interactive Journal of Medical Research

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

Accuracy, validity and reliability of an electronic visual analogue scale for pain on a touch screen tablet in healthy older adults

New technology for clinical data collection is rapidly evolving and may be useful for both researchers and clinicians however this new technology has not been tested for accuracy, reliability or validity. This study aim to test the accuracy of visual analogue scales (VAS) for pain on a newly designed application on the iPad (iPadVAS), measure the reliability and validity of iPadVAS compared to a paper copy (paperVAS). Accuracy was determined by physically measuring iPad scale on screen and comparing it to the results from the programme, with one researcher collecting 101 data points. Twenty-two healthy community dwelling older adults were then recruited to test reliability and validity. Each participant completed eight VAS (four using each tool) in a randomised order. Reliability was measured using interclass coefficient, and validity measured using Bland-Altman graphs and correlations. Accuracy; 64 results were identical, 2 results were manually measured as being 1mm higher than the program and 35 as 1mm lower. Reliability for the iPadVAS was excellent with individual (ICC, 95%CI; 0.90, 0.82 to 0.95) and averaged (0.97, 0.95 to 1.0). Linear regression demonstrated a strong relationship, with a small negative bias towards the iPad (-2.6±5.0) with limits of agreement from -12.4 to 7.1. Accuracy and reliability of the iPad VAS is excellent. Validity shows a small bias that is not clinically relevant. The iPadVAS provides a convenient, user-friendly and efficient way of collecting data from participants in measuring their current pain levels. It has potential use in documentation management and may encourage participatory healthcare.

2015-07-01

Thomson Reuters, producer of the Journal Citation Reports and Web of Science and other database products, is creating a new edition of Web of Science; and we are proud to report that JMIR journals have been selected for the content expansion. 

The new Thomson Reuters Web of Science edition, which launches later in 2015, will include influential journals covering a variety of disciplines. "The journals selected have been identified as important to key opinion leaders, funders, and evaluators worldwide.", say a Thomson Reuters communication about the database. "We are proud that the Thomson Reuters team recognizes the influence of the JMIR journals", says Gunther Eysenbach, publisher at JMIR Publications.

The following journals are confirmed to be part of the initial release:

JMIR Publications is working on getting its newer journals such as JMIR Mental Health into the collection as well. JMIR Publications is now publishing over a dozen journals with topics covering innovation in health and technology.

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Journal Description

i-JMR is a new general medical journal, harnessing the power of the Internet and mobile platforms (iPad) for knowledge dissemination and translation.

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 2011: 4.4), i-JMR has a broader scope and features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs (ready for deposit in PubMed Central), and an ipad App (in prep.).

 

Recent Articles:

  • The image is from http://www.bzga.de/presse/pressemotive/organspende/

The rights are explained here in German. https://www.organspende-info.de/presse-portal/pressemotive
It is allowed to use the image without manipulation in journals and online.

    Effectiveness of Organ Donation Information Campaigns in Germany: A Facebook Based Online Survey

    Abstract:

    Background: The German transplantation system is in a crisis due to a lack of donor organs. Information campaigns are one of the main approaches to increase organ donation rates. Since 2012, German health insurance funds are obliged by law to inform their members about organ donation. We raised the hypothesis: The willingness to sign a donor card rises due to the subsequent increase of specific knowledge by receiving the information material of the health insurance funds. Objective: The objective of the study was to assess the influence of information campaigns on the specific knowledge and the willingness to donate organs. Methods: We conducted an online survey based on recruitment via Facebook groups, advertisements using the snowball effect, and on mailing lists of medical faculties in Germany. Besides the demographic data, the willingness to hold an organ donor card was investigated. Specific knowledge regarding transplantation was explored using five factual questions resulting in a specific knowledge score. Results: We recruited a total of 2484 participants, of which 32.7% (300/917) had received information material. Mean age was 29.9 (SD 11.0, median 26.0). There were 65.81% (1594/2422) of the participants that were female. The mean knowledge score was 3.28 of a possible 5.00 (SD 1.1, median 3.0). Holding a donor card was associated with specific knowledge (P<.001), but not with the general education level (P=.155). Receiving information material was related to holding a donor card (P<.001), but not to a relevant increase in specific knowledge (difference in mean knowledge score 3.20 to 3.48, P=.006). The specific knowledge score and the percentage of organ donor card holders showed a linear association (P<.001). Conclusions: The information campaign was not associated with a relevant increase in specific knowledge, but with an increased rate in organ donor card holders. This effect is most likely related to the feeling of being informed, together with an easy access to the organ donor card.

  • ©Thinkstock/Assistance Publique – Hôpital de Paris (AP-HP).

    What Kind of Information About Marginal Donors Is Available Through Sources Other Than Health Care Professionals for Patients on the Waiting List for Organ...

    Abstract:

    Background: The current organ shortage has necessitated expanding the criteria for potential donations to marginal donors (older or sick donors whose organs would have been considered unsuitable before). In France, physicians are not required to provide information to recipients about marginal donors except for hepatitis C or hepatitis B infection and non-heart-beating donations. We hypothesized that patients can be informed about these risks by other information sources than health care professionals, such as websites and patient associations. Objective: The objectives of the study were to identify the main health information sources of transplant patients other than health professionals and to evaluate the information provided by websites and associations to patients about the risks of transplantation from marginal donors. Methods: In this study, the information sources for kidney, liver, heart, and lung patients that had already received transplants or registered on waiting lists were identified by a survey in four transplant centers. Further, the information proposed by French and English language websites and patient associations were evaluated, respectively, by a systematic review of websites and a survey among the presidents of kidney, liver, heart, and lung patient associations. Results: For the first survey, (367/402) 91.3% responses were registered. Apart from health professionals identified as the principal information source (363/367) 98.9%, 19 liver and 28 heart patients searched for information on the websites, while 37 kidney and 42 lung patients were more informed by patients’ associations. Our two last surveys showed that information about marginal donors is accessible by websites and (10/34) 30% of associations. All of the 60 Internet documents evaluated on French language and English language websites proposed information about marginal donors. Otherwise, (52/65) 80% of these documents were dedicated to health professionals and contained specialized information, difficult to understand by patients. Certain associations, (20/34) 59%, provided information about the risks of transplantation. There were 45/115 patients considering associations as their main information source that were informed by an association’s website. However, only (5/22) 23% of associations communicated the risks of transplantation with patients through their websites. Conclusions: Currently, patients want to be more informed by other information sources than health professionals, particularly by the websites. Nevertheless, they cannot always trust information proposed by these sources. They need to have their physicians inform them about specialized keywords and present them with reliable information sources. So reliable centers such as universities, transplant centers, and associations should develop the quality and quantity of information proposed to patients on their websites.

  • When parents seek information related to parenting of a child with cleft lip and/or palate they quickly learn that most resources available are at higher level than they can read.

    Readability of Information Related to the Parenting of a Child With a Cleft

    Abstract:

    Background: Many parents look to various sources for information about parenting when their child has a cleft lip and/or palate. More than 8 million Americans perform health-related searches every day on the World Wide Web. Furthermore, a significant number of them report feeling “overwhelmed” by the language and content of the information. Objective: The purpose of this study is to determine the readability of information related to parenting a child with cleft lip and/or palate. It was hypothesized that the readability of such materials would be at a level higher than 6th grade. Methods: In February of 2012, a Web-based search was conducted using the search engine Google for the terms “parenting cleft lip and palate.” Results: A total of 15 websites, 7 books, and 8 booklets/factsheets (N=30) entered the readability analysis. Flesch-Kincaid Grade Level, Fog Scale Level, and Simple Measure of Gobbledygook (SMOG) index scores were calculated. The reading level of the websites and books ranged from 8th to 9th and 9th to10th grade, respectively. The average reading level of the booklets/factsheets was 10th grade. Overall, the mean readability of the media resources analyzed was considered “hard to read.” No statistically significant mean difference was found for the readability level across websites, books, and booklets/factsheets (Kruskal-Wallis test, significance level .05). Conclusions: When considering websites, books, booklets, and factsheets analyzed, the average readability level was between 8th and 10th grade. With the US national reading level average at 8th grade and the general recommendation that health-related information be written at a 6th grade level, many parents may find the text they are reading too difficult to comprehend. Therefore, many families might be missing out on the opportunity to learn parenting practices that foster optimal psychosocial development of their children.

  • Feature image for homepage. Free stock image from rgbstock.com.

    An Innovative Approach to Informing Research: Gathering Perspectives on Diabetes Care Challenges From an Online Patient Community

    Abstract:

    Background: Funding agencies and researchers increasingly recognize the importance of patient stakeholder engagement in research. Despite calls for greater patient engagement, few studies have engaged a broad-based online community of patient stakeholders in the early stages of the research development process. Objective: The objective of our study was to inform a research priority-setting agenda by using a Web-based survey to gather perceptions of important and difficult aspects of diabetes care from patient members of a social networking site-based community. Methods: Invitations to participate in a Web-based survey were sent by email to members of the PatientsLikeMe online diabetes community. The survey asked both quantitative and qualitative questions addressing individuals’ level of difficulty with diabetes care, provider communication, medication management, diet and exercise, and relationships with others. Qualitative responses were analyzed using content analysis. Results: Of 6219 PatientsLikeMe members with diabetes who were sent survey invitations, 1044 (16.79%) opened the invitation and 320 (5.15% of 6219; 30.65% of 1044) completed the survey within 23 days. Of the 320 respondents, 33 (10.3%) reported having Type 1 diabetes; 107 (33.4%), Type 2 diabetes and taking insulin; and 180 (56.3%), Type 2 diabetes and taking oral agents or controlling their diabetes with lifestyle modifications. Compared to 2005-2010 National Health and Nutrition Examination Survey data for individuals with diabetes, our respondents were younger (mean age 55.8 years, SD 9.9 vs 59.4 years, SE 0.5); less likely to be male (111/320, 34.6% vs 48.4%); and less likely to be a racial or ethnic minority (40/312, 12.8% vs 37.5%). Of 29 potential challenges in diabetes care, 19 were categorized as difficult by 20% or more of respondents. Both quantitative and qualitative results indicated that top patient challenges were lifestyle concerns (diet, physical activity, weight, and stress) and interpersonal concerns (trying not to be a burden to others, getting support from family/friends). In our quantitative analysis, similar concerns were expressed across patient subgroups. Conclusions: Lifestyle and interpersonal factors were particularly challenging for our online sample of adults with Type 1 or Type 2 diabetes. Our study demonstrates the innovative use of social networking sites and online communities to gather rapid, meaningful, and relevant patient perspectives that can be used to inform the development of research agendas.

  • (cc) Pehora et al. How parents attending a Canadian tertiary hospital are using the Internet for their child's health information.

    Are Parents Getting it Right? A Survey of Parents’ Internet Use for Children’s Health Care Information

    Abstract:

    Background: The use of the Internet to search for medical and health-related information is increasing and associated with concerns around quality and safety. Objective: We investigated the current use and perceptions on reliable websites for children’s health information by parents. Methods: Following institutional ethics approval, we conducted a survey of parents/guardians of children presenting for day surgery. A 20-item survey instrument developed and tested by the investigators was administered. Results: Ninety-eight percent of respondents reported that they used the Internet to search for information about their child’s health. Many respondents reported beginning their search at public search engines (80%); less than 20% reported starting their search at university/hospital-based websites. Common conditions such as colds/flu, skin conditions and fever were the most frequently searched, and unique conditions directly affecting the child were second. Despite low usage levels of university/hospital-based websites for health information, the majority of respondents (74%) regarded these as providing safe, accurate, and reliable information. In contrast, only 24% of respondents regarded public search engines as providing safe and reliable information. Fifty percent of respondents reported that they cross-checked information found on the internet with a family physician. Conclusions: An unprecedented majority of parents and guardians are using the Internet for their child’s health information. Of concern is that parents and guardians are currently not using reliable and safe sources of information. Health care providers should begin to focus on improving access to safe, accurate, and reliable information through various modalities including education, designing for multiplatform, and better search engine optimization.

  • Side-by-side view of desktop layout (A) versus mobile layout (B) depicting appendicitis (ie, inflammation of the appendix). The control panel folds if the screen resolution is too small (B) to provide an unhindered view on the slide. Pathological annotations are shown.

    A Virtual Microscope for Academic Medical Education: The Pate Project

    Abstract:

    Background: Whole-slide imaging (WSI) has become more prominent and continues to gain in importance in student teaching. Applications with different scope have been developed. Many of these applications have either technical or design shortcomings. Objective: To design a survey to determine student expectations of WSI applications for teaching histological and pathological diagnosis. To develop a new WSI application based on the findings of the survey. Methods: A total of 216 students were questioned about their experiences and expectations of WSI applications, as well as favorable and undesired features. The survey included 14 multiple choice and two essay questions. Based on the survey, we developed a new WSI application called Pate utilizing open source technologies. Results: The survey sample included 216 students—62.0% (134) women and 36.1% (78) men. Out of 216 students, 4 (1.9%) did not disclose their gender. The best-known preexisting WSI applications included Mainzer Histo Maps (199/216, 92.1%), Histoweb Tübingen (16/216, 7.4%), and Histonet Ulm (8/216, 3.7%). Desired features for the students were latitude in the slides (190/216, 88.0%), histological (191/216, 88.4%) and pathological (186/216, 86.1%) annotations, points of interest (181/216, 83.8%), background information (146/216, 67.6%), and auxiliary informational texts (113/216, 52.3%). By contrast, a discussion forum was far less important (9/216, 4.2%) for the students. Conclusions: The survey revealed that the students appreciate a rich feature set, including WSI functionality, points of interest, auxiliary informational texts, and annotations. The development of Pate was significantly influenced by the findings of the survey. Although Pate currently has some issues with the Zoomify file format, it could be shown that Web technologies are capable of providing a high-performance WSI experience, as well as a rich feature set.

  • Illustrative pictures of the SintromacWeb software. In patient’s personal area (panel A), current medication schedule is available; INR results are introduced and sent to health care center. In physician’s area (panel B), the hematologist analyzes the data and introduces new medication schedule for patient.

    Effective and Safe Management of Oral Anticoagulation Therapy in Patients Who Use the Internet-Accessed Telecontrol Tool SintromacWeb

    Abstract:

    Background: Despite the existing evidence that highlights the benefits of oral anticoagulation therapy (OAT) self-testing and self-management by patients in comparison with conventional control, significant progress is still needed in the implementation of computer-based, Internet-assisted systems for OAT within health care centers. The telecontrol tool “SintromacWeb” is a previously validated system for OAT management at home, which is currently operative and accessed by patients through a hospital Web portal. Objective: The intent of the study was to assess the effectiveness and safety of OAT management in patients using the SintromacWeb telecontrol system in reference to control in patients using the conventional system (management at the hematology department), in terms of time in therapeutic range (TTR) of International Normalized Ratio (INR). Methods: In this observational prospective study, patients were identified by their physician and divided in two groups according to the OAT management system that they were already using (conventional control or telecontrol with SintromacWeb). For 6 months, patients were required to visit the hematology department every time their physician considered it necessary according to usual clinical practice. Sociodemographic and clinical variables for the study were collected at first visit (baseline) and at those visits closest to 2, 4, and 6 months after first visit. Results: A total of 173 patients were evaluated, 87 with conventional control and 86 with telecontrol. Follow-up time was a median of 6.3 (range 5.2-8.1) months. The average time of OAT treatment prior to enrollment was 9.2 (SD 6.4) years. Patients in the telecontrol group tested their INR a median of 21 (range 4-22) days versus a median of 35 (range 14-45) days in patients in the conventional control group (P<.001). TTR in the telecontrol group was 107 (SD 37) days versus 94 (SD 37) days in the conventional control group (an increase of 12.6%; P=.02). In all visits, the percentage of TTR was higher in the telecontrol group (at the third visit: 59% vs 48%; P=.01). Higher TTR (positive coefficient) was associated with patients under OAT telecontrol (P=.03). Under-anticoagulation (INR<1.5) and over-anticoagulation (INR>5) were observed in 34 (19.7%, 34/173) and 38 (22.0%, 38/173) patients, respectively (no differences between treatment groups). Seven thrombotic and/or bleeding events were serious, 12 were non-serious, and most of them (5 and 10, respectively) occurred in the conventional control group. Conclusions: In clinical practice, OAT management with the Internet-based tool SintromacWeb is effective and safe for those patients who are eligible for OAT telecontrol.

  • Table of Contents thumbnail.
It is from the bimonthly publication of National Health Insurance Administration, Ministry of Health and Welfare.

link: http://www.nhi.gov.tw/Resource/webdata/28008_1_%E5%85%A8%E6%B0%91%E5%81%A5%E4%BF%9D-1%E6%9C%88-%E7%B6%B2%E8%B7%AF%E7%89%88.pdf.

    Web-Based and Telephone Surveys to Assess Public Perception Toward the National Health Insurance in Taiwan: A Comparison of Cost and Results

    Abstract:

    Background: Numerous studies have examined the impact of global budget payment systems of health insurance on patient access to medical care. In order to monitor the population’s accessibility to health services, a series of survey are often used to understand public perceptions of the health care provider. Taiwan implemented the single-payer National Health Insurance in 1995 and has been conducting a series of surveys to monitor public perception of the NHI after adopting a global budget payment system in 2002. Although telephone surveys are commonly used in obtaining public opinions on various public health issues, limitations such as higher cost and influence of interviewers do raise some concerns. Web-based surveys, one of the alternative methods, may be free from these problems. Objective: Our aim was to examine the difference of sociodemographic characteristics, satisfaction of NHI and NHI-contracted health care providers, attitude toward NHI-related issues, behavior in seeking medical advice and self-reported health status between those who completed Web-based surveys and those reached by telephone. Methods: This study compared the demographic factors of participants who took either a Web-based survey (1313 participants) or random digit dialing telephone survey (2411 participants) that contained identical questions. Results: Compared to telephone survey respondents, Web-based respondents tended to be younger (P<.001), unmarried (P<.001), non-smokers (P<.001), with a higher education (P<.001), and a higher monthly household income (P<.001) and worse self-reported health status (P=.008); however, they were less likely to report suffering from a chronic disease (P<.001). Despite these differences in background characteristics, no significant differences were observed in their answers related to the seeking of medical care or NHI-related issues. Telephone survey respondents reported greater satisfaction with NHI services. Web-based surveys were also shown to provide a lower average cost per sample (US$0.71) compared to telephone surveys (US$3.98). Conclusions: Web-based surveys provide a low-cost alternative method for the polling of public attitudes toward NHI-related issues. Despite general similarities between the two polling methods with regard to responses, respondents to telephone surveys reported a stronger agreement with regard to satisfaction with NHI services and a more positive self-reported health status.

  • Searching the Internet for health information. (Photo: Arthur Dubowicz).

    Medical Information on the Internet: A Tool for Measuring Consumer Perception of Quality Aspects

    Abstract:

    Background: Most of adult Internet users have searched for health information on the Internet. The Internet has become one of the most important sources for health information and treatment advice. In most cases, the information found is not verified with a medical doctor, but judged by the “online-diagnosers” independently. Facing this situation, public health authorities raise concern over the quality of medical information laypersons can find on the Internet. Objective: The objective of the study was aimed at developing a measure to evaluate the credibility of websites that offer medical advice and information. The measure was tested in a quasi-experimental study on two sleeping-disorder websites of different quality. Methods: There were 45 survey items for rating the credibility of websites that were tested in a quasi-experimental study with a random assignment of 454 participants to either a high- or a low-quality website exposure. Using principal component analysis, the original items were reduced to 13 and sorted into the factors: trustworthiness, textual deficits of the content, interferences (external links on the Web site), and advertisements. The first two factors focus more on the provided content itself, while the other two describe the embedding of the content into the website. The 45 survey items had been designed previously using exploratory observations and literature research. Results: The final scale showed adequate power and reliability for all factors. The loadings of the principal component analysis ranged satisfactorily (.644 to .854). Significant differences at P<.001 were found between the low- and high-quality groups. Advertisements on the website were rated as disturbing in both experimental conditions, meaning that they do not differentiate between good and bad information. Conclusions: The scale reliably distinguished high- and low-quality of medical advice given on websites.

  • Copyright of Austin Health Urology http://austinurology.com.au/index.html.

    Patients' Perspectives of Accessibility and Digital Delivery of Factual Content Provided by Official Medical and Surgical Specialty Society Websites: A...

    Abstract:

    Background: Health care websites provide a valuable resource of health information to online consumers, especially patients. Official surgical and medical society websites should be a reliable first point of contact. Objective: The primary aim of this study was to quantitatively assess medical and surgical society websites for content and highlight the essential features required for a high-quality, user-friendly society website. Methods: Twenty specialty association websites from each of the regions, Australia, UK, Canada, Europe, and the USA were selected for a total of 100 websites. Medical and surgical specialities were consistent across each region. Each website was systematically and critically analysed for content and usability. Results: The average points scored per website was 3.2 out of 10. Of the total (N=100) websites, 12 scored at least 7 out of 10 points and 2 scored 9 out of 10. As well, 35% (35.0/100) of the websites had an information tab for patients on their respective homepages while 38% (38.0/100) had download access to patient information. A minority of the websites included different forms of multimedia such as pictures and diagrams (24.0/100, 24%) and videos (18.0/100, 18%). Conclusions: We found that most society websites did not meet an adequate standard for delivery of information. Half of the websites were not patient accessible, with the primary focus being for health professionals. As well, most required logins for information access. Specialty health care societies should create patient-friendly websites that would be beneficial to all online consumers.

  • Image courtesy of [ambro] at FreeDigitalPhotos.net.

    Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey

    Abstract:

    Background: Self-management education for cardiopulmonary diseases is primarily provided through time-limited, face-to-face programs, with access limited to a small percentage of patients. Telecommunication tools will increasingly be an important component of future health care delivery. Objective: The purpose of this study was to describe the patterns of technology use in patients attending a cardiopulmonary clinic in an academic medical center. Methods: A prevalence survey was developed to collect data on participant demographics (age in years, sex, and socioeconomic status); access to computers, Internet, and mobile phones; and use of current online health support sites or programs. Surveys were offered by reception staff to all patients attending the outpatient clinic. Results: A total of 123 surveys were collected between March and April 2014. Technological devices were a pervasive part of everyday life with respondents engaged in regular computer (102/123, 82.9%), mobile telephone (115/117, 98.3%), and Internet (104/121, 86.0%) use. Emailing (101/121, 83.4%), researching and reading news articles (93/121, 76.9%), social media (71/121, 58.7%), and day-to-day activities (65/121, 53.7%) were the most common telecommunication activities. The majority of respondents reported that access to health support programs and assistance through the Internet (82/111, 73.9%) would be of use, with benefits reported as better understanding of health information (16/111, 22.5%), avoidance of difficult travel requirements and time-consuming face-to-face appointments (13/111, 18.3%), convenient and easily accessible help and information (12/111, 16.9%), and access to peer support and sharing (9/111, 12.7%). The majority of patients did not have concerns over participating in the online environment (87/111, 78.4%); the few concerns noted related to privacy and security (10/15), information accuracy (2/15), and computer literacy and access (2/15). Conclusions: Chronic disease burden and long-term self-management tasks provide a compelling argument for accessible and convenient avenues to obtaining ongoing treatment and peer support. Online access to health support programs and assistance was reported as useful and perceived as providing convenient, timely, and easily accessible health support and information. Distance from the health care facility and a lack of information provision through traditional health sources were both barriers and enablers to telehealth. This is particularly important in the context of a cardiopulmonary clinic that attracts patients from a large geographical area, and in patients who are most likely to have high health care utilization needs in the future. Telecommunication interfaces will be an increasingly important adjunct to traditional forms of health care delivery.

  • This image is from the public domain (http://pixabay.com/en/tablets-pills-medicine-disease-193666/).

    Preferred Features of Oral Treatments and Predictors of Non-Adherence: Two Web-Based Choice Experiments in Multiple Sclerosis Patients

    Abstract:

    Background: Oral disease modifying therapies (DMTs) for multiple sclerosis (MS) differ in efficacy, tolerability, and safety. Objective: We sought to understand how these attributes impact patient preference and predicted DMT non-adherence among oral-naïve MS patients. Methods: Adult MS patients from the “PatientsLikeMe” Web-based health data-sharing platform completed a discrete choice exercise where they were asked to express their preference for one of three hypothetical oral DMTs, each with a certain combination of levels of tested attributes. Another Web-based exercise tested a number of possible drivers of non-adherence, mainly side effects. Data from an MS clinic were used to adjust for sample bias. Respondents’ preferences were analyzed using Hierarchical Bayesian estimation. Results: A total of 319 patients completed all questions. Most respondents were female (77.7%, 248/319) with mean age 48 years (SD 10). Liver toxicity was the attribute that emerged as the most important driver of patient preference (25.8%, relative importance out of 100%), followed by severe side effects (15.3%), delay to disability progression (10.7%), and common side effects (10.4%). The most important drivers of predicted non-adherence were frequency of daily dosing (17.4% out of 100%), hair thinning (14.8%), use during pregnancy (14.1%), severe side effects (13.8%), and diarrhea (13.0%). Conclusions: Understanding the important concerns expressed by patients may help health care providers to understand and educate their patients more completely about these concerns. This knowledge may therefore improve both choices of appropriate therapy and adherence to therapy over time.

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  • Accuracy, validity and reliability of an electronic visual analogue scale for pain on a touch screen tablet in healthy older adults

    Date Submitted: Jul 7, 2015

    Open Peer Review Period: Jul 11, 2015 - Sep 5, 2015

    New technology for clinical data collection is rapidly evolving and may be useful for both researchers and clinicians however this new technology has not been tested for accuracy, reliability or valid...

    New technology for clinical data collection is rapidly evolving and may be useful for both researchers and clinicians however this new technology has not been tested for accuracy, reliability or validity. This study aim to test the accuracy of visual analogue scales (VAS) for pain on a newly designed application on the iPad (iPadVAS), measure the reliability and validity of iPadVAS compared to a paper copy (paperVAS). Accuracy was determined by physically measuring iPad scale on screen and comparing it to the results from the programme, with one researcher collecting 101 data points. Twenty-two healthy community dwelling older adults were then recruited to test reliability and validity. Each participant completed eight VAS (four using each tool) in a randomised order. Reliability was measured using interclass coefficient, and validity measured using Bland-Altman graphs and correlations. Accuracy; 64 results were identical, 2 results were manually measured as being 1mm higher than the program and 35 as 1mm lower. Reliability for the iPadVAS was excellent with individual (ICC, 95%CI; 0.90, 0.82 to 0.95) and averaged (0.97, 0.95 to 1.0). Linear regression demonstrated a strong relationship, with a small negative bias towards the iPad (-2.6±5.0) with limits of agreement from -12.4 to 7.1. Accuracy and reliability of the iPad VAS is excellent. Validity shows a small bias that is not clinically relevant. The iPadVAS provides a convenient, user-friendly and efficient way of collecting data from participants in measuring their current pain levels. It has potential use in documentation management and may encourage participatory healthcare.

  • Baclofen treatment of bulimia nervosa and binge eating disorder: an Internet survey

    Date Submitted: Jun 19, 2015

    Open Peer Review Period: Jun 23, 2015 - Aug 18, 2015

    Background: Bulimia nervosa (BN) and binge eating disorder (BED) are conditions difficult to treat and for which there are very few approved treatments. Objective: Some preclinical and clinical studie...

    Background: Bulimia nervosa (BN) and binge eating disorder (BED) are conditions difficult to treat and for which there are very few approved treatments. Objective: Some preclinical and clinical studies have shown baclofen to be effective in BED, but these effects must be confirmed, and baclofen effectiveness investigated in other forms of eating disorders, such as BN. Methods: The present study is an Internet survey targeting the use of baclofen for the treatment of BN and BED. Survey questions were released on the “Baclofène” Internet site in December 2014. These questions relate to baclofen effectiveness in both disorders, doses used, step-by-step treatment increase, adverse effects, and, more generally, attempt to evaluate the impact of baclofen treatment on quality of life. Results: Eighty-one individuals responded (35 with BN, 46 with BED); 49% of BN and 30% of BED subjects reported total recovery on baclofen, while 29% of BN and 48% of BED reported some improvement. BN subjects were significantly younger and required significantly higher doses of baclofen than those with BED. Individual effective doses were highly variable (40-430mg/d), the average maximal dose used was 170mg/d. There were no correlations between the maximal baclofen dose and the intensity of adverse effects, quality of life, and recovery. Conclusions: The results of this survey confirm the effectiveness of baclofen in the treatment of BED and suggest its potential interest in BN. Controlled studies using high-dose baclofen are needed.