JMIR Publications

Interactive Journal of Medical Research

A general medical journal, focusing on innovation in health and medical research


Journal Description

i-JMR is a general medical journal with a focus on innovation in health, health care, and medicine - through new medical techniques and innovative ideas and/or research, including - but not limited to - technology, clinical informatics, or groundbreaking research.

Published by JMIR Publications, publisher of JMIR, the leading eHealth/mHealth journal (Impact Factor 2015: 4.532), i-JMR is a JMIR "sister journal" which features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs.

i-JMR is indexed in PubMed and archived in PubMed Central.

i-JMR is also indexed in Thomson Reuters new Emerging Sources Citation Index (ESCI) and has a projected impact factor (2015): 1.6.


Recent Articles:

  • Source:, Licence to use held by Macquarie University.

    Evaluation of Web-Based Consumer Medication Information: Content and Usability of 4 Australian Websites


    Background: Medication is the most common intervention in health care, and written medication information can affect consumers’ medication-related behavior. Research has shown that a large proportion of Australians search for medication information on the Internet. Objective: To evaluate the medication information content, based on consumer medication information needs, and usability of 4 Australian health websites: Better Health Channel, myDr, healthdirect, and NPS MedicineWise . Methods: To assess website content, the most common consumer medication information needs were identified using (1) medication queries to the healthdirect helpline (a telephone helpline available across most of Australia) and (2) the most frequently used medications in Australia. The most frequently used medications were extracted from Australian government statistics on use of subsidized medicines in the community and the National Census of Medicines Use. Each website was assessed to determine whether it covered or partially covered information and advice about these medications. To assess website usability, 16 consumers participated in user testing wherein they were required to locate 2 pieces of medication information on each website. Brief semistructured interviews were also conducted with participants to gauge their opinions of the websites. Results: Information on prescription medication was more comprehensively covered on all websites (3 of 4 websites covered 100% of information) than nonprescription medication (websites covered 0%-67% of information). Most websites relied on consumer medicines information leaflets to convey prescription medication information to consumers. Information about prescription medication classes was less comprehensive, with no website providing all information examined about antibiotics and antidepressants. Participants (n=16) were able to locate medication information on websites in most cases (accuracy ranged from 84% to 91%). However, a number of usability issues relating to website navigation and information display were identified. For example, websites not allowing combinations of search terms to be entered in search boxes and continuous blocks of text without subheadings. Conclusions: Of the 4 Australian health information websites tested, none provided consumers with comprehensive medication information on both prescription and nonprescription medications in a user-friendly way. Using data on consumer information needs and user testing to guide medication information content and website design is a useful approach to inform consumer website development.

  • Tacuina sanitatis (XIV century). Source:,_medicine,Taccuino_Sanitatis,.jpg; Public Domain.

    Internet Use for Searching Information on Medicines and Disease: A Community Pharmacy–Based Survey Among Adult Pharmacy Customers


    Background: The Internet is increasingly used as a source of health-related information, and a vast majority of Internet users are performing health-related searches in the United States and Europe, with wide differences among countries. Health information searching behavior on the Internet is affected by multiple factors, including demographics, socioeconomic factors, education, employment, attitudes toward the Internet, and health conditions, and their knowledge may help to promote a safer use of the Internet. Limited information however exists so far about Internet use to search for medical information in Italy. Objective: The objective of this study was to investigate the use of the Internet for searching for information on medicines and disease in adult subjects in Northern Italy. Methods: Survey in randomly selected community pharmacies, using a self-administered questionnaire, with open and multiple choices questions, was conducted. Results: A total of 1008 participants were enrolled (59.5% women; median age: 43 years; range: 14-88 years). Previous use of the Internet to search for information about medicines or dietary supplements was reported by 26.0% of respondents, more commonly by women (30.00% vs 20.10% men, P<.001), unmarried subjects (32.9% vs 17.4% widowed subjects, P=.022), and employed people (29.1% vs 10.4% retired people, P=.002). Use was highest in the age range of 26 to 35 (40.0% users vs 19.6% and 12.3% in the age range ≤25 and ≥56, respectively, P<.001) and increased with years of education (from 5.3% with 5 years, up to 41.0% with a university degree, P<.001). Previous use of the Internet to search for information about disease was reported by 59.1% of respondents, more commonly by women (64.5% vs 51.0% males, P<.001), unmarried subjects (64.2% vs 58.5% married or divorced subjects and 30.4% widowed subjects, P=.012), unemployed people (66.7% vs 64.0% workers and 29.9% retired people, P<.001). Use was highest in the age range of 26 to 35 (70.1% vs 64.4% in both 36-45 and 46-55 ranges and 35.1% in ≥56, P<.001) and increased with years of education (from 12.5% with 5 years up to 66.7% with 13 years and 68.6% with a university degree, P<.001). Retrieved information was rated as satisfactory by about 87.5% (88.1% women and 86.2% men, P=.562). Recent use of medicines or dietary supplements was associated with more frequent use of the Internet to search for disease and drugs. Conclusions: The study provides detailed information on the use of the Internet for searching for information on medicines and disease in the Italian population. Gender, age, social status and level of education, and the previous use of medicines, affect searching behaviors and use patterns. Results can support educational interventions to promote the retrieval of high-quality information by Internet users and health professionals advising patients about appropriate use of Internet for health-related purposes.

  • Image Source: Jean's Bionic Knee, copyright Dave Haygarth,,
Licensed under Creative Commons Attribution cc-by 2.0

    Relationship of Buckling and Knee Injury to Pain Exacerbation in Knee Osteoarthritis: A Web-Based Case-Crossover Study


    Background: Knee osteoarthritis (OA) is one of the most frequent causes of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Evidence shows that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation. Objective: Our objective was to examine whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA. Methods: We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the Internet. Participants were asked to log-on to the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control periods)—a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experienced an isolated incident of knee pain exacerbation (case periods). A pain exacerbation “case” period was defined as an increase of ≥2 compared to baseline. At each contact the pain exacerbation was designated a case period, and at all other regular 10-day contacts (control periods) participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models. Results: The analysis included 157 participants (66% women, mean age: 62 years, mean BMI: 29.5 kg/m2). Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio [OR] 10.2, 95% CI 5.4, 19.3) compared with no injury. Knee buckling was associated with experiencing a pain exacerbation (OR 4.0, 95% CI 2.6, 6.2) compared with no buckling and the association increased with a greater number of buckling events (for ≥ 6 buckling events, OR 20.1, 95% CI 3.7, 110). Conclusions: Knee injury and buckling are associated with knee pain exacerbation. Reducing the likelihood of these mechanical events through avoidance of particular activities and/or appropriate rehabilitation programs may decrease the risk of pain exacerbation.

  • Source:; CC0 Public Domain.

    Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk


    Background: People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls. Objective: To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration. Methods: We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age. Results: One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling. Conclusions: Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures.

  • Source:; CC-BY-2.0; Attribution: Sylvain Naudin.

    Quality of Web-based Information for the 10 Most Common Fractures


    Background: In today's technologically advanced world, 75% of patients have used Google to search for health information. As a result, health care professionals fear that patients may be misinformed. Currently, there is a paucity of data on the quality and readability of Web-based health information on fractures. Objectives: In this study, we assessed the quality and readability of Web-based health information related to the 10 most common fractures. Methods: Using the Google search engine, we assessed websites from the first results page for the 10 most common fractures using lay search terms. Website quality was measured using the DISCERN instrument, which scores websites as very poor (15-22.5), poor (22.5-37.5), fair (37.5-52.5), good (52.5-67.5), or excellent (67.5-75). The presence of Health on the Net code (HONcode) certification was assessed for all websites. Website readability was measured using the Flesch Reading Ease Score (0-100), where 60-69 is ideal for the general public, and the Flesch-Kincaid Grade Level (FKGL; −3.4 to ∞), where the mean FKGL of the US adult population is 8. Results: Overall, website quality was “fair” for all fractures, with a mean (standard deviation) DISCERN score of 50.3 (5.8). The DISCERN score correlated positively with a higher website position on the search results page (r2=0.1, P=.002) and with HONcode certification (P=.007). The mean (standard deviation) Flesch Reading Ease Score and FKGL for all fractures were 62.2 (9.1) and 6.7 (1.6), respectively. Conclusion: The quality of Web-based health information on fracture care is fair, and its readability is appropriate for the general public. To obtain higher quality information, patients should select HONcode-certified websites. Furthermore, patients should select websites that are positioned higher on the results page because the Google ranking algorithms appear to rank the websites by quality.

  • Toddler playing. Image sourced and copyright owned by authors Meltem Dinleyici et al.

    Media Use by Children, and Parents’ Views on Children's Media Usage


    Background: New (mobile phones, smartphones, tablets, and social media) and traditional media (television) have come to dominate the lives of many children and adolescents. Despite all of this media time and new technology, many parents seem to have few rules regarding the use of media by their children and adolescents. Objectives: The aim of this study was to evaluate media access/use of children and to evaluate beliefs and attitudes of parents concerning the use of old and new media in Turkey. Methods: This is a cross-sectional electronic survey of a national convenience sample in Turkey via SurveyMonkey, including 41 questions regarding topics relevant to television, computers, mobile phones, iPad/tablet use, and social media accounts. Results: The responses of the 333 participants (238 women, 95 men; 27-63 years) were evaluated. The average daily watching alone time was 0 to 2 hours among 53.4% (46/86), and daily coviewing time with parents of children was 0 to 2 hours among 62.7% (54/86) of children below 2 years of age. Regarding parents’ monitoring their children’s computer use (n=178), 35.4% (63/178) of the parents prefer coviewing, 13.5% of the parents use a family filter (24/178), and 33.1% (59/178) of the parents prefer to check Web history. Approximately 71.2% (237/333) of the participants had an iPad/tablet in the house, 84.3% (200/333) of the parents give their children permission to use the iPad/tablet. Of the parents, 22.5% (45/200) noted that their children used the iPad/tablet at the table during lunch/dinner and 57.9% (26/45) of these children were aged 5 years and below. Of parents, 27.3% (91/333) agreed that the optimal age for owning a mobile phone was 12 years, and 18.0% (60/333) of the parents noted that their children (one-third was below 2 years) used the mobile phone at the table during meals. A total of 33.3% (111/333) children/adolescents have a Facebook profile, and 54.0% (60/111) were below 13 years of age. Approximately 89.2% (297/333) of the parents emphasized that the Internet is essential for their child’s education. Discussion: According to our study results, knowledge regarding the use of old and new media is limited among the parents in Turkey. Our study showed that screen time and mobile device use (including during meals) are common in children below 2 years of age, whereas no screen time was recommended for children below 2 years of age. We concluded that there is need for evidence-based guidelines regarding the use of the Internet and social media for parents and parents should ensure that there is a plan in place for the use of children’s media.

  • Image Source:; attribution: Dirk Marwede, Licensed under CC-By 2.0.

    eHealth Literacy: In the Quest of the Contributing Factors


    Background: Understanding the factors that influence eHealth in a country is particularly important for health policy decision makers and the health care market, as it provides critical information to develop targeted and tailored interventions for relevant patient–consumer segments, and further suggests appropriate strategies for training the health illiterate part of the population. Objective: The objective of the study is to assess the eHealth literacy level of Greek citizens, using the eHealth Literacy Scale (eHEALS), and further explore the factors that shape it and are associated with it. Methods: This empirical study relies on a unique sample of 1064 citizens in Greece in the year 2013. The participants were requested to answer various questions about their ability to solve health-related issues using the Internet, and to provide information about their demographic characteristics and life-style habits. Ordered logit models were used to describe a certain citizen’s likelihood of being eHealth literate. Results: The demographic factors show that the probability of an individual being eHealth literate decreases by 23% (P=.001) when the individual ages and increases by 53% (P<.001) when he or she acquires higher level of education. Among the life-style variables, physical exercise appears to be strongly and positively associated with the level of eHealth literacy (P=.001). Additionally, other types of technology literacies, such as computer literacy and information literacy, further enhance the eHealth performance of citizens and have the greatest impact among all factors. Conclusions: The factors influencing eHealth literacy are complex and interdependent. However, the Internet is a disruptive factor in the relationship between health provider and health consumer. Further research is needed to examine how several factors associate with eHealth literacy, since, the latter is not only related to health care outcomes but also can be a tool for disseminating social inequalities.

  • Source:; CC0 Public Domain; modified.

    Evaluating the Quality of Website Information of Private-Practice Clinics Offering Cell Therapies in Japan


    Background: Although the safety and effectiveness of stem cell therapies are yet to be proven, recent studies show that such therapies are being advertised with some questionable marketing techniques to effect positive portrayal of the therapies on the webpages of private-practice clinics to sell their therapies worldwide. In such context, those clinics communicate directly with consumers (patients and their family members) via the clinics’ websites. Meanwhile, the Health Science Council at the Ministry of Health, Labour, and Welfare (MHLW) in Japan has pointed out noncompliance of some local clinics with the provisions concerning medical advertising in the Medical Care Act in the past. However, locally little is known about the current status of those clinics including the quality of their webpage information disseminated. Objective: To evaluate the quality of website information of private-practice clinics offering cell therapies in Japan. Methods: Twenty-four websites with 77 treatments from the Google search were identified for evaluation. The following three exploratory analyses were performed: first in order to ascertain web-based portrayal of private-practice clinics offering cell therapies, a descriptive analysis was conducted using a coding frame; second we evaluated the quality of the target website information from the viewpoint of the level of consideration taken for patients and their family members, using 10 quality criteria (“the Minimum Standard”) from the e-Health Code of Ethics 2.0; third we counted and coded expressions that matched set categories for “name-dropping” and “personalized medicine” in the information posted on these websites. Results: Analysis on the treatments (N=77) revealed 126 indications (multiple response): the top three indications were “cancer,” “skin-rejuvenation/antiaging/anti–skin aging,” and “breast augmentation/buttock augmentation.” As for the portrayal of treatment risks and benefits, 78% (60/77) of treatments were mentioned with “benefits,” whereas 77% (59/77) of treatments were mentioned with “risks.” As for the source(s) cited for the discussions of treatment risks and benefits, no treatment quoted an expert’s opinion for the risks, whereas 7% (6/77) treatments quoted external sources for the benefits. As for the results with e-Health Code of Ethics 2.0, not a single clinic fulfilled all the 10 criteria; 63% (15/24) of the clinics was found exercising “name-dropping,” and 21% (5/24) of the clinics mentioned expressions related to “personalized medicine” on their websites. Conclusions: Our website content analyses confirmed the following: (1) the clinics mentioned the risks or benefits of the treatments with hardly any scientific citations, (2) the way the website information was disseminated was inappropriate for patients and their families, and (3) many websites seemed to be using marketing techniques in order to draw patients’ interests or attentions. It is important that more similar studies are undertaken globally to enable an orchestrated regulatory approach toward private-practice clinics.

  • Source:, Attribution: George Hodan; Public Domain.

    An Observational Study to Evaluate the Usability and Intent to Adopt an Artificial Intelligence–Powered Medication Reconciliation Tool


    Background: Medication reconciliation (the process of creating an accurate list of all medications a patient is taking) is a widely practiced procedure to reduce medication errors. It is mandated by the Joint Commission and reimbursed by Medicare. Yet, in practice, medication reconciliation is often not effective owing to knowledge gaps in the team. A promising approach to improve medication reconciliation is to incorporate artificial intelligence (AI) decision support tools into the process to engage patients and bridge the knowledge gap. Objective: The aim of this study was to improve the accuracy and efficiency of medication reconciliation by engaging the patient, the nurse, and the physician as a team via an iPad tool. With assistance from the AI agent, the patient will review his or her own medication list from the electronic medical record (EMR) and annotate changes, before reviewing together with the physician and making decisions on the shared iPad screen. Methods: In this study, we developed iPad-based software tools, with AI decision support, to engage patients to “self-service” medication reconciliation and then share the annotated reconciled list with the physician. To evaluate the software tool’s user interface and workflow, a small number of patients (10) in a primary care clinic were recruited, and they were observed through the whole process during a pilot study. The patients are surveyed for the tool’s usability afterward. Results: All patients were able to complete the medication reconciliation process correctly. Every patient found at least one error or other issues with their EMR medication lists. All of them reported that the tool was easy to use, and 8 of 10 patients reported that they will use the tool in the future. However, few patients interacted with the learning modules in the tool. The physician and nurses reported the tool to be easy-to-use, easy to integrate into existing workflow, and potentially time-saving. Conclusions: We have developed a promising tool for a new approach to medication reconciliation. It has the potential to create more accurate medication lists faster, while better informing the patients about their medications and reducing burden on clinicians.

  • The project leaders with one of the mobile technologies tested (spirometer). Source and copyright: the authors.

    Telemonitoring in Cystic Fibrosis: A 4-year Assessment and Simulation for the Next 6 Years


    Background: Innovative technologies and informatics offer a wide range of services to health districts, doctors, nurses, and patients, and is changing the traditional concept of health care. In the last few years, the availability of portable devices, their easiness to transport and use, and the capability to collect and transmit various clinical data have resulted in the fast development of telemedicine. However, despite its potential impact in improving patient conditions, and its cost effectiveness reported in literature, telemedicine is not in daily practice. Objective: The aim of this study is to provide evidence of the positive impact of telemonitoring proving the sustainability of an application by sending spirometry outcomes from patients’ homes to the hospital doctors via the Internet, and from doctors to patients by an additional phone call solution. Methods: We examined collected data related to clinical improvement of patients with cystic fibrosis (CF). The patients were followed-up at home using telemonitoring for a period of 10 years, with the aims to prove the sustainability of the methodology (transmissions of spirometry from the patients' home to the doctors and feedback from the doctors to the patients by phone call from the hospital). We stored and analyzed all spirometry transmissions received, and tested the possible presence to decrease the costs between the standard clinical trial (only ambulatory visits) and standard clinical trial with telemonitoring for the follow-up of patients with CF (telemedicine). This was done through an economic analysis of the costs for patients followed at home by telemonitoring. We assessed four years of observation and a simulation of total long-term costs between 2010 and 2020. Results: We discovered a potential saving of €40,397.00 per patient for 10 years, actualized at €36,802.97 for the follow-up of all patients enrolled. Conclusions: The results from the study suggest that telemedicine can improve the health of patients with CF. It is a relatively cheap and potentially sustainable solution, compared to standard clinical trials. However, to establish and prove the long-term effectiveness and cost-effectiveness, more controlled psychological and behavioral studies are needed.

  • Image Source: Chest bone pain, copyright sos doctors. Published on Jun 25, 2014. Retrieved from Licensed under Creative Commons Attribution cc-by 2.0

    Assessing Quality of Life and Medical Care in Chronic Angina: An Internet Survey


    Background: Angina is a clinical syndrome whose recognition relies heavily on self-report, so its identification can be challenging. Most data come from cohorts identified by physicians and nurses at the point of care; however, current widespread access to the Internet makes identification of community cohorts feasible and offers a complementary picture of angina. Objective: To describe a population self-identified as experiencing chronic angina by use of an Internet survey. Methods: Using email and an Internet portal, we invited individuals with a diagnosis of angina and recent symptoms to complete an Internet survey on treatment and quality of life (QOL). In total, 1147 surveys were received. The main analysis was further limited to those reporting a definite coronary heart disease (CHD) history (N=646, 56% of overall). Results: Overall, about 15% reported daily angina and 40% weekly angina. Those with more frequent angina were younger, more often depressed, and reported a shorter time since diagnosis. They also had substantially worse treatment satisfaction, physical function, and overall QOL. Fewer than 40% were on ≥ 2 anti-anginals, even with daily angina. The subjects without a history of definite CHD had unexpectedly low use of antianginal and evidence-based medicines, suggesting either a lack of specificity in the use of self-reported angina to identify patients with CHD or lack of access to care. Conclusions: Use of inexpensive electronic tools can identify community-based angina cohorts for clinical research. Limitation to subjects with a definite history of CHD lends diagnostic face validity to the approach; however, other symptomatic individuals are also identified.

  • Image Source: Happy faces; Image Copyright Heather Collins et al. Source: Heather Collins et al. Licensed under Creative Commons Attribution cc-by 2.0

    Information Needs in the Precision Medicine Era: How Genetics Home Reference Can Help


    Precision medicine focuses on understanding individual variability in disease prevention, care, and treatment. The Precision Medicine Initiative, launched by President Obama in early 2015, aims to bring this approach to all areas of health care. However, few consumer-friendly resources exist for the public to learn about precision medicine and the conditions that could be affected by this approach to care. Genetics Home Reference, a website from the US National Library of Medicine, seeks to support precision medicine education by providing the public with summaries of genetic conditions and their associated genes, as well as information about issues related to precision medicine such as disease risk and pharmacogenomics. With the advance of precision medicine, consumer-focused resources like Genetics Home Reference can be foundational in providing context for public understanding of the increasing amount of data that will become available.

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  • An evaluation of the readability, suitability and quality of online health information regarding male infertility

    Date Submitted: Aug 3, 2016

    Open Peer Review Period: Aug 3, 2016 - Sep 28, 2016

    Background: Many men lack knowledge about male infertility, and this may have consequences for their reproductive and general health. Men may prefer to seek health information online, but these source...

    Background: Many men lack knowledge about male infertility, and this may have consequences for their reproductive and general health. Men may prefer to seek health information online, but these sources of information vary in quality. Objective: To determine if online sources of information regarding male infertility are readable, suitable and of appropriate quality for internet users in the general population. Methods: This study used a cross-sectional design to evaluate online sources resulting from search engine queries. Three categories of websites were considered: a) Canadian fertility clinics b) North American organizations related to fertility and c) the first 20 results of Google searches using the terms "male infertility" and "male fertility preservation" set to three different search locations: worldwide, Canada, and French Canada. Websites that met inclusion criteria (N= 85) were assessed using readability indices, the Suitability Assessment of Materials (SAM) and the DISCERN tool. The associations between website affiliation (government, university/medical, non-profit organization, commercial/corporate, private practice) and Google placement to readability, suitability, and quality were also examined. Results: None of the sampled websites met recommended levels of readability. Across all websites mean SAM score for suitability was 45.37%, or “adequate”, while DISCERN mean score for quality was 43.18 or “fair”. Websites that placed higher in Google obtained a higher overall score for quality, r(58) = - 0.328 p = 0.012, but this position was not related to readability or suitability. Twenty percent of fertility clinic websites did not include fertility information for men. Conclusions: There is a lack of high quality online sources of information on male fertility. Many websites target their information to women, or fail to meet established readability criteria for the general population. Since men may prefer to seek health information online, it is important that health care professionals develop high quality sources of information on male fertility for the general population.

  • YouTubeTM as a source of patient education on the role of the hospitalist

    Date Submitted: Jul 23, 2016

    Open Peer Review Period: Jul 26, 2016 - Sep 20, 2016

    Background: “Hospitalist” is a new field, dedicated to the delivery of comprehensive medical care to hospitalized patients. YouTubeTM is one of the most frequently used websites, offering access t...

    Background: “Hospitalist” is a new field, dedicated to the delivery of comprehensive medical care to hospitalized patients. YouTubeTM is one of the most frequently used websites, offering access to a gamut of videos, from self-produced to professionally-made. Objective: We sought to determine the adequacy of YouTubeTM as an effective means to define and depict the role of hospitalists. Methods: YouTubeTM was searched on 11/17/2014 using the following search words: “hospitalist,” “hospitalist definition,” “what is the role of a hospitalist,” “define hospitalist” and “who is a hospitalist.” Only videos found in the first 10 pages of each search were included. Non-English, non-educational and non-relevant videos were excluded. A novel 7 point scoring tool was created by the authors based on the Society of Hospital Medicine definition of a hospitalist. Three independent reviewers evaluated, scored and classified the videos into high, intermediate and low quality based on the average score. Results: A total of 102 videos out of 855 were identified as relevant and included in the analysis. Videos uploaded by academic institutions had the highest mean score. Only 6 videos were classified as high quality, 53 as intermediate quality and 42 as low quality, with 82% of the videos scoring an average of 4 or less. Conclusions: Most videos found in the search of a hospitalist definition are inadequate. Leading medical organizations and academic institutions should consider producing and uploading quality videos to YouTubeTM to help patients and their families better understand the roles and definition of the hospitalist.

  • Revelation and easy management of Rhomboids muscle Trigger point as a cause of distressing Non – Cardiac Chest pain- A case series

    Date Submitted: Jul 13, 2016

    Open Peer Review Period: Jul 18, 2016 - Sep 12, 2016

    Background: Non-cardiogenic chest pain is a major health problem all over the world. Besides, non organic musculoskeletal pain affects up to 85% of the general population at any point of time. Patient...

    Background: Non-cardiogenic chest pain is a major health problem all over the world. Besides, non organic musculoskeletal pain affects up to 85% of the general population at any point of time. Patients with musculoskeletal chest pain remain under diagnosed, untreated and potentially continuously disabled in terms of anxiety, depression and ability to carry out activities of daily living [1]. Here we present a new dimension in this area by revealing Rhomboids muscle trigger point as the cause of referred chest pain, which in itself lacks enough description in the available literature. Objective: Non-cardiogenic chest pain is a major health problem all over the world. Besides, non organic musculoskeletal pain affects up to 85% of the general population at any point of time. Patients with musculoskeletal chest pain remain under diagnosed, untreated and potentially continuously disabled in terms of anxiety, depression and ability to carry out activities of daily living [1]. Here we present a new dimension in this area by revealing Rhomboids muscle trigger point as the cause of referred chest pain, which in itself lacks enough description in the available literature. Methods: A prospective study was conducted between January 2013 to September 2014 at Physiotherapy Unit in the Department of Orthopaedics and Trauma of North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS) Shillong, Meghalaya (India), a tertiary teaching health care institute which comprised of 30 patients with age group ranging from 12 yrs to 60 yrs. All patients were ruled out of cardiac and other known causes of chest pain by evaluating them based on a properly designed Performa. Ischemic pressure was applied on Rhomboids muscle after establishing Rhomboids muscle trigger point as the possible cause of chest pain. They were subjected to Ischemic pressure therapy and all of them had fulfilled the new ACR criteria for fibromyalgia. The duration of Ischemic pressure varied from 2 to 7 days, and subsequent follow up was done till 2 months. Visual Analogue scale (VAS) and Modified DALLAS Pain Questionnaire was used as measurement tool for assessing the treatment outcome. Results: The results were analysed by using two tailed paired ‘t’ test and was performed using SPSS version 20. The two-tailed P value of <0.005 considered extremely significant for our data. Conclusions: Our study has highlighted that while evaluating a clinician should remember that Rhomboid Muscle trigger point can be a distressing cause of chest pain and which can be effectively taken care of by Ischemic compression therapy. It may help such patients of “Non Specific cardiac chest pain” who otherwise run from pillar to post or one department to another, in vain. Clinical Trial: yes