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A new general medical journal for the 21st centrury, focusing on innovation in health and medical research
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, sociotechnical and organizational health care innovations, or groundbreaking research.
Published by JMIR Publications, publisher of JMIR, the leading eHealth/mHealth journal (Impact Factor 2016: 5.175), i-JMR is a JMIR "sister journal" with a projected impact factor of about 2.03 (2016). 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 Clarivate Analytics (formerly the IP and Science Division of Thomson Reuters) new Emerging Sources Citation Index (ESCI).
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Background: Every year approximately 800,000 people die by suicide worldwide, accounting for 1–2 in every 100 deaths. It is always a tragic event with a huge impact on family, friends, community an...
Background: Every year approximately 800,000 people die by suicide worldwide, accounting for 1–2 in every 100 deaths. It is always a tragic event with a huge impact on family, friends, community and professionals. Unfortunately, suicide prevention and the development of risk assessment tools have been hindered by the complexity of the underlying mechanisms and the dynamic nature of people’s motivations and intent. Many of those who die by suicide have had contact with health services in the preceding year but identifying those most at risk is a challenge. Objective: To explore the feasibility of using artificial neural networks (ANNs) based on routinely collected electronic health records (EHRs) to support the identification of those at high risk of suicide when in contact with health services. Methods: Using the Secure Anonymised Information Linkage Databank UK, we extracted those who died by suicide between 2001 and 2015 and paired controls. Looking at primary (general practice: GP) and secondary (hospital admissions) EHRs, we built a binary feature vector coding the presence of risk factors at different times before the contact leading to death. Risk factors included: GP contacts and hospital admissions; diagnosis of mental health, injury and poisoning, substance misuse, maltreatment or sleep disorder; and prescription of opiates or psychotropics. We trained simple ANNs to differentiate between cases and controls and interpreted the output score as the estimated suicide risk score. We assessed system performance with 10x10 K-Folds repeated cross-valadiation and studied system performance and behaviour by representing the distribution of estimated risk across cases and controls and the distribution of factors across different estimated risks. Results: We extracted a total of 2,604 suicide cases and 20 paired controls per case. Our system obtained an error rate of 26.78% ± 1.46 (64.57% of sensitivity and 81.86% of specificity). While the distribution of controls was concentrated around estimated risks < 0.5, cases where almost uniformly distributed between 0 and 1. Prescription of psychotropics, depression and anxiety and self-harm increased the estimated risk by ~0.4. At least 95% of those presenting these factors were identified cases. Conclusions: Despite the simplicity of the implemented system, the proposed methodology obtained an accuracy similar to other published methods based on specialized questionnaire generated data. Most of the errors came from the heterogeneity of patterns shown by cases, some of which were identical to those of controls. Prescription of psychotropics, depression and anxiety and self-harm were strongly linked with higher estimated risk scores, followed by hospital admission and long-term drugs and alcohol misuse. Other risk factors such as sleep disorder and maltreatment had more complex effects.
Background: Physical therapy is an essential component of multidisciplinary treatment in amyotrophic lateral sclerosis (ALS). However, the meaning of physical therapy beside preservation of muscular s...
Background: Physical therapy is an essential component of multidisciplinary treatment in amyotrophic lateral sclerosis (ALS). However, the meaning of physical therapy beside preservation of muscular strength and functional maintenance is not fully understood. Objective: The purpose of this study was to examine the patient´s perception of physical therapy during symptom progression using an internet assessment approach. Methods: A prospective, longitudinal, observational study was performed. Recruitment took place in an ALS center in Berlin, Germany. Online self-assessment was established on a case management platform over 6 months. Participants self-assessed the disease progression using the ALS Functional Rating Scale, revised (ALSFRSr). The specific target of physical therapy was rated by Measure Yourself Medical Outcome Profile (MYMOP). To inquire about the level of recommendation we used the net promotor score (NPS). Results: 45 participants with ALS were included. 27 participants (60 %) started the online assessment. The mean duration of physical therapy sessions per week was 143 minutes (SD 60.4) with a mean frequency of 2.9 (SD 1.2) per week. As defined by MYMOP, most concerning symptoms were reported in the lower extremities (62 %), in the upper limbs (31 %) and less frequently in the trunk (7 %). Notwithstanding physical therapy, there was a functional decline of 3 points in the ALSFRSr at the end of the observation (n = 20). Furthermore, the MYMOP showed a significant loss of 0.8 points in the composite score, 0.9 points in the activity score and 0.8 points in the targeted symptom. Contrary to the functional decline, recommendation of PT raised from a baseline value of 20 NPS points to very high 50 points at the end of study (P = 0.05). Conclusions: Physical therapy is perceived as an important treatment by patients with ALS. Despite a functional decline, patients are satisfied with their physical therapy and recommend this intervention. The results underline the changing meaning of physical therapy throughout the course of the disease. Physical therapy in ALS has to be regarded as a supportive and palliative health care intervention beyond functional outcome parameters.