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Interactive Journal of Medical Research

A new general medical journal for the 21st centrury, 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, 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).


Recent Articles:

  • LUMOback tracker. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Usage, Acceptability, and Effectiveness of an Activity Tracker in a Randomized Trial of a Workplace Sitting Intervention: Mixed-Methods Evaluation


    Background: Wearable activity trackers are now a common feature of workplace wellness programs; however, their ability to impact sitting time (the behavior in which most of the desk-based workday is spent) is relatively unknown. This study evaluated the LUMOback, an activity tracker that targets sitting time, as part of a cluster-randomized workplace sitting intervention in desk-based office workers. Objective: Study objectives were to explore: (1) office workers’ self-directed LUMOback use, (2) individual-level characteristics associated with LUMOback use, (3) the impact of LUMOback use on activity and sitting behaviors, and (4) office workers’ perceived LUMOback acceptability. Methods: Exploratory analyses were conducted within the activity tracker intervention group (n=66) of a 2-arm cluster-randomized trial (n=153) with follow-up at 3 and 12 months. The intervention, delivered from within the workplace, consisted of organizational support strategies (eg, manager support, emails) to stand up, sit less, and move more, plus the provision of a LUMOback activity tracker. The LUMOback, worn belted around the waist, provides real-time sitting feedback through a mobile app. LUMOback usage data (n=62), Web-based questionnaires (n=33), activPAL-assessed sitting, prolonged (≥30 min bouts) and nonprolonged (<30 min bouts) sitting, standing and stepping time (7-day, 24 h/day protocol; n=40), and telephone interviews (n=27) were used to evaluate study aims. LUMOback usage data were downloaded and described. Associations between user characteristics and LUMOback usage (in the first 3 months) were analyzed using zero-inflated negative binomial models. Associations between LUMOback usage and 3-month activity outcomes were analyzed using mixed models, correcting for cluster. LUMOback acceptability was explored using 3-month questionnaire data and thematic analysis of telephone interviews (conducted 6 to 10 months post intervention commencement). Results: Tracker uptake was modest (43/61, 70%), and among users, usage over the first 3 months was low (1-48 days, median 8). Usage was greatest among team leaders and those with low self-perceived scores for job control and supervisor relationships. Greater tracker use (≥5 days vs <5 days) was significantly associated only with changes in prolonged unbroken sitting (−50.7 min/16 h; 95% CI −94.0 to −7.3; P=.02) during all waking hours, and changes in nonprolonged sitting (+32.5 min/10 h; 95% CI 5.0 to 59.9; P=.02) during work hours. Participants found the LUMOback easy to use but only somewhat comfortable. Qualitatively, participants valued the real-time app feedback. Nonuptake was attributed to being busy and setup issues. Low usage was attributed to discomfort wearing the LUMOback. Conclusions: The LUMOback—although able to reduce prolonged sitting time—was only used to a limited extent, and its low usage may provide a partial explanation for the limited behavior changes that occurred. Discomfort limited the feasibility of the LUMOback for ongoing use. Such findings yield insight into how to improve upon implementing activity trackers in workplace settings.

  • Source: Pixabay; Copyright: Angelo Esslinger; URL:; License: Public Domain (CC0).

    The Patient Perspective on the Impact of Tenosynovial Giant Cell Tumors on Daily Living: Crowdsourcing Study on Physical Function and Quality of Life


    Background: Tenosynovial giant cell tumor (TGCT) is a rare, benign lesion affecting the synovial lining of joints, bursae, and tendon sheaths. It is generally characterized as a locally aggressive and often recurring tumor. A distinction is made between localized- and diffuse-type. The impact of TGCT on daily living is currently ill-described. Objective: The aim of this crowdsourcing study was to evaluate the impact of TGCT on physical function, daily activities, societal participation (work, sports, and hobbies), and overall quality of life from a patient perspective. The secondary aim was to define risk factors for deteriorated outcome in TGCT. Methods: Members of the largest known TGCT Facebook community, PVNS is Pants!!, were invited to an e-survey, partially consisting of validated questionnaires, for 6 months. To confirm disease presence and TGCT-type, patients were requested to share histological or radiological proof of TGCT. Unpaired t tests and chi-square tests were used to compare groups with and without proof and to define risk factors for deteriorated outcome. Results: Three hundred thirty-seven questionnaires, originating from 30 countries, were completed. Median age at diagnosis was 33 (interquartile range [IQR]=25-42) years, majority was female (79.8% [269/337]), diffuse TGCT (70.3% [237/337]), and affected lower extremities (knee 70.9% [239/337] and hip 9.5% [32/337]). In 299 lower-extremity TGCT patients (32.4% [97/299]) with disease confirmation, recurrence rate was 36% and 69.5% in localized and diffuse type, respectively. For both types, pain and swelling decreased after treatment; in contrast, stiffness and range of motion worsened. Patients were limited in their employment (localized 13% [8/61]; diffuse 11.0% [21/191]) and sport-activities (localized 58% [40/69]; diffuse 63.9% [147/230]). Compared with general US population, all patients showed lower Patient-Reported Outcomes Measurements Information System-Physical Function (PROMIS-PF), Short Form-12 (SF-12), and EuroQoL 5 Dimensions 5 Levels (EQ5D-5L) scores, considered clinically relevant, according to estimated minimal important difference (MID). Diffuse versus localized type scored almost 0.5 standard deviation lower for PROMIS-PF (P<.001) and demonstrated a utility score of 5% lower for EQ-5D-5L (P=.03). In localized TGCT, recurrent disease and ≥2 surgeries negatively influenced scores of Visual Analog Scale (VAS)-pain/stiffness, SF-12, and EQ-5D-5L (P<.05). In diffuse type, recurrence resulted in lower score for VAS, PROMIS-PF, SF-12, and EQ-5D-5L (P<.05). In both types, patients with treatment ≤1year had significantly lower SF-12. Conclusions: TGCT has a major impact on daily living in a relatively young and working population. Patients with diffuse type, recurrent disease, and ≥2 surgeries represent lowest functional and quality of life outcomes. Physicians should be aware that TGCT patients frequently continue to experience declined health-related quality of life and physical function and often remain limited in daily life, even after treatment(s).

  • Source: Pexels; Copyright: Startup Stock Photos; URL:; License: Public Domain (CC0).

    Engaging a Community for Rare Genetic Disease: Best Practices and Education From Individual Crowdfunding Campaigns


    Background: Genetic sequencing is critically important to diagnostic health care efforts in the United States today, yet it is still inaccessible to many. Meanwhile, the internet and social networking have made crowdfunding a realistic avenue for individuals and groups hoping to fund medical and research causes, including patients in need of whole exome genetic sequencing (WES). Objective: Amplify Hope is an educational program designed to investigate what factors affect the success of medical crowdfunding campaigns. We conducted a needs assessment, a series of 25 interviews concerning crowdfunding, and provided training on best practices identified through our assessment for 11 individuals hoping to run their medical crowdfunding campaigns to raise money for patients to access trio WES to identify the mutated proteins that caused their apparent inherited disease. Methods: The crowdfunding education was given in a 30-day training period with resources such as webinars, fact sheets and a crowdfunding training guide emailed to each participant. All campaigns were launched on the same date and were given 30 days to raise the same goal amount of US $5000. Reviewing the 4 crowdfunding campaigns that raised the goal amount within the 30-day period, we sought to identify features that made the 4 crowdfunding campaigns successful. In addition, we sought to assess which factors the resulting 75 donors report as influencing their decision to donate to a campaign. Finally, we investigated whether crowdfunding campaigns for exome sequencing had an impact on increasing applicant’s and donors’ knowledge of genomics. Results: Of the 86 study inquiries, 11 participants submitted the required forms and launched their crowdfunding campaigns. A total of 4 of the 11 campaigns raised their goal amounts within 30 days. Conclusions: We found that social media played an important role in all campaigns. Specifically, a strong social media network, an active outreach process to networks, as well as engagement within the study all correlated with a higher success rate. Amplify Hope donors were more likely to support projects that were near their fundraising goals, and they found video far more effective for learning about genomics than any other medium.

  • Source: Pixabay; Copyright: rebcenter-moscow; URL:; License: Public Domain (CC0).

    A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments


    Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years. Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results: A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes.

  • Source: Pixabay; Copyright: SD5432SD; URL:; License: Public Domain (CC0).

    How, When and Why People Seek Health Information Online: Qualitative Study in Hong Kong


    Background: The Internet has become an established source for health information. The number of individuals using the Internet to search for health information, ranging from healthy lifestyle advice to treatment and diseases, continues to grow. Scholars have emphasized the need to give greater voice and influence to health consumers. Hong Kong, being one of the most technologically advanced and connected cities in the world, has one of the highest Internet penetration rates in the world. Given the dearth of research in an Asian context, Hong Kong is an excellent platform to study individuals’ perceptions (eg, benefits and limitations on seeking health information online and how the information is used) on health information seeking. Objective: The aim of this paper was to study individuals’ perceptions on health information seeking and to document their Internet information–seeking behaviors. Methods: Five focus groups (n=49) were conducted from November 2015 to January 2016 with individuals across different age groups (18 years or above). Focus group contents were audiotaped, transcribed, and analyzed using thematic analysis techniques. Results: Older (55+ years) and less educated respondents were less likely to use the Internet to search for health information. Among individuals who obtained health information via the Internet, regardless of the severity of the health issue, the Internet was always the first source for information. Limited doctor consultation time and barriers to accessing professional health services were the main reasons for using the Internet. Convenience and coverage were regarded as the main advantages, whereas credibility and trustworthiness of health information were noted as limitations. The use of Web-based health information varied among individuals; hence, the implications on the doctor-patient relationship were mixed. Conclusions: The prevalent and increasing use of the Internet for health information seeking suggests the need for health care professionals to understand how it can be optimally utilized to improve health outcomes. Strategies for communicating and disseminating credible health information in a form that users can understand and use are essential. Due to the rapid technological and related behavioral changes, online health information seeking and its effects need to be closely monitored.

  • Source: Pixabay; Copyright: Michal Jarmoluk; URL:; License: Public Domain (CC0).

    Shaping an Effective Health Information Website on Rare Diseases Using a Group Decision-Making Tool: Inclusion of the Perspectives of Patients, Their Family...


    Background: Despite diverging definitions on rare conditions, people suffering from rare diseases share similar difficulties. A lack of experience by health professionals, a long wait from first symptoms to diagnosis, scarce medical and scientific knowledge, and unsatisfactory treatment options all trigger the search for health information by patients, family members, and physicians. Examining and systematically integrating stakeholder needs can help design information platforms that effectively support this search. Objective: The aim of this study was to innovate on the group decision-making process involving patients, family members, and physicians for the establishment of a national rare disease Internet platform. We determined differences in the relevance of health information—especially examining quantifiable preference weights—between these subgroups and elucidated the structure and distribution of these differences in people suffering from rare diseases, their family members, and physicians, thus providing information crucial to their collaboration. Methods: The included items were identified using a systematic Internet research and verified through a qualitative interview study. The identified major information needs included medical issues, research, social help offers, and current events. These categories further comprised sublevels of diagnosis, therapy, general disease pattern, current studies, study results, registers, psychosocial counseling, self-help, and sociolegal advice. The analytic hierarchy process was selected as the group decision-making tool. A sensitivity analysis was used to determine the stability and distribution of results. t tests were utilized to examine the results’ significance. Results: A total of 176 questionnaires were collected; we excluded some questionnaires in line with our chosen consistency level of 0.2. Ultimately, 120 patients, 24 family members, and 32 physicians participated in the study (48 men and 128 women, mean age=48 years, age range=17-87 years). Rankings and preference weights were highly heterogeneous. Global ranking positions of patients, family members, and physicians are shown in parentheses, as follows: medical issues (3/4, 4, 4), research (3/4, 2/3, 3), social help offers (1, 2/3, 2), and current events (2, 1, 1); diagnosis (6, 8, 9), therapy (5, 9, 7), general disease pattern (9, 4/5/6, 6), current studies (7, 4/5/6, 3), study results (8, 7, 8), registers (4, 1, 5), psychosocial counseling (1, 2, 4), self-help (3, 3, 2), and sociolegal advice (2, 4/5/6, 1). Differences were verified for patients for 5 information categories (P=.03), physicians for 6 information categories (P=.03), and family members for 4 information categories (P=.04). Conclusions: Our results offer a clear-cut information structure that can transparently translate group decisions into practice. Furthermore, we found different preference structures for rare disease information among patients, family members, and physicians. Some websites already address differences in comprehension between those subgroups. Similar to pharmaceutical companies, health information providers on rare diseases should also acknowledge different information needs to improve the accessibility of information.

  • Physician listening to baby's heart. Source: Flickr; Copyright: Thomas Lillis IV; URL:; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).

    “A Phenomenal Person and Doctor”: Thank You Letters to Medical Care Providers


    Background: Thank you letters to physicians and medical facilities are an untapped resource, providing an invaluable glimpse into what patients notice and appreciate in their care. Objective: The aim of this study was to analyze such thank you letters as posted on the Web by medical institutions to find what patients and families consider to be good care. In an age of patient-centered care, it is pivotal to see what metrics patients and families apply when assessing their care and whether they grasp specific versus general qualities in their care. Methods: Our exploratory inquiry covered 100 thank you letters posted on the Web by 26 medical facilities in the United States and the United Kingdom. We systematically coded and descriptively presented the aspects of care that patients and their families thanked doctors and medical facilities for. We relied on previous work outlining patient priorities and satisfaction (Anderson et al, 2007), to which we added a distinction between global and specific evaluations for each of the already existing categories with two additional categories: general praise and other, and several subcategories, such as treatment outcome, to the category of medical care. Results: In 73% of the letters (73/100), physicians were primarily thanked for their medical treatment. In 71% (71/100) of the letters, they were thanked for their personality and demeanor. In 52% cases (52/100), these two aspects were mentioned together, suggesting that from the perspective of patient as well as the family member, both are deemed necessary in positive evaluation of medical care. Only 8% (8/100) of the letters lacked reference to medical care, personality or demeanor, or communication. No statistically significant differences were observed in the number of letters that expressed gratitude for the personality or demeanor of medical care providers versus the quality of medical care (χ21, N=200=0.1, not statistically significant). Letters tended to express more specific praise for personality or demeanor, such as being supportive, understanding, humane and caring (48/71, 68%) but more general praise for medical care (χ21, N=424=63.9, P<.01). The most often mentioned specific quality of medical care were treatment outcomes (30/73, 41%), followed by technical competence (15/73, 21%) and treatment approach (14/73, 19%). A limitation of this inquiry is that we analyzed the letters that medical centers chose to post on the Web. These are not necessarily a representative sample of all thank you letters as are sent to health care institutions but are still indicative of what centers choose to showcase on the Web. Conclusions: Physician demeanor and quality of interaction with patients are pivotal in how laymen perceive good care, no less so than medical care per se. This inquiry can inform care providers and medical curricula, leading to an improvement in the perceived quality of care.

  • Source:; Copyright: Ambro; URL:; License: Licensed by the authors.

    Willingness to Pay for Elderly Telecare Service Using the Internet and Digital Terrestrial Broadcasting


    Background: In Japan over the past few years, more attention has been focused on unnoticed solitary death in the context of an aging society and the trend toward nuclear family. A number of institutions and companies have implemented a prevention measure with digital terrestrial broadcasting telecare services for the elderly: Hokkaido University; TV-Asahi Corporation; Hitachi, Ltd; Iwamizawa City; Hokkaido Television Broadcasting Co, Ltd; and Hamanasu Information Co, Ltd. Although this system is provided free of charge as a demonstration test, determining the appropriate price for the service is required for its sustainable operation. Objective: The aim of this study was to quantify individual willingness to pay (WTP) so as to test the tenability of digital terrestrial broadcasting service for elderly telecare. Methods: We used the contingent valuation method (CVM) to estimate the WTP for this service among 305 citizens (valid response rate 76.0%) living in Japan. A questionnaire survey was conducted for people aged 18 to 100 years according to Japanese age distribution from September 2016. To elicit WTP, we adopted a double-bound dichotomous choice method to ask the respondents whether they agree or disagree with the price we offered. Results: The median WTP for this service’s monthly fee is estimated to be 431 JPY (approximately US $3.7). The finding suggests that gender (0.66, P=.01), health consciousness (1.08, P=.01), willingness to use (2.38, P<.001), and seeing others less than once a week (1.00, P=.06) made a positive effect on WTP. Conclusions: We conclude that reliable WTP was elicited by CVM based on an Internet survey. Calculated median WTP for digital terrestrial broadcasting service for elderly telecare was 431 JPY (approximately US $3.7). In the analysis of factors that affect WTP, constant factors, log-bid, health consciousness, gender, see others less than one time for week, and willingness to use made positive effect to probability of acceptance. In comparison of WTP in different groups, age groups showed that WTP of the elderly group was higher than WTP of the middle age group and younger age group. However, WTP surveys need to be carefully conducted to minimize the sampling bias and allocate accurate structure of gender distribution.

  • An infant in a neonatal intensive care unit. Source: Wikimedia Commons; Copyright: Jacoplane; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    A Strategy to Reduce Critical Cardiorespiratory Alarms due to Intermittent Enteral Feeding of Preterm Neonates in Intensive Care


    Background: Many preterm infants require enteral feeding as they cannot coordinate sucking, swallowing, and breathing. In enteral feeding, milk feeds are delivered through a small feeding tube passed via the nose or mouth into the stomach. Intermittent milk feeds may either be administered using a syringe to gently push milk into the infant’s stomach (push feed) or milk can be poured into a syringe attached to the tube and allowed to drip in by gravity (gravity feed). This practice of enteral feeding is common in neonatal intensive care units. There is, however, no evidence in the literature to recommend the use of one method of feeding over the other. Objective: The aim of this study was to investigate which of the two methods of feeding is physiologically better tolerated by infants, as measured by the incidence of critical cardiorespiratory alarms during and immediately after feeding. Methods: We conducted a prospectively designed observational study with records of all feeding episodes in infants of gestational age less than 30 weeks at birth and with a minimum enteral intake of 100 mL/kg/day. In total, 2140 enteral feeding episodes were noted from 25 infants over 308 infant-days with records for several characteristics of the infants (eg, gestational age), feeding (eg, the position of infants), and of nursing-care events before feeding (eg, diapering). Logistic regression with mixed effects was used to model cardiorespiratory alarms for the push and gravity methods of feeding. Results: After adjustments were made for all confounding variables, the position of infants was found to be statistically significant in changing the outcome of critical alarms for the two methods of feeding (P=.02). For infants in the lateral position, push feeds led to 40% more instances of one or more critical cardiorespiratory alarms in comparison with the gravity method. Both methods of feeding created a statistically comparable number of alarms for infants in the prone position. Conclusions: This study provides objective data that may assist in optimizing enteral feeding protocols for premature infants. The incidence of critical cardiorespiratory alarms for infants in the lateral position can be lowered by the use of gravity instead of push feeding. No differences were observed between the two types of feeding when infants were in the prone position.

  • Alzheimer's disease on YouTube (montage). Source: YouTube /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Alzheimer’s Disease in Social Media: Content Analysis of YouTube Videos


    Background: Approximately 5.5 million Americans are living with Alzheimer’s disease (AD) in 2017. YouTube is a popular platform for disseminating health information; however, little is known about messages specifically regarding AD that are being communicated through YouTube. Objective: This study aims to examine video characteristics, content, speaker characteristics, and mobilizing information (cues to action) of YouTube videos focused on AD. Methods: Videos uploaded to YouTube from 2013 to 2015 were searched with the term “Alzheimer’s disease” on April 30th, 2016. Two coders viewed the videos and coded video characteristics (the date when a video was posted, Uniform Resource Locator, video length, audience engagement, format, author), content, speaker characteristics (sex, race, age), and mobilizing information. Descriptive statistics were used to examine video characteristics, content, audience engagement (number of views), speaker appearances in the video, and mobilizing information. Associations between variables were examined using Chi-square and Fisher’s exact tests. Results: Among the 271 videos retrieved, 25.5% (69/271) were posted by nonprofit organizations or universities. Informal presentations comprised 25.8% (70/271) of all videos. Although AD symptoms (83/271, 30.6%), causes of AD (80/271, 29.5%), and treatment (76/271, 28.0%) were commonly addressed, quality of life of people with AD (34/271, 12.5%) had more views than those more commonly-covered content areas. Most videos featured white speakers (168/187, 89.8%) who were adults aged 20 years to their early 60s (164/187, 87.7%). Only 36.9% (100/271) of videos included mobilizing information. Videos about AD symptoms were significantly less likely to include mobilizing information compared to videos without AD symptoms (23/83, 27.7% vs 77/188, 41.0% respectively; P=.03). Conclusions: This study contributes new knowledge regarding AD messages delivered through YouTube. Findings of the current study highlight a potential gap between available information and viewers’ interests. YouTube videos on AD could be beneficial if the messages delivered meet users’ needs and provide mobilizing information for further resources. Study findings will be useful to government agencies, researchers, nonprofit organizations that promote information about AD, and those responsible for social media to provide useful and accurate health information for the public.

  • Source: Shutterstock; Copyright: Ditty_about_summer; URL:; License: Licensed by JMIR.

    Internet Usage by Parents Prior to Seeking Care at a Pediatric Emergency Department: Observational Study


    Background: Little is known about how parents utilize medical information on the Internet prior to an emergency department (ED) visit. Objective: The objective of the study was to determine the proportion of parents who accessed the Internet for medical information related to their child’s illness in the 24 hours prior to an ED visit (IPED), to identify the websites used, and to understand how the content contributed to the decision to visit the ED. Methods: A 40-question interview was conducted with parents presenting to an ED within a freestanding children’s hospital. If parents reported IPED, the number and names of websites were documented. Parents indicated the helpfulness of Web-based content using a 100-mm visual analog scale and the degree to which it contributed to the decision to visit the ED using 5-point Likert-type responses. Results: About 11.8 % (31/262) reported IPED (95% CI 7.3-5.3). Parents who reported IPED were more likely to have at least some college education (P=.04), higher annual household income (P=.001), and older children (P=.04) than those who did not report IPED. About 35% (11/31) could not name any websites used. Mean level of helpfulness of Web-based content was 62 mm (standard deviation, SD=25 mm). After Internet use, some parents (29%, 9/31) were more certain they needed to visit the ED, whereas 19% (6/31) were less certain. A majority (87%, 195/224) of parents who used the Internet stated that they would be somewhat likely or very likely to visit a website recommended by a physician. Conclusions: Nearly 1 out of 8 parents presenting to an urban pediatric ED reported using the Internet in the 24 hours prior to the ED visit. Among privately insured, at least one in 5 parents reported using the Internet prior to visiting the ED. Web-based medical information often influences decision making regarding ED utilization. Pediatric providers should provide parents with recommendations for high-quality sources of health information available on the Internet.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Social Media and Multiple Sclerosis in the Posttruth Age


    Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is really important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease, but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. This is why a professional approach is imperative in this posttruth age, in order to maintain confidentiality, honesty, and trust in the medical profession.

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  • Using neural networks with routine health records to identify suicide risk

    Date Submitted: Feb 15, 2018

    Open Peer Review Period: Feb 15, 2018 - Apr 12, 2018

    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.

  • Patient-reported outcome of physical therapy in amyotrophic lateral sclerosis: an observational online study

    Date Submitted: Feb 12, 2018

    Open Peer Review Period: Feb 12, 2018 - Apr 9, 2018

    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.