRRID): PRR1-10.2196/57931 %M 39531266 %R 10.2196/57931 %U https://www.researchprotocols.org/2024/1/e57931 %U https://doi.org/10.2196/57931 %U http://www.ncbi.nlm.nih.gov/pubmed/39531266 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e59772 %T Methods Used in Co-Creation Within the Health CASCADE Co-Creation Database and Gray Literature: Systematic Methods Overview %A Agnello,Danielle Marie %A Balaskas,George %A Steiner,Artur %A Chastin,Sebastien %+ School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, United Kingdom, 44 7871788785, danielle.agnello@gcu.ac.uk %K co-creation %K coproduction %K co-design %K methods %K participatory %K inventory %K text mining %K methodology %K research methods %K CASCADE %K research methods %D 2024 %7 11.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Co-creation is increasingly recognized for its potential to generate innovative solutions, particularly in addressing complex and wicked problems in public health. Despite this growing recognition, there are no standards or recommendations for method use in co-creation, leading to confusion and inconsistency. While some studies have examined specific methods, a comprehensive overview is lacking, limiting the collective understanding and ability to make informed decisions about the most appropriate methods for different contexts and research objectives. Objective: This study aimed to systematically compile and analyze methods used in co-creation to enhance transparency and deepen understanding of how co-creation is practiced. Methods: To enhance transparency and deepen understanding of how co-creation is practiced, this study systematically inventoried and analyzed methods used in co-creation. We conducted a systematic methods overview, applying 2 parallel processes: one within the peer-reviewed Health CASCADE Co-Creation Database and another within gray literature. An artificial intelligence–assisted recursive search strategy, coupled with a 2-step screening process, ensured that we captured relevant methods. We then extracted method names and conducted textual, comparative, and bibliometric analyses to assess the content, relationship between methods, fields of research, and the methodological underpinnings of the included sources. Results: We examined a total of 2627 academic papers and gray literature sources, with the literature primarily drawn from health sciences, medical research, and health services research. The dominant methodologies identified were co-creation, co-design, coproduction, participatory research methodologies, and public and patient involvement. From these sources, we extracted and analyzed 956 co-creation methods, noting that only 10% (n=97) of the methods overlap between academic and gray literature. Notably, 91.3% (230/252) of the methods in academic literature co-occurred, often involving combinations of multiple qualitative methods. The most frequently used methods in academic literature included surveys, focus groups, photo voice, and group discussion, whereas gray literature highlighted methods such as world café, focus groups, role-playing, and persona. Conclusions: This study presents the first systematic overview of co-creation methods, providing a clear understanding of the diverse methods currently in use. Our findings reveal a significant methodological gap between researchers and practitioners, offering insights into the relative prevalence and combinations of methods. By shedding light on these methods, this study helps bridge the gap and supports researchers in making informed decisions about which methods to apply in their work. Additionally, it offers a foundation for further investigation into method use in co-creation. This systematic investigation is a valuable resource for anyone engaging in co-creation or similar participatory methodologies, helping to navigate the diverse landscape of methods. %M 39527793 %R 10.2196/59772 %U https://www.i-jmr.org/2024/1/e59772 %U https://doi.org/10.2196/59772 %U http://www.ncbi.nlm.nih.gov/pubmed/39527793 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55067 %T Screening for Depression Using Natural Language Processing: Literature Review %A Teferra,Bazen Gashaw %A Rueda,Alice %A Pang,Hilary %A Valenzano,Richard %A Samavi,Reza %A Krishnan,Sridhar %A Bhat,Venkat %+ Unity Health Toronto, St. Michael’s Hospital, Interventional Psychiatry Program, 193 Yonge Street, 6-012, Toronto, ON, M5B 1M4, Canada, 1 4163604000 ext 76404, venkat.bhat@utoronto.ca %K depression %K natural language processing %K NLP %K sentiment analysis %K machine learning %K deep learning %K transformer-based models %K large language models %K cross-cultural %K research domain criteria %K RDoC %D 2024 %7 4.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Depression is a prevalent global mental health disorder with substantial individual and societal impact. Natural language processing (NLP), a branch of artificial intelligence, offers the potential for improving depression screening by extracting meaningful information from textual data, but there are challenges and ethical considerations. Objective: This literature review aims to explore existing NLP methods for detecting depression, discuss successes and limitations, address ethical concerns, and highlight potential biases. Methods: A literature search was conducted using Semantic Scholar, PubMed, and Google Scholar to identify studies on depression screening using NLP. Keywords included “depression screening,” “depression detection,” and “natural language processing.” Studies were included if they discussed the application of NLP techniques for depression screening or detection. Studies were screened and selected for relevance, with data extracted and synthesized to identify common themes and gaps in the literature. Results: NLP techniques, including sentiment analysis, linguistic markers, and deep learning models, offer practical tools for depression screening. Supervised and unsupervised machine learning models and large language models like transformers have demonstrated high accuracy in a variety of application domains. However, ethical concerns related to privacy, bias, interpretability, and lack of regulations to protect individuals arise. Furthermore, cultural and multilingual perspectives highlight the need for culturally sensitive models. Conclusions: NLP presents opportunities to enhance depression detection, but considerable challenges persist. Ethical concerns must be addressed, governance guidance is needed to mitigate risks, and cross-cultural perspectives must be integrated. Future directions include improving interpretability, personalization, and increased collaboration with domain experts, such as data scientists and machine learning engineers. NLP’s potential to enhance mental health care remains promising, depending on overcoming obstacles and continuing innovation. %M 39496145 %R 10.2196/55067 %U https://www.i-jmr.org/2024/1/e55067 %U https://doi.org/10.2196/55067 %U http://www.ncbi.nlm.nih.gov/pubmed/39496145 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e49660 %T Blended Psychological Therapy for the Treatment of Psychological Disorders in Adult Patients: Systematic Review and Meta-Analysis %A Ferrao Nunes-Zlotkowski,Kelly %A Shepherd,Heather L %A Beatty,Lisa %A Butow,Phyllis %A Shaw,Joanne Margaret %+ Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Rm 311B Level 3 Griffith Taylor (A19), Manning Road, Sydney, NSW 2006, Australia, 61 2 9351 3761, joanne.shaw@sydney.edu.au %K systematic review %K blended psychological therapy %K blended care %K face-to-face %K online %K psychological intervention %K intervention design %K digital care %K digital mental health %K psychological disorder %D 2024 %7 29.10.2024 %9 Review %J Interact J Med Res %G English %X Background: Blended therapy (BT) combines digital with face-to-face psychological interventions. BT may improve access to treatment, therapy uptake, and adherence. However, research is scarce on the structure of BT models. Objective: We synthesized the literature to describe BT models used for the treatment of psychological disorders in adults. We investigated whether BT structure, content, and ratio affected treatment efficacy, uptake, and adherence. We also conducted meta-analyses to examine treatment efficacy in intervention-control dyads and associations between treatment outcomes versus BT model structure. Methods: PsycINFO, CINAHL, Embase, ProQuest, and MEDLINE databases were searched. Eligibility criteria included articles published in English till March 2023 that described digital and face-to-face elements as part of an intervention plan for treating psychological disorders in adult patients. We developed a coding framework to characterize the BT interventions. A meta-analysis was conducted to calculate effect size (ES; Cohen d and 95% CIs) regarding pre- and posttreatment outcomes in depression and anxiety versus BT structure. The review was registered with PROSPERO and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Searches identified 8436 articles, and data were extracted from 29 studies. BT interventions were analyzed and classified according to mode of interaction between digital and face-to-face components (integrated vs sequential), role of the components (core vs supplementary), component delivery (alternate vs case-by-case), and digital materials assignment mode (standardized vs personalized). Most BT interventions (n=24) used a cognitive behavioral therapy approach for anxiety or depression treatment. Mean rates of uptake (91%) and adherence (81%) were reported across individual studies. BT interventions were more effective or noninferior to treatment as usual, with large spread in the data and a moderate to large ES in the treatment of depression (n=9; Cohen d=–1.1, 95% CI –0.6 to –1.6, P<.001, and z score=–4.3). A small, nonsignificant ES was found for anxiety outcomes (n=5; Cohen d=–0.1, 95% CI –0.3 to 0.05, P=.17, and z score=–1.4). Higher ESs were found in blended interventions with supplementary design (depression: n=11, Cohen d=–0.75, 95% CI –0.56 to –0.95; anxiety: n=8, Cohen d=–0.9, 95% CI –0.6 to –1.2); fewer (≤6) face-to-face sessions (depression: n=9, Cohen d=–0.7, 95% CI –0.5 to –0.9; anxiety: n=7, Cohen d=–0.8, 95% CI –0.3 to –1.3); and a lower ratio (≤50%) of face-to-face versus digital sessions (depression: n=5, Cohen d=–0.8, 95% CI –0.6 to –1.1; anxiety: n=4, Cohen d=–0.8, 95% CI 0.006 to –1.6). Conclusions: This study confirmed integrated BT models as feasible to deliver. We found BT to be effective in depression treatment, but anxiety treatment results were nonsignificant. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required. Trial Registration: PROSPERO CRD42021258977; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258977 %M 39470720 %R 10.2196/49660 %U https://www.i-jmr.org/2024/1/e49660 %U https://doi.org/10.2196/49660 %U http://www.ncbi.nlm.nih.gov/pubmed/39470720 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52287 %T Health Locus of Control and Medical Behavioral Interventions: Systematic Review and Recommendations %A Mozafari,Sogol %A Yang,Alan %A Talaei-Khoei,Jason %+ Department of Information Systems, College of Business, University of Nevada, Reno, 1664 North Virginia Street, Reno, NV, 89557, United States, 1 7757846428, alany@unr.edu %K medical behavioral interventions %K health locus of control %K internal control %K external control %K patient behavior %K synthesis %K review methods %K literature review %K narrative review %K behavior change %D 2024 %7 10.10.2024 %9 Review %J Interact J Med Res %G English %X Background: Health locus of control (HLOC) is a theory that describes how individuals perceive different forces that influence their lives. The concept of a locus of control can affect an individual’s likelihood to commit to behaviors related to their health. This study explores the literature on the relationships between HLOC and medical behavioral interventions. Objective: This study aims to better understand how HLOC constructs can potentially affect patient responses to health behavioral interventions and to propose a series of guidelines for individuals interested in designing medical behavioral interventions related to HLOC. Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and performed an analysis of 50 papers related to the topic of HLOC and medical behavioral interventions. Inclusion criteria were studies that had a behavioral intervention involving patients and contained a metric of at least 1 of the constructs related to HLOC. The initial screening and search were conducted by 2 researchers (AY and SM) separately. The results were then combined and compared. Results: Our findings explore the influence of different levels of HLOC along with the importance of both patient- and health-related context when assessing the relationships between HLOC constructs and the likelihood of health behavior change. The findings show that different constructs related to HLOC can act as reliable predictors for patient responses to medical behavioral interventions. Patients who score higher on internal HLOC measures are more likely to exhibit behaviors that are consistent with positive health outcomes. Patients who score higher on chance HLOC are more likely to exhibit behaviors that may lead to adverse health outcomes. These conclusions are supported by most of the 50 studies surveyed. Conclusions: We propose guidelines for individuals designing medical behavioral interventions so that they can make use of these relationships linked to HLOC. The three guidelines suggested are as follows: (1) in most situations, improving internal HLOC will improve health outcomes for patients; (2) patients with high external HLOC should be further studied to determine the source of the external HLOC; and (3) patients with a high chance HLOC are less likely to follow preventative behaviors or be responsive to interventions. Limitations of the study are that the primary search and analysis were conducted by 2 principal researchers (AY and SM). Interpretation and development of the guidelines are subject to individual interpretation of results and may not be applicable to all contexts. %M 39388686 %R 10.2196/52287 %U https://www.i-jmr.org/2024/1/e52287 %U https://doi.org/10.2196/52287 %U http://www.ncbi.nlm.nih.gov/pubmed/39388686 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55695 %T Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis %A Hillyar,Christopher Robert Timothy %A Bishop,Natalie %A Nibber,Anjan %A Bell-Davies,Frances Jean %A Ong,Juling %+ Oxford Medical School, Green Templeton College, University of Oxford, 43 Woodstock Rd, Oxford, OX2 6HG, United Kingdom, 44 01865 274770, christopher.hillyar@gtc.ox.ac.uk %K deformational plagiocephaly %K plagiocephaly %K flat head syndrome %K back to sleep %K meta-analysis %K systematic review %K meta-analyses %K systematic reviews %K vitamin D %K vit D %K head position preference %K head position %K head positioning %K bottle feeding %K tummy time %K sleeping position %K motor milestones %K obesity %K maternal education level %K male sex %K formula feeding %K macrocephaly %K head circumference %K mechanical ventilation %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K toddler %K toddlers %K child %K children %D 2024 %7 18.9.2024 %9 Review %J Interact J Med Res %G English %X Background: Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry. Objective: The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP. Methods: The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots. Results: A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP. Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected. Conclusions: This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed. Trial Registration: PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979 %M 39292504 %R 10.2196/55695 %U https://www.i-jmr.org/2024/1/e55695 %U https://doi.org/10.2196/55695 %U http://www.ncbi.nlm.nih.gov/pubmed/39292504 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56729 %T Improving Triage Accuracy in Prehospital Emergency Telemedicine: Scoping Review of Machine Learning–Enhanced Approaches %A Raff,Daniel %A Stewart,Kurtis %A Yang,Michelle Christie %A Shang,Jessie %A Cressman,Sonya %A Tam,Roger %A Wong,Jessica %A Tammemägi,Martin C %A Ho,Kendall %+ Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 W10 Ave, 3rd floor, Vancouver, BC, V5Z1M9, Canada, 1 6048220327, kendall.ho@ubc.ca %K telemedicine %K machine learning %K emergency medicine %K artificial intelligence %K chatbot %K triage %K scoping review %K prehospital %D 2024 %7 11.9.2024 %9 Review %J Interact J Med Res %G English %X Background: Prehospital telemedicine triage systems combined with machine learning (ML) methods have the potential to improve triage accuracy and safely redirect low-acuity patients from attending the emergency department. However, research in prehospital settings is limited but needed; emergency department overcrowding and adverse patient outcomes are increasingly common. Objective: In this scoping review, we sought to characterize the existing methods for ML-enhanced telemedicine emergency triage. In order to support future research, we aimed to delineate what data sources, predictors, labels, ML models, and performance metrics were used, and in which telemedicine triage systems these methods were applied. Methods: A scoping review was conducted, querying multiple databases (MEDLINE, PubMed, Scopus, and IEEE Xplore) through February 24, 2023, to identify potential ML-enhanced methods, and for those eligible, relevant study characteristics were extracted, including prehospital triage setting, types of predictors, ground truth labeling method, ML models used, and performance metrics. Inclusion criteria were restricted to the triage of emergency telemedicine services using ML methods on an undifferentiated (disease nonspecific) population. Only primary research studies in English were considered. Furthermore, only those studies using data collected remotely (as opposed to derived from physical assessments) were included. In order to limit bias, we exclusively included articles identified through our predefined search criteria and had 3 researchers (DR, JS, and KS) independently screen the resulting studies. We conducted a narrative synthesis of findings to establish a knowledge base in this domain and identify potential gaps to be addressed in forthcoming ML-enhanced methods. Results: A total of 165 unique records were screened for eligibility and 15 were included in the review. Most studies applied ML methods during emergency medical dispatch (7/15, 47%) or used chatbot applications (5/15, 33%). Patient demographics and health status variables were the most common predictors, with a notable absence of social variables. Frequently used ML models included support vector machines and tree-based methods. ML-enhanced models typically outperformed conventional triage algorithms, and we found a wide range of methods used to establish ground truth labels. Conclusions: This scoping review observed heterogeneity in dataset size, predictors, clinical setting (triage process), and reported performance metrics. Standard structured predictors, including age, sex, and comorbidities, across articles suggest the importance of these inputs; however, there was a notable absence of other potentially useful data, including medications, social variables, and health system exposure. Ground truth labeling practices should be reported in a standard fashion as the true model performance hinges on these labels. This review calls for future work to form a standardized framework, thereby supporting consistent reporting and performance comparisons across ML-enhanced prehospital triage systems. %R 10.2196/56729 %U https://www.i-jmr.org/2024/1/e56729 %U https://doi.org/10.2196/56729 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52167 %T Central Hemodynamic and Thermoregulatory Responses to Food Intake as Potential Biomarkers for Eating Detection: Systematic Review %A Chikwetu,Lucy %A Vakili,Parker %A Takais,Andrew %A Younes,Rabih %+ Department of Electrical and Computer Engineering, Duke University, 210 Hudson Hall, Durham, NC, 27708, United States, 1 919 660 5051, rabih.younes@duke.edu %K eating detection %K eating moment recognition %K postprandial physiological responses %K postprandial physiology %K eating %K food %K consumption %K postprandial %K hemodynamics prandial %K thermoregulation %K physiological %K heart rate %K vital %K vitals %K wearable %K wearables %K thermoregulatory hemodynamic %K biomarker %K biomarkers %K diet %K dietary %K monitoring %K detect %K detection %K detecting %K synthesis %K review methods %K review methodology %K systematic %K sensor %K sensors %K digital health %D 2024 %7 10.9.2024 %9 Review %J Interact J Med Res %G English %X Background: Diet-related diseases, such as type 2 diabetes, require strict dietary management to slow down disease progression and call for innovative management strategies. Conventional diet monitoring places a significant memory burden on patients, who may not accurately remember details of their meals and thus frequently falls short in preventing disease progression. Recent advances in sensor and computational technologies have sparked interest in developing eating detection platforms. Objective: This review investigates central hemodynamic and thermoregulatory responses as potential biomarkers for eating detection. Methods: We searched peer-reviewed literature indexed in PubMed, Web of Science, and Scopus on June 20, 2022, with no date limits. We also conducted manual searches in the same databases until April 21, 2024. We included English-language papers demonstrating the impact of eating on central hemodynamics and thermoregulation in healthy individuals. To evaluate the overall study quality and assess the risk of bias, we designed a customized tool inspired by the Cochrane assessment framework. This tool has 4 categories: high, medium, low, and very low. A total of 2 independent reviewers conducted title and abstract screening, full-text review, and study quality and risk of bias analysis. In instances of disagreement between the 2 reviewers, a third reviewer served as an adjudicator. Results: Our search retrieved 11,450 studies, and 25 met our inclusion criteria. Among the 25 included studies, 32% (8/25) were classified as high quality, 52% (13/25) as medium quality, and 16% (4/25) as low quality. Furthermore, we found no evidence of publication bias in any of the included studies. A consistent postprandial increase in heart rate, cardiac output, and stroke volume was observed in at least 95% (heart rate: 19/19, cardiac output: 18/19, stroke volume: 11/11) of the studies that investigated these variables’ responses to eating. Specifically, cardiac output increased by 9%-100%, stroke volume by 18%-41%, and heart rate by 6%-21% across these studies. These changes were statistically significant (P<.05). In contrast, the 8 studies that investigated postprandial thermoregulatory effects displayed grossly inconsistent results, showing wide variations in response with no clear patterns of change, indicating a high degree of variability among these studies. Conclusions: Our findings demonstrate that central hemodynamic responses, particularly heart rate, hold promise for wearable-based eating detection, as cardiac output and stroke volume cannot be measured by any currently available noninvasive medical or consumer-grade wearables. Trial Registration: PROSPERO CRD42022360600; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=360600 %M 39255485 %R 10.2196/52167 %U https://www.i-jmr.org/2024/1/e52167 %U https://doi.org/10.2196/52167 %U http://www.ncbi.nlm.nih.gov/pubmed/39255485 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48339 %T Parental Patterns of Alcohol Consumption During the COVID-19 Pandemic: Scoping Review %A Ou,Christine %A Corby,Kathryn %A Booth,Kelsey %A Ou,Hui-Hui %+ Canadian Institute for Substance Use Research, School of Nursing, University of Victoria, HSD Building Room 402, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada, 1 250 721 7954, christineou@uvic.ca %K parent %K alcohol use %K COVID-19 %K scoping review %K parenting %K alcohol %K addict %K addiction %K substance use %K health behavior %K health behaviors %K scoping %K review methods %K review methodology %K drink %K drinking %K alcoholic %K alcoholism %D 2024 %7 26.8.2024 %9 Review %J Interact J Med Res %G English %X Background: The declaration of the COVID-19 pandemic led to public health restrictions that impacted the lives of people across the globe. Parents were particularly burdened with balancing multiple responsibilities, such as working from home while caring for and educating their children. Alcohol use among parents is an area that warrants further exploration. Objective: This study aimed to investigate patterns of parental alcohol consumption during the COVID-19 pandemic, focusing on relative changes in the frequency and quantity of alcohol use compared to prepandemic use, nonparent adult samples, or both. Methods: A scoping review informed by the methodology of Arksey and O’Malley explored patterns of parental alcohol consumption during the COVID-19 pandemic. Searches were conducted in CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms were created using the Joanna Briggs Institute framework of Population, Concept, and Context, with the population being parents and the concept being alcohol consumption during the COVID-19 pandemic. Results: The database search yielded 3568 articles, which were screened for eligibility. Of the 3568 articles, 40 (1.12%) met the inclusion criteria and were included in the scoping review. Findings indicated the following: (1) having children at home was a factor associated with parental patterns of alcohol use; (2) mixed findings regarding gender-related patterns of alcohol consumption; and (3) linkages between parental patterns of alcohol use and mental health symptoms of stress, depression, and anxiety. Conclusions: This scoping review revealed heterogeneous patterns in parental alcohol use across sociocultural contexts during the COVID-19 pandemic. Given the known harms of alcohol use, it is worthwhile for clinicians to assess parental drinking patterns and initiate conversations regarding moderation in alcohol use. %M 39186759 %R 10.2196/48339 %U https://www.i-jmr.org/2024/1/e48339 %U https://doi.org/10.2196/48339 %U http://www.ncbi.nlm.nih.gov/pubmed/39186759 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e46946 %T Exploring Computational Techniques in Preprocessing Neonatal Physiological Signals for Detecting Adverse Outcomes: Scoping Review %A Rahman,Jessica %A Brankovic,Aida %A Tracy,Mark %A Khanna,Sankalp %+ Commonwealth Scientific and Industrial Research Organisation (CSIRO) Australian e-Health Research Centre, Australia, 160 Hawkesbury Road, Sydney, 2145, Australia, 61 02 9325 3016, jessica.rahman@csiro.au %K physiological signals %K preterm %K neonatal intensive care unit %K morbidity %K signal processing %K signal analysis %K adverse outcomes %K predictive and diagnostic models %D 2024 %7 20.8.2024 %9 Review %J Interact J Med Res %G English %X Background: Computational signal preprocessing is a prerequisite for developing data-driven predictive models for clinical decision support. Thus, identifying the best practices that adhere to clinical principles is critical to ensure transparency and reproducibility to drive clinical adoption. It further fosters reproducible, ethical, and reliable conduct of studies. This procedure is also crucial for setting up a software quality management system to ensure regulatory compliance in developing software as a medical device aimed at early preclinical detection of clinical deterioration. Objective: This scoping review focuses on the neonatal intensive care unit setting and summarizes the state-of-the-art computational methods used for preprocessing neonatal clinical physiological signals; these signals are used for the development of machine learning models to predict the risk of adverse outcomes. Methods: Five databases (PubMed, Web of Science, Scopus, IEEE, and ACM Digital Library) were searched using a combination of keywords and MeSH (Medical Subject Headings) terms. A total of 3585 papers from 2013 to January 2023 were identified based on the defined search terms and inclusion criteria. After removing duplicates, 2994 (83.51%) papers were screened by title and abstract, and 81 (0.03%) were selected for full-text review. Of these, 52 (64%) were eligible for inclusion in the detailed analysis. Results: Of the 52 articles reviewed, 24 (46%) studies focused on diagnostic models, while the remainder (n=28, 54%) focused on prognostic models. The analysis conducted in these studies involved various physiological signals, with electrocardiograms being the most prevalent. Different programming languages were used, with MATLAB and Python being notable. The monitoring and capturing of physiological data used diverse systems, impacting data quality and introducing study heterogeneity. Outcomes of interest included sepsis, apnea, bradycardia, mortality, necrotizing enterocolitis, and hypoxic-ischemic encephalopathy, with some studies analyzing combinations of adverse outcomes. We found a partial or complete lack of transparency in reporting the setting and the methods used for signal preprocessing. This includes reporting methods to handle missing data, segment size for considered analysis, and details regarding the modification of the state-of-the-art methods for physiological signal processing to align with the clinical principles for neonates. Only 7 (13%) of the 52 reviewed studies reported all the recommended preprocessing steps, which could have impacts on the downstream analysis. Conclusions: The review found heterogeneity in the techniques used and inconsistent reporting of parameters and procedures used for preprocessing neonatal physiological signals, which is necessary to confirm adherence to clinical and software quality management system practices, usefulness, and choice of best practices. Enhancing transparency in reporting and standardizing procedures will boost study interpretation and reproducibility and expedite clinical adoption, instilling confidence in the research findings and streamlining the translation of research outcomes into clinical practice, ultimately contributing to the advancement of neonatal care and patient outcomes. %M 39163610 %R 10.2196/46946 %U https://www.i-jmr.org/2024/1/e46946 %U https://doi.org/10.2196/46946 %U http://www.ncbi.nlm.nih.gov/pubmed/39163610 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53672 %T Debate and Dilemmas Regarding Generative AI in Mental Health Care: Scoping Review %A Xian,Xuechang %A Chang,Angela %A Xiang,Yu-Tao %A Liu,Matthew Tingchi %+ Department of Communication, Faculty of Social Sciences, University of Macau, University Avenue, Taipa, Macau SAR, 999078, China, 86 88228991, wychang@um.edu.mo %K generative artificial intelligence %K GAI %K ChatGPT %K mental health %K scoping review %K artificial intelligence %K depression %K anxiety %K generative adversarial network %K GAN %K variational autoencoder %K VAE %D 2024 %7 12.8.2024 %9 Review %J Interact J Med Res %G English %X Background: Mental disorders have ranked among the top 10 prevalent causes of burden on a global scale. Generative artificial intelligence (GAI) has emerged as a promising and innovative technological advancement that has significant potential in the field of mental health care. Nevertheless, there is a scarcity of research dedicated to examining and understanding the application landscape of GAI within this domain. Objective: This review aims to inform the current state of GAI knowledge and identify its key uses in the mental health domain by consolidating relevant literature. Methods: Records were searched within 8 reputable sources including Web of Science, PubMed, IEEE Xplore, medRxiv, bioRxiv, Google Scholar, CNKI and Wanfang databases between 2013 and 2023. Our focus was on original, empirical research with either English or Chinese publications that use GAI technologies to benefit mental health. For an exhaustive search, we also checked the studies cited by relevant literature. Two reviewers were responsible for the data selection process, and all the extracted data were synthesized and summarized for brief and in-depth analyses depending on the GAI approaches used (traditional retrieval and rule-based techniques vs advanced GAI techniques). Results: In this review of 144 articles, 44 (30.6%) met the inclusion criteria for detailed analysis. Six key uses of advanced GAI emerged: mental disorder detection, counseling support, therapeutic application, clinical training, clinical decision-making support, and goal-driven optimization. Advanced GAI systems have been mainly focused on therapeutic applications (n=19, 43%) and counseling support (n=13, 30%), with clinical training being the least common. Most studies (n=28, 64%) focused broadly on mental health, while specific conditions such as anxiety (n=1, 2%), bipolar disorder (n=2, 5%), eating disorders (n=1, 2%), posttraumatic stress disorder (n=2, 5%), and schizophrenia (n=1, 2%) received limited attention. Despite prevalent use, the efficacy of ChatGPT in the detection of mental disorders remains insufficient. In addition, 100 articles on traditional GAI approaches were found, indicating diverse areas where advanced GAI could enhance mental health care. Conclusions: This study provides a comprehensive overview of the use of GAI in mental health care, which serves as a valuable guide for future research, practical applications, and policy development in this domain. While GAI demonstrates promise in augmenting mental health care services, its inherent limitations emphasize its role as a supplementary tool rather than a replacement for trained mental health providers. A conscientious and ethical integration of GAI techniques is necessary, ensuring a balanced approach that maximizes benefits while mitigating potential challenges in mental health care practices. %M 39133916 %R 10.2196/53672 %U https://www.i-jmr.org/2024/1/e53672 %U https://doi.org/10.2196/53672 %U http://www.ncbi.nlm.nih.gov/pubmed/39133916 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54687 %T Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors %A Iyengar,M Sriram %A Block Ngaybe,Maiya G %A Gonzalez,Myla %A Arora,Mona %+ University of Arizona College of Medicine, 475 North 5th Street, E967C, Phoenix, AZ, 85004, United States, 1 2817934733, msiyengar@arizona.edu %K health informatics %K data science %K climate change %K pandemics %K COVID-19 %K migrations %K mobile phone %D 2024 %7 12.8.2024 %9 Viewpoint %J Interact J Med Res %G English %X Climate change, local epidemics, future pandemics, and forced displacements pose significant public health threats worldwide. To cope successfully, people and communities are faced with the challenging task of developing resilience to these stressors. Our viewpoint is that the powerful capabilities of modern informatics technologies including artificial intelligence, biomedical and environmental sensors, augmented or virtual reality, data science, and other digital hardware or software, have great potential to promote, sustain, and support resilience in people and communities. However, there is no “one size fits all” solution for resilience. Solutions must match the specific effects of the stressor, cultural dimensions, social determinants of health, technology infrastructure, and many other factors. %M 39133540 %R 10.2196/54687 %U https://www.i-jmr.org/2024/1/e54687 %U https://doi.org/10.2196/54687 %U http://www.ncbi.nlm.nih.gov/pubmed/39133540 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56452 %T Examining the Relationships Between Indoor Environmental Quality Parameters Pertaining to Light, Noise, Temperature, and Humidity and the Behavioral and Psychological Symptoms of People Living With Dementia: Scoping Review %A Au-Yeung,Wan-Tai M %A Miller,Lyndsey %A Wu,Chao-Yi %A Beattie,Zachary %A Nunnerley,Michael %A Hanna,Remonda %A Gothard,Sarah %A Wild,Katherine %A Kaye,Jeffrey %+ Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode: UHN13, Portland, OR, 97239, United States, 1 5034946695, auyeungm@ohsu.edu %K dementia %K behavioral and psychological symptoms of dementia %K neuropsychiatric symptoms %K physical environment %K light %K noise %K temperature %K humidity %D 2024 %7 9.8.2024 %9 Review %J Interact J Med Res %G English %X Background: A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers’ burden, and lower health care cost. Objective: In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions. Methods: Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD. Results: A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89%), while there were fewer studies (from 5/38, 13% to 11/38, 29%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated. Conclusions: The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system. %M 39121471 %R 10.2196/56452 %U https://www.i-jmr.org/2024/1/e56452 %U https://doi.org/10.2196/56452 %U http://www.ncbi.nlm.nih.gov/pubmed/39121471 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50047 %T Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review %A Xie,Yijun %A Wu,Jing %A Li,Yao %A Liu,Hui %A Peng,Yanyan %A Zhou,Ping %A Sun,Yizhou %A Kang,Luyan %A Jiang,Chenghua %A Wu,Hengjing %+ Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, No.2209 Guangxing Road, Songjiang District, Shanghai, 201619, China, 86 15821525700, whjdata@126.com %K children with disabilities %K barriers %K health services %K middle- and high-income countries %K child %K low income %K middle income %K disability %K children %K disabilities %K income %K barrier %K rehabilitation %K suitability %K availability %K affordability %K support system %K support %K awareness %K policy %D 2024 %7 7.8.2024 %9 Review %J Interact J Med Res %G English %X Background: The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. Objective: This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. Methods: A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. Results: The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. Conclusions: Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level. %M 39110502 %R 10.2196/50047 %U https://www.i-jmr.org/2024/1/e50047 %U https://doi.org/10.2196/50047 %U http://www.ncbi.nlm.nih.gov/pubmed/39110502 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e46888 %T Digital Health Literacy and Its Association With Sociodemographic Characteristics, Health Resource Use, and Health Outcomes: Rapid Review %A Yuen,Eva %A Winter,Natalie %A Savira,Feby %A Huggins,Catherine E %A Nguyen,Lemai %A Cooper,Paul %A Peeters,Anna %A Anderson,Kate %A Bhoyroo,Rahul %A Crowe,Sarah %A Ugalde,Anna %+ School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 03 92517074, e.yuen@deakin.edu.au %K digital health literacy %K eHealth literacy %K health literacy %K digital health %K web-based database %K health information %D 2024 %7 26.7.2024 %9 Review %J Interact J Med Res %G English %X Background: Digital health literacy has emerged as a critical skill set to navigate the digital age. Objective: This review sought to broadly summarize the literature on associations between digital health literacy and (1) sociodemographic characteristics, (2) health resource use, and (3) health outcomes in the general population, patient groups, or parent or caregiver groups. Methods: A rapid review of literature published between January 2016 and May 2022 was conducted through a search of 4 web-based databases. Articles were included on the basis of the following keywords: “measured digital health literacy,” “digital literacy,” “ehealth literacy,” “e-health literacy,” “electronic health literacy,” or “internet health literacy” in adult populations; participants were from countries where English was the primary language; studies had to be cross-sectional, longitudinal, prospective, or retrospective, and published in English. Results: Thirty-six articles met the inclusion criteria. Evidence on the associations between digital health literacy and sociodemographic characteristics varied (27/36, 75% included studies), with higher education (16/21, 76.2% studies that examined the association) and younger age (12/21, 57.1% studies) tending to predict higher digital health literacy; however, other studies found no associations. No differences between genders were found across the majority of studies. Evidence across ethnic groups was too limited to draw conclusions; some studies showed that those from racial and ethnic minority groups had higher digital health literacy than White individuals, while other studies showed no associations. Higher digital health literacy was associated with digital health resource use in the majority of studies (20/36, 55.6%) that examined this relationship. In addition, higher digital health literacy was also associated with health outcomes across 3 areas (psychosocial outcomes; chronic disease and health management behaviors; and physical outcomes) across 17 included studies (17/36, 47.2%) that explored these relationships. However, not all studies on the relationship among digital health literacy and health resource use and health outcomes were in the expected direction. Conclusions: The review presents mixed results regarding the relationship between digital health literacy and sociodemographic characteristics, although studies broadly found that increased digital health literacy was positively associated with improved health outcomes and behaviors. Further investigations of digital health literacy on chronic disease outcomes are needed, particularly across diverse groups. Empowering individuals with the skills to critically access and appraise reliable health information on digital platforms and devices is critical, given emerging evidence that suggests that those with low digital health literacy seek health information from unreliable sources. Identifying cost-effective strategies to rapidly assess and enhance digital health literacy capacities across community settings thus warrants continued investigation. %M 39059006 %R 10.2196/46888 %U https://www.i-jmr.org/2024/1/e46888 %U https://doi.org/10.2196/46888 %U http://www.ncbi.nlm.nih.gov/pubmed/39059006 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55699 %T Cardiovascular Comorbidities in COVID-19: Comprehensive Analysis of Key Topics %A Markovič,Rene %A Ternar,Luka %A Trstenjak,Tim %A Marhl,Marko %A Grubelnik,Vladimir %+ Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, SI-2000, Slovenia, 386 2 220 73 96, vlado.grubelnik@um.si %K COVID-19 %K cardiovascular diseases %K metabolic disorders %K embolism and thrombosis %K hypertension %K hyperglycemia %K iron metabolism disorders %K MeSH %K embolism %K thrombosis %K heart failure %K nutritional %K vascular disease %K glucose %K effective %D 2024 %7 24.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The interrelation between COVID-19 and various cardiovascular and metabolic disorders has been a critical area of study. There is a growing need to understand how comorbidities such as cardiovascular diseases (CVDs) and metabolic disorders affect the risk and severity of COVID-19. Objective: The objective of this study is to systematically analyze the association between COVID-19 and cardiovascular and metabolic disorders. The focus is on comorbidity, examining the roles of CVDs such as embolism, thrombosis, hypertension, and heart failure, as well as metabolic disorders such as disorders of glucose and iron metabolism. Methods: Our study involved a systematic search in PubMed for literature published from 2000 to 2022. We established 2 databases: one for COVID-19–related articles and another for CVD-related articles, ensuring all were peer-reviewed. In terms of data analysis, statistical methods were applied to compare the frequency and relevance of MeSH (Medical Subject Headings) terms between the 2 databases. This involved analyzing the differences and ratios in the usage of these terms and employing statistical tests to determine their significance in relation to key CVDs within the COVID-19 research context. Results: The study revealed that “Cardiovascular Diseases” and “Nutritional and Metabolic Diseases” were highly relevant as level 1 Medical Subject Headings descriptors in COVID-19 comorbidity research. Detailed analysis at level 2 and level 3 showed “Vascular Disease” and “Heart Disease” as prominent descriptors under CVDs. Significantly, “Glucose Metabolism Disorders” were frequently associated with COVID-19 comorbidities such as embolism, thrombosis, and heart failure. Furthermore, iron deficiency (ID) was notably different in its occurrence between COVID-19 and CVD articles, underlining its significance in the context of COVID-19 comorbidities. Statistical analysis underscored these differences, highlighting the importance of both glucose and iron metabolism disorders in COVID-19 research. Conclusions: This work lays the foundation for future research that utilizes a knowledge-based approach to elucidate the intricate relationships between these conditions, aiming to develop more effective health care strategies and interventions in the face of ongoing pandemic challenges. %M 39046774 %R 10.2196/55699 %U https://www.i-jmr.org/2024/1/e55699 %U https://doi.org/10.2196/55699 %U http://www.ncbi.nlm.nih.gov/pubmed/39046774 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52926 %T Effectiveness of Catch-Up Vaccination Interventions Versus Standard or Usual Care Procedures in Increasing Adherence to Recommended Vaccinations Among Different Age Groups: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Before-After Studies %A Fallucca,Alessandra %A Priano,Walter %A Carubia,Alessandro %A Ferro,Patrizia %A Pisciotta,Vincenzo %A Casuccio,Alessandra %A Restivo,Vincenzo %+ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy, 39 3804703272, alessandra.fallucca@unipa.it %K vaccine strategies %K catch-up interventions %K recall intervention %K vaccination coverage %K multicomponent %K education %K remind %K reward %K vaccination %K vaccine %K adherence %K systematic review %K meta-analysis %K immunization %K health care based %K multidimensional intervention %K education based %K vaccine literacy %K PRISMA %D 2024 %7 23.7.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: To address the global challenge of vaccine hesitancy, the Strategic Advisory Group of Experts on Immunization strongly promotes vaccination reminder and recall interventions. Coupled with the new opportunities presented by scientific advancements, these measures are crucial for successfully immunizing target population groups. Objective: This systematic review and meta-analysis aims to assess the effectiveness of various interventions in increasing vaccination coverage compared with standard or usual care. The review will cover all vaccinations recommended for different age groups. Methods: In February 2022, 2 databases were consulted, retrieving 1850 studies. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 79 manuscripts were included after the assessment phase. These comprised 46 trials/randomized controlled trials (RCTs) and 33 before-after studies. A meta-analysis using a random-effects model was performed with STATA software (version 14.1.2). The selected outcome was the risk ratio (RR) of vaccination coverage improvement effectiveness. Additionally, meta-regression analyses were conducted for the included manuscripts. Results: The analyses showed an overall efficacy of RR 1.22 (95% CI 1.19-1.26) for RCTs and RR 1.70 (95% CI 1.54-1.87) for before-after studies when considering all interventions cumulatively. Subgroup analyses identified multicomponent interventions (RR 1.58, 95% CI 1.36-1.85) and recall clinical interventions (RR 1.24, 95% CI 1.17-1.32) as the most effective in increasing vaccination coverage for RCTs. By contrast, educational interventions (RR 2.13, 95% CI 1.60-2.83) and multicomponent interventions (RR 1.61, 95% CI 1.43-1.82) achieved the highest increases for before-after studies. Meta-regression analyses indicated that the middle-aged adult population was associated with a higher increase in vaccination coverage (RCT: coefficient 0.54, 95% CI 0.12-0.95; before-after: coefficient 1.27, 95% CI 0.70-1.84). Conclusions: Community, family, and health care–based multidimensional interventions, as well as education-based catch-up strategies, effectively improve vaccination coverage. Therefore, their systematic implementation is highly relevant for targeting undervaccinated population groups. This approach aligns with national vaccination schedules and aims to eliminate or eradicate vaccine-preventable diseases. %M 39042433 %R 10.2196/52926 %U https://publichealth.jmir.org/2024/1/e52926 %U https://doi.org/10.2196/52926 %U http://www.ncbi.nlm.nih.gov/pubmed/39042433 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47280 %T Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review %A Nassehi,Damoun %A Gripsrud,Birgitta Haga %A Ramvi,Ellen %+ Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4036, Norway, 47 45426096, damoun.nassehi@uis.no %K digital health %K mobile health %K telemedicine %K physician-patient relations %K relational ethics %K primary care %K patient-provider %K physician-patient %K telehealth %K relationship %K eHealth %K scoping review %K review method %K mobile phone %D 2024 %7 15.5.2024 %9 Review %J Interact J Med Res %G English %X Background: The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. Objective: This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. Results: Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. Conclusions: The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies. %M 38748465 %R 10.2196/47280 %U https://www.i-jmr.org/2024/1/e47280 %U https://doi.org/10.2196/47280 %U http://www.ncbi.nlm.nih.gov/pubmed/38748465 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54490 %T Application of AI in Sepsis: Citation Network Analysis and Evidence Synthesis %A Wu,MeiJung %A Islam,Md Mohaimenul %A Poly,Tahmina Nasrin %A Lin,Ming-Chin %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 250 Wuxing St, Xinyi District, Taipei, 110, Taiwan, 886 66202589, arbiter@tmu.edu.tw %K AI %K artificial intelligence %K bibliometric analysis %K bibliometric %K citation %K deep learning %K machine learning %K network analysis %K publication %K sepsis %K trend %K visualization %K VOSviewer %K Web of Science %K WoS %D 2024 %7 15.4.2024 %9 Original %J Interact J Med Res %G English %X Background: Artificial intelligence (AI) has garnered considerable attention in the context of sepsis research, particularly in personalized diagnosis and treatment. Conducting a bibliometric analysis of existing publications can offer a broad overview of the field and identify current research trends and future research directions. Objective: The objective of this study is to leverage bibliometric data to provide a comprehensive overview of the application of AI in sepsis. Methods: We conducted a search in the Web of Science Core Collection database to identify relevant articles published in English until August 31, 2023. A predefined search strategy was used, evaluating titles, abstracts, and full texts as needed. We used the Bibliometrix and VOSviewer tools to visualize networks showcasing the co-occurrence of authors, research institutions, countries, citations, and keywords. Results: A total of 259 relevant articles published between 2014 and 2023 (until August) were identified. Over the past decade, the annual publication count has consistently risen. Leading journals in this domain include Critical Care Medicine (17/259, 6.6%), Frontiers in Medicine (17/259, 6.6%), and Scientific Reports (11/259, 4.2%). The United States (103/259, 39.8%), China (83/259, 32%), United Kingdom (14/259, 5.4%), and Taiwan (12/259, 4.6%) emerged as the most prolific countries in terms of publications. Notable institutions in this field include the University of California System, Emory University, and Harvard University. The key researchers working in this area include Ritankar Das, Chris Barton, and Rishikesan Kamaleswaran. Although the initial period witnessed a relatively low number of articles focused on AI applications for sepsis, there has been a significant surge in research within this area in recent years (2014-2023). Conclusions: This comprehensive analysis provides valuable insights into AI-related research conducted in the field of sepsis, aiding health care policy makers and researchers in understanding the potential of AI and formulating effective research plans. Such analysis serves as a valuable resource for determining the advantages, sustainability, scope, and potential impact of AI models in sepsis. %M 38621231 %R 10.2196/54490 %U https://www.i-jmr.org/2024/1/e54490 %U https://doi.org/10.2196/54490 %U http://www.ncbi.nlm.nih.gov/pubmed/38621231 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54680 %T Factors Underlying Vaccine Hesitancy and Their Mitigations in Saudi Arabia: Protocol for a Systematic Review %A Kanan,Mohammed %A Abdulrahman,Samar %A Alshehri,Abdulaziz %A AlSuhaibani,Renad %A Alotaibi,Nawaf M %A Alsaleh,Azhar %A Nasser,Bushra %A Baowaydhan,Rana %A Alredaini,Ibrahim %A Khalid,Taif %A Almukhtar,Fatima %A Altoaimi,Nourah %A Alhneshel,Almaha %A Alanazi,Shouq %A Algmaizi,Shahad %+ Department of Clinical Pharmacy, King Fahad Medical City, 2642, Makkah Al Mukarramah Br Rd, As Sulimaniyah, Riyadh, 12231, Saudi Arabia, 966 508564504, ii_kanan101@outlook.com %K acceptance %K campaigns %K effectiveness %K factors %K hesitancy %K immunization rates %K immunization %K intervention %K literature analysis %K misinformation %K mitigations %K prevention %K protocol %K public health %K review methodology %K review methods %K Saudi Arabia %K search %K searching %K syntheses %K synthesis %K systematic review %K systematic %K vaccination %K vaccine hesitancy %K vaccine %D 2024 %7 22.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Vaccine hesitancy is a growing concern in Saudi Arabia, impacting even well-educated parents. The decision-making process involves various factors such as accessibility, trustworthy information, and the influence of social networks, reflecting a complex interplay of emotional, cultural, social, spiritual, and political dimensions. Objective: This review seeks to evaluate the prevalence and trends of vaccine hesitancy, identify contributing factors, and explore potential solutions to enhance immunization rates. This review aligns with global concerns, as the World Health Organization has identified vaccine hesitancy as a top global health threat. Methods: Our systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and PICOS (Population, Intervention, Comparison, Outcomes, and Study) criteria for comprehensive assessment. We will conduct a thorough search across various databases, encompassing a wide range of vaccines, and pay special attention to vaccination campaigns and refusals. Inclusion criteria involve descriptive, observational, and analytical studies focusing on factors influencing vaccine acceptance or hesitancy. The study will use the Crowe Critical Appraisal Tool for quality assessment and perform a narrative synthesis to summarize findings thematically. Results: This systematic review is expected to unveil the prevalence and trends of vaccine hesitancy in diverse populations in Saudi Arabia, shedding light on cultural, religious, and social factors contributing to hesitancy. It aims to assess the effectiveness of implemented strategies, enable regional and global comparisons, and provide implications for tailored vaccination policies. Additionally, the review may pinpoint research gaps, guiding future investigations to address and mitigate vaccine hesitancy effectively. Conclusions: The findings are expected to have direct policy implications and guide interventions to strengthen vaccination programs and improve public health outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/54680 %M 38517463 %R 10.2196/54680 %U https://www.researchprotocols.org/2024/1/e54680 %U https://doi.org/10.2196/54680 %U http://www.ncbi.nlm.nih.gov/pubmed/38517463 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52296 %T Improvements in Neoplasm Classification in the International Classification of Diseases, Eleventh Revision: Systematic Comparative Study With the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision %A Xu,Yicong %A Zhou,Jingya %A Li,Hongxia %A Cai,Dong %A Zhu,Huanbing %A Pan,Shengdong %+ Department of Medical Administration, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China, 86 1 366 666 9123, psd618@zju.edu.cn %K Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision %K ICD-10 %K ICD-10-CCM %K ICD-11 %K improvement %K International Classification of Diseases, Eleventh Revision %K International Classification of Diseases, Tenth Revision %K International Classification of Diseases %K neoplasm %K transition %D 2024 %7 8.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The International Classification of Diseases, Eleventh Revision (ICD-11) improved neoplasm classification. Objective: We aimed to study the alterations in the ICD-11 compared to the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision (ICD-10-CCM) for neoplasm classification and to provide evidence supporting the transition to the ICD-11. Methods: We downloaded public data files from the World Health Organization and the National Health Commission of the People’s Republic of China. The ICD-10-CCM neoplasm codes were manually recoded with the ICD-11 coding tool, and an ICD-10-CCM/ICD-11 mapping table was generated. The existing files and the ICD-10-CCM/ICD-11 mapping table were used to compare the coding, classification, and expression features of neoplasms between the ICD-10-CCM and ICD-11. Results: The ICD-11 coding structure for neoplasms has dramatically changed. It provides advantages in coding granularity, coding capacity, and expression flexibility. In total, 27.4% (207/755) of ICD-10 codes and 38% (1359/3576) of ICD-10-CCM codes underwent grouping changes, which was a significantly different change (χ21=30.3; P<.001). Notably, 67.8% (2424/3576) of ICD-10-CCM codes could be fully represented by ICD-11 codes. Another 7% (252/3576) could be fully described by uniform resource identifiers. The ICD-11 had a significant difference in expression ability among the 4 ICD-10-CCM groups (χ23=93.7; P<.001), as well as a considerable difference between the changed and unchanged groups (χ21=74.7; P<.001). Expression ability negatively correlated with grouping changes (r=–.144; P<.001). In the ICD-10-CCM/ICD-11 mapping table, 60.5% (2164/3576) of codes were postcoordinated. The top 3 postcoordinated results were specific anatomy (1907/3576, 53.3%), histopathology (201/3576, 5.6%), and alternative severity 2 (70/3576, 2%). The expression ability of postcoordination was not fully reflected. Conclusions: The ICD-11 includes many improvements in neoplasm classification, especially the new coding system, improved expression ability, and good semantic interoperability. The transition to the ICD-11 will inevitably bring challenges for clinicians, coders, policy makers and IT technicians, and many preparations will be necessary. %M 38457228 %R 10.2196/52296 %U https://www.i-jmr.org/2024/1/e52296 %U https://doi.org/10.2196/52296 %U http://www.ncbi.nlm.nih.gov/pubmed/38457228 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48929 %T Digital Methods for the Spiritual and Mental Health of Generation Z: Scoping Review %A Park,Susanna Y %A Do,Bridgette %A Yourell,Jacqlyn %A Hermer,Janice %A Huberty,Jennifer %+ Skylight, Radiant Foundation, 55 N 300 W Suite 800, Salt Lake City, UT, 84101, United States, 1 (720) 675 7228, susanna@skylight.org %K Generation Z %K Gen Z %K spiritual health %K digital mental health %K spirituality %D 2024 %7 6.2.2024 %9 Review %J Interact J Med Res %G English %X Background: Generation Z (Gen Z) includes individuals born between 1995 and 2012. These individuals experience high rates of anxiety and depression. Most Gen Z individuals identify with being spiritual, and aspects from religion and spirituality can be integrated into mental health treatment and care as both are related to lower levels of depression. However, research on the spiritual and mental health of Gen Z is sparse. To date, there are no systematic or scoping reviews on digital methods to address the spiritual and mental health of Gen Z. Objective: This scoping review aimed to describe the current state of digital methods to address spiritual and mental health among Gen Z, identify the knowledge gaps, and make suggestions for how to leverage digital spiritual and mental health interventions for Gen Z. Methods: A comprehensive literature search was conducted in PubMed, Scopus, PsycInfo, CINAHL, Education Full Text, Google Scholar, SocIndex, and Sociological Abstracts. The inclusion criteria were as follows: (1) study population born between 1995 and 2012 (ie, Gen Z); (2) reporting on spiritual health or well-being, spirituality or religion, and mental health or well-being; (3) reporting on using digital methods; (4) publication in 1996 or beyond; (5) human subject research; (6) full text availability in English; (7) primary research study design; and (8) peer-reviewed article. Two authors screened articles and subsequently extracted data from the included articles to describe the available evidence. Results: A total of 413 articles were screened at the title and abstract levels, of which 27 were further assessed with full text for eligibility. Five studies met the inclusion criteria, and data were extracted to summarize study characteristics and findings. The studies were performed across 4 different countries. There were 2 mixed-methods studies (South Africa and Canada), 2 cross-sectional studies (China and United States), and 1 randomized controlled trial (United States). Of these studies, only 2 discussed digital interventions (a text messaging–based intervention to improve spiritual and mental health, and a feasibility study for a mental health app). Other studies had a digital component with minor or unclear spiritual and mental health measures. Overall, there was a lack of consistency in how spiritual and mental health were measured. Conclusions: Few studies have focused on assessing the spiritual and mental health of Gen Z in the digital context, and no research to date has examined a digital spiritual and mental health application among Gen Z. Research is needed to inform the development and evaluation of approaches to address the spiritual and mental health of Gen Z via digital means (eg, mobile apps). %M 38261532 %R 10.2196/48929 %U https://www.i-jmr.org/2024/1/e48929 %U https://doi.org/10.2196/48929 %U http://www.ncbi.nlm.nih.gov/pubmed/38261532 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e49746 %T Worldwide Distribution and Extracutaneous Manifestations of Henoch-Schönlein Purpura in Adults: Narrative Review %A Harris,Blair W %A Maxfield,Luke %A Hunter,Abigail %A Alhajj,Mandy %A Ban,Byung %A Pulsipher,Kayd J %+ Department of Dermatology, Sampson Regional Medical Center, Campbell University, 607 Beaman Street, Clinton, NC, 28328, United States, 1 4355356888, kpulsipher@sampsonrmc.org %K extracutaneous manifestations %K HSP %K Henoch-Schönlein purpura %K immunoglobulin A vasculitis %K IgAV %K IgA vasculitis %K narrative review %D 2024 %7 25.1.2024 %9 Review %J JMIR Dermatol %G English %X Background: Henoch-Schönlein purpura (HSP), a leukocytoclastic small vessel vasculitis, exhibits both cutaneous and systemic manifestations. While predominantly observed in childhood, it may manifest in adults with more pronounced systemic involvement. Furthermore, HSP is a global phenomenon showcasing epidemiological and systemic variances. Objective: This study aims to scrutinize extracutaneous manifestations in adults with HSP, discerning distinctions according to geographical regions on a worldwide scale. Methods: A comprehensive search encompassing PubMed, Embase, Cochrane Library, and Web of Science was executed, covering papers published from January 1, 1970, to December 1, 2019. Keywords used included “Henoch-Schönlein purpura,” “henoch schonlein purpura+adult,” “IgA vasculitis+adult,” “HSP+adult,” and “IgAV.” A total of 995 publications were identified, from which 42 studies encompassing 4064 patients were selected, with a predominant focus on cases reported in Asia, Europe, and the Americas. Results: Among adults afflicted with HSP, European patients exhibited a higher propensity for male predominance (P<.001), gastrointestinal involvement (P<.001), and musculoskeletal complications (P<.001). Conversely, patients from the Americas were least likely to experience genitourinary involvement (P<.001). Conclusions: HSP demonstrates a variance in distribution and extracutaneous manifestations within distinct geographical boundaries. In the adult population, European patients exhibited a higher prevalence of male gender and gastrointestinal and musculoskeletal involvement. Asian patients were more predisposed to genitourinary involvement when compared to their American counterparts. The establishment of prospective studies using standardized reporting measures is imperative to validate the relationships unveiled in this investigation. %M 38271008 %R 10.2196/49746 %U https://derma.jmir.org/2024/1/e49746 %U https://doi.org/10.2196/49746 %U http://www.ncbi.nlm.nih.gov/pubmed/38271008 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48587 %T Strategies to Alleviate the Burden Experienced by Informal Caregivers of Persons With Severe Mental Disorders in Low- and Middle-Income Countries: Scoping Review %A Silaule,Olindah %A Casteleijn,Daleen %A Adams,Fasloen %A Nkosi,Nokuthula Gloria %+ Department of Occupational Therapy, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa, 27 0782035213, osilaule@cartafrica.org %K severe mental disorders %K informal caregivers %K caregiver stress %K caregiver support %K low- and middle-income country %K mobile phone %D 2024 %7 18.1.2024 %9 Review %J Interact J Med Res %G English %X Background: There is considerable evidence of the burden of care encountered by informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. Previous studies have highlighted the need to support these informal caregivers as key players in the care of these patients. To date, limited evidence exists on the extent and types of strategies for supporting these informal caregivers in low- and middle-income countries. Objective: This scoping review aims to identify and describe the extent and type of evidence on the existing strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. Methods: A systematic literature search was completed following the Joanna Briggs Institute methodology for scoping reviews. The participants, concept, and context framework was used to guide the search for literature sources across 5 databases: PubMed, MEDLINE, CINAHL, and PsycINFO for published literature and ProQuest for unpublished literature. This review included studies that reported on strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions, with a focus on studies that evaluated or recommended caregiver interventions and support strategies in low- and middle-income countries. The search was limited to studies conducted between 2001 and 2021, and only papers written in English were considered for inclusion. Using the Covidence software (Veritas Health Innovation), 2 reviewers independently screened the papers, applied the inclusion and exclusion criteria, and met biweekly to discuss and resolve conflicts. The relevant studies and reported outcomes were summarized, organized, and analyzed descriptively using numeric summary analysis and deductive content analysis. Results: Of the 18,342 studies identified, 44 (0.24%) met the inclusion criteria. The included studies were from 16 low- and middle-income countries in Asia, Africa, Europe, and South and North America. Most studies (21/44, 48%) were randomized controlled trials conducted in Asian countries. The identified strategies were grouped into 2 categories: implemented and recommended intervention strategies. Identified strategies included community-based interventions, psychoeducation interventions, support groups, cognitive behavioral therapy, spirituality-based interventions, and smartphone-based interventions. In addition, mindfulness and empowerment, collaborative interventions, standard care, financial and social support, counseling, occupation-based interventions, policy and legislature, and access to mental health care were identified. Psychoeducation and support group interventions were identified as common strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions. Conclusions: This review provides evidence on the types of implemented and recommended strategies for alleviating the burden of care among informal caregivers in low- and middle-income countries. Although psychoeducational interventions were the most preferred strategy for alleviating burden, their benefits were short-lived when compared with peer-led support groups. International Registered Report Identifier (IRRID): RR2-10.2196/44268 %M 38236636 %R 10.2196/48587 %U https://www.i-jmr.org/2024/1/e48587 %U https://doi.org/10.2196/48587 %U http://www.ncbi.nlm.nih.gov/pubmed/38236636 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48625 %T Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review %A Ribaut,Janette %A DeVito Dabbs,Annette %A Dobbels,Fabienne %A Teynor,Alexandra %A Mess,Elisabeth Veronica %A Hoffmann,Theresa %A De Geest,Sabina %+ Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland, 41 61 207 09 16, sabina.degeest@unibas.ch %K telemedicine %K smartphone %K mobile apps %K program evaluation %K decision-making %K systematic review %K mobile phone %D 2024 %7 15.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose. Objective: Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps. Methods: We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team. Results: Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more—mainly related to ethical, legal, and social aspects—resulting in 216 evaluation criteria. No criteria had to be moved between dimensions. Conclusions: This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064 %M 38224477 %R 10.2196/48625 %U https://mhealth.jmir.org/2024/1/e48625 %U https://doi.org/10.2196/48625 %U http://www.ncbi.nlm.nih.gov/pubmed/38224477 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e47250 %T Phone-Based Text Therapy for Youth Mental Health: Rapid Review %A Karnik,Varun %A Henderson,Hamish %A Khan,Urooj Raza %A Boyd,James %+ La Trobe University, 360 Collins Street, Melbourne, 3086, Australia, 61 3 9479 6000, varun.karnik@griffithuni.edu.au %K text therapy %K mHealth %K adolescent health %K distance counseling %K mental illness %K mobile health intervention %K adolescent %K health promotion %K digital mental health intervention %D 2023 %7 14.12.2023 %9 Review %J Interact J Med Res %G English %X Background: Mental illness has become a prevalent issue impacting adolescents worldwide. Many barriers, including stigma and poor health literacy, prevent this population group from accessing reliable mental health care services. Synchronous text–therapy counseling is an underused therapeutic approach in combating adolescent mental illness. Phone-based text therapy is uniquely placed to offer personalized counseling to adolescents through a familiar and engaging treatment modality. Objective: This rapid review aims to understand the clinical effectiveness, usability, and accessibility of phone-based text therapy for youth mental health. Methods: Cochrane CENTRAL, Embase, PubMed, and PsycINFO were used to search for suitable literature. Five groups of keywords were used: those related to (1) “therapy,” (2) “text,” (3) “phone,” (4) “youth,” and (5) “mental health.” Eligibility criteria were formed through the PICO (Population, Intervention, Control, and Outcome) framework. Studies were included if a synchronous phone-based text therapy intervention was used in an adolescent population, with an age range of 12-24 years. Only literature available in full-text, English, and a peer-reviewed journal was considered. Furthermore, a date limit of 5 years was set to reflect the recent development of digital interventions for mental health. Pertinent information from each study was tabulated, and a narrative synthesis was used to assess, describe, and organize the included studies comprehensively and concisely. Results: Of the 771 studies dual screened, 7 studies were included in this rapid review. Most of the exclusions occurred due to the use of the wrong intervention, such as asynchronous messaging. The selected studies had a low risk of bias and were suitable for the review. All interventional trials demonstrated reductions in mental health symptoms, primarily depression and anxiety. Most studies displayed high usability among participants, while data were unclear regarding accessibility. Conclusions: This review reveals the high potential of phone-based text therapy as an intervention for adolescents experiencing mental illness. We hope that this review promotes further refinement of text-based phone therapies and encourages future research on this subject matter. %M 38096012 %R 10.2196/47250 %U https://www.i-jmr.org/2023/1/e47250 %U https://doi.org/10.2196/47250 %U http://www.ncbi.nlm.nih.gov/pubmed/38096012 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43572 %T Nonface-to-Face Visitation to Restrict Patient Visits for Infection Control: Integrative Review %A Jeong,Hyunwoo %A Choi,Yonsu %A Kim,Heejung %+ College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 02 2228 3273, hkim80@yuhs.ac %K nonface-to-face visitation %K visit restriction %K infection control %K patient %K family %D 2023 %7 28.11.2023 %9 Review %J Interact J Med Res %G English %X Background: In the COVID-19 pandemic, a visit restriction policy for patients has been implemented in medical institutions worldwide and visits are being made using alternative communication technologies. This shift has also required the use of platforms to prevent negative consequences of these restrictions. Objective: The purpose of this review was to comprehensively explore nonface-to-face visits as an alternative during infection prevention and to synthesize the scientific evidence of their benefits and disadvantages. Methods: A comprehensive search was conducted via the PubMed, Embase, CINAHL, Cochrane, and Web of Science electronic databases; unpublished trials in the clinical trials register ClinicalTrials.gov; and Virginia Henderson International Nursing Library up to September 10, 2021. The search query was developed according to the guidelines of the Peer Review of Electronic Search Strategies and included keywords on the topics of telemedicine and visitation restrictions. The inclusion criteria were a nonface-to-face modality using telemedicine with family in a hospital setting, experimental and observational studies, and articles written in English. The exclusion criteria were inaccessible in full text, not related to patient or family involvement, mainly focused on the study protocol, or only discussing the pros and cons of telemedicine. Results: Overall, patients’ families experienced emotional distress due to restrictions on face-to-face visits. Nonface-to-face virtual visits compensating for these restrictions had a positive effect on reducing the risk of infection to the patient and the family. This further encouraged psychological and physical recovery and decreased psychological distress. However, nonface-to-face virtual technology could not replace the existence of actual families, and technical problems with networks and devices are reported as limitations. Conclusions: Ensuring the availability of technology and educating on the same in alignment with the characteristics of patients and their families, nonface-to-face virtual visits need to show more potential as an effective patient-centered treatment strategy based on more research and advanced practice. %M 38015595 %R 10.2196/43572 %U https://www.i-jmr.org/2023/1/e43572 %U https://doi.org/10.2196/43572 %U http://www.ncbi.nlm.nih.gov/pubmed/38015595 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45258 %T Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review %A Schulze,Annett %A Lindemann,Ann-Kathrin %A Brand,Fabian %A Geppert,Johanna %A Menning,Axel %A Stehr,Paula %A Reifegerste,Doreen %A Rossmann,Constanze %+ Department of Risk Communication, German Federal Institute for Risk Assessment, Max-Dohrn-Str 8-10, Berlin, 10589, Germany, 49 18412 52002, annett.schulze@bfr.bund.de %K mobile health %K mHealth %K caregiver %K parental %K prevention %K first aid %K pediatric %K review method %K injuries %K health app %K needs %K mobile phone %D 2023 %7 6.9.2023 %9 Review %J Interact J Med Res %G English %X Background: Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. Objective: This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. Methods: In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app’s architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. Conclusions: The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies. %M 37672312 %R 10.2196/45258 %U https://www.i-jmr.org/2023/1/e45258 %U https://doi.org/10.2196/45258 %U http://www.ncbi.nlm.nih.gov/pubmed/37672312 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45504 %T Use of Wearable Devices for Peak Oxygen Consumption Measurement in Clinical Cardiology: Case Report and Literature Review %A Bayshtok,Gabriella %A Tiosano,Shmuel %A Furer,Ariel %+ Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 972 52 927 7372, furera@gmail.com %K cardiac fitness %K cardiac patient %K cardiorespiratory fitness %K CRF %K clinical cardiology %K oxygen consumption %K peak VO2 %K smartwatch %K wearable device %D 2023 %7 15.8.2023 %9 Case Report %J Interact J Med Res %G English %X Background: Oxygen consumption is an important index to evaluate in cardiac patients, particularly those with heart failure, and is measured in the setting of advanced cardiopulmonary exercise testing. However, technological advances now allow for the estimation of this parameter in many consumer and medical-grade wearable devices, making it available for the medical provider at the initial evaluation of patients. We report a case of an apparently healthy male aged 40 years who presented for evaluation due to an Apple Watch (Apple Inc) notification of low cardiac fitness. This alert triggered a thorough workup, revealing a diagnosis of familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. While the use of wearable devices for the measurement of oxygen consumption and related parameters is promising, further studies are needed for validation. Objective: The aim of this report is to investigate the potential utility of wearable devices as a screening and risk stratification tool for cardiac fitness for the general population and those with increased cardiovascular risk, particularly through the measurement of peak oxygen consumption (VO2). We discuss the possible advantages of measuring oxygen consumption using wearables and propose its integration into routine patient evaluation and follow-up processes. With the current evidence and limitations, we encourage researchers and clinicians to explore bringing wearable devices into clinical practice. Methods: The case was identified at Sheba Medical Center, and the patient’s cardiac fitness was monitored through an Apple Watch Series 6. The patient underwent a comprehensive cardiac workup following his presentation. Subsequently, we searched the literature for articles relating to the clinical utility of peak VO2 monitoring and available wearable devices. Results: The Apple Watch data provided by the patient demonstrated reduced peak VO2, a surrogate index for cardiac fitness, which improved after treatment initiation. A cardiological workup confirmed familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. A review of the literature revealed the potential clinical benefit of peak VO2 monitoring in both cardiac and noncardiac scenarios. Additionally, several devices on the market were identified that could allow for accurate oxygen consumption measurement; however, future studies and approval by the Food and Drug Administration (FDA) are still necessary. Conclusions: This case report highlights the potential utility of peak VO2 measurements by wearable devices for early identification and screening of cardiac fitness for the general population and those at increased risk of cardiovascular disease. The integration of wearable devices into routine patient evaluation may allow for earlier presentation in the diagnostic workflow. Cardiac fitness can be serially measured using the wearable device, allowing for close monitoring of functional capacity parameters. Devices need to be used with caution, and further studies are warranted. %M 37581915 %R 10.2196/45504 %U https://www.i-jmr.org/2023/1/e45504 %U https://doi.org/10.2196/45504 %U http://www.ncbi.nlm.nih.gov/pubmed/37581915 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46042 %T Studies on HIV/AIDS Among Students: Bibliometric Analysis %A Wang,Na %A Zhang,Runxi %A Ye,Zeyan %A Lan,Guanghua %A Zhu,Qiuying %A Chen,Huanhuan %A Zhang,Xiangjun %A Tan,Shengkui %A Ruan,Yuhua %A Lin,Mei %+ Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, 18 Jinzhou Road, Nanning, 530028, China, 86 07712518689, gxlinmei@126.com %K bibliometric analysis %K HIV %K acquired immunodeficiency syndrome %K AIDS %K student %K university %K college %K postsecondary %K bibliometric %K communicable %K sexually transmitted disease %K STD %K sexual transmission %K sexually transmitted infection %K STI %D 2023 %7 4.8.2023 %9 Review %J Interact J Med Res %G English %X Background: In recent years, HIV infection in students has been an ongoing concern worldwide. A large number of articles have been published; however, statistical analysis of the data presented in these publications is lacking. Objective: This study aimed to detect and analyze emerging trends and collaborative networks in research on HIV/AIDS among students. Methods: Research publications on HIV/AIDS among students from 1985 to 2022 were collected from the Web of Science Core Collection. A topic search was used for this study, and articles in English were included. CiteSpace was used to generate visual networks of countries/regions, institutions, references, and keywords. Citation analysis was used to discover milestones in the field and trace the roots of the knowledge base. Keyword analysis was used to detect research hotspots and predict future trends. Results: A total of 2726 publications met the inclusion criteria. Over the past 38 years, the number of publications annually has been on the rise overall. The United States had the highest number of publications (n=1303) and the highest centrality (0.91). The University of California system was the core institution. The main target population of studies on HIV/AIDS among students were medical and university students. These studies focused on students’ knowledge, attitudes, risk behaviors, and education about HIV/AIDS. The recent bursting keywords (gay, sexual health, adherence, barriers, mental health, HIV testing, stigma, and antiretroviral therapy) revealed research trends and public interest on this topic. Conclusions: This study identified countries/regions and institutions contributing to the research area of HIV/AIDS among students and revealed research hotspots and emerging trends. The field of research on HIV/AIDS among students was growing rapidly. The United States was at the center, and the University of California system was the core institution. However, academic collaboration should be strengthened. Future research may focus on exploring gay students, sexual health, adherence, barriers, mental health, HIV testing, stigma, and antiretroviral therapy. %M 37540553 %R 10.2196/46042 %U https://www.i-jmr.org/2023/1/e46042 %U https://doi.org/10.2196/46042 %U http://www.ncbi.nlm.nih.gov/pubmed/37540553 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e40205 %T Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review %A Pedersen,Keld %A Schlichter,Bjarne Rerup %+ Information Systems, Department of Management, Aarhus University, Bartholins Allé 14, Aarhus C, 8000, Denmark, 45 51157818, keldp@mgmt.au.dk %K mobile health %K mHealth %K digital interventions %K adoption %K implementation %K prevention %K physical activity %K diet %K mobile phone %K scoping review %K review %D 2023 %7 20.7.2023 %9 Review %J Interact J Med Res %G English %X Background: Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society. Objective: This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations. Methods: The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature. Results: In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations. Conclusions: The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome. %M 37471129 %R 10.2196/40205 %U https://www.i-jmr.org/2023/1/e40205 %U https://doi.org/10.2196/40205 %U http://www.ncbi.nlm.nih.gov/pubmed/37471129 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e40653 %T The Global Prevalence of Nonalcoholic Fatty Liver Disease and its Association With Cancers: Systematic Review and Meta-Analysis %A Muhamad,Nor Asiah %A Maamor,Nur Hasnah %A Leman,Fatin Norhasny %A Mohamad,Zuraifah Asrah %A Bakon,Sophia Karen %A Abdul Mutalip,Mohd Hatta %A Rosli,Izzah Athirah %A Aris,Tahir %A Lai,Nai Ming %A Abu Hassan,Muhammad Radzi %+ Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Malaysia, 60 33628000 ext 8705, norasiahdr@gmail.com %K fatty liver %K nonalcoholic fatty liver %K NAFL %K nonalcoholic fatty liver disease %K NAFLD %K prevalence %K cancers %K cancer %K extrahepatic %K liver %K carcinoma %D 2023 %7 19.7.2023 %9 Review %J Interact J Med Res %G English %X Background: Nonalcoholic fatty liver disease (NAFLD) is one of the common causes of chronic liver disease globally. Obesity, metabolic diseases, and exposure to some environmental agents contribute to NAFLD. NAFLD is commonly considered a precursor for some types of cancers. Since the leading causes of death in people with NAFLD are cardiovascular disease and extrahepatic cancers, it is important to understand the mechanisms of the progression of NAFLD to control its progression and identify its association with extrahepatic cancers. Thus, this review aims to estimate the global prevalence of NAFLD in association with the risk of extrahepatic cancers. Objective: We aimed to determine the prevalence of various cancers in NAFLD patients and the association between NAFLD and cancer. Methods: We searched PubMed, ProQuest, Scopus, and Web of Science from database inception to March 2022 to identify eligible studies reporting the prevalence of NAFLD and the risk of incident cancers among adult individuals (aged ≥18 years). Data from selected studies were extracted, and meta-analysis was performed using random effects models to obtain the pooled prevalence with the 95% CI. The quality of the evidence was assessed with the Newcastle-Ottawa Scale. Results: We identified 11 studies that met our inclusion criteria, involving 222,523 adults and 3 types of cancer: hepatocellular carcinoma (HCC), breast cancer, and other types of extrahepatic cancer. The overall pooled prevalence of NAFLD and cancer was 26% (95% CI 16%-35%), while 25% of people had NAFLD and HCC (95% CI 7%-42%). NAFLD and breast cancer had the highest prevalence out of the 3 forms of cancer at 30% (95% CI 14%-45%), while the pooled prevalence for NAFLD and other cancers was 21% (95% CI 12%-31%). Conclusions: The review suggests that people with NAFLD may be at an increased risk of cancer that might not affect not only the liver but also other organs, such as the breast and bile duct. The findings serve as important evidence for policymakers to evaluate and recommend measures to reduce the prevalence of NAFLD through lifestyle and environmental preventive approaches. Trial Registration: PROSPERO CRD42022321946; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321946 %M 37467012 %R 10.2196/40653 %U https://www.i-jmr.org/2023/1/e40653 %U https://doi.org/10.2196/40653 %U http://www.ncbi.nlm.nih.gov/pubmed/37467012 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45903 %T The Role of Artificial Intelligence Model Documentation in Translational Science: Scoping Review %A Brereton,Tracey A %A Malik,Momin M %A Lifson,Mark %A Greenwood,Jason D %A Peterson,Kevin J %A Overgaard,Shauna M %+ Center for Digital Health, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 (507) 284 2511, brereton.tracey@mayo.edu %K health %K informatics %K artificial intelligence %K machine learning %K documentation %K explainability %K ethics %K translational science %K scoping review %K medical modeling software %K clinical decision support %K decision support intervention %D 2023 %7 14.7.2023 %9 Review %J Interact J Med Res %G English %X Background: Despite the touted potential of artificial intelligence (AI) and machine learning (ML) to revolutionize health care, clinical decision support tools, herein referred to as medical modeling software (MMS), have yet to realize the anticipated benefits. One proposed obstacle is the acknowledged gaps in AI translation. These gaps stem partly from the fragmentation of processes and resources to support MMS transparent documentation. Consequently, the absence of transparent reporting hinders the provision of evidence to support the implementation of MMS in clinical practice, thereby serving as a substantial barrier to the successful translation of software from research settings to clinical practice. Objective: This study aimed to scope the current landscape of AI- and ML-based MMS documentation practices and elucidate the function of documentation in facilitating the translation of ethical and explainable MMS into clinical workflows. Methods: A scoping review was conducted in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed was searched using Medical Subject Headings key concepts of AI, ML, ethical considerations, and explainability to identify publications detailing AI- and ML-based MMS documentation, in addition to snowball sampling of selected reference lists. To include the possibility of implicit documentation practices not explicitly labeled as such, we did not use documentation as a key concept but as an inclusion criterion. A 2-stage screening process (title and abstract screening and full-text review) was conducted by 1 author. A data extraction template was used to record publication-related information; barriers to developing ethical and explainable MMS; available standards, regulations, frameworks, or governance strategies related to documentation; and recommendations for documentation for papers that met the inclusion criteria. Results: Of the 115 papers retrieved, 21 (18.3%) papers met the requirements for inclusion. Ethics and explainability were investigated in the context of AI- and ML-based MMS documentation and translation. Data detailing the current state and challenges and recommendations for future studies were synthesized. Notable themes defining the current state and challenges that required thorough review included bias, accountability, governance, and explainability. Recommendations identified in the literature to address present barriers call for a proactive evaluation of MMS, multidisciplinary collaboration, adherence to investigation and validation protocols, transparency and traceability requirements, and guiding standards and frameworks that enhance documentation efforts and support the translation of AI- and ML-based MMS. Conclusions: Resolving barriers to translation is critical for MMS to deliver on expectations, including those barriers identified in this scoping review related to bias, accountability, governance, and explainability. Our findings suggest that transparent strategic documentation, aligning translational science and regulatory science, will support the translation of MMS by coordinating communication and reporting and reducing translational barriers, thereby furthering the adoption of MMS. %M 37450330 %R 10.2196/45903 %U https://www.i-jmr.org/2023/1/e45903 %U https://doi.org/10.2196/45903 %U http://www.ncbi.nlm.nih.gov/pubmed/37450330 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43783 %T Possibilities and Challenges of Delivering Health-Related Small Group Interventions Online: Scoping Review %A Preuhs,Katharina %A Klein Velderman,Mariska %A van Empelen,Pepijn %+ Netherlands Organization for Applied Scientific Research, Expertise Group Child Health, PO Box 2215, Leiden, 2301 CE, Netherlands, 31 615597505, katharina.preuhs@tno.nl %K small groups %K online groups %K group intervention %K group cohesion %K therapeutic alliance %K scoping review %D 2023 %7 20.6.2023 %9 Review %J Interact J Med Res %G English %X Background: The outbreak of the COVID-19 pandemic required the transition of health-related face-to-face group interventions to an online setting. While it seems that group outcomes can be realized in an online setting, less is known about resulting potential challenges (and advantages) and how these can be overcome. Objective: The aim of this article is to explore what challenges and advantages may arise when providing health-related small group interventions in an online setting and how to overcome these challenges. Methods: Scopus and Google Scholar databases were searched for relevant literature. Effect studies, meta-analyses, literature reviews, theoretical frameworks, and research reports relating to synchronous, face-to-face, health-related small group interventions, online group interventions, and video teleconferencing group interventions were identified and screened. Findings relating to potential challenges and corresponding strategies are described. In addition, potential advantages of online group settings were explored. Relevant insights were gathered until saturation of results relating to the research questions was reached. Results: The literature indicated several aspects that require extra attention and preparation in the online group setting. These include the delivery of nonverbal communication and affect regulation, as well as the build-up of group cohesion and therapeutic alliance, which seem more challenging online. Yet there are strategies to overcome these challenges, such as metacommunication, collecting participant feedback, and providing guidance concerning technical accessibility. In addition, the online setting provides opportunities to reinforce group identity, such as by allowing independence and the ability to create homogeneous groups. Conclusions: While online, health-related small group interventions offer a considerable number of possibilities and benefits compared to face-to-face groups, there are also potential drawbacks to consider, which, if anticipated, can be to a great extent overcome. %M 37338971 %R 10.2196/43783 %U https://www.i-jmr.org/2023/1/e43783 %U https://doi.org/10.2196/43783 %U http://www.ncbi.nlm.nih.gov/pubmed/37338971 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e44430 %T Heart Rate Variability and Pregnancy Complications: Systematic Review %A Sharifi-Heris,Zahra %A Rahmani,Amir M %A Axelin,Anna %A Rasouli,Mahkameh %A Bender,Miriam %+ University of California Irvine, 8420 Palo Verde, Irvine, CA, 92697, United States, 1 6506805432, sharifiz@uci.edu %K autonomic nervous system %K heart rate variability %K pregnancy complication %K pregnancy %K maternal %K hypertensive disorder %K fetal growth %K global developmental delay %K hypertension %D 2023 %7 5.6.2023 %9 Review %J Interact J Med Res %G English %X Background: The autonomic nervous system (ANS) is known as a critical regulatory system for pregnancy-induced adaptations. If it fails to function, life-threatening pregnancy complications could occur. Hence, understanding and monitoring the underlying mechanism of action for these complications are necessary. Objective: We aimed to systematically review the literature concerned with the associations between heart rate variability (HRV), as an ANS biomarker, and pregnancy complications. Methods: We performed a comprehensive search in the PubMed, Medline Completion, CINAHL Completion, Web of Science Core Collection Classic, Cochrane Library, and SCOPUS databases in February 2022 with no time span limitation. We included studies concerned with the association between any pregnancy complications and HRV, with or without a control group. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used for the review of the studies, and Covidence software was used for the study selection process. For data synthesis, we used the guideline by Popay et al. Results: Finally, 12 studies with 6656 participants were included. Despite the methodological divergency that hindered a comprehensive comparison, our findings suggest that ANS is linked with some common pregnancy complications including fetal growth. However, existing studies do not support an association between ANS and gestational diabetes mellitus. Studies that linked pulmonary and central nervous system disorders with ANS function did not provide enough evidence to draw conclusions. Conclusions: This review highlights the importance of understanding and monitoring the underlying mechanism of ANS in pregnancy-induced adaptations and the need for further research with robust methodology in this area. %M 37276013 %R 10.2196/44430 %U https://www.i-jmr.org/2023/1/e44430 %U https://doi.org/10.2196/44430 %U http://www.ncbi.nlm.nih.gov/pubmed/37276013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41942 %T Using Smart Home Technologies to Promote Physical Activity Among the General and Aging Populations: Scoping Review %A Oyibo,Kiemute %A Wang,Kang %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 41372, plinio.morita@uwaterloo.ca %K smart home %K physical activity %K aging population %K activity of daily living %K remote health care monitoring %K health monitoring %K health promotion %K smart home technology %K assisted living %K mobile phone %D 2023 %7 12.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Health-monitoring smart homes are becoming popular, with experts arguing that 9-to-5 health care services might soon become a thing of the past. However, no review has explored the landscape of smart home technologies that aim to promote physical activity and independent living among a wide range of age groups. Objective: This review aims to map published studies on smart home technologies aimed at promoting physical activity among the general and aging populations to unveil the state of the art, its potential, and the research gaps and opportunities. Methods: Articles were retrieved from 6 databases (PubMed, CINAHL, Scopus, IEEE Xplore, ACM Library, and Web of Science). The criteria for inclusion were that the articles must be user studies that dealt with smart home or Active Assisted Living technologies and physical activity, were written in English, and were published in peer-reviewed journals. In total, 3 researchers independently and collaboratively assessed the eligibility of the retrieved articles and elicited the relevant data and findings using tables and charts. Results: This review synthesized 20 articles that met the inclusion criteria, 70% (14/20) of which were conducted between 2018 and 2020. Three-quarters of the studies (15/20, 75%) were conducted in Western countries, with the United States accounting for 25% (5/20). Activities of daily living were the most studied (9/20, 45%), followed by physical activity (6/20, 30%), therapeutic exercise (4/20, 20%), and bodyweight exercise (1/20, 5%). K-nearest neighbor and naïve Bayes classifier were the most used machine learning algorithms for activity recognition, with at least 10% (2/20) of the studies using either algorithm. Ambient and wearable technologies were equally studied (8/20, 40% each), followed by robots (3/20, 15%). Activity recognition was the most common goal of the evaluated smart home technologies, with 55% (11/20) of the studies reporting it, followed by activity monitoring (7/20, 35%). Most studies (8/20, 40%) were conducted in a laboratory setting. Moreover, 25% (5/20) and 10% (2/20) were conducted in a home and hospital setting, respectively. Finally, 75% (15/20) had a positive outcome, 15% (3/20) had a mixed outcome, and 10% (2/20) had an indeterminate outcome. Conclusions: Our results suggest that smart home technologies, especially digital personal assistants, coaches, and robots, are effective in promoting physical activity among the young population. Although only few studies were identified among the older population, smart home technologies hold bright prospects in assisting and aiding older people to age in place and function independently, especially in Western countries, where there are shortages of long-term care workers. Hence, there is a need to do more work (eg, cross-cultural studies and randomized controlled trials) among the growing aging population on the effectiveness and acceptance of smart home technologies that aim to promote physical activity. %M 37171839 %R 10.2196/41942 %U https://www.jmir.org/2023/1/e41942 %U https://doi.org/10.2196/41942 %U http://www.ncbi.nlm.nih.gov/pubmed/37171839 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44066 %T Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Protocol for a Mixed Method Systematic Review %A Kachimanga,Chiyembekezo %A Divala,Titus H %A Ket,Johannes C F %A Kulinkina,Alexandra V %A Zaniku,Haules R %A Murkherjee,Joia %A Palazuelos,Daniel %A Abejirinde,Ibukun-Oluwa Omolade %A Akker,Thomas van den %+ Clinical Department, Partners In Health Malawi, Post Office Box 56, Neno, 265, Malawi, 265 887247777, c.kachimanga@vu.nl %K community health worker %K maternal health %K mobile health %K sub-Saharan Africa %K systematic review %K review method %K maternal %K maternity %K gynecology %K mHealth %K narrative synthesis %K review method %K antenatal %K post natal %K women's health %K health care provider %K health worker %K health care worker %D 2023 %7 4.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa. Objective: This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services. Methods: We will include studies that report the impact of mHealth by CHWs on the use of antenatal care, facility-based births, and PNC visits in sub-Saharan Africa. We will search 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus), with additional articles identified from Google Scholar and manual screening of references of the included studies. The included studies will not be limited by language or year of publication. After study selection, 2 independent reviewers will perform title and abstract screening, followed by full-text screening to identify the final papers to be included. Data extraction and risk-of-bias assessment will be performed using Covidence software by 2 independent reviewers. We will use a Mixed Methods Appraisal Tool to perform risk-of-bias assessments on all included studies. Finally, we will perform a narrative synthesis of the outcomes, integrating information about the effect of mHealth on maternal health use and barriers and facilitators of mHealth use. This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. Results: In September 2022, we conducted an initial search in the eligible databases. After removing duplicates, we identified 1111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, assessment of methodological quality, and narrative synthesis by June 2023. Conclusions: This systematic review will present new and up-to-date evidence on the use of mHealth by CHWs along the pregnancy, childbirth, and PNC continuum of care. We anticipate the results will inform program implementation and policy by highlighting the potential impacts of mHealth and presenting contextual factors that should be addressed to ensure the success of the programs. Trial Registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364 International Registered Report Identifier (IRRID): DERR1-10.2196/44066 %M 37140981 %R 10.2196/44066 %U https://www.researchprotocols.org/2023/1/e44066 %U https://doi.org/10.2196/44066 %U http://www.ncbi.nlm.nih.gov/pubmed/37140981 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43969 %T Nondrug Intervention for Opportunistic Infections in Individuals With Hematological Malignancy: Systematic Review %A Muhamad,Nor Asiah %A Ma'amor,Nur Hasnah %A Mustapha,Normi %A Leman,Fatin Norhasny %A Rosli,Izzah Athirah %A Umar,Marilyn %A Aris,Tahir %A Lai,Nai Ming %+ Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, 1, Persiaran Setia Murni, Setia Alam, Shah Alam, 40170, Malaysia, 60 123390723, norasiahdr@gmail.com %K nondrug %K intervention %K opportunistic infection %K hematological malignancies %D 2023 %7 31.3.2023 %9 Review %J Interact J Med Res %G English %X Background: Hematological malignancies disturb the blood, lymph nodes, and bone marrow. Taking medications for treating opportunistic infections (OIs) in these individuals may enhance the risk of medication interaction as well as adverse drug reactions. Objective: This review aims to evaluate the effectiveness of nondrug interventions in reducing OIs among patients with hematological cancers. Methods: The PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Embase databases were searched on December 26, 2022, for all randomized controlled trials (RCTs). The primary endpoint was OIs. The quality of included studies was assessed by the Cochrane Risk-of-Bias tool. Results: A total of 6 studies were included in this review with 4 interventions: (1) types of mouthwash received, (2) presence of coating on central venous catheters (CVCs), (3) use of well-fitted masks, and (4) types of diet consumed. The results were presented in 8 different comparisons: (1) chlorhexidine-nystatin versus saline mouth rinse, (2) chlorhexidine versus saline mouth rinse, (3) nystatin versus saline mouth rinse, (4) chlorhexidine silver sulfadiazine–coated CVCs versus uncoated catheters, (5) well-fitted masks versus no mask, (6) amine fluoride-stannous fluoride versus sodium fluoride mouthwash, (7) low-bacterial diet versus standard hospital diet, and (8) herbal versus placebo mouthwash. No clear differences were reported in any of the outcomes examined in the first 3 comparisons. There were also no clear differences in the rate of catheter-related bloodstream infection or insertion site infection between the use of chlorhexidine silver sulfadiazine–coated CVCs versus uncoated catheters in the patients. Further, no significant differences were seen between patients who used a well-fitted mask and those without a mask in the incidence of OI. The all-cause mortality and mortality due to OI were similar between the 2 groups. There was no clear difference in all-cause mortality, although common adverse effects were reported in patients who used sodium fluoride mouthwash compared with those using amine fluoride-stannous fluoride mouthwash. There was no evidence of any difference in the incidence of possible invasive aspergillosis or candidemia between patients who consumed a low-bacterial diet and a standard diet. For the last comparison, no significant difference was seen between patients who received herbal and placebo mouthwash. Conclusions: Very limited evidence was available to measure the effectiveness of nondrug interventions in hematological cancers. The effectiveness of the interventions included in this review needs to be evaluated further in high-quality RCTs in a dedicated setting among patients with hematological malignancies. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020169186; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=169186 %M 37000482 %R 10.2196/43969 %U https://www.i-jmr.org/2023/1/e43969 %U https://doi.org/10.2196/43969 %U http://www.ncbi.nlm.nih.gov/pubmed/37000482 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42292 %T Big Data and Infectious Disease Epidemiology: Bibliometric Analysis and Research Agenda %A Amusa,Lateef Babatunde %A Twinomurinzi,Hossana %A Phalane,Edith %A Phaswana-Mafuya,Refilwe Nancy %+ Centre for Applied Data Science, University of Johannesburg, Bunting Road Campus, Auckland Park, Johannesburg, 2006, South Africa, 27 659904686, amusasuxes@gmail.com %K big data %K bibliometrics %K infectious disease %K COVID-19 %K disease surveillance %K disease %K pandemic %K data %K surveillance %K hotspot %K epidemiology %K social media %K utility %K electronic health records %D 2023 %7 31.3.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Infectious diseases represent a major challenge for health systems worldwide. With the recent global pandemic of COVID-19, the need to research strategies to treat these health problems has become even more pressing. Although the literature on big data and data science in health has grown rapidly, few studies have synthesized these individual studies, and none has identified the utility of big data in infectious disease surveillance and modeling. Objective: The aim of this study was to synthesize research and identify hotspots of big data in infectious disease epidemiology. Methods: Bibliometric data from 3054 documents that satisfied the inclusion criteria retrieved from the Web of Science database over 22 years (2000-2022) were analyzed and reviewed. The search retrieval occurred on October 17, 2022. Bibliometric analysis was performed to illustrate the relationships between research constituents, topics, and key terms in the retrieved documents. Results: The bibliometric analysis revealed internet searches and social media as the most utilized big data sources for infectious disease surveillance or modeling. The analysis also placed US and Chinese institutions as leaders in this research area. Disease monitoring and surveillance, utility of electronic health (or medical) records, methodology framework for infodemiology tools, and machine/deep learning were identified as the core research themes. Conclusions: Proposals for future studies are made based on these findings. This study will provide health care informatics scholars with a comprehensive understanding of big data research in infectious disease epidemiology. %M 36913554 %R 10.2196/42292 %U https://www.i-jmr.org/2023/1/e42292 %U https://doi.org/10.2196/42292 %U http://www.ncbi.nlm.nih.gov/pubmed/36913554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42289 %T Data Provenance in Biomedical Research: Scoping Review %A Johns,Marco %A Meurers,Thierry %A Wirth,Felix N %A Haber,Anna C %A Müller,Armin %A Halilovic,Mehmed %A Balzer,Felix %A Prasser,Fabian %+ Medical Informatics Group, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 15147112798, marco.johns@charite.de %K data provenance %K biomedical research %K scoping review %K systematization %K comparison %D 2023 %7 27.3.2023 %9 Review %J J Med Internet Res %G English %X Background: Data provenance refers to the origin, processing, and movement of data. Reliable and precise knowledge about data provenance has great potential to improve reproducibility as well as quality in biomedical research and, therefore, to foster good scientific practice. However, despite the increasing interest on data provenance technologies in the literature and their implementation in other disciplines, these technologies have not yet been widely adopted in biomedical research. Objective: The aim of this scoping review was to provide a structured overview of the body of knowledge on provenance methods in biomedical research by systematizing articles covering data provenance technologies developed for or used in this application area; describing and comparing the functionalities as well as the design of the provenance technologies used; and identifying gaps in the literature, which could provide opportunities for future research on technologies that could receive more widespread adoption. Methods: Following a methodological framework for scoping studies and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, articles were identified by searching the PubMed, IEEE Xplore, and Web of Science databases and subsequently screened for eligibility. We included original articles covering software-based provenance management for scientific research published between 2010 and 2021. A set of data items was defined along the following five axes: publication metadata, application scope, provenance aspects covered, data representation, and functionalities. The data items were extracted from the articles, stored in a charting spreadsheet, and summarized in tables and figures. Results: We identified 44 original articles published between 2010 and 2021. We found that the solutions described were heterogeneous along all axes. We also identified relationships among motivations for the use of provenance information, feature sets (capture, storage, retrieval, visualization, and analysis), and implementation details such as the data models and technologies used. The important gap that we identified is that only a few publications address the analysis of provenance data or use established provenance standards, such as PROV. Conclusions: The heterogeneity of provenance methods, models, and implementations found in the literature points to the lack of a unified understanding of provenance concepts for biomedical data. Providing a common framework, a biomedical reference, and benchmarking data sets could foster the development of more comprehensive provenance solutions. %M 36972116 %R 10.2196/42289 %U https://www.jmir.org/2023/1/e42289 %U https://doi.org/10.2196/42289 %U http://www.ncbi.nlm.nih.gov/pubmed/36972116 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e33185 %T Telemedical Interventions for Chronic Obstructive Pulmonary Disease Management: Umbrella Review %A Koh,Jin Hean %A Chong,Lydia Ching Yee %A Koh,Gerald Choon Huat %A Tyagi,Shilpa %+ Ministry of Health Office for Healthcare Transformation, Ministry of Health, 1 Maritime Square, #12-10 Harborfront Centre, Singapore, 099253, Singapore, 65 6679 3147, gerald.koh@moht.com.sg %K telemedicine %K telehealth %K chronic obstructive pulmonary disease %D 2023 %7 16.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a growing epidemic, with a heavy associated economic burden. Education, physical activity, and pulmonary rehabilitation programs are important aspects of the management of COPD. These interventions are commonly delivered remotely as part of telemedicine interventions. Several systematic reviews and meta-analyses have been conducted to assess the effectiveness of these interventions. However, these reviews often have conflicting conclusions. Objective: We aim to conduct an umbrella review to critically appraise and summarize the available evidence on telemedicine interventions for the management of COPD. Methods: In this umbrella review, the MEDLINE, Embase, PsycINFO, and Cochrane databases were searched from inception to May 2022 for systematic reviews and meta-analyses relating to telemedicine interventions for the management of COPD. We compared odds ratios, measures of quality, and heterogeneity across different outcomes. Results: We identified 7 systematic reviews that met the inclusion criteria. Telemedicine interventions used in these reviews were teletreatment, telemonitoring, and telesupport. Telesupport interventions significantly reduced the number of inpatient days and quality of life. Telemonitoring interventions were associated with significant reductions in respiratory exacerbations and hospitalization rates. Teletreatment showed significant effectiveness in reducing respiratory exacerbations, hospitalization rate, compliance (acceptance and dropout rate), and physical activity. Among studies that used integrated telemedicine interventions, there was a significant improvement in physical activity. Conclusions: Telemedicine interventions showed noninferiority or superiority over the standard of care for the management of COPD. Telemedicine interventions should be considered as a supplement to usual methods of care for the outpatient management of COPD, with the aim of reducing the burden on health care systems. %M 36795479 %R 10.2196/33185 %U https://www.jmir.org/2023/1/e33185 %U https://doi.org/10.2196/33185 %U http://www.ncbi.nlm.nih.gov/pubmed/36795479 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42396 %T Cost-effectiveness of Digital Tools for Behavior Change Interventions Among People With Chronic Diseases: Systematic Review %A Kyaw,Tun Lin %A Ng,Nawi %A Theocharaki,Margarita %A Wennberg,Patrik %A Sahlen,Klas-Göran %+ Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Universitetstorget 4, Umeå, SE-901 87, Sweden, 46 764229739, tunlinnkyawrcs@gmail.com %K digital tools %K chronic diseases %K cost-effectiveness %K lifestyle %K behavior %K systematic review %K mobile phone %D 2023 %7 16.2.2023 %9 Review %J Interact J Med Res %G English %X Background: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive. Objective: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases. Methods: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute’s criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review. Results: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis. Conclusions: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon. %M 36795470 %R 10.2196/42396 %U https://www.i-jmr.org/2023/1/e42396 %U https://doi.org/10.2196/42396 %U http://www.ncbi.nlm.nih.gov/pubmed/36795470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39786 %T Intelligent Physical Robots in Health Care: Systematic Literature Review %A Huang,Rong %A Li,Hongxiu %A Suomi,Reima %A Li,Chenglong %A Peltoniemi,Teijo %+ Department of Management and Entrepreneurship, Turku School of Economics, University of Turku, Rehtorinpellonkatu 3, Turku, 20500, Finland, 358 417560485, rong.r.huang@utu.fi %K intelligent physical robot %K artificial intelligence %K health care %K literature review %D 2023 %7 18.1.2023 %9 Review %J J Med Internet Res %G English %X Background: Intelligent physical robots based on artificial intelligence have been argued to bring about dramatic changes in health care services. Previous research has examined the use of intelligent physical robots in the health care context from different perspectives; however, an overview of the antecedents and consequences of intelligent physical robot use in health care is lacking in the literature. Objective: In this paper, we aimed to provide an overview of the antecedents and consequences of intelligent physical robot use in health care and to propose potential agendas for future research through a systematic literature review. Methods: We conducted a systematic literature review on intelligent physical robots in the health care field following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Literature searches were conducted in 5 databases (PubMed, Scopus, PsycINFO, Embase, and CINAHL) in May 2021, focusing on studies using intelligent physical robots for health care purposes. Subsequently, the quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We performed an exploratory content analysis and synthesized the findings extracted from the included articles. Results: A total of 94 research articles were included in the review. Intelligent physical robots, including mechanoid, humanoid, android, and animalistic robots, have been used in hospitals, nursing homes, mental health care centers, laboratories, and patients’ homes by both end customers and health care professionals. The antecedents for intelligent physical robot use are categorized into individual-, organization-, and robot-related factors. Intelligent physical robot use in the health care context leads to both non–health-related consequences (emotional outcomes, attitude and evaluation outcomes, and behavioral outcomes) and consequences for (physical, mental, and social) health promotion for individual users. Accordingly, an integrative framework was proposed to obtain an overview of the antecedents and consequences of intelligent physical robot use in the health care context. Conclusions: This study contributes to the literature by summarizing current knowledge in the field of intelligent physical robot use in health care, by identifying the antecedents and the consequences of intelligent physical robot use, and by proposing potential future research agendas in the specific area based on the research findings in the literature and the identified knowledge gaps. %M 36652280 %R 10.2196/39786 %U https://www.jmir.org/2023/1/e39786 %U https://doi.org/10.2196/39786 %U http://www.ncbi.nlm.nih.gov/pubmed/36652280 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e40721 %T Electronic Medical Record System Use and Determinants in Ethiopia: Systematic Review and Meta-Analysis %A Tegegne,Masresha Derese %A Wubante,Sisay Maru %A Kalayou,Mulugeta Hayelom %A Melaku,Mequannent Sharew %A Tilahun,Binyam %A Yilma,Tesfahun Melese %A Dessie,Hiwote Simane %+ Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia, 251 935474755, masresha1derese@gmail.com %K electronic medical record system %K health professional %K utilization %K determinants %K Ethiopia %K medical record %K EMR %K EHR %K electronic health record %K health information technology %K systematic review %D 2023 %7 11.1.2023 %9 Review %J Interact J Med Res %G English %X Background: The strategic plan of the Ethiopian Ministry of Health recommends an electronic medical record (EMR) system to enhance health care delivery and streamline data systems. However, only a few exhaustive systematic reviews and meta-analyses have been conducted on the degree of EMR use in Ethiopia and the factors influencing success. This will emphasize the factors that make EMR effective and increase awareness of its widespread use among future implementers in Ethiopia. Objective: This study aims to determine the pooled estimate of EMR use and success determinants among health professionals in Ethiopia. Methods: We developed a protocol and searched PubMed, Web of Sciences, African Journals OnLine, Embase, MEDLINE, and Scopus to identify relevant studies. To assess the quality of each included study, we used the Joanna Briggs Institute quality assessment tool using 9 criteria. The applicable data were extracted using Microsoft Excel 2019, and the data were then analyzed using Stata software (version 11; StataCorp). The presence of total heterogeneity across included studies was calculated using the index of heterogeneity I2 statistics. The pooled size of EMR use was estimated using a random effect model with a 95% CI. Results: After reviewing 11,026 research papers, 5 papers with a combined total of 2439 health workers were included in the evaluation and meta-analysis. The pooled estimate of EMR usage in Ethiopia was 51.85% (95% CI 37.14%-66.55%). The subgroup study found that the northern Ethiopian region had the greatest EMR utilization rate (58.75%) and that higher (54.99%) utilization was also seen in publications published after 2016. Age groups <30 years, access to an EMR manual, EMR-related training, and managerial support were identified factors associated with EMR use among health workers. Conclusions: The use of EMR systems in Ethiopia is relatively low. Belonging to a young age group, accessing an EMR manual, receiving EMR-related training, and managerial support were identified as factors associated with EMR use among health workers. As a result, to increase the use of EMRs by health care providers, it is essential to provide management support and an EMR training program and make the EMR manual accessible to health professionals. %M 36630161 %R 10.2196/40721 %U https://www.i-jmr.org/2023/1/e40721 %U https://doi.org/10.2196/40721 %U http://www.ncbi.nlm.nih.gov/pubmed/36630161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39742 %T Stakeholder Perspectives of Clinical Artificial Intelligence Implementation: Systematic Review of Qualitative Evidence %A Hogg,Henry David Jeffry %A Al-Zubaidy,Mohaimen %A , %A Talks,James %A Denniston,Alastair K %A Kelly,Christopher J %A Malawana,Johann %A Papoutsi,Chrysanthi %A Teare,Marion Dawn %A Keane,Pearse A %A Beyer,Fiona R %A Maniatopoulos,Gregory %+ Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, United Kingdom, 44 020 7253 3411, p.keane@ucl.ac.uk %K artificial intelligence %K systematic review %K qualitative research %K computerized decision support %K qualitative evidence synthesis %K implementation %D 2023 %7 10.1.2023 %9 Review %J J Med Internet Res %G English %X Background: The rhetoric surrounding clinical artificial intelligence (AI) often exaggerates its effect on real-world care. Limited understanding of the factors that influence its implementation can perpetuate this. Objective: In this qualitative systematic review, we aimed to identify key stakeholders, consolidate their perspectives on clinical AI implementation, and characterize the evidence gaps that future qualitative research should target. Methods: Ovid-MEDLINE, EBSCO-CINAHL, ACM Digital Library, Science Citation Index-Web of Science, and Scopus were searched for primary qualitative studies on individuals’ perspectives on any application of clinical AI worldwide (January 2014-April 2021). The definition of clinical AI includes both rule-based and machine learning–enabled or non–rule-based decision support tools. The language of the reports was not an exclusion criterion. Two independent reviewers performed title, abstract, and full-text screening with a third arbiter of disagreement. Two reviewers assigned the Joanna Briggs Institute 10-point checklist for qualitative research scores for each study. A single reviewer extracted free-text data relevant to clinical AI implementation, noting the stakeholders contributing to each excerpt. The best-fit framework synthesis used the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. To validate the data and improve accessibility, coauthors representing each emergent stakeholder group codeveloped summaries of the factors most relevant to their respective groups. Results: The initial search yielded 4437 deduplicated articles, with 111 (2.5%) eligible for inclusion (median Joanna Briggs Institute 10-point checklist for qualitative research score, 8/10). Five distinct stakeholder groups emerged from the data: health care professionals (HCPs), patients, carers and other members of the public, developers, health care managers and leaders, and regulators or policy makers, contributing 1204 (70%), 196 (11.4%), 133 (7.7%), 129 (7.5%), and 59 (3.4%) of 1721 eligible excerpts, respectively. All stakeholder groups independently identified a breadth of implementation factors, with each producing data that were mapped between 17 and 24 of the 27 adapted Nonadoption, Abandonment, Scale-up, Spread, and Sustainability subdomains. Most of the factors that stakeholders found influential in the implementation of rule-based clinical AI also applied to non–rule-based clinical AI, with the exception of intellectual property, regulation, and sociocultural attitudes. Conclusions: Clinical AI implementation is influenced by many interdependent factors, which are in turn influenced by at least 5 distinct stakeholder groups. This implies that effective research and practice of clinical AI implementation should consider multiple stakeholder perspectives. The current underrepresentation of perspectives from stakeholders other than HCPs in the literature may limit the anticipation and management of the factors that influence successful clinical AI implementation. Future research should not only widen the representation of tools and contexts in qualitative research but also specifically investigate the perspectives of all stakeholder HCPs and emerging aspects of non–rule-based clinical AI implementation. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021256005; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256005 International Registered Report Identifier (IRRID): RR2-10.2196/33145 %M 36626192 %R 10.2196/39742 %U https://www.jmir.org/2023/1/e39742 %U https://doi.org/10.2196/39742 %U http://www.ncbi.nlm.nih.gov/pubmed/36626192 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42549 %T Closed Endotracheal Suction Systems for COVID-19: Rapid Review %A Ramírez-Torres,Carmen Amaia %A Rivera-Sanz,Félix %A Sufrate-Sorzano,Teresa %A Pedraz-Marcos,Azucena %A Santolalla-Arnedo,Ivan %+ Health and Care Research Group, University of La Rioja, 88, Duquesa de la Victoria, Logroño, 26004, Spain, 34 941299050, caramit@unirioja.es %K endotracheal suctioning %K closed suction system %K rapid review %K suction %K mechanical ventilation %K COVID-19 %K intensive care unit %K health intervention %K endotracheal %K patient care %K healthcare %K ventilator %K health benefit %D 2023 %7 10.1.2023 %9 Review %J Interact J Med Res %G English %X Background: The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. Objective: This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. Methods: A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words “endotracheal,” “suction,” and “closed system.” Results: A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. Conclusions: Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time—though it does produce the greatest number of mucosal occlusions—and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines. %M 36548950 %R 10.2196/42549 %U https://www.i-jmr.org/2023/1/e42549 %U https://doi.org/10.2196/42549 %U http://www.ncbi.nlm.nih.gov/pubmed/36548950 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e37232 %T The Impact of Heating, Ventilation, and Air-Conditioning Design Features on the Transmission of Viruses, Including SARS-CoV-2: Overview of Reviews %A Thornton,Gail M %A Kroeker,Emily %A Fleck,Brian A %A Zhong,Lexuan %A Hartling,Lisa %+ Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, 116 Street and 85 Avenue, Edmonton, AB, T6G 2R3, Canada, 1 780 492 3111, gail.thornton@ualberta.ca %K COVID-19 %K public health %K epidemiology %K outbreak %K pandemic %K environment %K literature review %K virus transmission %K ventilation %K coronavirus %D 2022 %7 23.12.2022 %9 Review %J Interact J Med Res %G English %X Background: The COVID-19 or SARS-CoV-2 outbreak was declared a pandemic by the World Health Organization in March 2020. Almost 2 years later (early February 2022), the World Health Organization reported over 383 million cases of the disease caused by the virus, with over 5.6 million deaths worldwide. Debate regarding the routes of transmission was substantial early in the pandemic; however, airborne transmission emerged as an important consideration. Infectious airborne agents can spread within the built environment through heating, ventilation, and air-conditioning (HVAC) systems. Multiple features of HVAC systems can influence transmission (eg, ventilation, filtration, UV radiation, and humidity). Understanding how HVAC features influence airborne transmission is critical to mitigate the spread of infectious agents. Objective: Given the airborne transmission of SARS-CoV-2, an overview of reviews was conducted to understand what is already known from the scientific literature about how virus transmission may be affected by HVAC design features in the built environment. Methods: Ovid MEDLINE and Compendex were searched from inception to January 2021. Two reviewers independently screened the titles, abstracts, and full text of potentially relevant reviews, using a priori inclusion criteria: systematic reviews examining the effects of HVAC design features on virus transmission. Two reviewers independently assessed the methodological quality using AMSTAR2. Results: Searching identified 361 citations, of which 45 (12.5%) were potentially relevant and 7 (2%) were included. Reviews were published between 2007 and 2021 and included 47 virus studies. Two earlier reviews (2007 and 2016) of 21 studies found sufficient evidence that mechanical ventilation (airflow patterns and ventilation rates) plays a role in airborne transmission; however, both found insufficient evidence to quantify the minimum mechanical ventilation requirements. One review (2017) of 9 studies examining humidity and indoor air quality found that influenza virus survival was lowest between 40% and 80% relative humidity; the authors noted that ventilation rates were a confounding variable. Two reviews (2021) examined mitigation strategies for coronavirus transmission, finding that transmission decreased with increasing temperature and relative humidity. One review (2020) identified 14 studies examining coronavirus transmission in air-conditioning systems, finding that HVAC systems played a role in virus spread during previous coronavirus outbreaks. One review (2020) examined virus transmission interventions in public ground transportation, finding ventilation and filtration to be effective. Conclusions: Seven reviews synthesizing 47 studies demonstrated a role for HVAC in mitigating airborne virus transmission. Ventilation, humidity, temperature, and filtration can play a role in the viability and transmission of viruses, including coronaviruses. Recommendations for minimum standards were not possible owing to few studies investigating a given HVAC parameter. This overview examining HVAC design features and their effects on the airborne transmission of viruses serves as a starting point for future systematic reviews and identifying priorities for primary research. %M 36343208 %R 10.2196/37232 %U https://www.i-jmr.org/2022/2/e37232 %U https://doi.org/10.2196/37232 %U http://www.ncbi.nlm.nih.gov/pubmed/36343208 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e43741 %T Contemporary Databases in Real-world Studies Regarding the Diverse Health Care Systems of India, Thailand, and Taiwan: Protocol for a Scoping Review %A Shau,Wen-Yi %A Setia,Sajita %A Shinde,Salil Prakash %A Santoso,Handoko %A Furtner,Daniel %+ Executive Office, Transform Medical Communications Limited, 184 Glasgow Street, Wanganui, 4500, New Zealand, 64 276175433, sajita.setia@transform-medcomms.com %K Asia %K health care databases %K real-world data %K real-world evidence %K scoping review %D 2022 %7 13.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Real-world data (RWD) related to patient health status or health care delivery can be broadly defined as data collected outside of conventional clinical trials, including those from databases, treatment and disease registries, electronic medical records, insurance claims, and information directly contributed by health care professionals or patients. RWD are used to generate real-world evidence (RWE), which is increasingly relevant to policy makers in Asia, who use RWE to support decision-making in several areas, including public health policy, regulatory health technology assessment, and reimbursement; set priorities; or inform clinical practice. Objective: To support the achievement of the benefits of RWE in Asian health care strategies and policies, we sought to identify the linked contemporary databases used in real-world studies from three representative countries—India, Thailand, and Taiwan—and explore variations in results based on these countries’ economies and health care reimbursement systems by performing a systematic scoping review. Herein, we describe the protocol and preliminary findings of our scoping review. Methods: The PubMed search strategy covered 3 concepts. Concept 1 was designed to identify potential RWE and RWD studies by applying various Medical Subject Headings (MeSH) terms (“Treatment Outcome,” “Evidence-Based Medicine,” “Retrospective Studies,” and “Time Factors”) and related keywords (eg, “real-world,” “actual life,” and “actual practice”). Concept 2 introduced the three countries—India, Taiwan, and Thailand. Concept 3 focused on data types, using a combination of MeSH terms (“Electronic Health Records,” “Insurance, Health,” “Registries,” “Databases, Pharmaceutical,” and “Pharmaceutical Services”) and related keywords (eg, “electronic medical record,” “electronic healthcare record,” “EMR,” “EHR,” “administrative database,” and “registry”). These searches were conducted with filters for language (English) and publication date (publications in the last 5 years before the search). The retrieved articles will undergo 2 screening phases (phase 1: review of titles and abstracts; phase 2: review of full texts) to identify relevant and eligible articles for data extraction. The data to be extracted from eligible studies will include the characteristics of databases, the regions covered, and the patient populations. Results: The literature search was conducted on September 27, 2022. We retrieved 3,172,434, 1,094,125, and 672,794 articles for concepts 1, 2, and 3, respectively. After applying all 3 concepts and the language and publication date filters, 2277 articles were identified. These will be further screened to identify eligible studies. Based on phase 1 screening and our progress to date, approximately 44% (1003/2277) of articles have undergone phase 2 screening to judge their eligibility. Around 800 studies will be used for data extraction. Conclusions: Our research will be crucial for nurturing advancement in RWD generation within Asia by identifying linked clinical RWD databases and new avenues for public-private partnerships and multiple collaborations for expanding the scope and spectrum of high-quality, robust RWE generation in Asia. International Registered Report Identifier (IRRID): DERR1-10.2196/43741 %M 36512386 %R 10.2196/43741 %U https://www.researchprotocols.org/2022/12/e43741 %U https://doi.org/10.2196/43741 %U http://www.ncbi.nlm.nih.gov/pubmed/36512386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e42397 %T Dropout Rate in Digital Health Interventions for the Prevention of Skin Cancer: Systematic Review, Meta-analysis, and Metaregression %A Hernández-Rodríguez,Juan-Carlos %A García-Muñoz,Cristina %A Ortiz-Álvarez,Juan %A Saigí-Rubió,Francesc %A Conejo-Mir,Julián %A Pereyra-Rodriguez,Jose-Juan %+ Department of Nursing and Physical Therapy, University of Cadiz, Avda. Ana de Viya 52, Cadiz, 11009, Spain, 34 956 01 90 00, ccriss.g@gmail.com %K skin cancer %K digital health %K dropout %K prevention %K systematic review %K meta-analysis %K meta analyses %K review methodology %K cancer %K skin %K dermatology %K attrition %K digital intervention %K digital treatment %K eHealth %K randomized controlled trial %K RCT %D 2022 %7 9.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital strategies are innovative approaches to the prevention of skin cancer, but the attrition following this kind of intervention needs to be analyzed. Objective: The aim of this paper is to assess the dropouts from studies focused on digital strategies for the prevention of skin cancer. Methods: We conducted this systematic review with meta-analyses and metaregression according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statements. Search terms for skin cancer, digital strategies, and prevention were combined to search PubMed, Scopus, Web of Science, CINAHL, and Cochrane Library from inception until July 2022. Randomized clinical trials that reported dropouts of participants and compared digital strategies with other interventions to prevent skin cancer in healthy or disease-free participants were included. Two independent reviewers extracted data for analysis. The Revised Cochrane Collaboration Bias tool was employed. We calculated the pooled dropout rate of participants through a meta-analysis of proportions and examined whether dropout was more or less frequent in digital interventions against comparators via an odds ratio (OR) meta-analysis. Data were pooled using a random-effects model. Subgroup meta-analyses were conducted in a meta-analysis of proportions and OR meta-analysis to assess the dropout events when data were sorted by digital interventions or control comparator. A univariate metaregression based on a random-effects model assessed possible moderators of dropout. Participants’ dropout rates as pooled proportions were calculated for all groups combined, and the digital and comparator groups separately. OR>1 indicated higher dropouts for digital-based interventions. Metaregressions were performed for age, sex, length of intervention, and sample size. Results: A total of 17 studies were included. The overall pooled dropout rate was 9.5% (95% CI 5.0-17.5). The subgroup meta-analysis of proportions revealed a dropout rate of 11.6% for digital strategies (95% CI 6.8-19.0) and 10.0% for comparators (95% CI 5.5-17.7). A trend of higher dropout rates for digital strategies was observed in the overall (OR 1.16, 95% CI 0.98-1.36) and subgroup OR meta-analysis, but no significant differences were found between the groups. None of the covariates moderated the effect size in the univariate metaregression. Conclusions: Digital strategies had a higher dropout rate compared to other prevention interventions, but the difference was not significant. Standardization is needed regarding reporting the number of and reasons for dropouts. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329669; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329669 %M 36485027 %R 10.2196/42397 %U https://www.jmir.org/2022/12/e42397 %U https://doi.org/10.2196/42397 %U http://www.ncbi.nlm.nih.gov/pubmed/36485027 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40589 %T Applications of Artificial Intelligence to Obesity Research: Scoping Review of Methodologies %A An,Ruopeng %A Shen,Jing %A Xiao,Yunyu %+ Department of Physical Education, China University of Geosciences, No. 29, Xueyuan Road, Haidian District, Beijing, 100083, China, 86 010 82322397, shenjing@cugb.edu.cn %K artificial intelligence %K deep learning %K machine learning %K obesity %K scoping review %D 2022 %7 7.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Obesity is a leading cause of preventable death worldwide. Artificial intelligence (AI), characterized by machine learning (ML) and deep learning (DL), has become an indispensable tool in obesity research. Objective: This scoping review aimed to provide researchers and practitioners with an overview of the AI applications to obesity research, familiarize them with popular ML and DL models, and facilitate the adoption of AI applications. Methods: We conducted a scoping review in PubMed and Web of Science on the applications of AI to measure, predict, and treat obesity. We summarized and categorized the AI methodologies used in the hope of identifying synergies, patterns, and trends to inform future investigations. We also provided a high-level, beginner-friendly introduction to the core methodologies to facilitate the dissemination and adoption of various AI techniques. Results: We identified 46 studies that used diverse ML and DL models to assess obesity-related outcomes. The studies found AI models helpful in detecting clinically meaningful patterns of obesity or relationships between specific covariates and weight outcomes. The majority (18/22, 82%) of the studies comparing AI models with conventional statistical approaches found that the AI models achieved higher prediction accuracy on test data. Some (5/46, 11%) of the studies comparing the performances of different AI models revealed mixed results, indicating the high contingency of model performance on the data set and task it was applied to. An accelerating trend of adopting state-of-the-art DL models over standard ML models was observed to address challenging computer vision and natural language processing tasks. We concisely introduced the popular ML and DL models and summarized their specific applications in the studies included in the review. Conclusions: This study reviewed AI-related methodologies adopted in the obesity literature, particularly ML and DL models applied to tabular, image, and text data. The review also discussed emerging trends such as multimodal or multitask AI models, synthetic data generation, and human-in-the-loop that may witness increasing applications in obesity research. %M 36476515 %R 10.2196/40589 %U https://www.jmir.org/2022/12/e40589 %U https://doi.org/10.2196/40589 %U http://www.ncbi.nlm.nih.gov/pubmed/36476515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40192 %T Digital Engagement of Older Adults: Scoping Review %A Kebede,Abraham Sahilemichael %A Ozolins,Lise-Lotte %A Holst,Hanna %A Galvin,Kathleen %+ School of Sport and Health Sciences, University of Brighton, Village Way, Brighton, BN1 9PH, United Kingdom, 44 7502375585, a.s.kebede@brighton.ac.uk %K digital divide %K digital engagement %K older adults %K older people %K sustained engagement %K technology acceptance %K technological nonuse %D 2022 %7 7.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults’ experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time. Objective: Our objectives were to identify the extent and breadth of existing literature on older adults’ perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. Methods: We used the Arksey and O’Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults’ digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability). Conclusions: The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults’ digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults’ digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults’ knowledge and skills to cope with digital technology development. International Registered Report Identifier (IRRID): RR2-10.2196/25616 %M 36477006 %R 10.2196/40192 %U https://www.jmir.org/2022/12/e40192 %U https://doi.org/10.2196/40192 %U http://www.ncbi.nlm.nih.gov/pubmed/36477006 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39542 %T Physicians’ Perspectives on Inpatient Portals: Systematic Review %A Banguilan,Kaila Louise %A Sonnenberg,Frank %A Chen,Catherine %+ Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, Suite 2300, 125 Paterson St, New Brunswick, NJ, 08901, United States, 1 732 235 7112, cmchen@rwjms.rutgers.edu %K inpatient portals %K personal health record %K physician perspectives %K patient portals %K inpatients %K technology %D 2022 %7 15.11.2022 %9 Review %J Interact J Med Res %G English %X Background: Inpatient portals are online platforms that allow patients to access their personal health information and monitor their health while in the acute care setting. Despite their potential to improve quality of care and empower patients and families to participate in their treatment, adoption remains low. Outpatient portal studies have shown that physician endorsement can drive patients' adoption of these systems. Insights on physicians’ perspectives on use of these platforms can help improve patient and physician satisfaction and inpatient portal uptake. Objective: The purpose of this systematic review is to better understand physicians’ perspectives toward inpatient portals. Methods: A systematic literature review was conducted for studies published between 1994 and November 2021 using keywords for physicians’ perspectives toward patient portals and personal health records. Databases included PubMed, MEDLINE, Web of Science, and Scopus. Articles solely focused on nonphysician clinicians or addressing only outpatient settings or shared notes were excluded from this review. Two reviewers performed title, abstract, and full-text screening independently. Bias assessment was performed using the JBI SUMARI Critical Appraisal Tool (Joanna Briggs Institute). Inductive thematic analysis was done based on themes reported by original authors. Data were synthesized using narrative synthesis and reported according to overarching themes. Results: In all, 4199 articles were collected and 9 included. All but 2 of the studies were conducted in the United States. Common themes identified were communication and privacy, portal functionality and patient use, and workflow. In studies where physicians had no prior patient portal experience, concerns were expressed about communication issues created by patients’ access to laboratory results and potential impact on existing workflow. Concerns about negative communication impacts were not borne out in postimplementation studies. Conclusions: Physicians perceived inpatient portals to be beneficial to patients and saw improvement in communication as a result. This is consistent with outpatient studies and highlights the need to improve training on portal use and include physicians during the design process. Health care organizations and information technology entities can take steps to increasing clinician comfort. Physician concerns involving patient portal usage and managing patient expectations also need to be addressed. With improved clinician support, initial pessimism about communication and workload issues can be overcome. Limitations of this review include the small number of pre- and postimplementation studies found. This is also not a review of perspectives on open notes, which merits separate discussion. %M 36378521 %R 10.2196/39542 %U https://www.i-jmr.org/2022/2/e39542 %U https://doi.org/10.2196/39542 %U http://www.ncbi.nlm.nih.gov/pubmed/36378521 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e41456 %T Scientific Publication Patterns of Systematic Reviews on Psychosocial Interventions Improving Well-being: Bibliometric Analysis %A Shubina,Ivanna %+ Liberal Arts Department, American University of the Middle East, Block 6, Building 1, Egaila, 25612, Kuwait, 965 97420150, ivanna.shubina@aum.edu.kw %K psychosocial intervention %K well-being %K systematic review %K bibliometric analysis %K bibliometrics %K scientific research %K medical research %K publication %K publish %K citation %K scientometrics %K mental health %D 2022 %7 11.11.2022 %9 Review %J Interact J Med Res %G English %X Background: Despite numerous empirical studies and systematic reviews conducted on the effectiveness of interventions improving psychological well-being, there is no holistic overview of published systematic reviews in this field. Objective: This bibliometric study explored the scientific patterns of the effectiveness of different psychosocial interventions improving well-being among various categories of individuals with mental and physical diseases, to synthesize well-being intervention studies, and to suggest gaps and further studies in this emerging field. Methods: The bibliometric analysis included identifying the most productive authors, institutions, and countries; most explored fields and subjects of study; most active journals and publishers; and performing citation analysis and analyzing publication trends between 2014 and 2022. We focused on data retrieved from known databases, and the study was conducted with a proven bibliometric approach. Results: In total, 156 studies were found concerning the research domains and retrieved using LENS software from high-ranking databases (Crossref, Microsoft Academic, PubMed, and Core). These papers were written in English by 100 authors from 24 countries, among which, the leading country was the United Kingdom. Descriptive characteristics of the publications involved an increased number of publications in 2017 (n=35) and 2019 (n=34) and a decreased number in 2021 (n=4). The top 2 leading authors by citation score are James Thomas (3 papers and 260 citations) and Chris Dickens (3 papers and 182 citations). However, the most cited study had 592 citations. BMJ Open (n=6 articles) is the leading journal in the field of medicine; Clinical Psychology Review (n=5), in psychology; and Frontiers in Psychology, in psychological intervention (n=5) and psychology (n=5). The top 2 publishers were Wiley (n=28) and Elsevier (n=25). Conclusions: This study indicates an overall interest in the declared domains within the last decade. Our findings primarily indicate that psychosocial interventions (PIs) were evaluated as being effective in managing mental and physical problems and enhancing well-being. Cognitive behavioral therapy was assessed as being effective in treating anxiety, psychoeducation in relapse prevention, and gratitude interventions in improving overall health, and the mindfulness approach had a positive impact on decreasing distress and depression. Moreover, all these intervention types resulted in an overall increase in an individuals’ well-being and resilience. Integrating social and cultural factors while considering individual differences increases the efficiency of PIs. Furthermore, PIs were evaluated as being effective in managing symptoms of eating disorders, dementia, and cancer. Our findings could help provide researchers an overview of the publication trends on research domains of focus for further studies, since it shows current findings and potential research needs in these fields, and would also benefit practitioners working on increasing their own and their patients' well-being. %M 36367767 %R 10.2196/41456 %U https://www.i-jmr.org/2022/2/e41456 %U https://doi.org/10.2196/41456 %U http://www.ncbi.nlm.nih.gov/pubmed/36367767 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e40580 %T Education During Ward Rounds: Systematic Review %A Khalaf,Zahra %A Khan,Shaheer %+ Department of Postgraduate Surgical Studies, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, D02 YN77, Ireland, 353 14022100, zahra.khalaf@hotmail.com %K education %K learning %K rounds %K trainee %K ward rounds %K medical education %K simulation-based learning %K digital health %K digital learning %K education intervention %D 2022 %7 9.11.2022 %9 Review %J Interact J Med Res %G English %X Background: Enhancing the educational experience provided by ward rounds requires an understanding of current perceptions of the educational value of rounds. Objective: This systematic review examines perceptions of education in ward rounds, educational activities in ward rounds, barriers to learning, and perceptions of simulation-based ward rounds. Methods: The 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. MEDLINE (EBSCO), Cochrane, and Scopus were searched on May 29, 2022, for studies assessing learning during ward rounds. The search terms included “ward rounds,” “education,” and “trainees.” Then, the selected articles were reference searched. In total, 354 articles were retrieved. The articles were assessed for eligibility by 2 independent reviewers who screened titles, abstracts, and full-length texts. Articles addressing trainees’ education in all ward rounds were included. Articles were excluded if they were specific to certain disciplines, were reviews, were not published in scholarly journals, were published before 2015, were published in languages other than English, or did not concern human participants. Following the removal of 63 duplicates, a total of 268 articles were excluded. The risk of bias within the selected articles was also assessed via the Critical Appraisal Skills Programme checklist for qualitative research. Qualitative data were used to describe results in a narrative synthesis and in tables. Results: A total of 23 articles were included. Perceptions of teaching in rounds were addressed by 6 studies, of which 3 showed negative perceptions among participants, 2 reported ambivalent perceptions, and 1 showed positive perceptions. Perceived barriers to teaching during rounds were assessed by 7 studies. The reported barriers included time constraints, workloads, schedules, interruptions, the service-oriented nature of rounds, the lack of feedback, hierarchies, the lack of opportunities to ask questions and be engaged in patient management, and divergent learner needs. Further, 8 studies identified types of educational activities, including observation, patient-specific teaching, and discussion. Perceptions of learning through simulated ward rounds were assessed by 8 studies, and a consensus of satisfaction was noted among learners. The interventions that were explored to improve education included using teaching frameworks, involving clinical librarians, and changing the setting of ward rounds. Conclusions: The main limitations of this review are the predominant use of qualitative data in the included articles and the lack of standardization for the educational compositions of ward rounds among articles, which made the articles hard to compare. In conclusion, learning opportunities in ward rounds are often missed, and trainees perceive rounds to have low educational value. It is important to recognize the barriers to education during ward rounds and address them to maximize the benefits of ward rounds. Finally, there is a need to develop plans that incorporate teaching regularly during ward rounds in the inpatient setting. Trial Registration: PROSPERO CRD42022337736; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337736 %M 36285742 %R 10.2196/40580 %U https://www.i-jmr.org/2022/2/e40580 %U https://doi.org/10.2196/40580 %U http://www.ncbi.nlm.nih.gov/pubmed/36285742 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e36773 %T Characteristics of Smart Health Ecosystems That Support Self-care Among People With Heart Failure: Scoping Review %A Nourse,Rebecca %A Lobo,Elton %A McVicar,Jenna %A Kensing,Finn %A Islam,Sheikh Mohammed Shariful %A Kayser,Lars %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, 3125, Australia, 61 392443075, rnourse@deakin.edu.au %K digital health %K review %K chronic diseases %K cardiovascular disease %K information technology %K digital technology %K mobile phone %K self-management %D 2022 %7 2.11.2022 %9 Review %J JMIR Cardio %G English %X Background: The management of heart failure is complex. Innovative solutions are required to support health care providers and people with heart failure with decision-making and self-care behaviors. In recent years, more sophisticated technologies have enabled new health care models, such as smart health ecosystems. Smart health ecosystems use data collection, intelligent data processing, and communication to support the diagnosis, management, and primary and secondary prevention of chronic conditions. Currently, there is little information on the characteristics of smart health ecosystems for people with heart failure. Objective: We aimed to identify and describe the characteristics of smart health ecosystems that support heart failure self-care. Methods: We conducted a scoping review using the Joanna Briggs Institute methodology. The MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, and ACM Digital Library databases were searched from January 2008 to September 2021. The search strategy focused on identifying articles describing smart health ecosystems that support heart failure self-care. A total of 2 reviewers screened the articles and extracted relevant data from the included full texts. Results: After removing duplicates, 1543 articles were screened, and 34 articles representing 13 interventions were included in this review. To support self-care, the interventions used sensors and questionnaires to collect data and used tailoring methods to provide personalized support. The interventions used a total of 34 behavior change techniques, which were facilitated by a combination of 8 features for people with heart failure: automated feedback, monitoring (integrated and manual input), presentation of data, education, reminders, communication with a health care provider, and psychological support. Furthermore, features to support health care providers included data presentation, alarms, alerts, communication tools, remote care plan modification, and health record integration. Conclusions: This scoping review identified that there are few reports of smart health ecosystems that support heart failure self-care, and those that have been reported do not provide comprehensive support across all domains of self-care. This review describes the technical and behavioral components of the identified interventions, providing information that can be used as a starting point for designing and testing future smart health ecosystems. %M 36322112 %R 10.2196/36773 %U https://cardio.jmir.org/2022/2/e36773 %U https://doi.org/10.2196/36773 %U http://www.ncbi.nlm.nih.gov/pubmed/36322112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39748 %T The Impact of Artificial Intelligence on Health Equity in Oncology: Scoping Review %A Istasy,Paul %A Lee,Wen Shen %A Iansavichene,Alla %A Upshur,Ross %A Gyawali,Bishal %A Burkell,Jacquelyn %A Sadikovic,Bekim %A Lazo-Langner,Alejandro %A Chin-Yee,Benjamin %+ Division of Hematology, Department of Medicine, London Health Sciences Centre, 800 Comissioners Rd E, London, ON, N6A 5W9, Canada, 1 519 685 8475, Benjamin.Chin-Yee@lhsc.on.ca %K artificial intelligence %K eHealth %K digital health %K machine learning %K oncology %K cancer %K health equity %K health disparity %K bias %K global health %K public health %K cancer epidemiology %K epidemiology %K scoping %K review %K mobile phone %D 2022 %7 1.11.2022 %9 Review %J J Med Internet Res %G English %X Background: The field of oncology is at the forefront of advances in artificial intelligence (AI) in health care, providing an opportunity to examine the early integration of these technologies in clinical research and patient care. Hope that AI will revolutionize health care delivery and improve clinical outcomes has been accompanied by concerns about the impact of these technologies on health equity. Objective: We aimed to conduct a scoping review of the literature to address the question, “What are the current and potential impacts of AI technologies on health equity in oncology?” Methods: Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases from January 2000 to August 2021 for records engaging with key concepts of AI, health equity, and oncology. We included all English-language articles that engaged with the 3 key concepts. Articles were analyzed qualitatively for themes pertaining to the influence of AI on health equity in oncology. Results: Of the 14,011 records, 133 (0.95%) identified from our review were included. We identified 3 general themes in the literature: the use of AI to reduce health care disparities (58/133, 43.6%), concerns surrounding AI technologies and bias (16/133, 12.1%), and the use of AI to examine biological and social determinants of health (55/133, 41.4%). A total of 3% (4/133) of articles focused on many of these themes. Conclusions: Our scoping review revealed 3 main themes on the impact of AI on health equity in oncology, which relate to AI’s ability to help address health disparities, its potential to mitigate or exacerbate bias, and its capability to help elucidate determinants of health. Gaps in the literature included a lack of discussion of ethical challenges with the application of AI technologies in low- and middle-income countries, lack of discussion of problems of bias in AI algorithms, and a lack of justification for the use of AI technologies over traditional statistical methods to address specific research questions in oncology. Our review highlights a need to address these gaps to ensure a more equitable integration of AI in cancer research and clinical practice. The limitations of our study include its exploratory nature, its focus on oncology as opposed to all health care sectors, and its analysis of solely English-language articles. %M 36005841 %R 10.2196/39748 %U https://www.jmir.org/2022/11/e39748 %U https://doi.org/10.2196/39748 %U http://www.ncbi.nlm.nih.gov/pubmed/36005841 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39213 %T Knowledge Translation and Implementation Planning to Promote Research Governance in Nongovernment Organizations in the Torres Strait: Descriptive Study %A Shibasaki,Sanchia %A Watkin Lui,Felecia %A Ah Mat,Lynda %+ ThinkThrough, PO Box 7083, Holland Park, 4121, Australia, 61 0447040224, sanchia.shibasaki@gmail.com %K knowledge translation %K implementation planning %K research governance %K nongovernment organizations %K nongovernment organisations %K Aboriginal and Torres Strait Islander %D 2022 %7 1.11.2022 %9 Short Paper %J Interact J Med Res %G English %X Background: Aboriginal and Torres Strait Islander people in Australia have participated in Western research for decades. When done well, research has resulted in significant benefits and positive impacts on society. However, the primary benefactor of this research has and continues to be researchers, with limited or no research knowledge mobilized for uptake and beneficial use by end users, such as individuals and communities. In 2021, the Torres Strait Islanders Research to Policy and Practice Hub (the Hub) at James Cook University designed and implemented several strategies, including a games-based interactive workshop with representatives from nongovernment organizations (NGOs). Feedback suggests the workshop and associated activities were a success. Objective: We describe knowledge translation (KT) and implementation planning to design and implement strategies to increase awareness and understanding of NGOs in research governance. Methods: This descriptive study involved representatives from NGOs on Thursday Island in the Torres Strait. We collected data from a literature review and informal discussions. We used several models and frameworks to guide our approach and underpin data collection and analysis. Results: Designing and implementing strategies to increase awareness and understanding of NGOs in the Torres Strait to govern research involved several key steps: (1) identifying and defining what needed to change and who needed to change, (2) identifying and mapping barriers and facilitators, (3) selecting the most appropriate strategies to support change, (4) implementing activities, and (5) monitoring and evaluating our approach. We developed a program logic to understand and communicate to others how we would implement activities and what resources would be required to support this process. We drew on several evidence-based KT and implementation models and frameworks to do this. First, a KT planning template was used to inform what evidence we wanted to mobilize, to whom, and for what purpose. Based on this step, we recognized we wanted to bring about change with the target audience, and as such, we drew on the previously mentioned implementation planning models and frameworks. We collated the outcomes from these initial steps. Conclusions: Our KT and implementation practice experience were successful. Encouraging researchers and end users to adopt similar practices requires investment in training and development of KT and implementation practice. This also entails modifying research standards and guidelines to include KT and implementation practice when working with Aboriginal and Torres Strait Islander people and other vulnerable groups, creating incentives for researchers and end users to embed KT and implementation practice in research, and recognizing and rewarding the benefits and impact beyond publication and presentation. %M 36318255 %R 10.2196/39213 %U https://www.i-jmr.org/2022/2/e39213 %U https://doi.org/10.2196/39213 %U http://www.ncbi.nlm.nih.gov/pubmed/36318255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40877 %T The Current Status of Telemedicine Technology Use Across the World Health Organization European Region: An Overview of Systematic Reviews %A Saigí-Rubió,Francesc %A Borges do Nascimento,Israel Júnior %A Robles,Noemí %A Ivanovska,Keti %A Katz,Che %A Azzopardi-Muscat,Natasha %A Novillo Ortiz,David %+ Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Marmorej 51, Copenhagen, 2100, Denmark, 45 61614868, dnovillo@who.int %K telemedicine %K Europe %K World Health Organization %K mobile phone %D 2022 %7 27.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Several systematic reviews evaluating the use of telemedicine by clinicians, patients, and health authorities to improve the delivery of care in the 53 member states of the World Health Organization (WHO) European Region have been conducted in recent years. However, a study summarizing the findings of these reviews has not been conducted. Objective: This overview of systematic reviews aimed to summarize findings regarding the use of telemedicine across the 53 member states and identify the medical fields and levels of care in and at which the effectiveness, feasibility, and applicability of telemedicine have been demonstrated. The barriers to and facilitators of telemedicine use were also evaluated and collated to help with the design and implementation of telemedicine interventions. Methods: Through a comprehensive systematic evaluation of the published and unpublished literature, we extracted clinical, epidemiological, and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 member states considered. We rated the methodological quality of each of the included reviews based on A Measurement Tool to Assess Systematic Review 2 approach and judged the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. The entire process was performed by 2 independent authors. Results: This overview drew on data from >2239 primary studies, with >20,000 enrolled patients in total, within the WHO European Region. On the basis of data from randomized trials, observational studies, and economic evaluations from several countries, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment, and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter because of the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings, and geographical locations. In addition to the clinical outcomes of the interventions, the social and economic outcomes are highlighted. Conclusions: The application of telemedicine is well established across countries in the WHO European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers related to users, technology, and infrastructure were the largest. Conversely, the provision of health services using technological devices was found to significantly enhance patients’ clinical outcomes, improve the long-term follow-up of patients by medical professionals, and offer logistical benefits for both patients and health workers. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022309375; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375 %M 36301602 %R 10.2196/40877 %U https://www.jmir.org/2022/10/e40877 %U https://doi.org/10.2196/40877 %U http://www.ncbi.nlm.nih.gov/pubmed/36301602 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38267 %T Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review %A Southgate,Genevieve %A Yassaee,Arrash A %A Harmer,Matthew J %A Livesey,Helen %A Pryde,Kate %A Roland,Damian %+ Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College, South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 (0)20 7589 5111, arrash.yassaee@nhs.net %K telemedicine %K telehealth %K eHealth %K digital health %K video consultation %K remote consultation %K paediatric %K child %K safeguarding %K diabetes %K diabetic %K asthma %K epilepsy %K epileptic %K renal %K kidney %K evidence-based medicine %K review %D 2022 %7 26.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers. Objective: This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings. Methods: This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness. Results: Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs. Conclusions: There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions. %M 36287609 %R 10.2196/38267 %U https://www.jmir.org/2022/10/e38267 %U https://doi.org/10.2196/38267 %U http://www.ncbi.nlm.nih.gov/pubmed/36287609 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39006 %T The Effect of Classroom-Based Interventions on Sedentary Behavior and Spinal Health in Schoolchildren: Systematic Review %A Fisher,Dominic %A Louw,Quinette %+ Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Francie van Zijl Avenue, PO Box 241, Cape Town, 8000, South Africa, 27 021 938 9300, dominic@sun.ac.za %K sedentary behavior %K classroom sitting %K spinal health %D 2022 %7 26.10.2022 %9 Review %J Interact J Med Res %G English %X Background: Multifaceted school-based interventions involving many stakeholders show promise toward the reduction of sedentary behavior (SB) and improved musculoskeletal conditions in schoolchildren. In resource-limited contexts, where schools face multiple, complex demands, broad school-based interventions may not be possible. In these settings, less complex, resource-efficient interventions are more likely to be adopted and implemented. Interventions that are limited to classrooms and that do not require broader stakeholder participation may be more appropriate to lower-resource settings. Objective: The aim of this study was to systematically search for, identify, and summarize the literature on the effectiveness of classroom-based interventions on SB and spinal health in schoolchildren. Methods: PubMed, EBSCOhost CINAHL, Web of Science, and Scopus were searched between January 1, 2021, and April 30, 2021. We included experimental studies conducted exclusively in school classrooms that objectively measured classroom SB and spinal health. The search terms related to SB, classroom sitting, and classroom neck and back pain. Studies that reported on objectively measured classroom physical activity and instrumented observation of healthy spinal behavior were included in the review. The included studies were critically appraised using the McMaster critical review form for quantitative studies. The study findings were summarized in tables, and a meta-analysis of homogeneous review outcome data was conducted. Results: Overall, 12 experimental studies from high-income countries were included: 9 (75%) studies focused on SB, and 3 (25%) focused on spinal health. Of the 9 SB studies, 8 (89%) reported decreases in classroom sitting time. The pooled medium-term effects of a subset of SB interventions showed statistically significant decreases in sitting time (P=.03), whereas short-term effects and long-term effects were not significantly reduced (P=.13 and P=.23, respectively). A meta-analysis of spinal health studies demonstrated statistically significant improvements in spinal behavior during functional tasks (P=.005). Conclusions: Classroom-based interventions aimed at reducing SB and improving spinal health may be effective without placing an additional burden on teachers and parents. SB interventions must include strategies to overcome teachers’ and learners’ hedonic motivation to sit during class time. Standardized outcomes for school-based SB are encouraged so that findings from various settings may be pooled to determine the overall effect across studies. The use of standardized functional outcomes in spinal health studies will aid in determining the effectiveness of spinal health interventions across studies. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020176080; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020176080 %M 36287590 %R 10.2196/39006 %U https://www.i-jmr.org/2022/2/e39006 %U https://doi.org/10.2196/39006 %U http://www.ncbi.nlm.nih.gov/pubmed/36287590 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e38635 %T Co-design of Digital Health Interventions for Young Adults: Protocol for a Scoping Review %A Malloy,Jessica A %A Partridge,Stephanie R %A Kemper,Joya A %A Braakhuis,Andrea %A Roy,Rajshri %+ Discipline of Nutrition & Dietetics, Faculty of Medical & Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1011, New Zealand, 64 212676742, jess.malloy5@gmail.com %K digital health intervention %K eHealth %K mHealth %K digital intervention %K co-design %K user participation %K participatory research %K participatory medicine %K user feedback %K participatory design %K social media %K web-based tool %K young adult %K youth %K teenager %K adolescent %K review %K protocol %K search strategy %K medical librarian %K health librarian %K library science %K information science %D 2022 %7 24.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health interventions, including apps and web-based services, are on the rise due to their facilitated access to target groups. The constant evolution of technology calls for participatory research methodologies to understand youth expectations and the use of technology. The creative and collaborative nature of co-design allows for the active integration of youth desires and may enhance acceptability when it comes to digital health tools. Objective: The primary objective of this review is to assess the breadth of literature on digital health interventions that have been co-designed for and by young adults, including the types of available evidence, the identification of key characteristics relevant to young adult co-design, and the examination of research conduct in this space. Methods: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Scoping Reviews. As well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for reporting scoping reviews, an adaptation of Arksey and O’Malley’s 6-stage framework for scoping reviews will be referenced. Peer-reviewed primary research, where young adults (aged 15-35 years) were actively involved in the design and development process of digital health interventions, will be collated for analyses. Five databases, including MEDLINE (Ovid), Cochrane, CINAHL Plus, Google Scholar, and Scopus, will be searched for relevant papers. Search strategies will be comprehensive to identify both published and unpublished literature. Relevant gray literature and secondary research will be excluded but pooled for separate analysis and citation chaining. Results will be presented in one or multiple forms, including narrative, tabular, or diagrammatic. Results: Data collection commenced in October 2021. Following data extraction according to the JBI results extraction instrument and independent quality assurance of included studies, a narrative synthesis of each paper included in the final pool will allow for data charting. As of May 2022, 19 papers are included for analysis. We expect the results to be published by autumn 2022. Conclusions: This protocol provides guidance for researchers who plan to conduct a similar style of investigation and promotes standardization of the scoping review process. We anticipate the provision of an overview of participatory digital health research involving young adults, highlighting any gaps in this research area, as well as potential areas for further study. International Registered Report Identifier (IRRID): DERR1-10.2196/38635 %M 36279167 %R 10.2196/38635 %U https://www.researchprotocols.org/2022/10/e38635 %U https://doi.org/10.2196/38635 %U http://www.ncbi.nlm.nih.gov/pubmed/36279167 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e39023 %T Health Literacy in Health Professionals Two Years into the COVID-19 Pandemic: Results From a Scoping Review %A Grepmeier,Eva-Maria %A Pawellek,Maja %A Curbach,Janina %A Sommoggy,Julia von %A Drewitz,Karl Philipp %A Hasenpusch,Claudia %A Bitzer,Eva Maria %A Apfelbacher,Christian %A Matterne,Uwe %+ Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 39124300, eva-maria.grepmeier@med.ovgu.de %K SARS-CoV-2 %K COVID-19 %K health competence %K COVID-19–related health literacy %K health care worker %D 2022 %7 17.10.2022 %9 Review %J JMIR Med Educ %G English %X Background: Health literacy (HL) is an important public health goal but also crucial in individuals providing medical care. During the pandemic, COVID-19–related HL of health professionals (HPs) has gained momentum; it helps to minimize the risk of self-infection, on the one hand, and to protect patients and relatives from infection, on the other. However, comprehensive information about the levels of individual pandemic-related HL in HPs is scarce. Objective: In this paper, we aimed at describing the extent of existing research on HL (concept) conducted in HPs (population) in the COVID-19 pandemic (context). The review intends to map the literature on HL in HPs, thereby highlighting research gaps. Methods: This scoping review was conducted using the methodology of Khalil et al (2016). This involved an electronic search of PubMed (MEDLINE) and PsycInfo and a hand search. The included studies were iteratively examined to find items representing the four HL dimensions of access, understand, critically appraise, and apply COVID-19–related health information. Results: The search yielded a total of 3875 references. Only 7 (1.4%) of the 489 included studies explicitly stated to have addressed HL; 2 (0.4%) studies attempted to develop an instrument measuring COVID-19–related HL in HPs; 6 (1.2%) studies included an HL measure in an observational survey design. Of the remainder, the vast majority used a cross-sectional design. The dimensions access and understand were frequently examined, but few studies looked at the dimensions critical appraisal or apply. Very few studies reported an intervention aiming to improve a COVID-19–related HL outcome. Conclusions: High levels of COVID-19–related HL among HPs are necessary to ensure not only safe practice with necessary protection of HPs, their patients, and relatives, but also successful care delivery and subsequently improved health outcomes in the long term. To advance our understanding of how high COVID-19–related HL manifests itself in HPs, how it relates to health outcomes, and how it can be improved, more research is necessary. Trial Registration: Open Science Framework dbfa5; https://osf.io/dbfa5/ %M 36179148 %R 10.2196/39023 %U https://mededu.jmir.org/2022/4/e39023 %U https://doi.org/10.2196/39023 %U http://www.ncbi.nlm.nih.gov/pubmed/36179148 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e36842 %T Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review %A Pagaki-Skaliora,Marina %A Morrow,Eileen %A Theologis,Tim %+ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Centre, Windmill Road, Oxford, OX3 7LE, United Kingdom, 44 1865227607, eileen.morrow@ouh.nhs.uk %K cerebral palsy %K CP %K assistive technology %K scoping review %K software %K application %K telehealth %K telerehabilitation %K rehabilitation %K COVID-19 %K children %K health intervention %K health care %K digital intervention %D 2022 %7 17.10.2022 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP. Objective: This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research. Methods: A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children’s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate. Results: In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions: The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth. %M 36041012 %R 10.2196/36842 %U https://rehab.jmir.org/2022/4/e36842 %U https://doi.org/10.2196/36842 %U http://www.ncbi.nlm.nih.gov/pubmed/36041012 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40381 %T The National and Global Impact of Systemic and Structural Violence on the Effective Prevention, Treatment, and Management of COVID-19 in African or Black Communities: Protocol for a Scoping Review %A Timothy,Roberta %A Chin-see,Robert Ainsley %A Martyniuk,Julia %A Djiadeu,Pascal %+ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada, 1 4168840138, roberta.timothy@utoronto.ca %K African %K Black people %K COVID-19 %K systemic and structural barriers %K health disparities %K minority health %K racism %K racial health inequity %K structural violence %K anti-Black racism %K decolonizing %K resistance %K social justice %D 2022 %7 17.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: As COVID-19 ravages the globe and cases increase rapidly, countries are presented with challenging policy choices to contain and mitigate its spread. In Canada and globally, the COVID-19 pandemic has added a new stratum to the debate concerning the root causes of global and racial health inequities and disparities. Individuals who exist as targets of systemic inequities are not only more susceptible to contracting COVID-19, but also more likely to bear the greatest social, economic, and physical burdens. Therefore, data collection that focuses on the impact of COVID-19 on the lives and health of African/Black communities worldwide is needed to develop intersectional, culturally relative, antiracist/antioppression, and empowerment-centered interventions and social policies for supporting affected communities. Objective: The primary objective of this review is to investigate the impact and management of COVID-19 among African/Black individuals and communities, and understand how anti-Black racism and intersectional violence impact the health of African/Black communities during the pandemic. Moreover, the study aims to explore research pertaining to the impact of COVID-19 on Black communities in the global context. We seek to determine how Black communities are impacted with regard to structural violence, systematic racism, and health outcomes, and the ways in which attempts have been made to mitigate or manage the consequences of the pandemic and other injurious agents. Methods: A systematic search of quantitative and qualitative studies published on COVID-19 will be conducted in MEDLINE (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (EBSCO), Cochrane Library, PsychInfo (Ovid), CAB Abstracts (Ovid), Scopus (Elsevier), Web of Science (Clarivate), and Global Index Medicus. To be included in the review, studies should present data on COVID-19 in relation to African/Black individuals, populations, and communities in the global sphere. Studies must discuss racism, oppression, antioppression, or systemic and structural violence and be published in English, French, Spanish, or Portuguese. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, the findings will be synthesized quantitatively and qualitatively through thematic analysis. The risk of bias will not be assessed. Results: Title, abstract, and full-text screening concluded in June 2022. Data collection is in progress and is expected to be completed by December 2022. Data analysis and drafting of the manuscript will be done thereafter. Findings from the scoping review are expected to be provided for peer review in 2023. Conclusions: This review will collect important data and evidence related to COVID-19 in African/Black communities. The findings could help identify existing gaps in COVID-19 management in African/Black communities and inform future research paradigms. Furthermore, the findings could be applied to decision-making for health policy and promotion, and could potentially influence services provided by health care facilities and community organizations around the globe. International Registered Report Identifier (IRRID): DERR1-10.2196/40381 %M 36219749 %R 10.2196/40381 %U https://www.researchprotocols.org/2022/10/e40381 %U https://doi.org/10.2196/40381 %U http://www.ncbi.nlm.nih.gov/pubmed/36219749 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40538 %T The Influence of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Protocol for an Overview of Systematic Reviews %A Matthias,Katja %A Honekamp,Ivonne %A De Santis,Karina Karolina %+ Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Zur Schwedenschanze 15, Stralsund, 18435, Germany, 49 3831456651, katja.matthias@hochschule-stralsund.de %K digital technologies %K digital intervention %K COPD %K AMSTAR 2 %K chronic obstructive pulmonary disease %K gender %K sex %K age %K overview %K systematic review %K treatment %K monitoring %K chronic disease %K chronic illness %K outcome reporting %K review methodology %K critical appraisal %D 2022 %7 12.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a common chronic disease that can be treated and monitored with various digital technologies. Digital technologies offer unique opportunities for treating and monitoring people with chronic diseases, but little is known about whether the outcomes of such technologies depend on sex, gender, or age in people with COPD. Objective: The general objective of this study is to assess the possible influence of sex, gender, or age on outcomes of digital technologies for treatment and monitoring of COPD through an overview of systematic reviews. Methods: The study is planned as an overview of systematic reviews. Study reporting is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines because guidelines for overviews are not available as of this writing. The information sources for the overview will include 4 bibliographic databases (MEDLINE, Cochrane Library, Epistemonikos, and Web of Science) as well as the bibliographies of the included systematic reviews. The electronic search strategy will be developed and conducted in collaboration with an experienced database specialist. The search results will be presented in accordance with the PRISMA 2020 guidelines. The eligibility of studies is based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria: (1) people with COPD (population), (2) digital technology intervention for treatment or monitoring (intervention), (3) any control group or no control group (comparison), (4) any outcome, and (5) systematic review of randomized controlled trials or non–randomized controlled trials with or without a meta-analysis (study design). Critical appraisal of the included systematic reviews will be performed using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data will be extracted using a standardized data extraction sheet. Results: The literature search is scheduled for June 2022. We expect to select the relevant systematic reviews, code the data, and appraise the systematic reviews by December 2022. Conclusions: There is a growing recognition that the influence of sex, gender, or age should be considered in research design and outcome reporting in the context of health care interventions. Our overview will identify systematic reviews of various digital technologies for treatment or monitoring of COPD. The most interesting aspect of the overview will be to investigate if any systematic reviews considered the influence of sex, gender, or age on the outcomes of such digital technologies in COPD. Evidence from the overview could be used to guide more individualized (sex, gender, or age-based) recommendations for the use of digital technologies among people with COPD. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022322924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322924 %M 36222803 %R 10.2196/40538 %U https://www.researchprotocols.org/2022/10/e40538 %U https://doi.org/10.2196/40538 %U http://www.ncbi.nlm.nih.gov/pubmed/36222803 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40265 %T Interactive Conversational Agents for Health Promotion, Prevention, and Care: Protocol for a Mixed Methods Systematic Scoping Review %A Sasseville,Maxime %A Barony Sanchez,Romina H %A Yameogo,Achille R %A Bergeron-Drolet,Laurie-Ann %A Bergeron,Frédéric %A Gagnon,Marie-Pierre %+ Faculté des Sciences Infirmières, Université Laval, 1050, Avenue de la Médecine, Québec, QC, R-G1V 0A6, Canada, 1 418 656 3356, maxime.sasseville@fsi.ulaval.ca %K conversational agents %K chatbots %K scoping review %K literature review %K healthcare %K health care %K health promotion %K prevention %K care %K computer %K natural language processing %K literature %K community %D 2022 %7 11.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interactive conversational agents, also known as “chatbots,” are computer programs that use natural language processing to engage in conversations with humans to provide or collect information. Although the literature on the development and use of chatbots for health interventions is growing, important knowledge gaps remain, such as identifying design aspects relevant to health care and functions to offer transparency in decision-making automation. Objective: This paper presents the protocol for a scoping review that aims to identify and categorize the interactive conversational agents currently used in health care. Methods: A mixed methods systematic scoping review will be conducted according to the Arksey and O’Malley framework and the guidance of Peters et al for systematic scoping reviews. A specific search strategy will be formulated for 5 of the most relevant databases to identify studies published in the last 20 years. Two reviewers will independently apply the inclusion criteria using the full texts and extract data. We will use structured narrative summaries of main themes to present a portrait of the current scope of available interactive conversational agents targeting health promotion, prevention, and care. We will also summarize the differences and similarities between these conversational agents. Results: The search strategy and screening steps were completed in March 2022. Data extraction and analysis started in May 2022, and the results are expected to be published in October 2022. Conclusions: This fundamental knowledge will be useful for the development of interactive conversational agents adapted to specific groups in vulnerable situations in health care and community settings. International Registered Report Identifier (IRRID): DERR1-10.2196/40265 %M 36222804 %R 10.2196/40265 %U https://www.researchprotocols.org/2022/10/e40265 %U https://doi.org/10.2196/40265 %U http://www.ncbi.nlm.nih.gov/pubmed/36222804 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e39905 %T Methodological Frameworks and Dimensions to Be Taken Into Consideration in Digital Health Technology Assessment: Protocol for a Scoping Review %A Segur-Ferrer,Joan %A Moltó-Puigmartí,Carolina %A Pastells-Peiró,Roland %A Vivanco-Hidalgo,Rosa Maria %+ Health Technology Assessment and Quality of Care Area, Agency for Health Quality and Assessment of Catalonia, Carrer de Roc Boronat, 81-95 (segona planta), Barcelona, 08005, Spain, 34 935 513 900, joan.segur@gencat.cat %K digital health %K eHealth %K mobile health %K artificial intelligence %K framework %K health technology assessment %D 2022 %7 11.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health technology assessment (HTA) is one of the main tools that health systems have to appraise evidence and determine the value of a given health technology. Although the existing HTA frameworks are useful tools for the evaluation of a wide range of health technologies, more and more experts, organizations across the world, and HTA agencies are highlighting the need to update or develop specific methodological frameworks for the evaluation of digital health technologies in order to take into account additional domains that cover these technologies’ intrinsic characteristics. Objective: The purpose of our scoping review is to identify the methodological frameworks that are used worldwide for the assessment of digital health technologies; determine what dimensions and aspects are being considered; and generate, through a thematic analysis, a proposal for a methodological framework that is based on the most frequently described dimensions in the literature. Methods: The scoping review will be performed in accordance with the guidelines established in the updated statement of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). We will search for peer-reviewed and grey literature published between 2011 and the date of the search execution. The retrieved references will be reviewed in a single-blind manner by 2 independent authors, and their quality will be assessed by using the Critical Appraisal Skills Program tool. The ATLAS.ti software (Scientific Software Development GmbH) will be used for data extraction and to perform the thematic analysis. Results: The scoping review is currently (May 2022) in progress. It is expected to be completed in October 2022, and the final results of the research will be presented and published by November 2022. Conclusions: To our knowledge, no studies have been published to date that identify the existing methodological frameworks for digital HTA, determine which dimensions must be evaluated for correct decision-making, and serve as a basis for the development of a methodological framework of reference that health care systems can use to carry out this kind of assessment. This work is intended to address this knowledge gap of key relevance for the field of HTA. International Registered Report Identifier (IRRID): DERR1-10.2196/39905 %M 36222788 %R 10.2196/39905 %U https://www.researchprotocols.org/2022/10/e39905 %U https://doi.org/10.2196/39905 %U http://www.ncbi.nlm.nih.gov/pubmed/36222788 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e37718 %T mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review %A DeWitt,Akeiylah %A Kientz,Julie %A Coker,Tumaini R %A Liljenquist,Kendra %+ Department of Human-Centered Design and Engineering, University of Washington, 423 Sieg Building, Seattle, WA, 98195, United States, 1 206 543 2100, adewitt@uw.edu %K mobile health technologies %K early childhood health promotion %K child development %K parent support technologies %K mobile phone %D 2022 %7 6.10.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations. Objective: In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity. Methods: We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions. Results: Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields. Conclusions: To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations. Trial Registration: PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2 %M 36201391 %R 10.2196/37718 %U https://pediatrics.jmir.org/2022/4/e37718 %U https://doi.org/10.2196/37718 %U http://www.ncbi.nlm.nih.gov/pubmed/36201391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40238 %T Artificial Intelligence Applications in Health Care Practice: Scoping Review %A Sharma,Malvika %A Savage,Carl %A Nair,Monika %A Larsson,Ingrid %A Svedberg,Petra %A Nygren,Jens M %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K artificial intelligence %K health care %K implementation %K scoping review %K technology adoption %D 2022 %7 5.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) is often heralded as a potential disruptor that will transform the practice of medicine. The amount of data collected and available in health care, coupled with advances in computational power, has contributed to advances in AI and an exponential growth of publications. However, the development of AI applications does not guarantee their adoption into routine practice. There is a risk that despite the resources invested, benefits for patients, staff, and society will not be realized if AI implementation is not better understood. Objective: The aim of this study was to explore how the implementation of AI in health care practice has been described and researched in the literature by answering 3 questions: What are the characteristics of research on implementation of AI in practice? What types and applications of AI systems are described? What characteristics of the implementation process for AI systems are discernible? Methods: A scoping review was conducted of MEDLINE (PubMed), Scopus, Web of Science, CINAHL, and PsycINFO databases to identify empirical studies of AI implementation in health care since 2011, in addition to snowball sampling of selected reference lists. Using Rayyan software, we screened titles and abstracts and selected full-text articles. Data from the included articles were charted and summarized. Results: Of the 9218 records retrieved, 45 (0.49%) articles were included. The articles cover diverse clinical settings and disciplines; most (32/45, 71%) were published recently, were from high-income countries (33/45, 73%), and were intended for care providers (25/45, 56%). AI systems are predominantly intended for clinical care, particularly clinical care pertaining to patient-provider encounters. More than half (24/45, 53%) possess no action autonomy but rather support human decision-making. The focus of most research was on establishing the effectiveness of interventions (16/45, 35%) or related to technical and computational aspects of AI systems (11/45, 24%). Focus on the specifics of implementation processes does not yet seem to be a priority in research, and the use of frameworks to guide implementation is rare. Conclusions: Our current empirical knowledge derives from implementations of AI systems with low action autonomy and approaches common to implementations of other types of information systems. To develop a specific and empirically based implementation framework, further research is needed on the more disruptive types of AI systems being implemented in routine care and on aspects unique to AI implementation in health care, such as building trust, addressing transparency issues, developing explainable and interpretable solutions, and addressing ethical concerns around privacy and data protection. %M 36197712 %R 10.2196/40238 %U https://www.jmir.org/2022/10/e40238 %U https://doi.org/10.2196/40238 %U http://www.ncbi.nlm.nih.gov/pubmed/36197712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37497 %T Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores %A Messner,Eva-Maria %A Sturm,Niklas %A Terhorst,Yannik %A Sander,Lasse B %A Schultchen,Dana %A Portenhauser,Alexandra %A Schmidbaur,Simone %A Stach,Michael %A Klaus,Jochen %A Baumeister,Harald %A Walter,Benjamin M %+ Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany, 49 0731 5000, benjamin.walter@uniklinik-ulm.de %K gastrointestinal diseases %K mHealth %K mobile health %K MARS %K Mobile Application Rating Scale %K systematic review %K app quality %K gastrointestinal %K mobile app %K app %D 2022 %7 5.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective: This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods: A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results: The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions: Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps. %M 36197717 %R 10.2196/37497 %U https://www.jmir.org/2022/10/e37497 %U https://doi.org/10.2196/37497 %U http://www.ncbi.nlm.nih.gov/pubmed/36197717 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37070 %T A Living Database of HIV Implementation Research (LIVE Project): Protocol for Rapid Living Reviews %A Eshun-Wilson,Ingrid %A Ford,Nathan %A Le Tourneau,Noelle %A Baral,Stefan %A Schwartz,Sheree %A Kemp,Christopher %A Geng,Elvin %+ Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, 4990 Childrens Pl, St. Louis, MO, 63110, United States, 1 3147471206, i.eshun-wilsonova@wustl.edu %K living review %K HIV %K systematic review %K rapid review %K implementation %K HIV infection %D 2022 %7 5.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV implementation research evolves rapidly and is often complex and poorly characterized, which makes the synthesis of data on HIV implementation strategies inherently difficult. This is further compromised by prolonged data abstraction processes due to variable interventions, outcomes, and context, and delays in the publication of review findings; this can all result in outdated and irrelevant systematic reviews. Objective: The LIVE project (A Living Database of HIV Implementation Research) aims to overcome these challenges by applying an implementation science lens to the conduct of rapid living systematic reviews and meta-analyses to inform HIV service delivery priorities and guideline development. Methods: The LIVE project will generate a series of living systematic reviews exploring implementation strategies for improving HIV cascade outcomes (HIV infection, HIV diagnosis, linkage and retention in HIV care, viral suppression, and mortality). We will search Embase and MEDLINE as well databases specific to review questions for studies conducted after 2004 using predefined search terms to identify studies conducted in any age group or setting, and using implementation strategies that target policy makers, society, health organizations, health workers, and beneficiaries of care and their families. Both randomized controlled trials and observational studies will be included to ensure reviews include pragmatic data. In addition to assessments of methodological quality, features of the implementation strategies, relevance for implementation, and evidence quality will be determined using recognized frameworks. After initial publication, knowledge gaps will be identified, and review questions and search strategies revised to address ongoing critical areas of inquiry. Updated searches will be conducted every 6 months, with subsequent ongoing screening, data abstraction, and revision of meta-analyses. Results: As of July 2022, five reviews are at various stages of development within the LIVE project. Three systematic reviews are underway and living review processes are in development for two reviews with estimated completion over the next 12 months. Conclusions: This project and resulting systematic reviews will provide critical insights for HIV service delivery to inform international guideline development. International Registered Report Identifier (IRRID): DERR1-10.2196/37070 %M 36197704 %R 10.2196/37070 %U https://www.researchprotocols.org/2022/10/e37070 %U https://doi.org/10.2196/37070 %U http://www.ncbi.nlm.nih.gov/pubmed/36197704 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e36077 %T Soil-Transmitted Helminth Infection in Malaysia: Protocol for a Scoping Review %A Mohd Hisham,Muhammad Faiz %A Ahmad,Fazila Haryati %A Mohamed Haris,Hasmah %A Lodz,Noor Aliza %A Yoep,Norzawati %A Muhammad,Eida Nurhadzira %A Ali,Rafidah %A Muhamad,Nor Asiah %+ Institute for Public Health, National Institute of Health, No 1, Jalan Setia Murni U13/52, Setia Alam, B6L6, Institute of Public Health, Shah Alam, 40170, Malaysia, 60 333628888 ext 8722, faizhisham86@gmail.com %K STH %K soil-transmitted helminth %K PRISMA-ScR %K Malaysia %K helminth %K tropical disease %D 2022 %7 5.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Soil-transmitted helminth (STH) infection is 1 of the 20 notable neglected tropical diseases according to the Centers for Disease Control and Prevention and World Health Organization. In 2010, it is estimated that 1.73 billion people are infected with STH globally, of which 70% of cases occur in Asia. To date, there is a dearth of published literature on the prevalence of STH infection throughout Malaysia. Objective: The objectives of this study are to review research activity on STH infection in Malaysia, to estimate the prevalence of STH infection among Malaysians, and to identify significant risk factors associated with the infection. This review aims to provide the current state of evidence pertaining to STH infections, focusing on the main areas, limitations, and biases of research and mapping out the morbidity distribution of the diseases and their causative agents, and to identify significant risk factors for preventive measures. Methods: We will conduct a scoping review based on the 6-stage structured framework developed by Arksey and O’Malley. A comprehensive search strategy focusing on STH infection will be executed using electronic databases (Scopus, PubMed, Web of Science, and Embase). A systematic approach for searching, screening, reviewing, and data extraction will be applied based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Mendeley software and Microsoft Excel will be used to manage the references and to remove duplicates. Relevant data from selected articles will be extracted using a standardized data extraction form. Results: A total of 164 potential manuscripts were retrieved. Data extraction is currently in progress and completion is expected by the end of 2022. Conclusions: Our scoping review will summarize the current state of research in this field and provide comprehensive information regarding STH infections in Malaysia for future reference. Trial Registration: National Medical Research Register NMRR-20-2889-54348; https://nmrr.gov.my/research-directory/e52ea778-d31c-4eb4-9163-a45bb3680bbf International Registered Report Identifier (IRRID): DERR1-10.2196/36077 %M 36197715 %R 10.2196/36077 %U https://www.researchprotocols.org/2022/10/e36077 %U https://doi.org/10.2196/36077 %U http://www.ncbi.nlm.nih.gov/pubmed/36197715 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e31055 %T Trends in Health Quality–Related Publications Over the Past Three Decades: Systematic Review %A Mendlovic,Joseph %A Mimouni,Francis B %A Arad,Iris %A Heiman,Eyal %+ Shaare Zedek Medical Center, 12 Shmuel Bail, Jerusalem, 9103102, Israel, 972 508685121, Mendlovic@szmc.org.il %K health quality %K publication %K medline %K quality assessmnet %K healthcare quality %D 2022 %7 4.10.2022 %9 Review %J Interact J Med Res %G English %X Background: Quality assessment in health care is a process of planned activities with the ultimate goal of achieving a continuous improvement of medical care through the evaluation of structure, process, and outcome measures. Physicians and health care specialists involved with quality issues are faced with an enormous and nearly always increasing amount of literature to read and integrate. Nevertheless, the novelty and quality of these articles (in terms of evidence-based medicine) has not been systematically assessed and described. Objective: The objective of this study was to test the hypothesis that the number of high-evidence journal articles (according to the pyramid of evidence), such as randomized control trials, systematic reviews, and ultimately, practice guidelines, increases over time, relative to lower-evidence journal articles, such as editorials, reviews, and letters to the editors. Methods: We used PubMed database to retrieve relevant articles published during the 31-year period between January 1, 1989, and December 31, 2021. The search was conducted in April 2022. We used the keywords “quality care,” “quality management,” “quality indicators,” and “quality improvement” and limited the search fields to title and abstract in order to limit our search results to articles nearly exclusively related to health care quality. Results: During this 31-year evaluation period, there was a significant cubic increase in the total number of publications, reviews, clinical trials (peaking in 2017, with a sharp decline until 2021), controlled trials (peaking in 2016, with a sharp drop until 2021), randomized controlled trials (peaking in 2017, with a sharp drop until 2021), systematic reviews (nearly nonexistent in the 1980s through 1990s to a peak of 222 in 2021), and meta-analyses (from nearly none in the 1980s through 1990s to a peak of approximately 40 per year in 2020). There was a linear increase in practice guidelines from none during 1989-1991 to approximately 25 per year during 2019-2021, including a cubic increase in editorials, peaking in 2021 at 125 per year, and in letters to the editor, peaking at 50-78 per year in the last 4 years (ie, 2018-2021). Conclusions: Over the past 31 years, the field of quality in health care has seen a significant yearly increase of published original studies with a relative stagnation since 2015. We suggest that contributors to this dynamic field of research should focus on producing more evidence-based publications and guidelines. %M 36194464 %R 10.2196/31055 %U https://www.i-jmr.org/2022/2/e31055 %U https://doi.org/10.2196/31055 %U http://www.ncbi.nlm.nih.gov/pubmed/36194464 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38239 %T Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review %A Schlief,Merle %A Saunders,Katherine R K %A Appleton,Rebecca %A Barnett,Phoebe %A Vera San Juan,Norha %A Foye,Una %A Olive,Rachel Rowan %A Machin,Karen %A Shah,Prisha %A Chipp,Beverley %A Lyons,Natasha %A Tamworth,Camilla %A Persaud,Karen %A Badhan,Monika %A Black,Carrie-Ann %A Sin,Jacqueline %A Riches,Simon %A Graham,Tom %A Greening,Jeremy %A Pirani,Farida %A Griffiths,Raza %A Jeynes,Tamar %A McCabe,Rose %A Lloyd-Evans,Brynmor %A Simpson,Alan %A Needle,Justin J %A Trevillion,Kylee %A Johnson,Sonia %+ NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, katherine.saunders@kcl.ac.uk %K telemental health %K remote care %K telemedicine %K mental health %K COVID-19 %K digital exclusion %K realist review %K telemedicine %K virtual care %K rapid realist review %K gray literature %K therapy %K health care staff %K digital consultation %K frontline staff %K children %K inpatient %K mobile phone %D 2022 %7 29.9.2022 %9 Review %J Interact J Med Res %G English %X Background: Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed. Objective: This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms. Methods: Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including “gray literature,” to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups. Results: A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed. Conclusions: Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910 %M 35767691 %R 10.2196/38239 %U https://www.i-jmr.org/2022/2/e38239 %U https://doi.org/10.2196/38239 %U http://www.ncbi.nlm.nih.gov/pubmed/35767691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38144 %T The Impact of Electronic Health Record Interoperability on Safety and Quality of Care in High-Income Countries: Systematic Review %A Li,Edmond %A Clarke,Jonathan %A Ashrafian,Hutan %A Darzi,Ara %A Neves,Ana Luisa %+ National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary’s Hospital Campus, London, W2 1NY, United Kingdom, 44 02033127259, edmond.li19@imperial.ac.uk %K electronic health records %K interoperability %K patient safety %K systematic literature review %K health information exchange %K digital health %D 2022 %7 15.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Electronic health records (EHRs) and poor system interoperability are well-known issues in the use of health information technologies in most high-income countries worldwide. Despite the abundance of literature exploring their relationship, their practical implications on patient safety and quality of care remain unclear. Objective: This study aimed to examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income health care settings. Methods: A systematic search was conducted using 4 web-based medical journal repositories and grey literature sources. The publications included were published in English between 2010 and 2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by 3 researchers in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias assessments were performed using the Risk of Bias in Non-randomized Studies of Interventions and the Cochrane Risk of Bias 2 tools. The findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for health care quality. Results: A total of 12 studies met the inclusion criteria to be included in our review. The findings were categorized into 6 common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost savings. EHR interoperability positively influenced medication safety, reduced patient safety events, and reduced costs. Improvements in time saving and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty because of the heterogeneity in the outcome measures used and notable variation in study quality. Conclusions: The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect extensive heterogeneity in the interventions, designs, and outcome measures used. The establishment of common health information technology research outcome measures would support higher-quality research on the topic. Future research efforts should focus on both the positive and negative impacts of interoperable EHR interventions and explore patient perspectives, given the growing trend for patient involvement and stewardship over their own electronic clinical data. Trial Registration: PROSPERO CRD42020209285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209285 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-044941 %M 36107486 %R 10.2196/38144 %U https://www.jmir.org/2022/9/e38144 %U https://doi.org/10.2196/38144 %U http://www.ncbi.nlm.nih.gov/pubmed/36107486 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e25959 %T Consumers’ Willingness to Pay for eHealth and Its Influencing Factors: Systematic Review and Meta-analysis %A Xie,Zhenzhen %A Chen,Jiayin %A Or,Calvin Kalun %+ Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Room 8-7, 8/f, Haking Wong Building, The University of Hong Kong, Pokfulam Road, Hong Kong, China (Hong Kong), 852 3917 2587, klor@hku.hk %K systematic review %K meta-analysis %K willingness to pay %K eHealth %K contingent valuation %K discrete choice experiment %K mobile phone %D 2022 %7 14.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Despite the great potential of eHealth, substantial costs are involved in its implementation, and it is essential to know whether these costs can be justified by its benefits. Such needs have led to an increased interest in measuring the benefits of eHealth, especially using the willingness to pay (WTP) metric as an accurate proxy for consumers’ perceived benefits of eHealth. This offered us an opportunity to systematically review and synthesize evidence from the literature to better understand WTP for eHealth and its influencing factors. Objective: This study aimed to provide a systematic review of WTP for eHealth and its influencing factors. Methods: This study was performed and reported as per the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL Plus, Cochrane Library, EconLit, and PsycINFO databases were searched from their inception to April 19, 2022. We conducted random-effects meta-analyses to calculate WTP values for eHealth (at 2021 US dollar rates) and meta-regression analyses to examine the factors affecting WTP. Results: A total of 30 articles representing 35 studies were included in the review. We found that WTP for eHealth varied across studies; when expressed as a 1-time payment, it ranged from US $0.88 to US $191.84, and when expressed as a monthly payment, it ranged from US $5.25 to US $45.64. Meta-regression analyses showed that WTP for eHealth was negatively associated with the percentages of women (β=−.76; P<.001) and positively associated with the percentages of college-educated respondents (β=.63; P<.001) and a country’s gross domestic product per capita (multiples of US $1000; β=.03; P<.001). Compared with eHealth provided through websites, people reported a lower WTP for eHealth provided through asynchronous communication (β=−1.43; P<.001) and a higher WTP for eHealth provided through medical devices (β=.66; P<.001), health apps (β=.25; P=.01), and synchronous communication (β=.58; P<.001). As for the methods used to measure WTP, single-bounded dichotomous choice (β=2.13; P<.001), double-bounded dichotomous choice (β=2.20; P<.001), and payment scale (β=1.11; P<.001) were shown to obtain higher WTP values than the open-ended format. Compared with ex ante evaluations, ex post evaluations were shown to obtain lower WTP values (β=−.37; P<.001). Conclusions: WTP for eHealth varied significantly depending on the study population, modality used to provide eHealth, and methods used to measure it. WTP for eHealth was lower among certain population segments, suggesting that these segments may be at a disadvantage in terms of accessing and benefiting from eHealth. We also identified the modalities of eHealth that were highly valued by consumers and offered suggestions for the design of eHealth interventions. In addition, we found that different methods of measuring WTP led to significantly different WTP estimates, highlighting the need to undertake further methodological explorations of approaches to elicit WTP values. %M 36103227 %R 10.2196/25959 %U https://www.jmir.org/2022/9/e25959 %U https://doi.org/10.2196/25959 %U http://www.ncbi.nlm.nih.gov/pubmed/36103227 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e39532 %T Wearables for Measuring Health Effects of Climate Change–Induced Weather Extremes: Scoping Review %A Koch,Mara %A Matzke,Ina %A Huhn,Sophie %A Gunga,Hanns-Christian %A Maggioni,Martina Anna %A Munga,Stephen %A Obor,David %A Sié,Ali %A Boudo,Valentin %A Bunker,Aditi %A Dambach,Peter %A Bärnighausen,Till %A Barteit,Sandra %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 5634030, mara.koch@uni-heidelberg.de %K wearable %K consumer-grade wearables %K fitness trackers %K climate change %K heat %K global health %K public health %K review %K mobile phone %D 2022 %7 9.9.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although climate change is one of the biggest global health threats, individual-level and short-term data on direct exposure and health impacts are still scarce. Wearable electronic devices (wearables) present a potential solution to this research gap. Wearables have become widely accepted in various areas of health research for ecological momentary assessment, and some studies have used wearables in the field of climate change and health. However, these studies vary in study design, demographics, and outcome variables, and existing research has not been mapped. Objective: In this review, we aimed to map existing research on wearables used to detect direct health impacts and individual exposure during climate change–induced weather extremes, such as heat waves or wildfires. Methods: We conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework and systematically searched 6 databases (PubMed [MEDLINE], IEEE Xplore, CINAHL [EBSCOhost], WoS, Scopus, Ovid [MEDLINE], and Google Scholar). The search yielded 1871 results. Abstracts and full texts were screened by 2 reviewers (MK and IM) independently using the inclusion and exclusion criteria. The inclusion criteria comprised studies published since 2010 that used off-the-shelf wearables that were neither invasive nor obtrusive to the user in the setting of climate change–related weather extremes. Data were charted using a structured form, and the study outcomes were narratively synthesized. Results: The review included 55,284 study participants using wearables in 53 studies. Most studies were conducted in upper–middle-income and high-income countries (50/53, 94%) in urban environments (25/53, 47%) or in a climatic chamber (19/53, 36%) and assessed the health effects of heat exposure (52/53, 98%). The majority reported adverse health effects of heat exposure on sleep, physical activity, and heart rate. The remaining studies assessed occupational heat stress or compared individual- and area-level heat exposure. In total, 26% (14/53) of studies determined that all examined wearables were valid and reliable for measuring health parameters during heat exposure when compared with standard methods. Conclusions: Wearables have been used successfully in large-scale research to measure the health implications of climate change–related weather extremes. More research is needed in low-income countries and vulnerable populations with pre-existing conditions. In addition, further research could focus on the health impacts of other climate change–related conditions and the effectiveness of adaptation measures at the individual level to such weather extremes. %M 36083624 %R 10.2196/39532 %U https://mhealth.jmir.org/2022/9/e39532 %U https://doi.org/10.2196/39532 %U http://www.ncbi.nlm.nih.gov/pubmed/36083624 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39005 %T In-Home Monitoring Technology for Aging in Place: Scoping Review %A Kim,Daejin %A Bian,Hongyi %A Chang,Carl K %A Dong,Liang %A Margrett,Jennifer %+ Department of Interior Design, Iowa State University, 158 College of Design, 715 Bissell Road, Ames, IA, 50011, United States, 1 5152941532, daejink@iastate.edu %K in-home monitoring %K aging in place %K ambient assisted living %K home modification %K monitoring %K aging %K technology %K intervention %K older adult %K wellness %K independence %K monitor %K research %K sensor %K activity %K behavior %K cognitive %K sleep %D 2022 %7 1.9.2022 %9 Review %J Interact J Med Res %G English %X Background: For successful aging-in-place strategy development, in-home monitoring technology is necessary as a new home modification strategy. Monitoring an older adult’s daily physical activity at home can positively impact their health and well-being by providing valuable information about functional, cognitive, and social health status. However, it is questionable how these in-home monitoring technologies have changed the traditional residential environment. A comprehensive review of existing research findings should be utilized to characterize recent relative technologies and to inform design considerations. Objective: The main purpose of this study was to classify recent smart home technologies that monitor older adults’ health and to architecturally describe these technologies as they are used in older adults’ homes. Methods: The scoping review method was employed to identify key characteristics of in-home monitoring technologies for older adults. In June 2021, four databases, including Web of Science, IEEE Xplore, ACM Digital Library, and Scopus, were searched for peer-reviewed articles pertaining to smart home technologies used to monitor older adults’ health in their homes. We used two search strings to retrieve articles: types of technology and types of users. For the title, abstract, and full-text screening, the inclusion criteria were original and peer-reviewed research written in English, and research on monitoring, detecting, recognizing, analyzing, or tracking human physical, emotional, and social behavior. The exclusion criteria included theoretical, conceptual, or review papers; studies on wearable systems; and qualitative research. Results: This scoping review identified 30 studies published between June 2016 and 2021 providing overviews of in-home monitoring technologies, including (1) features of smart home technologies and (2) sensor locations and sensor data. First, we found six functions of in-home monitoring technology among the reviewed papers: daily activities, abnormal behaviors, cognitive impairment, falls, indoor person positioning, and sleep quality. Most of the research (n=27 articles) focused on functional monitoring and analysis, such as activities of daily living, instrumental activities of daily living, or falls among older adults; a few studies (n=3) covered social interaction monitoring. Second, this scoping review also found 16 types of sensor technologies. The most common data types encountered were passive infrared motion sensors (n=21) and contact sensors (n=19), which were used to monitor human behaviors such as bodily presence and time spent on activities. Specific locations for each sensor were also identified. Conclusions: This wide-ranging synthesis demonstrates that in-home monitoring technologies within older adults’ homes play an essential role in aging in place, in that the technology monitors older adults’ daily activities and identifies various health-related issues. This research provides a key summarization of in-home monitoring technologies that can be applied in senior housing for successful aging in place. These findings will be significant when developing home modification strategies or new senior housing. %M 36048502 %R 10.2196/39005 %U https://www.i-jmr.org/2022/2/e39005 %U https://doi.org/10.2196/39005 %U http://www.ncbi.nlm.nih.gov/pubmed/36048502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37100 %T Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review %A Lewinski,Allison A %A Walsh,Conor %A Rushton,Sharron %A Soliman,Diana %A Carlson,Scott M %A Luedke,Matthew W %A Halpern,David J %A Crowley,Matthew J %A Shaw,Ryan J %A Sharpe,Jason A %A Alexopoulos,Anastasia-Stefania %A Tabriz,Amir Alishahi %A Dietch,Jessica R %A Uthappa,Diya M %A Hwang,Soohyun %A Ball Ricks,Katharine A %A Cantrell,Sarah %A Kosinski,Andrzej S %A Ear,Belinda %A Gordon,Adelaide M %A Gierisch,Jennifer M %A Williams Jr,John W %A Goldstein,Karen M %+ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attention: Health Services Research and Development Center of Innovation (558/152), 508 Fulton Street, Durham, NC, 27705, United States, 1 919 286 2936, allison.lewinski@duke.edu %K telemedicine %K diabetes mellitus, type 2 %K heart failure %K pulmonary disease %K chronic obstructive %K veterans %K delivery of health care %K systematic review %D 2022 %7 26.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. Objective: We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? Methods: We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ≥2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. Results: We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. Conclusions: This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases. %M 36018711 %R 10.2196/37100 %U https://www.jmir.org/2022/8/e37100 %U https://doi.org/10.2196/37100 %U http://www.ncbi.nlm.nih.gov/pubmed/36018711 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37188 %T Randomized Controlled Trials of Artificial Intelligence in Clinical Practice: Systematic Review %A Lam,Thomas Y T %A Cheung,Max F K %A Munro,Yasmin L %A Lim,Kong Meng %A Shung,Dennis %A Sung,Joseph J Y %+ Lee Kong Chian School of Medicine, Nanyang Technological University, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore, 65 65138886, josephsung@ntu.edu.sg %K artificial intelligence %K randomized controlled trial %K systematic review %K clinical %K gastroenterology %K clinical informatics %K mobile phone %D 2022 %7 25.8.2022 %9 Review %J J Med Internet Res %G English %X Background: The number of artificial intelligence (AI) studies in medicine has exponentially increased recently. However, there is no clear quantification of the clinical benefits of implementing AI-assisted tools in patient care. Objective: This study aims to systematically review all published randomized controlled trials (RCTs) of AI-assisted tools to characterize their performance in clinical practice. Methods: CINAHL, Cochrane Central, Embase, MEDLINE, and PubMed were searched to identify relevant RCTs published up to July 2021 and comparing the performance of AI-assisted tools with conventional clinical management without AI assistance. We evaluated the primary end points of each study to determine their clinical relevance. This systematic review was conducted following the updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Results: Among the 11,839 articles retrieved, only 39 (0.33%) RCTs were included. These RCTs were conducted in an approximately equal distribution from North America, Europe, and Asia. AI-assisted tools were implemented in 13 different clinical specialties. Most RCTs were published in the field of gastroenterology, with 15 studies on AI-assisted endoscopy. Most RCTs studied biosignal-based AI-assisted tools, and a minority of RCTs studied AI-assisted tools drawn from clinical data. In 77% (30/39) of the RCTs, AI-assisted interventions outperformed usual clinical care, and clinically relevant outcomes improved with AI-assisted intervention in 70% (21/30) of the studies. Small sample size and single-center design limited the generalizability of these studies. Conclusions: There is growing evidence supporting the implementation of AI-assisted tools in daily clinical practice; however, the number of available RCTs is limited and heterogeneous. More RCTs of AI-assisted tools integrated into clinical practice are needed to advance the role of AI in medicine. Trial Registration: PROSPERO CRD42021286539; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286539 %M 35904087 %R 10.2196/37188 %U https://www.jmir.org/2022/8/e37188 %U https://doi.org/10.2196/37188 %U http://www.ncbi.nlm.nih.gov/pubmed/35904087 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36414 %T Digital Health Competencies Among Health Care Professionals: Systematic Review %A Longhini,Jessica %A Rossettini,Giacomo %A Palese,Alvisa %+ Department of Medical Sciences, University of Udine, Viale Ungheria, 20, Udine, 33100, Italy, 39 0432590926, alvisa.palese@uniud.it %K eHealth literacy %K eHealth competencies %K digital health %K competencies %K eHealth %K health literacy %K digital technology %K health care professionals %K health care workers %K review %K systematic review %D 2022 %7 18.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them. Objective: This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals. Methods: A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was performed. The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus databases were accessed up to September 4, 2021. Studies assessing digital health competencies with quantitative designs, targeting health care professionals, and written in English were included. The methodological quality of included studies was evaluated using the Joanna Briggs Institute tools. Results: A total of 26 studies, published from 1999 to 2021, met the inclusion criteria, and the majority were cross sectional in design, while only 2 were experimental study designs. Most studies were assessed with moderate to low methodological quality; 4 categories and 9 subcategories of investigated digital health competencies have been identified. The most investigated category was “Self-rated competencies,” followed by “Psychological and emotional aspects toward digital technologies,” “Use of digital technologies,” and “Knowledge about digital technologies.” In 35% (9/26) of the studies, a previously validated tool was used to measure the competencies assessed, while others developed ad hoc questionnaires. Conclusions: Mainly descriptive studies with issues regarding methodology quality have been produced to date investigating 4 main categories of digital health competencies mostly with nonvalidated tools. Competencies investigated might be considered while designing curricula for undergraduate, postgraduate, and continuing education processes, whereas the methodological lacks detected might be addressed with future research. There is a need to expand research on psychological and emotional elements and the ability to use digital technology to self-learn and teach others. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021282775; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282775 %M 35980735 %R 10.2196/36414 %U https://www.jmir.org/2022/8/e36414 %U https://doi.org/10.2196/36414 %U http://www.ncbi.nlm.nih.gov/pubmed/35980735 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38591 %T Evolution of Interdisciplinary Approaches Among Research-Oriented Universities in Vietnam Toward a Modern Industrial Economy: Exploratory Study %A Tran,Bach Xuan %A Nguyen,Long Hoang %A Nguyen,Hao Anh Si %A Vu,Thuc Minh Thi %A Do,Anh Linh %A Nguyen,Lien Thi Khanh %A Kim,Nga Thanh Ngoc %A Trinh,Trang Thu Hong %A Latkin,Carl %A Ho,Cyrus S H %A Ho,Roger C M %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi, 10000, Vietnam, 84 888678577, bach.ipmph@gmail.com %K research %K performance %K productivity %K scientometric %K Vietnam %K Asia %K metric %K pattern %K journal %K publication %K publishing %K output %K science %K scientific %D 2022 %7 17.8.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Vietnam’s 2045 development plan requires thorough reforms in science and technology, which underlines the role of research-oriented universities in generating and transforming knowledge. Understanding the current research performance and productivity in Vietnam is important for exploiting future agendas. Objective: This study aims to explore the growth patterns and collaborations in the scientific publications of Vietnam. Methods: Data on documents in the Web of Science Core Collection database were searched and extracted to examine the research performance in Vietnam. Publication growth patterns in both quantity and quality were examined. The evolution of research disciplines and collaboration networks were also analyzed. Trends in the growth in the number of publications, citations, and average citations per publication between 1966 and 2020 were presented. Temporal tendencies of the 10 most productive research areas in each period were illustrated. VOSviewer software was used to analyze the discipline network, country network, and institution networks. The trends and the geographical distribution of the number of publications and citations were analyzed. Results: A total of 62,752 documents in 8354 different sources from 1966 to 2020 were retrieved. A substantial growth was observed in the Vietnamese scientific output during this period, which was mainly research with international collaboration. Natural sciences such as mathematics, materials science, and physics were the top 3 most productive research fields during 1966-2020 in Vietnam, followed by experimental research fields such as multidisciplinary sciences, plant sciences, public, environmental, and occupational health. In 1966-2020, there was the emergence of multidisciplinary research–oriented universities in both public and private sectors along with a significant increase in the number of interdisciplinary and multidisciplinary publications. Although the scientific quality has improved, these publications are still of mostly medium quality as they are concentrated in middle-ranking journals. Conclusions: Our study highlights the notable growth in research performance in terms of both quality and quantity in Vietnam from 1966 to 2020. Building multidisciplinary and interdisciplinary research agenda, developing networks of local and international researchers for addressing specific local issues, improving the participation of private sectors, and developing science and technology mechanisms are critical for boosting the research productivity in Vietnam. %M 35976182 %R 10.2196/38591 %U https://www.i-jmr.org/2022/2/e38591 %U https://doi.org/10.2196/38591 %U http://www.ncbi.nlm.nih.gov/pubmed/35976182 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38745 %T Examining how Ethics in Relation to Health Technology is Described in the Research Literature: Scoping Review %A Steerling,Emilie %A Houston,Rebecca %A Gietzen,Luke J %A Ogilvie,Sarah J %A de Ruiter,Hans-Peter %A Nygren,Jens M %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K ethics %K ethical principles %K ethical theory %K health technology %K eHealth %K digital health %K telehealth %K mHealth %K health care %K scoping review %D 2022 %7 15.8.2022 %9 Review %J Interact J Med Res %G English %X Background: Given the increased use of technology in health care, both in extent and application, the importance of understanding the ethical implications of new health technologies increases. Profound insight into the possible ethical implications of new health technologies enhances the research and development of such technologies and the likelihood of eventual successful implementation in clinical practice. Objective: This study aimed to gain an understanding of how and if researchers focused on health technologies describe the actual or possible ethical aspects of their research findings. Methods: An established framework for scoping reviews was used to guide the methodology. Studies published in PubMed over the last 10 years were included if they study or refer to ethics in relation to health technology as defined by established frameworks. In total, 14,532 articles were screened, 692 were retained for full-text evaluation, and 227 were included for data extraction. Results: In total, 250 (80.9%, N=309) studies were conducted in North America and Europe; literature review studies were dominant. Most studies (52.9%, 120/227) had no direct reference to any of the 4 basic ethical principles: beneficence, nonmaleficence, autonomy, and justice. In cases where studies referenced ethical theory, consequentialism dominated. Conclusions: When research about technology and ethics is published, the predominant focus is on its intent rather than its actual effect on patients. This lack of insight is problematic considering the vast advancement of technology in which ethics cannot keep up with understanding and offer insights on addressing ethical issues. This finding has implications for practice, research, and education. %M 35969434 %R 10.2196/38745 %U https://www.i-jmr.org/2022/2/e38745 %U https://doi.org/10.2196/38745 %U http://www.ncbi.nlm.nih.gov/pubmed/35969434 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39955 %T Teledentistry Implementation During the COVID-19 Pandemic: Scoping Review %A Hung,Man %A Lipsky,Martin S %A Phuatrakoon,Teerarat N %A Nguyen,Mindy %A Licari,Frank W %A Unni,Elizabeth J %+ College of Dental Medicine, Roseman University of Health Sciences, 10894 S River Front Parkway, South Jordan, UT, 84095, United States, 1 801 878 1270, mhung@roseman.edu %K teledentistry %K telehealth %K COVID-19 %K pandemic %K innovation %K implementation %K dental profession %D 2022 %7 21.7.2022 %9 Review %J Interact J Med Res %G English %X Background: COVID-19 spreads via aerosol droplets. The dental profession is at high risk of contracting the virus since their work includes treatment procedures that produce aerosols. Teledentistry offers an opportunity to mitigate the risk to dental personnel by allowing dentists to provide care without direct patient contact. Objective: The purpose of this scoping review was to examine the implementation, challenges, strategies, and innovations related to teledentistry during the COVID-19 pandemic lockdown. Methods: This scoping review evaluated teledentistry use during the pandemic by searching for articles in PubMed and Google Scholar using the search terms teledentistry, tele-dentistry, covid-19, coronavirus, telehealth, telemedicine, and dentistry. Inclusion criteria consisted of articles published in English from March 1, 2020, to April 1, 2022, that were relevant to dentistry and its specialties, and that included some discussion of teledentistry and COVID-19. Specifically, the review sought to explore teledentistry implementation, challenges, strategies to overcome challenges, and innovative ideas that emerged during the pandemic. It followed the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). This approach is organized into 5 distinct steps: formulating a defined question, using the question to develop inclusion criteria to identify relevant studies, an approach to appraise the studies, summarizing the evidence using an explicit methodology, and interpreting the findings of the review. Results: A total of 32 articles was included in this scoping review and summarized by article type, methodology and population, and key points about the aims; 9 articles were narrative review articles, 10 were opinion pieces, 4 were descriptive studies, 3 were surveys, 2 were integrative literature reviews, and there was 1 each of the following: observational study, systematic review, case report, and practice brief. Teledentistry was used both synchronously and asynchronously for virtual consultations, often employing commercial applications such as WhatsApp, Skype, and Zoom. Dental professionals most commonly used teledentistry for triage, to reduce in-person visits, and for scheduling and providing consultations remotely. Identified challenges included patient and clinician acceptance of teledentistry, having adequate infrastructure, reimbursement, and security concerns. Strategies to address these concerns included clinician and patient training and utilizing Health Insurance Portability and Accountability Act-compliant applications. Benefits from teledentistry included providing care for patients during the pandemic and extending care to areas lacking access to dental care. Conclusions: Pandemic lockdowns led to new teledentistry implementations, most commonly for triage but also for follow-up and nonprocedural care. Teledentistry reduced in-person visits and improved access to remote areas. Challenges such as technology infrastructure, provider skill level, billing issues, and privacy concerns remain. %M 35862174 %R 10.2196/39955 %U https://www.i-jmr.org/2022/2/e39955 %U https://doi.org/10.2196/39955 %U http://www.ncbi.nlm.nih.gov/pubmed/35862174 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38935 %T Published Research on COVID-19 in the Eastern Mediterranean Region: Bibliometric Analysis %A Saad,Randa K %A Abu Khudair,Sara %A El Rabbat,Maha %A Omar,Mayeh %A Al Nsour,Mohannad %A Khader,Yousef %A Rawaf,Salman %+ Global Health Development| Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St, Building No 42, Amman, Jordan, 962 781665060, randaksaad@gmail.com %K COVID-19 %K Eastern Mediterranean Region %K bibliometric analysis %K literature %K research %K health care system %K social inequality %K epidemiology %K depression %K research trend %K bibliometry %D 2022 %7 19.7.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: The challenges presented by the COVID-19 pandemic have led to unprecedented global research activity. The Eastern Mediterranean Region (EMR) continues to contribute to COVID-19 research driven by the unique challenges of the region, including the protracted conflicts, already stressed health systems, and serious health and social inequalities. Objective: This study aims to provide an overview of the publication activities and trends in COVID-19 research in the EMR from the onset of the disease to early 2022 using bibliometric methods. Methods: A literature search using Scopus was conducted from December 1, 2019, to January 31, 2022, using keywords relevant to COVID-19 and the World Health Organization (WHO) EMR country list. Data were exported and analyzed using Microsoft Excel and the Citation Overview function on Scopus. The quality of journals was determined using SCImago Journal Rank and CiteScore. VOSviewer software was used to visualize the relationships between authors, countries, and key terms used in the retrieved documents. Results: A total of 6880 documents were retrieved, of which 1805 (26.24%) were from the Kingdom of Saudi Arabia (KSA) and 1782 (25.90%) from Iran, followed by Pakistan, Egypt, and Jordan. Most published documents were affiliated with EMR universities, primarily the Tehran University of Medical Sciences in Iran and King Saud University in KSA (396/6880, 5.76%, and 370/6880, 5.4%, respectively), while only 407 (5.92%) of 6880 documents were associated with universities outside the EMR. For most of the identified publications (5020/6880, 72.97%), no funding source was reported, while King Saud University contributed the largest share (282/1860, 15.16%) of funded publications. Retrieved documents were cited 53,516 times, with an average of 7.78 (SD 34.30). Iran was the EMR country with the most links to other countries (77 links and total link strength of 1279). The 5 authors with the most publications were from KSA, Qatar, and Jordan. There were 290 high-frequency keywords that occurred ≥10 times and were linked in 7 different clusters. The cluster with the most linked keywords was related to epidemiology and mortality. Recent topics included vaccines, vaccination, machine learning, and online learning. Conclusions: This is the first study to show trends in and project future developments of COVID-19 research activity in the EMR. Authors and institutions who led research on COVID-19 in the region were from Iran and KSA. There were multiple regional collaborative efforts; however, international collaboration was limited. Recently, interest has been shifting toward topics related to vaccination, machine learning, and online learning. Understanding the current state of research is instrumental to future research production, and our study will inform regional research initiatives on emerging concepts, as well as opportunities for collaboration and funding. %M 35852846 %R 10.2196/38935 %U https://www.i-jmr.org/2022/2/e38935 %U https://doi.org/10.2196/38935 %U http://www.ncbi.nlm.nih.gov/pubmed/35852846 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38419 %T Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews %A Uwizeye,Claude Bernard %A Zomahoun,Hervé Tchala Vignon %A Bussières,André %A Thomas,Aliki %A Kairy,Dahlia %A Massougbodji,José %A Rheault,Nathalie %A Tchoubi,Sébastien %A Philibert,Leonel %A Abib Gaye,Serigne %A Khadraoui,Lobna %A Ben Charif,Ali %A Diendéré,Ella %A Langlois,Léa %A Dugas,Michèle %A Légaré,France %+ VITAM Research Center on Sustainable Health, Laval University, 2480, chemin de la Canardière, Québec, QC, G1J 2G1, Canada, 1 418 663 5313, France.Legare@mfa.ulaval.ca %K knowledge translation %K knowledge product %K implementation strategies %K review %K health care professionals %K primary care %D 2022 %7 11.7.2022 %9 Review %J Interact J Med Res %G English %X Background: The underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. Objective: This study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. Methods: We performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis. Results: Of the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level. Conclusions: Clinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes. %M 35635786 %R 10.2196/38419 %U https://www.i-jmr.org/2022/2/e38419 %U https://doi.org/10.2196/38419 %U http://www.ncbi.nlm.nih.gov/pubmed/35635786 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e36194 %T Existing Funding Sources in Degenerative Cervical Myelopathy Research: Scoping Review %A Bestwick,Henry %A Teh,Jye Quan %A Mowforth,Oliver %A Grodzinski,Ben %A Kotter,Mark %A Davies,Benjamin %+ Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Academic Neurosurgery Unit, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom, 44 779 478 0568, bd375@cam.ac.uk %K cervical cord %K myelopathy %K spondylosis %K stenosis %K disc herniation %K ossification posterior longitudinal ligament %K degeneration %K research funding %K systematic review %K spinal cord %K patient and public involvement %D 2022 %7 30.6.2022 %9 Review %J Interact J Med Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a common, disabling condition of symptomatic cervical spinal cord compression that requires significant research advances to improve patient outcomes. A James Lind Alliance Partnership recently identified the top research priorities for DCM. To effectively address these priorities, appropriate funding of DCM research is essential. Objective: The aim of this paper is to review current funding in DCM research and highlight future research funding opportunities. Methods: A systematic search of Web of Science for “cervical AND myelopathy” was conducted. Papers exclusively studying DCM with declared funding and published between January 1, 1995, and March 21, 2020, were considered eligible. Funding sources were classified by country of origin and organization type. A grant search was also conducted using Dimensions.ai (Digital Science Ltd). Results: A total of 621 papers were included, with 300 unique funding bodies. The top funders were AO Spine (n=87); National Institutes of Health, USA (n=63); and National Natural Science Foundation, China (n=63). Funding sources in the USA (n=242) supported the most DCM research, followed by China (n=209) and Japan (n=116). Funding in the USA was primarily provided by corporate or nonprofit organizations (146/242, 60.3%), while in China, the majority of funding was from institutions (208/209, 99.5%). Dimensions.ai gives an estimate for the total declared grant funding awards for DCM-specific research. Data here showed 180 grants awarded specifically for DCM research, with a total value of US $45.6 million since 1996. Conclusions: DCM funding appears to be predominantly from the USA, China, and Japan, aligning with areas of high DCM research activity and underpinning the importance of funding to increasing research capacity. The existing funding sources differ from medical research in general, representing opportunities for future investment in DCM. %M 35771617 %R 10.2196/36194 %U https://www.i-jmr.org/2022/1/e36194 %U https://doi.org/10.2196/36194 %U http://www.ncbi.nlm.nih.gov/pubmed/35771617 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e38249 %T Interventions in Chinese Undergraduate Students’ Mental Health: Systematic Review %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Li,Rongying %A Qian,Xiaobo %A Zhang,Xiaomin %A Hao,Tianyong %+ School of Foreign Studies, Nantong University, No 9 Seyuan Rd, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K systematic review %K intervention %K mental health %K depression %K anxiety %K stress %K Chinese undergraduate students %D 2022 %7 15.6.2022 %9 Review %J Interact J Med Res %G English %X Background: Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students’ mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being. Objective: The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students’ affairs counselors, and mental health providers. Methods: We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis. Results: We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students’ affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers. Conclusions: This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students’ mental health is a research topic worth further investigation. %M 35704383 %R 10.2196/38249 %U https://www.i-jmr.org/2022/1/e38249 %U https://doi.org/10.2196/38249 %U http://www.ncbi.nlm.nih.gov/pubmed/35704383 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e35062 %T Ethical, Legal, and Sociocultural Issues in the Use of Mobile Technologies and Call Detail Records Data for Public Health in the East African Region: Scoping Review %A Sekandi,Juliet Nabbuye %A Murray,Kenya %A Berryman,Corinne %A Davis-Olwell,Paula %A Hurst,Caroline %A Kakaire,Robert %A Kiwanuka,Noah %A Whalen,Christopher C %A Mwaka,Erisa Sabakaki %+ Global Health Institute, College of Public Health, University of Georgia, Wright Hall, Room 227B, 100 Foster Rd, Athens, GA, 30602, United States, 1 706 542 5257, jsekandi@uga.edu %K mobile health %K public health %K ethics %K privacy %K call detail records %K East Africa %K Africa %K mobile apps %K mHealth %D 2022 %7 2.6.2022 %9 Review %J Interact J Med Res %G English %X Background: The exponential scale and pace of real-time data generated from mobile phones present opportunities for new insights and challenges across multiple sectors, including health care delivery and public health research. However, little attention has been given to the new ethical, social, and legal concerns related to using these mobile technologies and the data they generate in Africa. Objective: The objective of this scoping review was to explore the ethical and related concerns that arise from the use of data from call detail records and mobile technology interventions for public health in the context of East Africa. Methods: We searched the PubMed database for published studies describing ethical challenges while using mobile technologies and related data in public health research between 2000 and 2020. A predefined search strategy was used as inclusion criteria with search terms such as “East Africa,” “mHealth,” “mobile phone data,” “public health,” “ethics,” or “privacy.” We screened studies using prespecified eligibility criteria through a two-stage process by two independent reviewers. Studies were included if they were (1) related to mobile technology use and health, (2) published in English from 2000 to 2020, (3) available in full text, and (4) conducted in the East African region. We excluded articles that (1) were conference proceedings, (2) studies presenting an abstract only, (3) systematic and literature reviews, (4) research protocols, and (5) reports of mobile technology in animal subjects. We followed the five stages of a published framework for scoping reviews recommended by Arksey and O’Malley. Data extracted included title, publication year, target population, geographic region, setting, and relevance to mobile health (mHealth) and ethics. Additionally, we used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews checklist to guide the presentation of this scoping review. The rationale for focusing on the five countries in East Africa was their geographic proximity, which lends itself to similarities in technology infrastructure development. Results: Of the 94 studies identified from PubMed, 33 met the review inclusion criteria for the final scoping review. The 33 articles retained in the final scoping review represent studies conducted in three out of five East African countries: 14 (42%) from Uganda, 13 (39%) from Kenya, and 5 (16%) from Tanzania. Three main categories of concerns related to the use of mHealth technologies and mobile phone data can be conceptualized as (1) ethical issues (adequate informed consent, privacy and confidentiality, data security and protection), (2) sociocultural issues, and (3) regulatory/legal issues. Conclusions: This scoping review identified major cross-cutting ethical, regulatory, and sociocultural concerns related to using data from mobile technologies in the East African region. A comprehensive framework that accounts for the critical concerns raised would be valuable for guiding the safe use of mobile technology data for public health research purposes. %M 35533323 %R 10.2196/35062 %U https://www.i-jmr.org/2022/1/e35062 %U https://doi.org/10.2196/35062 %U http://www.ncbi.nlm.nih.gov/pubmed/35533323 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28137 %T Approaches to Determine and Manage Sexual Consent Abilities for People With Cognitive Disabilities: Systematic Review %A Esmail,Shaniff %A Concannon,Brendan %+ Department of Occupational Therapy, University of Alberta, Corbett Hall, 8205 - 114St 2-64, Edmonton, AB, T6G 2G4, Canada, 1 (780) 492 0397, shaniff.esmail@ualberta.ca %K sexual consent %K capacity %K disability %K sexual expression %K dementia %K ethics %K long-term care %D 2022 %7 4.2.2022 %9 Review %J Interact J Med Res %G English %X Background: This review focused on how sexual consent ability was determined, managed, and enhanced in people with cognitive disabilities, with the aim of better understanding the recurring themes influencing the design and implementation of these approaches. If a person’s consensual ability becomes compromised, owing to either an early or late-onset cognitive disability, the formal systems involved must establish plans to balance the individual’s rights and restrictions on sexual expression. This review identified these plans, focusing on how they promoted the intimacy rights of the individual. Objective: This study aims to identify approaches that determine sexual consent ability in people with cognitive disabilities, identify the means of managing and enhancing sexual consent ability in people with cognitive disabilities, and note the recurring themes that influence how these approaches and management systems are designed and implemented. Methods: A systematic literature review was performed using EBSCOhost (Social Gerontology, CINAHL Plus, MEDLINE, and SocINDEX), Embase, PsyInfo, and Scopus to locate reports on terms expanded on sexual consent and cognitive disability. Results: In all, 47 articles were identified, featuring assessment practices, legal case studies, and clinical standards for managing sexual consent capacity in people with cognitive disabilities. A total of 8 studies (5/8, 63% qualitative and 3/8, 38% quantitative) were included out of the 47 articles identified. Approaches for determining sexual consent included functional capacity and person-centered, integrated, and contextual approaches. Management of sexual consent ability included education, attitude, and advanced directives and support networks. The recurring themes that influenced these approaches included the 3 legal criteria of consent, American Bar Association and American Psychological Association Model, Lichtenberg and Strzepek Instrument, Ames and Samowitz Instrument, Lyden approach, Mental Capacity Act of 2005, and Vancouver Coastal Health Authority of 2009. Conclusions: Determining sexual consent takes a holistic approach, with individuals judged in terms of their adaptive abilities, capacities, and human rights. The attitudes of those using this holistic approach need to be balanced; otherwise, the sexual rights of assessed people could be moved either in favor or against them. The ideal outcome, after person-centered considerations of those living with cognitive disabilities includes the people themselves being involved in the process of personalizing these approaches used to facilitate healthy intimate relationships. %M 35119371 %R 10.2196/28137 %U https://www.i-jmr.org/2022/1/e28137 %U https://doi.org/10.2196/28137 %U http://www.ncbi.nlm.nih.gov/pubmed/35119371 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30479 %T Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review %A Martel,Rhiannon %A Shepherd,Matthew %A Goodyear-Smith,Felicity %+ Department of General Practice & Primary Health Care, Faculty of Medical & Health Science, University of Auckland, 22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 99232357, f.goodyear-smith@auckland.ac.nz %K adolescent %K mental health %K risk behavior %K screening %K primary care %D 2021 %7 19.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective: This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods: Electronic databases—MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews—were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results: e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions: To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work. %M 34807833 %R 10.2196/30479 %U https://mental.jmir.org/2021/11/e30479 %U https://doi.org/10.2196/30479 %U http://www.ncbi.nlm.nih.gov/pubmed/34807833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28185 %T Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis %A Ang,Siew Min %A Chen,Juliana %A Liew,Jia Huan %A Johal,Jolyn %A Dan,Yock Young %A Allman-Farinelli,Margaret %A Lim,Su Lin %+ Department of Dietetics, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore, 65 67725166, siew_min_ang@nuhs.edu.sg %K systematic review %K meta-analysis %K mobile app %K obesity %K weight loss %K Asian %K diet %K physical activity %K adults %K mobile phone %D 2021 %7 16.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps have shown potential in enhancing weight management in Western populations in the short to medium term. With a rapidly growing obesity burden in Asian populations, researchers are turning to apps as a service delivery platform to reach a larger target audience to efficiently address the problem. Objective: This systematic review and meta-analysis aims to determine the efficacy of interventions that incorporate apps in facilitating weight loss and health behavior change in the Asian population. Methods: A total of 6 databases were searched in June 2020. The eligible studies included controlled trials in which an app was used in the intervention. The participants were aged 18 years or older and were of Asian ethnicity. A meta-analysis to test intervention efficacy, subgroup analyses, and post hoc analyses was conducted to determine the effects of adding an app to usual care and study duration. The primary outcome was absolute or percentage weight change, whereas the secondary outcomes were changes to lifestyle behaviors. Results: A total of 21 studies were included in this review, and 17 (81%) were selected for the meta-analysis. The pooled effect size across 82% (14/17) of the randomized controlled trials for weight change was small to moderate (Hedges g=–0.26; 95% CI –0.41 to –0.11), indicating slightly greater weight loss achieved in the intervention group; however, this may not be representative of long-term studies (lasting for more than a year). Supplementing multicomponent usual care with an app led to greater weight loss (Hedges g=–0.28; 95% CI –0.47 to –0.09). Asian apps were largely culturally adapted and multifunctional, with the most common app features being communication with health professionals and self-monitoring of behaviors and outcomes. Conclusions: More evidence is required to determine the efficacy of apps in the long term and address the low uptake of apps to maximize the potential of the intervention. Future research should determine the efficacy of each component of the multicomponent intervention to facilitate the designing of studies that are most effective and cost-efficient for weight management. Trial Registration: PROSPERO CRD42020165240; https://tinyurl.com/2db4tvn6 %M 34783674 %R 10.2196/28185 %U https://www.jmir.org/2021/11/e28185 %U https://doi.org/10.2196/28185 %U http://www.ncbi.nlm.nih.gov/pubmed/34783674 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e27869 %T Trends in Hidradenitis Suppurativa Disease Severity and Quality of Life Outcome Measures: Scoping Review %A Maghfour,Jalal %A Sivesind,Torunn Elise %A Dellavalle,Robert Paul %A Dunnick,Cory %+ Department of Dermatology, University of Colorado School of Medicine, 1665 Aurora Ct, Aurora, CO, 80045, United States, 1 7208480500, cory.dunnick@cuanschutz.edu %K hidradenitis suppurativa %K severity of illness index %K patient-reported outcome measures %K quality of life %K treatment outcome %K illness index %K patient outcomes %K disease severity %K Sartorius %K dermatology %K treatment interventions %D 2021 %7 1.10.2021 %9 Review %J JMIR Dermatol %G English %X Background: Although there has been an increase in the number of randomized controlled trials evaluating treatment efficacy for hidradenitis suppurativa (HS), instrument measurements of disease severity and quality of life (QoL) are varied, making the compilation of data and comparisons between studies a challenge for clinicians. Objective: We aimed to perform a systematic literature search to examine the recent trends in the use of disease severity and QoL outcome instruments in randomized controlled trials that have been conducted on patients with HS. Methods: A scoping review was conducted in February 2021. The PubMed, Embase, Web of Science, and Cochrane databases were used to identify all articles published from January 1964 to February 2021. In total, 41 articles were included in this systematic review. Results: The HS Clinical Response (HiSCR) score (18/41, 44%) was the most commonly used instrument for disease severity, followed by the Sartorius and Modified Sartorius scales (combined: 16/41, 39%). The Dermatology Life Quality Index (18/41, 44%) and visual analogue pain scales (12/41, 29%) were the most commonly used QoL outcome instruments in HS research. Conclusions: Randomized controlled trials conducted from 2013 onward commonly used the validated HiSCR score, while older studies were more heterogeneous and less likely to use a validated scale. A few (6/18, 33%) QoL measures were validated instruments but were not specific to HS; therefore, they may not be representative of all factors that impact patients with HS. Trial Registration: National Institute of Health Research PROSPERO CRD42020209582; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209582 %M 37632807 %R 10.2196/27869 %U https://derma.jmir.org/2021/2/e27869 %U https://doi.org/10.2196/27869 %U http://www.ncbi.nlm.nih.gov/pubmed/37632807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25171 %T How Self-tracking and the Quantified Self Promote Health and Well-being: Systematic Review %A Feng,Shan %A Mäntymäki,Matti %A Dhir,Amandeep %A Salmela,Hannu %+ Department of Management and Entrepreneurship, Turku School of Economics, University of Turku, Rehtorinpellonkatu 3, Turku, 20500, Finland, 358 504867657, matti.mantymaki@utu.fi %K self-tracking %K quantified self %K health %K well-being %K systematic literature review %K literature review %D 2021 %7 21.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Self-tracking technologies are widely used in people’s daily lives and health care. Academic research on self-tracking and the quantified self has also accumulated rapidly in recent years. Surprisingly, there is a paucity of research that reviews, classifies, and synthesizes the state of the art with respect to self-tracking and the quantified self. Objective: Our objective was to identify the state of the art of self-tracking and the quantified self in terms of health and well-being. Methods: We have undertaken a systematic literature review on self-tracking and the quantified self in promoting health and well-being. After a rigorous literature search, followed by inclusions, exclusions, and the application of article quality assessment protocols, 67 empirical studies qualified for the review. Results: Our results demonstrate that prior research has focused on 3 stakeholders with respect to self-tracking and the quantified self, namely end users, patients and people with illnesses, and health care professionals and caregivers. We used these stakeholder groups to cluster the research themes of the reviewed studies. We identified 11 research themes. There are 6 themes under the end-user cluster: user motivation and goal setting, usage and effects of self-tracking, continuance intention and long-term usage, management of personal data, rejection and discontinuance, and user characteristics. The patient and people with illnesses cluster contains three themes: usage experience of patients and people with illnesses, management of patient-generated data, and advantages and disadvantages in the clinical context. The health care professional and caregiver cluster contains two themes: collaboration among patients, health care professionals, and caregivers, and changes in the roles of patients and professionals. Moreover, we classified the future research suggestions given in the literature into 5 directions in terms of research designs and research topics. Finally, based on our reflections on the observations from the review, we suggest four future research directions: (1) users’ cognitions and emotions related to processing and interpreting the information produced by tracking devices and apps; (2) the dark side of self-tracking (eg, its adverse psychosocial consequences); (3) self-tracking as a societal phenomenon; and (4) systemic impacts of self-tracking on health care and the actors involved. Conclusions: This systematic literature review contributes to research and practice by assisting future research activities and providing practitioners with a concise overview of the state of the art of self-tracking and the quantified self. %M 34546176 %R 10.2196/25171 %U https://www.jmir.org/2021/9/e25171 %U https://doi.org/10.2196/25171 %U http://www.ncbi.nlm.nih.gov/pubmed/34546176 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e27075 %T Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review %A Maleki,Arash %A Qoreishy,Seyyed Mohammad %A Bahrami,Mohammad Nabi %+ Orthopedic Department, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, Iran, 98 9178851457, mnabibahrami1364@gmail.com %K surgical treatment %K Legg-Calvé-Perthes disease %K pediatric %K hip %K treatment outcome %D 2021 %7 3.5.2021 %9 Review %J Interact J Med Res %G English %X Background: Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective: The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods: An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results: A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions: This review provides clinicians with a brief guideline for the treatment of patients with LCPD. %M 33938444 %R 10.2196/27075 %U https://www.i-jmr.org/2021/2/e27075 %U https://doi.org/10.2196/27075 %U http://www.ncbi.nlm.nih.gov/pubmed/33938444 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e22768 %T Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review %A Birkeland,Kade %A Zimmer,Raymond %A Kimchi,Asher %A Kedan,Ilan %+ Smidt Cedars-Sinai Heart Institute, 8501 Wilshire Blvd Suite 200, Beverly Hills, CA, 90211, United States, 1 3103853496, kedani@cshs.org %K VTE %K COVID-19 %K anticoagulation %K SARS-CoV-2 %K review %K heart %K morbidity %K hospital %K incidence %K treatment %K incidence %D 2020 %7 1.9.2020 %9 Review %J Interact J Med Res %G English %X Background: Coagulopathy associated with COVID-19 infection and venous thromboembolism (VTE) have emerged as significant contributors to morbidity among patients infected with SARS-CoV-2. Objective: We performed a systematic review to estimate VTE incidence in hospitalized patients and to analyze characteristic factors in the VTE cohort. Methods: We searched PubMed and Google Scholar using specified title search terms “SARS-CoV-2” or “COVID-19” and “venous thromboembolism” and “anticoagulation” among others to identify peer-reviewed journal articles published between June 22, 2019, and June 22, 2020. Data were systematically extracted and synthesized using Microsoft Excel for analysis. The main outcome was VTE incidence, and measures included patient characteristics, anticoagulation, and clinical outcomes with assessment for associations. Results: In total, 14 studies were included comprising 1677 patients. Most patients (n=1306, 82.4%) received anticoagulation (either VTE prophylaxis or treatment). VTE incidence was 26.9% (SE 3.1; 95% CI 20.8-33.1) and was correlated with systematic screening (r2=0.34, P=.03) and study duration (r2=–0.33, P=.03). D-dimer was higher for the VTE cohort (5.62 [SD 0.9] vs 1.43 [SD 0.6]; P<.001). Odds of VTE were higher at the intensive care unit (odds ratio [OR] 6.38, 95% CI 3.67-11.11; P<.001) but lower with anticoagulation (OR 0.58, 95% CI 0.36-0.92; P=.02). Conclusions: Despite the utilization of background anticoagulation, VTE incidence was historically high. Future studies are needed to provide additional data to guide optimal VTE prophylaxis and diagnostic strategies. %M 32805702 %R 10.2196/22768 %U http://www.i-jmr.org/2020/3/e22768/ %U https://doi.org/10.2196/22768 %U http://www.ncbi.nlm.nih.gov/pubmed/32805702 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 1 %P e13684 %T Improving Patient Preference Elicitation by Applying Concepts From the Consumer Research Field: Narrative Literature Review %A Ver Donck,Niki %A Vander Stichele,Geert %A Huys,Isabelle %+ Health Economics Consultancy, ISMS, Campus Blairon 477, Turnhout, 2300, Belgium, 32 14 701 930, niki.verdonck@student.kuleuven.be %K preference elicitation methods %K decision making %K consumer research methods %D 2020 %7 31.3.2020 %9 Review %J Interact J Med Res %G English %X Background: Although preference research finds its origins in consumer research, preference elicitation methods have increasingly attracted attention in different decision-making contexts in health care. Simulating real-life decision making is believed to be important during consumer preference elicitation. Objective: The aims of this study were to compare the process of decision making between patients and consumers and to identify methods from the consumer research field that could be applied in patient preference elicitation. Methods: A narrative literature review was performed to identify preference elicitation concepts from a consumer context that could offer improvements in health care. Results: The process of decision making between patients and consumers was highly comparable. The following five concepts from the consumer research field that could effectively simulate a real-life decision-making process for applications in health care were identified: simulating alternatives, self-reflection, feedback-driven exploration, separated (adaptive) dual response, and arranging profiles in blocks. Conclusions: Owing to similarities in the decision-making process, patients could be considered as a subgroup of consumers, suggesting that preference elicitation concepts from the consumer field may be relevant in health care. Five concepts that help to simulate real-life decision making have the potential to improve patient preference elicitation. However, the extent to which real decision-making contexts can be mimicked in health care remains unknown. %M 32229460 %R 10.2196/13684 %U http://www.i-jmr.org/2020/1/e13684/ %U https://doi.org/10.2196/13684 %U http://www.ncbi.nlm.nih.gov/pubmed/32229460 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e12593 %T Oncofertility Decision Support Resources for Women of Reproductive Age: Systematic Review %A Speller,Brittany %A Micic,Selena %A Daly,Corinne %A Pi,Lebei %A Little,Tari %A Baxter,Nancy N %+ Department of Surgery, St. Michael’s Hospital, 16-040 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 416 864 5168, baxtern@smh.ca %K decision aids %K health education materials %K fertility %K cancer %K young women %K decision-making %K patient education %D 2019 %7 6.6.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer treatments have the potential to cause infertility among women of reproductive age. Many cancer patients do not receive sufficient oncofertility information or referrals to reproductive specialists prior to starting cancer treatment. While health care providers cite lack of awareness on the available oncofertility resources, the majority of cancer patients use the internet as a resource to find additional information to supplement discussions with their providers. Objective: Our aim was to identify and characterize Web-based oncofertility decision aids and health education materials accessible for women of reproductive age with a diagnosis of any cancer. Methods: We searched five databases and the gray literature for the years 1994-2018. The developer and content information for identified resources was extracted. Each resource underwent a quality assessment. Results: We identified 31 open access resources including 4 decision aids and 27 health educational materials. The most common fertility preservation options listed in the resources included embryo (31/31, 100%), egg (31, 100%), and ovarian tissue freezing (30, 97%). Notably, approximately one-third (11, 35%) contained references and 5 (16%) had a reading level of grade 8 or below. Resources were of varying quality; two decision aids from Australia and the Netherlands, two booklets from Australia and the United Kingdom, and three websites from Canada and the United States rated as the highest quality. Conclusions: This comprehensive review characterizes numerous resources available to support patients and providers with oncofertility information, counseling, and decision making. More focus is required to improve the awareness and the access of existing resources among patients and providers. Providers can address patient information needs by leveraging or adapting existing resources to support clinical discussions and their specific patient population. %M 31199289 %R 10.2196/12593 %U http://cancer.jmir.org/2019/1/e12593/ %U https://doi.org/10.2196/12593 %U http://www.ncbi.nlm.nih.gov/pubmed/31199289