bluuebunny/crossref_metadata_2025 huggingface dataset:
Usability of a psychotherapeutic interactive gaming tool used in Facial Emotion Recognition for people with Schizophrenia (Preprint)
Authors: Tortadès Ingrid , Gonzalez Roberto , Alpiste Francesc , Fernandez Joaquin , Torner Jordi , Garcia-Franco Mar , Martin-Martinez José R. , Vilamala Sònia , Escandell Maria J. , Casas-Anguera Emma , Gemma Prat , Ochoa Susana
Published: March 2018

UNSTRUCTURED

The interactive software “Feeling Master” (a Cartoon Facial Recognition Tool) was developed to investigate the deficit in facial emotion recognition (FER) with a sample of patients with schizophrenia in a pilot project framework. 24 persons with schizophrenia and 17 healthy control (HC) subjects completed the “Feeling Master” including five emotions (happiness, sadness, anger, fear and surprise). Regarding the group with schizophrenia they were evaluated with the Personal and Situational Attribution Questionnaire (IPSAQ) and the Hinting Task (Theory of Mind) to evaluate social cognition. Descriptive data showed suitable usability, adaptability, effectiveness and efficiency of “feeling master”.
Patients with schizophrenia showed impairments in emotion recognition. The individuals with schizophrenia remained slower than the HC in the recognition of each emotion. Regarding the impairment in the recognition of each emotion we only have found significant error rates on fear discrimination (P=.07). And the correlations between correct response on the “Feeling Master” and the Hinting Task showed significant values in the correlation of surprise and Theory of Mind (P=.46). In conclusion, the study puts forward the usability of the “feeling master” in FER for people with schizophrenia. These findings lend support to the notion that difficulties in emotion recognition are more prevalent in people with schizophrenia, and those are associated with an imparment in ToM, suggesting the potential utility of the FER in the rehabilitation of people with schizophrenia.
Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)
Authors: Ploderer Bernd , Brown Ross , Seng Leonard Si Da , Lazzarini Peter , van Netten Jaap
Published: March 2018

BACKGROUND

Without effective self-care, people with diabetic foot ulcers (DFUs) are at risk of prolonged healing times, hospitalization, amputation, and reduced quality of life. Despite these consequences, adherence to DFU self-care remains low. New strategies are needed to engage people in the self-care of their DFUs.

OBJECTIVE

We aimed to evaluate the usability and usefulness of a new mobile application to engage people with DFUs in self-care.

METHODS

We developed a new mobile application, “MyFootCare”, to engage patients with DFU through goal-setting, progress monitoring, and reminders in self-care. Key features included novel visual analytics that automatically extracts and monitors DFU size information from mobile phone photos of the foot. A functional prototype of MyFootCare was created and evaluated through a user-centred design process with 11 participants with DFUs. Data were collected through semi-structured interviews discussing existing self-care practices and observations of MyFootCare with participants. Data were analysed qualitatively through thematic analysis.

RESULTS

Key themes were: (1) Participants already used mobile phone photos to monitor their DFU progress, but (2) had limited experience with using smartphone applications. (3) Participants desired the objective DFU size data provided by the tracking feature of MyFootCare to monitor their DFU progress. (4) Participants were ambivalent about the MyFootCare goal setting and diary features, commenting that these features were useful but also that it was unlikely that they would use them. (5) Participants desired to share their MyFootCare data with their clinicians to demonstrate engagement in self-care and to reflect on their progress.

CONCLUSIONS

MyFootCare shows promising features to engage people in DFU self-care. Most notably, ulcer size data is useful to monitor progress and engage people. However, more work is needed to improve the usability and accuracy of MyFootCare, i.e., by refining the process of taking and analysing DFU photos and removing unnecessary features. These findings open the door for further work to develop a system that is easy to use and functions in everyday life conditions, and to trial it with people with DFUs and their carers.
Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change (Preprint)
Authors: Karin Eyal , Dear Blake F , Heller Gillian Z , Gandy Milena , Titov Nickolai
Published: March 2018

BACKGROUND

Accurate measurement of treatment-related change is a key part of psychotherapy research and the investigation of treatment efficacy. For this reason, the ability to measure change with accurate and valid methods is critical for psychotherapy.

OBJECTIVE

The aims of this study were to (1) explore the underlying characteristics of depressive symptom change, measured with the nine-item Patient Health Questionnaire (PHQ-9), following psychotherapy, and (2) compare the suitability of different ways to measure and interpret symptom change. A treatment sample of Web-based psychotherapy participants (n=1098) and a waitlist sample (n=96) were used to (1) explore the statistical characteristics of depressive symptom change, and (2) compare the suitability of two common types of change functions: linear and proportional change.

METHODS

These objectives were explored using hypotheses that tested (1) the relationship between baseline symptoms and the rate of change, (2) the shape of symptom score distribution following treatment, and (3) measurement error associated with linear and proportional measurement models.

RESULTS

Findings demonstrated that (1) individuals with severe depressive baseline symptoms had greater reductions in symptom scores than individuals with mild baseline symptoms (11.4 vs 3.7); however, as a percentage measurement, change remained similar across individuals with mild, moderate, or severe baseline symptoms (50%-55%); (2) positive skewness was observed in PHQ-9 score distributions following treatment; and (3) models that measured symptom change as a proportional function resulted in greater model fit and reduced measurement error (<30%).

CONCLUSIONS

This study suggests that symptom scales, sharing an implicit feature of score bounding, are associated with a proportional function of change. Selecting statistics that overlook this proportional change (eg, Cohen d) is problematic and leads to (1) artificially increased estimates of change with higher baseline symptoms, (2) increased measurement error, and (3) confounded estimates of treatment efficacy and clinical change. Implications, limitations, and idiosyncrasies from these results are discussed.
A Digital Health App to Assess Decisional Capacity to Provide Informed Consent: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Furberg Robert D , Raspa Melissa , Wheeler Anne C , McCormack Lauren A , Bailey Donald B
Published: March 2018

BACKGROUND

Any study with human subjects must have a robust consent process to ensure that participants understand the study and can decide whether they want to be involved. Investigators must determine whether a potential study participant is able to make an informed decision and what modifications or supports are needed to maximize participation in decision making. A variety of approaches have been used to modify consent forms and the consent process to increase the research participants’ decisional capacity. This protocol describes a randomized controlled trial (RCT) of a digital health app to support decision making among individuals contemplating providing consent to participate in a clinical trial.

OBJECTIVE

The objective of this RCT will be to determine if the use of a tablet-based app facilitates greater participation in and satisfaction with the consent process compared with standard practice and identify which individual factors are associated with better response to the decision aid. We hypothesize that the tablet-based version of the consent process will promote more informed decision making, including decisions that are more consistent with individual preferences and values expressed during qualitative data collection.

METHODS

A two-arm RCT will be conducted in a sample of approximately 100 individuals with fragile X syndrome in their homes across the United States.

RESULTS

Data analysis will be completed by late 2018.

CONCLUSIONS

By developing and testing a novel consent decision aid, we will have a better understanding of whether and how technological support can optimize the fit between the decisional capacity and the decisional process.

CLINICALTRIAL

ClinicalTrials.gov NCT02465931; https://clinicaltrials.gov/ct2/show/NCT02465931 (Archived by WebCite at http://www.webcitation.org/72Q3xJQAw)

INTERNATIONAL REGISTERED REPOR

PRR1-10.2196/10360
Internet Exposure Associated With Canadian Parents� Perception of Risk on Childhood Immunization: Cross-Sectional Study (Preprint)
Authors: Tustin Jordan Lee , Crowcroft Natasha Sarah , Gesink Dionne , Johnson Ian , Keelan Jennifer
Published: March 2018

BACKGROUND

There is a large presence of provaccination and antivaccination content on the Internet. The Internet has been identified as an important source for parents to seek and share vaccine information. There are concerns that parental fears or hesitancy on childhood immunizations are increasing due to the popularity of social media and exposure to online antivaccination sentiment. No other studies have investigated the association between seeking vaccine information online and Canadian parents’ perception of risk on childhood immunization.

OBJECTIVE

We aimed to investigate the potential association between seeking vaccine information on the Internet and Canadian parents’ perception of risk on childhood immunization in order to quantify the perceived association and increase our understanding on the impact of the Internet to help guide public health interventions.

METHODS

We analyzed this association in two population samples: a self-selecting Web-based sample of Canadian parents recruited through Facebook (n=966) and a population-based sample of parents recruited by random digit dialing (RDD; n=951). The outcome was parental perception of vaccine safety on a seven-point ordinal scale from “not safe” to “extremely safe.” An ordinal regression model was used to investigate if Internet information seeking on childhood vaccination predicted parental perception of vaccine safety.

RESULTS

After adjusting for income level, Internet reliability, age of parent, and region, the odds of perceiving vaccines as less safe rather than more safe were 1.6 times higher (95% CI 1.3-2.1) for parents who used the Internet to search for vaccination information compared to parents who did not search the Internet in the Web-based sample, and 2.0 times higher (95% CI 1.6-2.5) in the population-based RDD sample.

CONCLUSIONS

The results suggest the Internet is significantly associated with Canadian parents’ negative perception of vaccine risk. Governmental and scientific sectors should consider the development and implementation of Web-based vaccine interventions to promote confidence in immunization.
A Mobile App (BEDSide Mobility) to Support Nurses� Tasks at the Patient's Bedside: Usability Study (Preprint)
Authors: Ehrler Frederic , Weinhold Thomas , Joe Jonathan , Lovis Christian , Blondon Katherine
Published: March 2018

BACKGROUND

The introduction of clinical information systems has increased the amount of clinical documentation. Although this documentation generally improves patient safety, it has become a time-consuming task for nurses, which limits their time with the patient. On the basis of a user-centered methodology, we have developed a mobile app named BEDSide Mobility to support nurses in their daily workflow and to facilitate documentation at the bedside.

OBJECTIVE

The aim of the study was to assess the usability of the BEDSide Mobility app in terms of the navigation and interaction design through usability testing.

METHODS

Nurses were asked to complete a scenario reflecting their daily work with patients. Their interactions with the app were captured with eye-tracking glasses and by using the think aloud protocol. After completing the tasks, participants filled out the system usability scale questionnaire. Descriptive statistics were used to summarize task completion rates and the users’ performance.

RESULTS

A total of 10 nurses (aged 21-50) participated in the study. Overall, they were satisfied with the navigation, layout, and interaction design of the app, with the exception of one user who was unfamiliar with smartphones. The problems identified were related to the ambiguity of some icons, the navigation logic, and design inconsistency.

CONCLUSIONS

Besides the usability issues identified in the app, the participants’ results do indicate good usability, high acceptance, and high satisfaction with the developed app. However, the results must be taken with caution because of the poor ecological validity of the experimental setting.
Development and Evaluation of a New Security and Privacy Track in a Health Informatics Graduate Program: Multidisciplinary Collaboration in Education (Preprint)
Authors: Zhou Leming , Parmanto Bambang , Joshi James
Published: March 2018

BACKGROUND

The widespread application of technologies such as electronic health record systems, mobile health apps, and telemedicine platforms, has made it easy for health care providers to collect relevant data and deliver health care regimens. While efficacious, these new technologies also pose serious security and privacy challenges.

OBJECTIVE

The training program described here aims at preparing well-informed health information security and privacy professionals with enhanced course materials and various approaches.

METHODS

A new educational track has been built within a health informatics graduate program. Several existing graduate courses have been enhanced with new security and privacy modules. New labs and seminars have been created, and students are being encouraged to participate in research projects and obtain real-world experience from industry partners. Students in this track receive both theoretical education and hands-on practice. Evaluations have been performed on this new track by conducting multiple surveys on a sample of students.

RESULTS

We have succeeded in creating a new security track and developing a pertinent curriculum. The newly created security materials have been implemented in multiple courses. Our evaluation indicated that students (N=72) believed that receiving security and privacy training was important for health professionals, the provided security contents were interesting, and having the enhanced security and privacy training in this program was beneficial for their future career.

CONCLUSIONS

The security and privacy education for health information professionals in this new security track has been significantly enhanced.
Digital Access in Working-Age and Older Adults and Their Caregivers Attending Psychiatry Outpatient Clinics: Quantitative Survey (Preprint)
Authors: Cruickshank Callum , MacIntyre Donald J
Published: March 2018

BACKGROUND

It has been suggested that improving access to mental health services, supporting self-management, and increasing clinical productivity can be achieved through the delivery of technology-enabled care by personal mobile-based and internet-based services. There is little evidence available about whether working-age and older adults with mental health problems or their caregivers have access to these technologies or their confidence with these technologies.

OBJECTIVE

This study aimed to ascertain the prevalence and range of devices used to access the internet in patients and caregivers attending general and older adult psychiatry outpatient services and their confidence in using these technologies.

METHODS

We conducted an anonymous survey of 77 patients and caregivers from a general psychiatry and old age psychiatry clinic to determine rates of internet access and device ownership, and attitudes to technology-enabled care.

RESULTS

We found high levels of internet access and confidence in using the internet in working-age adults, their caregivers, and older adult caregivers but not in older adult patients. The smartphone usage predominated in working-age adults and their caregivers. Older adult caregivers were more likely to use desktop or laptop computers. In our sample, tablets were the least popular form factor.

CONCLUSIONS

Access rates and uptake of internet-based services have the potential to be high in working-age adults and their caregivers but are likely to be markedly lower among older adult patients attending psychiatry clinics. Applications designed for tablets are likely to have low uptake. All groups identified appointment reminders as likely to be beneficial.
User engagement and utilisation of an app for anxiety management: analysis and evaluation of usage patterns (Preprint)
Authors: Matthews Paul , Topham Phil , Caleb-Solly Praminda
Published: March 2018

BACKGROUND

SAM is a mobile app providing self-help for anxiety management. Launched in 2013, the app has achieved over a 1 million downloads and favourable ratings on the platform app stores. Key features of the app are anxiety monitoring, self-help techniques and social support via an online forum (“the social cloud”). This paper presents unique insights into e-mental health app usage patterns and explores user behaviour and usage of self-help techniques.

OBJECTIVE

To investigate behavioural engagement and to establish discernible usage patterns of the app linked to the features of: anxiety monitoring, rating of self-help techniques and social participation.

METHODS

We use data mining techniques on aggregate data from registered users of the app’s cloud services

RESULTS

Engagement in general conforms to common online participation patterns, with an inverted pyramid or “funnel” of engagement of increasing intensity. We further identify four distinct groups of behavioural engagement, differentiated by levels of activity in anxiety monitoring and social feature usage. Anxiety levels among all monitoring users show a marked reduction in the first few days of usage, with some “bounce back” effect thereafter. A small group of users with demonstrable long-term anxiety reduction (using a robust measure) typically monitored for 12-110 days with 10-30 discrete updates and showed low levels of social participation.

CONCLUSIONS

The data supports our expectation of different usage patterns given flexible user journeys and varying commitment in an unstructured mobile usage setting. We nevertheless show an aggregate trend of reduction in self-reported anxiety across all minimally engaged users. We find several commonalities between these patterns and traditional therapy engagement.
The Impact of Visualization Dashboards on Quality of Care and Clinician Satisfaction: Integrative Literature Review (Preprint)
Authors: Khairat Saif Sherif , Dukkipati Aniesha , Lauria Heather Alico , Bice Thomas , Travers Debbie , Carson Shannon S
Published: March 2018

BACKGROUND

Intensive Care Units (ICUs) in the United States admit more than 5.7 million people each year. The ICU level of care helps people with life-threatening illness or injuries and involves close, constant attention by a team of specially-trained health care providers. Delay between condition onset and implementation of necessary interventions can dramatically impact the prognosis of patients with life-threatening diagnoses. Evidence supports a connection between information overload and medical errors. A tool that improves display and retrieval of key clinical information has great potential to benefit patient outcomes. The purpose of this review is to synthesize research on the use of visualization dashboards in health care.

OBJECTIVE

The purpose of conducting this literature review is to synthesize previous research on the use of dashboards visualizing electronic health record information for health care providers. A review of the existing literature on this subject can be used to identify gaps in prior research and to inform further research efforts on this topic. Ultimately, this evidence can be used to guide the development, testing, and implementation of a new solution to optimize the visualization of clinical information, reduce clinician cognitive overload, and improve patient outcomes.

METHODS

Articles were included if they addressed the development, testing, implementation, or use of a visualization dashboard solution in a health care setting. An initial search was conducted of literature on dashboards only in the intensive care unit setting, but there were not many articles found that met the inclusion criteria. A secondary follow-up search was conducted to broaden the results to any health care setting. The initial and follow-up searches returned a total of 17 articles that were analyzed for this literature review.

RESULTS

Visualization dashboard solutions decrease time spent on data gathering, difficulty of data gathering process, cognitive load, time to task completion, errors, and improve situation awareness, compliance with evidence-based safety guidelines, usability, and navigation.

CONCLUSIONS

Researchers can build on the findings, strengths, and limitations of the work identified in this literature review to bolster development, testing, and implementation of novel visualization dashboard solutions. Due to the relatively few studies conducted in this area, there is plenty of room for researchers to test their solutions and add significantly to the field of knowledge on this subject.
Social Drinking on Social Media: Content Analysis of the Social Aspects of Alcohol-Related Posts on Facebook and Instagram (Preprint)
Authors: Hendriks Hanneke , Van den Putte Bas , Gebhardt Winifred A , Moreno Megan A
Published: March 2018

BACKGROUND

Alcohol is often consumed in social contexts. An emerging social context in which alcohol is becoming increasingly apparent is social media. More and more young people display alcohol-related posts on social networking sites such as Facebook and Instagram.

OBJECTIVE

Considering the importance of the social aspects of alcohol consumption and social media use, this study investigated the social content of alcohol posts (ie, the evaluative social context and presence of people) and social processes (ie, the posting of and reactions to posts) involved with alcohol posts on social networking sites.

METHODS

Participants (N=192; mean age 20.64, SD 4.68 years, 132 women and 54 men) gave researchers access to their Facebook and/or Instagram profiles, and an extensive content analysis of these profiles was conducted. Coders were trained and then coded all screenshotted timelines in terms of evaluative social context, presence of people, and reactions to post.

RESULTS

Alcohol posts of youth frequently depict alcohol in a positive social context (425/438, 97.0%) and display people holding drinks (277/412, 67.2%). In addition, alcohol posts were more often placed on participants’ timelines by others (tagging; 238/439, 54.2%) than posted by participants themselves (201/439, 45.8%). Furthermore, it was revealed that such social posts received more likes (mean 35.50, SD 26.39) and comments than nonsocial posts (no people visible; mean 10.34, SD 13.19, P<.001).

CONCLUSIONS

In terms of content and processes, alcohol posts on social media are social in nature and a part of young people’s everyday social lives. Interventions aiming to decrease alcohol posts should therefore focus on the broad social context of individuals in which posting about alcohol takes place. Potential intervention strategies could involve making young people aware that when they post about social gatherings in which alcohol is visible and tag others, it may have unintended negative consequences and should be avoided.
Development and feasibility of an electronic-Swallowing Intervention Package (e-SiP) to support swallowing function in patients with head and neck cancer (Preprint)
Authors: Cowie Julie , Boa Sally , King Emma , Wells Mary , Cairns David
Published: March 2018

BACKGROUND

Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemo-radiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work.

OBJECTIVE

To develop and conduct preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for head and neck cancer.

METHODS

The study involved health professionals and patients who were undergoing CRT for head and neck cancer. The scoping stage of e-SiP development involved investigated the potential usefulness of e-SiP, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as a means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SIP and informed the next stage of its development around requirements for tool. This was followed by further development and a testing stage of e-SiP involved the coding of a prototype which was then evaluated using a series of steering group meetings, semi-structured interviews with both patients and health care professionals, and analysis of e-SiP log data.

RESULTS

Feedback from focus groups and health professional interviews was very positive and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the ten patients offered e-SIP, only two opted to use it. For these patients, aspects of the e-SIP application were considered useful, in particular the ease of keeping a diary of exercises performed. Interviews with users and non-users suggested significant barriers to its use. Most significantly the lack of flexibility of platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use.

CONCLUSIONS

Results suggest a need for further research to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care, and through patient training and staff engagement, can be seen as a beneficial tool to help support patients in conducting swallowing exercises.
Combining online and offline peer support groups in mental health care: A qualitative study of service users� experiences (Preprint)
Authors: Strand Monica , Gammon Deede , Eng Lillian Sofie , Ruland Cornelia
Published: March 2018

BACKGROUND

Peer support groups for people with long-term mental health problems are at the heart of recovery-oriented approaches in mental health care. When conducted face-to-face (offline) or on the Internet (online), peer support groups have proven to have differing strengths and weaknesses. Little is known about the benefits and challenges of combining the two formats.

OBJECTIVE

The aim of this study was to gain insights into the benefits and challenges of combining online and offline peer support groups facilitated through an Internet intervention designed to support recovery processes.

METHODS

In this exploratory and descriptive study, an e-recovery portal called ReConnect was used by service users in two mental health communities in Norway for 6-12 months. The portal included an online peer support forum which also facilitated participation in local in-person ReConnect-cafés. Both formats of peer support were facilitated by an employed service user consultant with lived experience of mental health problems and with training in peer support. Qualitative data about service users’ experiences of using the portal were collected through focus groups and individual interviews and inductively analyzed thematically with focus on benefits and challenges of peer support online and offline.

RESULTS

A total of 14 service users 22-63 years of age with various diagnoses, receiving services at both primary and specialist levels of mental health care participated in three focus groups and 10 individual interviews. Two main themes were identified in the analysis: 1) balancing anonymity and openness, and 2) enabling connectedness. These themes are further illustrated with the subthemes: i) dilemmas of anonymity and confidentiality, ii) towards self-disclosure and openness, iii) new friendships, and iv) networks in the local community. Three of the subthemes mainly describe benefits. Challenges were more implicit and cut across the subthemes. Identified challenges were linked to transitions from anonymity to revealing one’s identity, how to protect confidentiality, or to participation at face-to-face meetings in the local community.

CONCLUSIONS

Our study suggests that online peer support groups and offline meetings complement each other, and the combination is mainly beneficial to users. The identified benefits appeared to arise from participants’ options of one format or the other, or that they could combine formats in ways that suited their individual values and comfort zones. We also identified challenges related to combination of formats, and both formats require appropriate facilitation of peer support. Combining online formats that enable anonymity, a non-judgmental atmosphere, and 24/7 accessibility regardless of location, with offline formats that foster local, in-person community ties, is a promising concept for facilitating recovery-oriented care, and warrants continued research.
Digital Technology for Caregivers of People With Psychosis: Systematic Review (Preprint)
Authors: Onwumere Juliana , Amaral Filipa , Valmaggia Lucia R
Published: March 2018

BACKGROUND

Psychotic disorders are severe mental health conditions that adversely affect the quality of life and life expectancy. Schizophrenia, the most common and severe form of psychosis affects 21 million people globally. Informal caregivers (families) are known to play an important role in facilitating patient recovery outcomes, although their own health and well-being could be adversely affected by the illness. The application of novel digital interventions in mental health care for patient groups is rapidly expanding; interestingly, however, far less is known about their role with family caregivers.

OBJECTIVE

This study aimed to systematically identify the application of digital interventions that focus on informal caregivers of people with psychosis and describe their outcomes.

METHODS

We completed a search for relevant papers in four electronic databases (EMBASE, MEDLINE, PsycINFO, and Web of Science). The search also included the Cochrane database and manual search of reference lists of relevant papers. The search was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.

RESULTS

The search identified 9 studies derived from 8 unique datasets. Most studies were assessments of feasibility and were undertaken in the United States. Interventions were predominately Web-based, with a focus on improving the caregivers’ knowledge and understanding about psychosis.

CONCLUSIONS

This study offers preliminary support for the feasibility and acceptability of digital interventions for psychosis in informal caregiver populations. However, the findings underpin a clear need for greater development in the range of caregiver-focused digital approaches on offer and robust evaluation of their outcomes. The use of digital approaches with caregiver populations seemingly lags someway behind the significant developments observed in patient groups.
Value of Face-to-Face Interactions Between Clinician-Educators and Patients or Students to Improve Health Care Education (Preprint)
Authors: Singh Manisha
Published: March 2018

UNSTRUCTURED

The power and outreach of the media is enormous and has restructured our society today; the author acknowledges the impact and appreciates the outreach. However, I question the relative lack of focus on physical human interactions and express concern over future training efforts. I have compared and attempted to highlight the components of two interaction scenarios: those of teacher-student, and those of physician-patient. The physician-educators need to generate a discussion regarding the value of each interaction. As a teacher, there is value in online classrooms, and a different value in face-to-face interactions. Similarly, a physician can have major outreach impact by online tele-medicine and tele-education efforts, but in some instances, may need to have the human, physical interaction with the patient. The value of these interactions depends on the roles in which these interactions are experienced. Medical education training must incorporate an understanding of the unique value of different interactions.
A Healthy Eating Education Program for Midwives to Investigate and Explore Their Knowledge, Understanding, and Confidence to Support Pregnant Women to Eat Healthily: Protocol for a Mixed-Methods Study (Preprint)
Authors: Othman Shwikar Mahmoud Etman , Steen Mary P , Jayasekara Rasika , Fleet Julie-Anne
Published: March 2018

BACKGROUND

Nutrition and healthy eating behaviors during pregnancy are vitally important for the health of a mother and her developing baby. However, some midwives have reported a lack of evidence-based nutrition knowledge for providing information about healthy eating to women during pregnancy.

OBJECTIVE

In this study, the aim is to design and evaluate a healthy eating education program to enhance midwives’ knowledge, understanding, and confidence to support pregnant women in South Australia to make healthy eating choices.

METHODS

This mixed-methods study consists of two phases. The first phase, Phase 1, consists of an education program for midwives, “Healthy Eating in Pregnancy,” to be delivered through a workshop or webinar. Each midwife will attend one workshop or webinar, which will be approximately two hours in length. This program will be evaluated through pre-, immediate-, and post-educational questionnaires utilizing a website specifically designed for this study. The participants will be midwives who are members of the Australian College of Midwives and the Australian Nursing and Midwives Federation, and users of social media (eg, Facebook and Twitter) residing and employed in South Australia. Phase 2 will consist of semistructured interviews with a purposive sample of midwives. These interviews will be undertaken to gain an in-depth understanding of midwives’ views and how confident they feel educating pregnant women after receiving the healthy eating education. Interviews will be face-to-face or conducted by telephone with midwives who have participated in the healthy eating educational program.

RESULTS

A systematic review has previously been undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed-methods study, which will be completed in April 2019.

CONCLUSIONS

The results from the systematic review suggest that there is clear justification to undertake this mixed-methods study to investigate and explore midwives’ knowledge, understanding and confidence to support healthy eating in pregnant women. The results and conclusions from the systematic review provided some guidance for the design and development of this study protocol. This mixed-methods study will address a gap in the literature. The results from quantitative and qualitative data sources in this proposed study will help to draw conclusions to address the research topic.

REGISTERED REPORT IDENTIFIER

RR1-10.2196/9861
Development of a Tailored Intervention With Computerized Clinical Decision Support to Improve Quality of Care for Patients With Knee Osteoarthritis: Multi-Method Study (Preprint)
Authors: Van de Velde Stijn , Kortteisto Tiina , Spitaels David , Jamtvedt Gro , Roshanov Pavel , Kunnamo Ilkka , Aertgeerts Bert , Vandvik Per Olav , Flottorp Signe
Published: March 2018

BACKGROUND

Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery.

OBJECTIVE

This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis.

METHODS

Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors.

RESULTS

The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient.

CONCLUSIONS

The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time.
Predicting Caller Type From a Mental Health and Well-Being Helpline: Analysis of Call Log Data (Preprint)
Authors: Grigorash Alexander , O'Neill Siobhan , Bond Raymond , Ramsey Colette , Armour Cherie , Mulvenna Maurice D
Published: March 2018

BACKGROUND

This paper presents an analysis of call data records pertaining to a telephone helpline in Ireland among individuals seeking mental health and well-being support and among those who are in a suicidal crisis.

OBJECTIVE

The objective of our study was to examine whether rule sets generated from decision tree classification, trained using features derived from callers’ several initial calls, could be used to predict what caller type they would become.

METHODS

Machine learning techniques were applied to the call log data, and five distinct patterns of caller behaviors were revealed, each impacting the helpline capacity in different ways.

RESULTS

The primary findings of this study indicate that a significant model (P<.001) for predicting caller type from call log data obtained from the first 8 calls is possible. This indicates an association between callers’ behavior exhibited during initial calls and their behavior over the lifetime of using the service.

CONCLUSIONS

These data-driven findings contribute to advanced workload forecasting for operational management of the telephone-based helpline and inform the literature on helpline caller behavior in general.
Associations of Plasma Amino Acid and Acylcarnitine Profiles with Incident Reduced Glomerular Filtration Rate
Authors: Wang Feijie , Sun Liang , Sun Qi , Liang Liming , Gao Xianfu , Li Rongxia , Pan An , Li Huaixing , Deng Yueyi , Hu Frank B. , Wu Jiarui , Zeng Rong , Lin Xu
Published: March 2018

Background and objectives

Metabolomics is instrumental in identifying novel biomarkers of kidney function to aid in the prevention and management of CKD. However, data linking the metabolome to incident eGFR are sparse, particularly in Asian populations with different genetic backgrounds and environmental exposures. Therefore, we aimed to investigate the associations of amino acid and acylcarnitine profiles with change in eGFR in a Chinese cohort.

Design, setting, participants, & measurements

This study included 1765 community-living Chinese adults aged 50–70 years with baseline eGFR≥60 ml/min per 1.73 m2. At baseline, 22 amino acids and 34 acylcarnitines in plasma were quantified by gas or liquid chromatography coupled with mass spectrometry. Annual rate of change in eGFR was calculated, and incident eGFR decline was defined as eGFR<60 ml/min per 1.73 m2 by the end of 6 years of follow-up.

Results

The mean (SD) unadjusted annual change in eGFR was 2.2±2.0 ml/min per 1.73 m2 and the incidence of reduced eGFR was 16%. After Bonferroni correction, 13 of 56 metabolites were significantly associated with annual eGFR change. After multivariable adjustment of baseline covariates, including baseline eGFR, seven of the 13 metabolites, including cysteine, long-chain acylcarnitines (C14:1OH, C18, C18:2, and C20:4), and other acylcarnitines (C3DC and C10), were significantly associated with incident reduced eGFR (relative risks ranged from 1.16 to 1.25 per SD increment of metabolites; P<3.8E-03 after Bonferroni correction of multiple testing of the 13 metabolites). Moreover, principal component analysis identified two factors, consisting of cysteine and long-chain acylcarnitines, respectively, that were associated with incident reduced eGFR.

Conclusions

Elevated plasma levels of cysteine and a panel of acylcarnitines were associated with a higher incidence of reduced eGFR in Chinese adults, independent of baseline eGFR and other conventional risk factors.
Association of FGF-2 Concentrations with Atheroma Progression in Chronic Kidney Disease Patients
Authors: Bozic Milica , Betriu Angels , Bermudez-Lopez Marcelino , Ortiz Alberto , Fernandez Elvira , Valdivielso Jose M. ,   on behalf of the NEFRONA investigators
Published: March 2018

Background and objectives

Atherosclerosis is highly prevalent in CKD. The rate of progression of atherosclerosis is associated with cardiovascular events. Fibroblast growth factor 2 (FGF-2) is a member of the FGF family with potentially both protective and deleterious effects in the development of atherosclerosis. The role of circulating FGF-2 levels in the progression of atherosclerosis in CKD is unknown.

Design, setting, participants, & measurements

We used a multicenter, prospective, observational cohorts study of 481 patients with CKD. We determined the presence of atheroma plaque in ten arterial territories by carotid and femoral ultrasounds. Progression of atheromatosis was defined as an increase in the number of territories with plaque after 24 months. Plasma levels of FGF-2 were measured by multiplex analysis. A multivariable logistic regression analysis was performed to determine whether plasma FGF-2 levels were associated with atheromatosis progression.

Results

Average age of the population was 61 years. The percentage of patients in each CKD stage was 51% in stage 3, 41% in stages 4–5, and 8% in dialysis. A total of 335 patients (70%) showed plaque at baseline. Atheromatosis progressed in 289 patients (67%). FGF-2 levels were similar between patients with or without plaque at baseline (79 versus 88 pg/ml), but lower in patients with atheromatosis progression after 2 years (78 versus 98 pg/ml; P<0.01). In adjusted analyses, higher plasma FGF-2 was associated with lower risk of atheromatosis progression (odds ratio [OR], 0.86; 95% confidence interval [95% CI], 0.76 to 0.96; per 50 pg/ml increment). Analysis of FGF-2 in tertiles showed that atheroma progression was observed for 102 participants in the lowest tertile of FGF-2 (reference group), 86 participants in the middle tertile of FGF-2 (adjusted OR, 0.70; 95% CI, 0.40 to 1.20), and 74 participants in the lowest tertile of FGF-2 (adjusted OR, 0.48; 95% CI, 0.28 to 0.82).

Conclusions

Low FGF-2 levels are independently associated with atheromatosis progression in CKD.
BIOMIMETIC SYNTHESIS AND ANTIBACTERIAL PROPERTIES OF STRONTIUM OXIDE NANOPARTICLES USING OCIMUM SANCTUM LEAF EXTRACT
Authors: G Apsana , Pp George , N Devanna , R Yuvasravana
Published: March 2018

Objective: The investigation and synthesis of nanoparticles using green chemical methods is an emerging field due to ecologically derived materials. In the present study, the reaction under microwave irradiation technique is proposed for synthesizing the strontium oxide nanoparticles (SrO NPs) by reacting the strontium nitrate powder with Ocimum sanctum L. leaf extract followed by heat treatment at 500oC for 2 h.Methods: The crystalline nature, size, and morphological structure of the SrO powder sample were characterized by techniques such as powder X-ray diffraction (PXRD), scanning electron microscopy, ultraviolet (UV)-Vis spectroscopy, Fourier-transform infrared spectroscopy (FTIR) and photoluminescence (PL) spectral analysis. To investigate the antibacterial properties of SrO NPs, pathogens such as Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Proteus vulgaris, Klebsiella pneumonia, and Morganella morganii was tested in Mueller–Hinton disc diffusion method.Results: The particle size of the SrO NPs is calculated to be 42 nm using Debye–Scherrer equation. The SrO NPs exhibited absorption peak in the range of 250–350 nm centered at 274 nm in UV region. In addition, it is demonstrated that band gap energy was calculated to be 5.39 eV from Tauc’s plot. The SrO NPs has shown the efficient antibacterial effect by inhibiting zone against Gram-negative bacteria.Conclusion: The main aim of the study is to synthesize cost-effective and eco-friendly green synthesis of SrO NPs from the OS (O. sanctum) leaf extract and their characterization. The mechanism for the formation of SrO NPs in the presence of eugenol as reducing agent is also discussed. The present green chemical approach using plant-based materials for the synthesis of nanoparticles enhances the eco-friendliness, compatibility, effectiveness, and reduces the toxicity.