bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study (Preprint)
Authors: Lau Annie YS , Piper Kalman , Bokor Desmond , Martin Paige , Lau Victor SL , Coiera Enrico
Published: July 2018

BACKGROUND

Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings.

OBJECTIVE

The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting.

METHODS

A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care.

RESULTS

Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation.

CONCLUSIONS

Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians.
A Wearable Sensor-Based Exercise Biofeedback System: Mixed Methods Evaluation of Formulift (Preprint)
Authors: O'Reilly Martin Aidan , Slevin Patrick , Ward Tomas , Caulfield Brian
Published: July 2018

BACKGROUND

Formulift is a newly developed mobile health (mHealth) app that connects to a single inertial measurement unit (IMU) worn on the left thigh. The IMU captures users’ movements as they exercise, and the app analyzes the data to count repetitions in real time and classify users’ exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively.

OBJECTIVE

The aim of this study was to assess the Formulift system with three different and realistic types of potential users (beginner gym-goers, experienced gym-goers, and qualified strength and conditioning [S&C] coaches) under a number of categories: (1) usability, (2) functionality, (3) the perceived impact of the system, and (4) the subjective quality of the system. It was also desired to discover suggestions for future improvements to the system.

METHODS

A total of 15 healthy volunteers participated (12 males; 3 females; age: 23.8 years [SD 1.80]; height: 1.79 m [SD 0.07], body mass: 78.4 kg [SD 9.6]). Five participants were beginner gym-goers, 5 were experienced gym-goers, and 5 were qualified and practicing S&C coaches. IMU data were first collected from each participant to create individualized exercise classifiers for them. They then completed a number of nonexercise-related tasks with the app. Following this, a workout was completed using the system, involving squats, deadlifts, lunges, and single-leg squats. Participants were then interviewed about their user experience and completed the System Usability Scale (SUS) and the user version of the Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts, and survey results were analyzed.

RESULTS

Qualitative and quantitative analysis found the system has “good” to “excellent” usability. The system achieved a mean (SD) SUS usability score of 79.2 (8.8). Functionality was also deemed to be good, with many users reporting positively on the systems repetition counting, technique classification, and feedback. A number of bugs were found, and other suggested changes to the system were also made. The overall subjective quality of the app was good, with a median star rating of 4 out of 5 (interquartile range, IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them, and help them avoid injury.

CONCLUSIONS

This study demonstrated an overall positive evaluation of Formulift in the categories of usability, functionality, perceived impact, and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor-based exercise biofeedback systems.
The Perceived Benefits of an Artificial Intelligence–Embedded Mobile App Implementing Evidence-Based Guidelines for the Self-Management of Chronic Neck and Back Pain: Observational Study (Preprint)
Authors: Lo Wai Leung Ambrose , Lei Di , Li Le , Huang Dong Feng , Tong Kin-Fai
Published: July 2018

BACKGROUND

Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technology has been suggested as an alternative way to increase adherence to exercise therapy, which may improve clinical outcomes.

OBJECTIVE

The aim was to investigate the self-perceived benefits of an artificial intelligence (AI)–embedded mobile app to self-manage chronic neck and back pain.

METHODS

A total of 161 participants responded to the invitation. The evaluation questionnaire included 14 questions that were intended to explore if using the AI rehabilitation system may (1) increase time spent on therapeutic exercise, (2) affect pain level (assessed by the 0-10 Numerical Pain Rating Scale), and (3) reduce the need for other interventions.

RESULTS

An increase in time spent on therapeutic exercise per day was observed. The median Numerical Pain Rating Scale scores were 6 (interquartile range [IQR] 5-8) before and 4 (IQR 3-6) after using the AI-embedded mobile app (95% CI 1.18-1.81). A 3-point reduction was reported by the participants who used the AI-embedded mobile app for more than 6 months. Reduction in the usage of other interventions while using the AI-embedded mobile app was also reported.

CONCLUSIONS

This study demonstrated the positive self-perceived beneficiary effect of using the AI-embedded mobile app to provide a personalized therapeutic exercise program. The positive results suggest that it at least warrants further study to investigate the physiological effect of the AI-embedded mobile app and how it compares with routine clinical care.
Unhappy Patients Are Not Alike: Content Analysis of the Negative Comments from China's Good Doctor Website (Preprint)
Authors: Zhang Wei , Deng Zhaohua , Hong Ziying , Evans Richard , Ma Jingdong , Zhang Hui
Published: July 2018

BACKGROUND

With the rise in popularity of Web 2.0 technologies, the sharing of patient experiences about physicians on online forums and medical websites has become a common practice. However, negative comments posted by patients are considered to be more influential by other patients and physicians than those that are satisfactory.

OBJECTIVE

The aim of this study was to analyze negative comments posted online about physicians and to identify possible solutions to improve patient satisfaction, as well as their relationship with physicians.

METHODS

A Java-based program was developed to collect patient comments on the Good Doctor website, one of the most popular online health communities in China. A total of 3012 negative comments concerning 1029 physicians (mean 2.93 [SD 4.14]) from 5 highly ranked hospitals in Beijing were extracted for content analysis. An initial coding framework was constructed with 2 research assistants involved in the codification.

RESULTS

Analysis, based on the collected 3012 negative comments, revealed that unhappy patients are not alike and that their complaints cover a wide range of issues experienced throughout the whole process of medical consultation. Among them, physicians in Obstetrics and Gynecology (606/3012, 20.12%; P=.001) and Internal Medicine (487/3012, 16.17%; P=.80) received the most negative comments. For negative comments per physician, Dermatology and Sexually Transmitted Diseases (mean 5.72, P<.001) and Andrology (mean 5, P=.02) ranked the highest. Complaints relating to insufficient medical consultation duration (577/3012, 19.16%), physician impatience (527/3012, 17.50%), and perceived poor therapeutic effect (370/3012, 12.28%) received the highest number of negative comments. Specific groups of people, such as those accompanying older patients or children, traveling patients, or very important person registrants, were shown to demonstrate little tolerance for poor medical service.

CONCLUSIONS

Analysis of online patient complaints provides an innovative approach to understand factors associated with patient dissatisfaction. The outcomes of this study could be of benefit to hospitals or physicians seeking to improve their delivery of patient-centered services. Patients are expected to be more understanding of overloaded physicians’ workloads, which are impacted by China’s stretched medical resources, as efforts are made to build more harmonious physician-patient relationships.
Medication Adherence and Technology-Based Interventions for Adolescents With Chronic Health Conditions: A Few Key Considerations (Preprint)
Authors: Badawy Sherif M , Thompson Alexis A , Kuhns Lisa M
Published: July 2018

UNSTRUCTURED

The number of children and adolescents with chronic health conditions (CHCs) has doubled over the past two decades. Medication adherence is a key component of disease management within these groups. Low adherence to prescribed medications is a known problem in adolescents with CHCs and is related to health outcomes, including quality of life, disease complications, and mortality. Adolescence is a critical time to create routines and health behaviors that optimize disease self-management and transition to adult care. The mounting interest in the development and use of mobile health tools provides novel opportunities to connect patients, particularly adolescents, with their providers outside of the clinic and to improve health outcomes. There is growing evidence to support the efficacy of technology-based approaches, in particular text-messaging and mobile apps, to improve adherence behavior in adolescents, although cost-effectiveness and long-term health benefits remain unclear. In this short viewpoint article, we review some important considerations for promoting medication adherence in adolescents with CHCs using technology-based approaches.
Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review (Preprint)
Authors: Carrazzone Oreste Lemos , Belloti João Carlos , Matsunaga Fabio Teruo , Mansur Nacime Salomão Barbachan , Matsumoto Marcelo Hide , Faloppa Flavio , Tamaoki Marcel Jun Sugawara
Published: July 2018

BACKGROUND

The treatment of supracondylar humerus fracture in children (SHFC) is associated with complications such as functional deficit, residual deformity, and iatrogenic neurological damage. The standard treatment is closed reduction and percutaneous Kirschner wire fixation with different configurations. Despite this fact, there is still no consensus on the most effective technique for the treatment of these fractures.

OBJECTIVE

The aim of this systematic review will be to evaluate the effect of surgical interventions on the treatment of Gartland type II and III SHFC by assessing function, complications, and error as primary outcomes. Clinical outcomes such as range of motion and pain and radiographic outcomes will also be judged.

METHODS

A systematic review of randomized controlled trials or quasi-randomized controlled trials evaluating the surgical treatment of SHFC will be carried out in the Cochrane Central Register of Controlled Trials, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and Excerpta Medica Database. The search will also occur at ongoing and recently completed clinical trials in selected databases. Data management and extraction will be performed using a data withdrawal form and by analyzing the following: study method characteristics, participant characteristics, intervention characteristics, results, methodological domains, and risk of bias. To assess the risk of bias of the included trials, the Cochrane Risk of Bias Tool will be used. Dichotomous outcome data will be analyzed as risk ratios, and continuous outcome data will be expressed as mean differences, both with 95% confidence intervals. Also, whenever possible, subgroup analysis, sensitivity analysis, and assessment of heterogeneity will be performed.

RESULTS

Following the publication of this protocol, searches will be run and included studies will be deeply analyzed. We hope to obtain final results in the next few months and have the final paper published by the end of 2018. This study was funded by a government-based noncommercial agency, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).

CONCLUSIONS

This study may provide surgical treatment effects evidence for SHFC. The results will assist clinical practice by demonstrating the effectiveness and potential complications of these interventions and might serve as a reference for future clinical trials on the topic.

CLINICALTRIAL

PROSPERO CRD42014009304; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=9304 (Archived by WebCite at http://www.webcitation.org/6usiDHzD7)
Artificial Intelligence Learning Semantics via External Resources for Classifying Diagnosis Codes in Discharge Notes (Preprint)
Authors: Lin Chin , Hsu Chia-Jung , Lou Yu-Sheng , Yeh Shih-Jen , Lee Chia-Cheng , Su Sui-Lung , Chen Hsiang-Cheng
Published: July 2018

BACKGROUND

Automated disease code classification using free-text medical information is important for public health surveillance. However, traditional natural language processing (NLP) pipelines are limited, so we propose a method combining word embedding with a convolutional neural network (CNN).

OBJECTIVE

Our objective was to compare the performance of traditional pipelines (NLP plus supervised machine learning models) with that of word embedding combined with a CNN in conducting a classification task identifying International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes in discharge notes.

METHODS

We used 2 classification methods: (1) extracting from discharge notes some features (terms, n-gram phrases, and SNOMED CT categories) that we used to train a set of supervised machine learning models (support vector machine, random forests, and gradient boosting machine), and (2) building a feature matrix, by a pretrained word embedding model, that we used to train a CNN. We used these methods to identify the chapter-level ICD-10-CM diagnosis codes in a set of discharge notes. We conducted the evaluation using 103,390 discharge notes covering patients hospitalized from June 1, 2015 to January 31, 2017 in the Tri-Service General Hospital in Taipei, Taiwan. We used the receiver operating characteristic curve as an evaluation measure, and calculated the area under the curve (AUC) and F-measure as the global measure of effectiveness.

RESULTS

In 5-fold cross-validation tests, our method had a higher testing accuracy (mean AUC 0.9696; mean F-measure 0.9086) than traditional NLP-based approaches (mean AUC range 0.8183-0.9571; mean F-measure range 0.5050-0.8739). A real-world simulation that split the training sample and the testing sample by date verified this result (mean AUC 0.9645; mean F-measure 0.9003 using the proposed method). Further analysis showed that the convolutional layers of the CNN effectively identified a large number of keywords and automatically extracted enough concepts to predict the diagnosis codes.

CONCLUSIONS

Word embedding combined with a CNN showed outstanding performance compared with traditional methods, needing very little data preprocessing. This shows that future studies will not be limited by incomplete dictionaries. A large amount of unstructured information from free-text medical writing will be extracted by automated approaches in the future, and we believe that the health care field is about to enter the age of big data.
Internet- and mobile-based general practice: Who are the suitable consultants? (Preprint)
Authors: Qiu Yan , Liu Ying , Ren Wen , Qiu Yunqing , Ren Jingjing
Published: July 2018

BACKGROUND

As a promising technology for the promotion of quality healthcare, mHealth is increasing in the world. To make full use of the advantages, an increase of internet hospitals established in China. However, there is no study of the service scope and patient satisfaction of the internet hospital yet.

OBJECTIVE

The aim of the study was to explore the features of outpatients in general practice clinic of the internet hospital in order to provide the references for general practitioners (GPs) who will work for online clinic.

METHODS

Data were collected from the internet hospital of the first affiliated hospital, Zhejiang University between February 2016 and February 2017. Patients logon the internet hospital with the computer or mobile phone. The information included patients’ characteristics and the information of diseases.

RESULTS

There were totally 715 visits. According to the system classification, the former five ones were musculoskeletal system (12.73%), the digestive system (11.33%), the reproductive system (9.23%), urinary tract (7.69%) and the endocrine system (6.58%). According to the management, 451 patients (63.08%) should visit the offline clinic, 181 patients (25.31%) had received medication or test appointment, 9 people (1.26%) should use emergency department, and 74 people (10.35%) need supportive counseling. All patients received the corresponding health education. According to the diagnosis, 563 patients (78.74%) are diagnosed, while 152 individuals (21.26%) are medically unexplained physical symptoms (MUPS).

CONCLUSIONS

Internet- and mobile-based online practice is feasible and convenient for patients with high satisfaction. Patients with chronic disease, health consultation and health education are suitable for internet hospital.
A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study (Preprint)
Authors: Gbadamosi Semiu Olatunde , Eze Chuka , Olawepo John Olajide , Iwelunmor Juliet , Sarpong Daniel F , Ogidi Amaka Grace , Patel Dina , Oko John Okpanachi , Onoka Chima , Ezeanolue Echezona Edozie
Published: July 2018

BACKGROUND

Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings.

OBJECTIVE

Here we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection.

METHODS

We engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security.

RESULTS

We successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity.

CONCLUSIONS

Our findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection.

CLINICALTRIAL

ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE)
Testing MD-Link, a Low-Cost Mobile Electrocardiography Monitoring Device, in Patients With Irregular Heartbeat: Protocol for a Cross-Sectional Study (Preprint)
Authors: Kilimo Precious J , Le Tai , Phan Ngoc T , Han Huy-Dung , Hoang Hoc T , Vu Nguyen C , Pham Nga TT , Cao Hung , Nguyen Cuong K
Published: July 2018

BACKGROUND

Having mobile devices that provide patients with the ability to record and monitor the electrical activity of their heart enhances patient self-care and the early detection of irregular heartbeat (cardiac arrhythmia), yet few such devices exist in Vietnam. Challenges exist for introducing mobile electrocardiography (ECG) monitoring devices in Vietnam, including patient accessibility and affordability. A low-cost mobile ECG monitoring device designed and developed in Vietnam, which allows patients to easily measure their heart’s electrical activity and navigate recordings, may be a solution.

OBJECTIVE

The aim of this project is to assess the usability of the MD-Link system, a newly developed mobile handheld 1-lead ECG device, in detecting patients with irregular heartbeat. We will compare its outputs to the standard printed outputs of a 12-lead electrocardiogram generated by the Nihon Kohden Cardiofax S Electrocardiograph Model ECG-1250K.

METHODS

We will conduct a cross-sectional study in two stages, including the measurement of ECG signals of patients using the MD-Link and the Nihon Kohden Cardiofax S and analysis of the selected standard outputs collected from the ECG recordings of the MD-Link and the Nihon Kohden Cardiofax S. The MD-Link consists of (1) a mobile device (eg, a smartphone); (2) a lead wire with 2 disposable electrodes; and (3) an easy-to-use mobile app interface enabling the upload and accurate display of ECG recordings to patients and their clinicians. Our research team, consisting of members from Dartmouth College; the Institute of Health, Population and Development; Hanoi University of Science and Technology; and physicians and nurses from Thanh Chan Clinic, will assist in carrying out this project.

RESULTS

We will proceed with a publication plan that includes a project report and, ultimately, articles for peer-reviewed journals. We also hope to disseminate our work at relevant conferences to provide more coverage and exposure to the MD-Link mobile device. Recruitment and data collection were completed in January 2018. Data analysis started in February 2018 and is ongoing. Results are expected mid-2019.

CONCLUSIONS

At the end of this project, we will have developed and tested the MD-Link, a low-cost mobile ECG monitoring device, with some supportive comparisons to standard ECG devices commonly used in heart clinics or hospitals in Vietnam. Our long-term goal is for the MD-Link to be easily accessible, affordable, and to fit into a patient’s daily routine, thus improving the care and treatment of patients with cardiovascular diseases (CVDs).

INTERNATIONAL REGISTERED REPOR

RR1-10.2196/8762
Using the Inflammacheck Device to Measure the Level of Exhaled Breath Condensate Hydrogen Peroxide in Patients With Asthma and Chronic Obstructive Pulmonary Disease (The EXHALE Pilot Study): Protocol for a Cross-Sectional Feasibility Study (Preprint)
Authors: Neville Daniel M , Fogg Carole , Brown Thomas P , Jones Thomas L , Lanning Eleanor , Bassett Paul , Chauhan Anoop J
Published: July 2018

BACKGROUND

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common conditions that affect over 5 million people in the United Kingdom. These groups of patients suffer significantly from breathlessness and recurrent exacerbations that can be difficult to diagnose and go untreated. A common feature of COPD and asthma is airway inflammation that increases before and during exacerbations. Current methods of assessing airway inflammation can be invasive, difficult to perform, and are often inaccurate. In contrast, measurement of exhaled breath condensate (EBC) hydrogen peroxide (H2O2) is performed during normal tidal breathing and is known to reflect the level of global inflammation in the airways. There is a need for novel tools to diagnose asthma and COPD earlier and to detect increased airway inflammation that precedes an exacerbation.

OBJECTIVE

The aim of this study was to explore the use of a new handheld device (called Inflammacheck) in measuring H2O2 levels in EBC. We will study whether it can measure EBC H2O2 levels consistently and whether it can be used to differentiate asthma and COPD from healthy controls.

METHODS

We will perform a cross-sectional, feasibility, pilot study of EBC H2O2 levels, as measured by Inflammacheck, and other markers of disease severity and symptom control in patients with asthma and COPD and volunteers with no history of lung disease. Participants will be asked to provide an exhaled breath sample for measurement of their EBC H2O2 using Inflammacheck. The result will be correlated with disease stage, spirometry, fractional exhaled nitric oxide (FeNO), and symptom control scores.

RESULTS

This study’s recruitment is ongoing; it is anticipated that the results will be available in 2018.

CONCLUSIONS

The EXhaled Hydrogen peroxide As a marker of Lung diseasE (EXHALE) pilot study will provide an evaluation of a new method of measuring EBC H2O2. It will assess the device’s consistency and ability to distinguish airway inflammation in asthma and COPD compared with healthy controls.
Correction: Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy (Preprint)
Authors: Wu Yuan , Yao Xun , Vespasiani Giacomo , Nicolucci Antonio , Dong Yajie , Kwong Joey , Li Ling , Sun Xin , Tian Haoming , Li Sheyu
Published: July 2018

UNSTRUCTURED

In “Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy” (JMIR Mhealth Uhealth 2017;5(3):e35), there was an error in Table 2. The “Mean (SD) HbA1c, %: baseline; end; change” for “Rossi 2013[1]” should read “I: 8.4 (NR); 7.9 (NR); –0.5 (NR); C: 8.5 (NR); 8.1 (NR); –0.5 (NR)” instead of “I: 8.4 (0.1); 7.9 (0.1); –0.5 (0.1); C: 8.5 (0.1); 8.1 (0.1); –0.5 (0.1)”. As a result, data were slightly changed as follows:
Impact of an Electronic Health Record-Integrated Personal Health Record on Patient Participation in Health Care: Development and Randomized Controlled Trial of MyHealthKeeper (Preprint)
Authors: Ryu Borim , Kim Nari , Heo Eunyoung , Yoo Sooyoung , Lee Keehyuck , Hwang Hee , Kim Jeong-Whun , Kim Yoojung , Lee Joongseek , Jung Se Young
Published: July 2018

BACKGROUND

Personal health record (PHR)–based health care management systems can improve patient engagement and data-driven medical diagnosis in a clinical setting.

OBJECTIVE

The purpose of this study was (1) to demonstrate the development of an electronic health record (EHR)–tethered PHR app named MyHealthKeeper, which can retrieve data from a wearable device and deliver these data to a hospital EHR system, and (2) to study the effectiveness of a PHR data-driven clinical intervention with clinical trial results.

METHODS

To improve the conventional EHR-tethered PHR, we ascertained clinicians’ unmet needs regarding PHR functionality and the data frequently used in the field through a cocreation workshop. We incorporated the requirements into the system design and architecture of the MyHealthKeeper PHR module. We constructed the app and validated the effectiveness of the PHR module by conducting a 4-week clinical trial. We used a commercially available activity tracker (Misfit) to collect individual physical activity data, and developed the MyHealthKeeper mobile phone app to record participants’ patterns of daily food intake and activity logs. We randomly assigned 80 participants to either the PHR-based intervention group (n=51) or the control group (n=29). All of the study participants completed a paper-based survey, a laboratory test, a physical examination, and an opinion interview. During the 4-week study period, we collected health-related mobile data, and study participants visited the outpatient clinic twice and received PHR-based clinical diagnosis and recommendations.

RESULTS

A total of 68 participants (44 in the intervention group and 24 in the control group) completed the study. The PHR intervention group showed significantly higher weight loss than the control group (mean 1.4 kg, 95% CI 0.9-1.9; P<.001) at the final week (week 4). In addition, triglyceride levels were significantly lower by the end of the study period (mean 2.59 mmol/L, 95% CI 17.6-75.8; P=.002).

CONCLUSIONS

We developed an innovative EHR-tethered PHR system that allowed clinicians and patients to share lifelog data. This study shows the effectiveness of a patient-managed and clinician-guided health tracker system and its potential to improve patient clinical profiles.

CLINICALTRIAL

ClinicalTrials.gov NCT03200119; https://clinicaltrials.gov/ct2/show/NCT03200119 (Archived by WebCite at http://www.webcitation.org/6v01HaCdd)
Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study (Preprint)
Authors: Brar Prayaga Rena , Jeong Erwin W , Feger Erin , Noble Harmony K , Kmiec Magdalen , Prayaga Ram S
Published: July 2018

BACKGROUND

Nonadherence is a major concern in the management of chronic conditions such as hypertension, cardiovascular disease, and diabetes where patients may discontinue or interrupt their medication for a variety of reasons. Text message reminders have been used to improve adherence. However, few programs or studies have explored the benefits of text messaging with older populations and at scale. In this paper, we present a program design using tailored and interactive text messaging to improve refill rates of partially adherent or nonadherent Medicare members of a large integrated health plan.

OBJECTIVE

The aim of this 3-month program was to gain an understanding of whether tailored interactive text message dialogues could be used to improve medication refills in Medicare patients with one or more chronic diseases.

METHODS

We used the mPulse Mobile interactive text messaging solution with partially adherent and nonadherent Medicare patients (ie, over age 65 years or younger with disabilities) of Kaiser Permanente Southern California (KP), a large integrated health plan, and compared refill rates of the text messaging group (n=12,272) to a group of partially adherent or nonadherent Medicare patients at KP who did not receive text messages (nontext messaging group, n=76,068). Both groups were exposed to other forms of refill and adherence outreach including phone calls, secure emails, and robo-calls from December 2016 to February 2017.

RESULTS

The text messaging group and nontext messaging group were compared using an independent samples t test to test difference in group average of refill rates. There was a significant difference in medication refill rates between the 2 groups, with a 14.07 percentage points higher refill rate in the text messaging group (P<.001).

CONCLUSIONS

The results showed a strong benefit of using this text messaging solution to improve medication refill rates among Medicare patients. These findings also support using interactive text messaging as a cost-effective, convenient, and user-friendly solution for patient engagement. Program outcomes and insights can be used to enhance the design of future text-based solutions to improve health outcomes and promote adherence and long-term behavior change.
Technological Health Intervention in Population Aging to Assist People to Work Smarter not Harder: Qualitative Study (Preprint)
Authors: Chen Sonia Chien-I
Published: July 2018

BACKGROUND

Technology-based health care has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work.

OBJECTIVE

The objective of this study was to investigate how and why electronic health (eHealth) has been applied in Taiwan and to suggest implications that may inspire other countries facing similar challenges.

METHODS

A qualitative methodology was adopted to obtain insightful inputs from deeper probing. Taiwan was selected as a typical case study, given its aging population, advanced technology, and comprehensive health care system. This study investigated 38 stakeholders in the health care ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion.

RESULTS

First, respondents indicated that the use of technology can enable seamless patient care and clinical benefits such as flexibility in time management. Second, the results suggested that a leader’s vision, authority, and management skills might influence success in health care innovation. Finally, the results implied that both internal and external organizational governance are highly relevant for implementing technology-based innovation in health care.

CONCLUSIONS

This study provided Taiwanese perspectives on how to intelligently use technology to benefit health care and debated the perception that technology prevents human interaction between clinicians and patients.
Responsiveness, Reliability, and Minimally Important and Minimal Detectable Changes of 3 Electronic Patient-Reported Outcome Measures for Low Back Pain: Validation Study (Preprint)
Authors: Froud Robert , Fawkes Carol , Foss Jonathan , Underwood Martin , Carnes Dawn
Published: July 2018

BACKGROUND

The Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) of pain intensity, and numerical rating scale (NRS) are among the most commonly used outcome measures in trials of interventions for low back pain. Their use in paper form is well established. Few data are available on the metric properties of electronic counterparts.

OBJECTIVE

The goal of our research was to establish responsiveness, minimally important change (MIC) thresholds, reliability, and minimal detectable change at a 95% level (MDC95) for electronic versions of the RMDQ, VAS, and NRS as delivered via iOS and Android apps and Web browser.

METHODS

We recruited adults with low back pain who visited osteopaths. We invited participants to complete the eRMDQ, eVAS, and eNRS at baseline, 1 week, and 6 weeks along with a health transition question at 1 and 6 weeks. Data from participants reporting recovery were used in MIC and responsiveness analyses using receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs). Data from participants reporting stability were used for analyses of reliability (intraclass correlation coefficient [ICC] agreement) and MDC95.

RESULTS

We included 442 participants. At 1 and 6 weeks, ROC AUCs were 0.69 (95% CI 0.59 to 0.80) and 0.67 (95% CI 0.46 to 0.87) for the eRMDQ, 0.69 (95% CI 0.58 to 0.80) and 0.74 (95% CI 0.53 to 0.95) for the eVAS, and 0.73 (95% CI 0.66 to 0.80) and 0.81 (95% CI 0.69 to 0.92) for the eNRS, respectively. Associated MIC thresholds were estimated as 1 (0 to 2) and 2 (–1 to 5), 13 (9 to 17) and 7 (–12 to 26), and 2 (1 to 3) and 1 (0 to 2) points, respectively. Over a 1-week period in participants categorized as “stable” and “about the same” using the transition question, ICCs were 0.87 (95% CI 0.66 to 0.95) and 0.84 (95% CI 0.73 to 0.91) for the eRMDQ with MDC95 of 4 and 5, 0.31 (95% CI –0.25 to 0.71) and 0.61 (95% CI 0.36 to 0.77) for the eVAS with MDC95 of 39 and 34, and 0.52 (95% CI 0.14 to 0.77) to 0.67 (95% CI 0.51 to 0.78) with MDC95 of 4 and 3 for the eNRS.

CONCLUSIONS

The eRMDQ was reliable with borderline adequate responsiveness. The eNRS was responsive with borderline reliability. While the eVAS had adequate responsiveness, it did not have an attractive reliability profile. Thus, the eNRS might be preferred over the eVAS for measuring pain intensity. The observed electronic outcome measures’ metric properties are within the ranges of values reported in the literature for their paper counterparts and are adequate for measuring changes in a low back pain population.
LIPOSOME AS A DRUG DELIVERY CARRIER-A REVIEW
Authors: Kumari Rekha , Varma Kuldeep , Srivastava Surabhi , Prachya Jyoti Rai , Maurya Sheo Datta
Published: July 2018

The evolution of the science and technology of liposomes as a drug carrier has passed through a number ofdistinct phases. Because they exhibit peculiar properties due to their structure, chemical compositionamphiphilic nature, physico-chemical characters and colloidal size, which are used in various applications.These properties point to several applications as the solubilizer for insoluble drugs, dispersants, and sustainedrelease system, delivery system for the encapsulated substance, stabilizer, protective agents, and micro reactivebeing the most obvious ones. Yet interest in liposomes, especially among academic workers, spread rapidly weattribute this to the remarkable structural versatility of the system, which enables the design of countlessliposomes versions to satisfy particular needs in terms of both technology and optimal function in vivo.
Ateologia bíblica: convite a uma exegese laica
Authors: Lima Anderson De Oliveira
Published: July 2018

Desenvolvido a partir de uma comunicação científica, apresentada em maio de 2017, na Pontifícia Universidade Católica de Campinas (num painel cuja temática era: Pluralismo e fundamentalismo: desafios religiosos em colóquio intitulado Por uma cultura da paz, em comemoração aos 50 anos da Populorum Progressio, organizado pelo Núcleo de Fé e Cultura da mesma universidade), este artigo apresenta a visão pessimista de um exegeta sobre sua profissão, e traz uma proposta para uma renovação das produções exegéticas em geral. Em poucas palavras, o autor propõe uma análise literária da Bíblia, que aproveita a laconicidade própria da narratividade bíblica para criar novas leituras, que faz um uso inusitado da filosofia materialista e hedonista do escritor francês Michel Onfray, em sua hermenêutica para fugir às leituras canônicas e institucionais, e que expõe a pluralidade de caminhos interpretativos possíveis para negar a produção dogmática e inaugurar o que aqui foi chamado de ateologia bíblica.
Investigation of higher education students' learning styles and attitudes towards mobile learning according to various variables
Authors: TUNCER Murat , DİKMEN Melih , AKMENÇE Ahmet Egemen
Published: July 2018

The purpose of this study is to examine students' learning styles and
their attitudes towards mobile learning. In this study, a screening model was
used to describe the existing situation. In this context, research was
conducted on 209 undergraduate students at Fırat University. To collect data,
Kolb Learning Styles Inventory developed by Kolb and adapted to Turkish by Evin
Gencel was used. The Mobile Learning Attitude scale developed by Demir and
Akpınar was used to examine students' attitudes toward mobile learning. When
the findings were examined, it was determined that 46.4% of the students had
Assimilator, 25.8% of them Divergers, 14.8% of them Convergers and 12.9% of
them had Accommodator learning style. The students with the highest attitude
towards mobile learning were found to have a Converger learning style. It was
determined that the students with the lowest attitudes towards mobile learning
had a Diverger learning style. Among the important characteristics of the
individuals with a Converger learning style are shown to prefer to work
individually in learning activities. It can be said that individuals who have a
Converger learning style are positively influenced by their attitudes toward
mobile learning, because many applications on mobile learning platforms allow
individual learning.
The effect of commercial and social entrepreneurship motives on entrepreneurial intention
Authors: ILGAZ SÜMER Selay , KORKMAZ DEVRANİ Tülay
Published: July 2018

Entrepreneurship
is seen as one of the most notable concepts in recent years. The main purpose
of this study is to examine students’ commercial and social entrepreneurship
motives (motive-based attributes) on their entrepreneurial intention. In the
study, the effects of commercial and social entrepreneurship motives on entrepreneurial
intention of the students were investigated. The sample was chosen by the
convenience sampling from the students of a private university in Ankara. The
data obtained in the study were analyzed using SPSS. As a result, two
sub-dimensions of commercial entrepreneurship motives (risk-taking and
self-confidence), and one sub-dimension of social entrepreneurship motive (change-oriented)
have significant effect on entrepreneurial intention.
BANGUNAN PERKEBUNAN TEH ZAMAN BELANDA DI JAWA BARAT: KAJIAN ARKEOLOGI PUBLIK
Authors: Nuralia Lia
Published: July 2018

Tulisan ini bertujuan mempublikasikan bangunan industri perkebunan peninggalan zaman Belanda, yang diduga sebagai bangunan dan situs cagar budaya. Metode penelitian desk research terhadap laporan hasil penelitian arkeologi, buku, artikel jurnal, dan lain sebagainya. Kemudian dilakukan pembaruan gambar dan peta yang terkait dengan contoh bangunan yang dikemukakan. Pada saat penelitian dilakukan di tahun 2009, 2019, dan 2011, digunakan metode penelitian arkeologi dengan teknis pengumpulan data studi pustaka, survey permukaan, dan wawancara. Pembahasan dilakukan terhadap bangunan dan lingkungan perkebunan (kawasan emplasemen, situs, struktur) yang diduga sebagai Cagar Budaya industri perkebunan zaman Belanda. Hasil yang diperoleh adalah terdapat empat cara arkeologi publik warisan industri perkebunan zaman Belanda, yaitu (1) museum alam dan laboratorium alam, (2) agrowisata dan destinasi wisata, (3) penerbitan, dan (4) sosialisasi hasil penelitian.Kata Kunci: Bangunan industri perkebunan, arkeologi publicAbstractThis paper aims to publicize the plantation industry building of the Dutch era, which is suspected as a building and cultural heritage site. Research method is desk research to report of archeology research, book, journal article, and so forth. Image updates and maps related to the example of the proposed building are then updated. At the time of the research conducted in 2009, 2019, and 2011, used the method of archaeological research with technical data collection literature study, surface survey, and interviews. The analysis was conducted on the plantation environment and building (emplacement area, site, structure) which is suspected as the Cultural Heritage of plantation industry at the Dutch era.  The results obtained are four public archaeological method to the cultural heritage of plantation industry, namely (1) natural museums and natural laboratories, (2) agro-tourism and tourism destinations, (3) publications, and (4) socialization of research resultsKey words: Plantation industry building, public archeology
Technology transfer from British to Vietnamese industrial companies - venturing into a new business culture
Authors: Tran Ngoc Ca
Published: July 2018

The paper examines the process of technology transfer from British industrial companies to Vietnamese companies, to look at the obstacles of this process, especially in dealing with different business culture environments. The study uses the case studies method, conducting interviews with about ten companies working in oil and gas service industry. Since this is only a first stage of the longer term project, only preliminary results were discussed. Therefore, a company in civil engineering consulting has been examined for comparison. The paper argues that the differences in perception of the same operation activity like service in oil and gas industry are crucial factors to take into account if the transfer process is to be successful. Also, the transferor and the recipient may have different behaviour in negotiating, in communicating with each other. Thus, the preparation of background information, to do "home work", patience and pro-active attitudes in trying to understand partners are important for transferring technology into different business environment.

 

In addition, the factors, sometime not very technology-related, such as internal political motives and organisational issues of the firms involved can be very influential in the success of technology transfer process.
AS RELAÇÕES ENTRE MODA E MÚSICA OBSERVADAS PELO VIÉS DO MOVIMENTO GRUNGE
Authors: Pires Marianna , Moreira Bruna Ruschel
Published: July 2018

Este artigo objetiva a reflexão sobre possíveis relações entre moda e música, destacando o movimento musical grunge, surgido na década de 1990, em Seattle, de forma que busca identificar as possíveis influências na moda, por meio de vestimentas usadas pelos integrantes do movimento. Neste estudo, é destacada a banda Nirvana – significativa representante do movimento grunge – com o objetivo de comparar suas vestimentas com as coleções criadas por estilistas que se inspiraram na estética grunge no desenvolvimento de suas coleções. São analisados os trabalhos dos estilistas Marc Jacobs, Juliana Jabour, e Dries Van Noten, além do trabalho da marca britânica Marques’ Almeida, nas décadas de 1990 e 2000. Assim, procurou-se evidenciar a teoria da ebulição, mencionada por Doris Treptow (2005), e verificar que estilos alternativos originários das ruas podem elevar-se na camada social, sendo trabalhados através do viés do luxo. Nesse sentido, entende-se a moda e a música como manifestações da cultura e enquanto formas de comunicação, de maneira que este artigo pretende contribuir com estudiosos de moda, música e áreas inter-relacionadas, considerando o caráter interdisciplinar da moda.Palavras-chave: Moda. Música. Identidade. Grunge.ABSTRACTThis article aims the reflection on possible relationships between fashion and music, highlighting the Grunge Musical Movement, emerged in the 1990s in Seattle, so that search to identificate possible influences on fashion, through the clothing worn by the members of the Movement. In this study, is highlighted the band Nirvana – a significant representative of the Grunge Movement – with the aim of comparing their clothes with collections created by stylists inspired by the Grunge aesthetics in their collections development. Thereby, it was tried to evident the Bubble-Up Theory, mentioned by Doris Treptow (2005), and check that alternative styles originating from the streets can elevate themselves in the social layer, being worked through the bias of the luxury. In this sense, fashion and music are understood as manifestations of culture and as forms of communication, that way this article intends to contribute with scholars of fashion, music and interrelated areas, considering the interdisciplinary character of fashion.Keywords: Fashion. Music. Identity. Grunge.