JMIR Research Protocols

Ongoing Trials, Grant Proposals, Formative Research, Methods, Early Results

Application of Web-enabled leg training system for the objective monitoring and quantitative analysis of exercise-induced fatigue

Background: Sustained cardiac rehabilitation is the key intervention in prevention and treatment of many human diseases, but implementation of exercise programs can be challenging because of early fatigability in patients with chronic diseases, overweight individuals and aged people. Current methods of fatigability assessment are based on subjective self-reporting such as rating of perceived exertion or require specialised laboratory conditions and sophisticated equipment. A practical approach allowing objective measurement of exercise-induced fatigue would be useful for the optimisation of sustained delivery of cardiac rehabilitation to improve patient outcomes. Objective: In this work we aimed to develop and validate an innovative approach, allowing objective assessment of exercise-induced fatigue using the Web-enabled leg rehabilitation system. Methods: MedExercise® training devices were equipped with wireless temperature sensors in order to monitor their usage by temperature rise in the resistance unit (Δt°). Since Δt° correlated with the intensity and duration of exercise, this parameter was used to characterise participants’ leg work output (LWO). Personal smart devices such as laptop computers with wireless gateways and relevant software were used for monitoring of self-control training. Connection of smart devices to the Internet and cloud-based software allowed remote monitoring of LWO in participants training at home. The heart rates were measured by fingertip pulse-oximeters simultaneously with Δt° in overall seven healthy volunteers. Results: It was shown that exercise-induced fatigue manifested as the decline of LWO and/or raising the heart rate, which could be observed in real time. Conversely, training at the steady-state LWO and heart rate for the entire duration of exercise bout was considered as fatigue-free. The amounts of recommended daily physical activity were expressed as the individual Δt° values reached during 30-minute fatigue-free exercise of moderate intensity and averaged at 8.1±1.5C° (n=7). These Δt° values were applied as the thresholds for sending automatic notifications upon taking the personalised LWO doses by self-control training at home. While the average time of taking LWO doses was 30.3±4.1 minutes (n=25), analysis of times required to reach the same Δt° by the same participant revealed that longer durations were due to fatigability, manifesting as reduced LWO at the later stages of training bouts. Typically, exercising in the afternoons associated with no fatigue, although longer durations of evening sessions suggested a diurnal fatigability pattern. Conclusions: This pilot study demonstrated the feasibility of objective monitoring of fatigue development in real time and online as well as retrospective fatigability quantification by the duration of training bouts to reach the same exercise dose. This simple method of leg training at home accompanied by routine fatigue monitoring might be useful for the optimisation of exercise interventions in primary care and special populations.

2015-07-01

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

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

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

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

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Journal Description

 

JMIR Research Protocols (ISSN 1929-0748) publishes peer-reviewed, openly accessible research ideas and grant proposals, study and trial protocols, reports of ongoing research, current methods and approaches, and preliminary results from pilot studies or formative research informing the design of medical and health-related research and technology innovations.

  • JMIR Res Protoc is a new journal spin-off of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics (Impact Factor: 4.7)
  • JMIR Res Protoc publishes protocols and grant proposals in all areas of medicine (and their peer-review reports, if available), as well as feasibility studies, early reports and formative/process evaluations of ongoing studies and descriptions of the development and pilot evaluations of innovations and software applications or other interventions
  • JMIR Res Protoc is fully open access, with full text articles deposited in PubMed Central
  • Publishing research protocols, grant proposals, pilot/feasibility studies and early reports of ongoing and planned work encourages collaboration and early feedback, and reduces duplication of effort 
  • JMIR Res Protoc will be a valuable ressource for researchers who want to learn about current research methodologies and how to write a winning grant proposal
  • JMIR Res Protoc creates an early scientific record for researchers who have developed novel methodologies, software, innovations or elaborate protocols
  • JMIR Res Protoc faciliates subsequent publication of results demonstrating that the methodology has already been reviewed, and reduces the effort of writing up the results, as the protocol can be easily referenced
  • JMIR Res Protoc demonstrates to reviewers of subsequent results papers that authors followed and adhered to carefully developed and described a-priori methods
  • Studies whose protocols or grant proposal have been accepted in JMIR Res Protoc are "in principle accepted" for subsequent publication of results in other JMIR journals as long as authors adhere to their original protocol - regardless of study results (even if they are negative), reducing publication bias in medicine
  • Authors publishing their protocols in JMIR Res Protoc will receive a 20% discount on the article processing fee if they publish their results in another journal of the JMIR journal family (for example, JMIR for ehealth studies, i-JMR for others)
 
 

Recent Articles:

  • (cc) de Courten et al. CC-BY-SA 2.0, please cite as (http://www.researchprotocols.org/article/viewFile/4552/1/63504).

    Dietary Advanced Glycation End Products Consumption as a Direct Modulator of Insulin Sensitivity in Overweight Humans: A Study Protocol for a Double-Blind,...

    Abstract:

    Background: Advanced glycation end products (AGEs) are formed during the processing, storage, and cooking of foods. As part of a western diet, AGEs are consumed in excess and impair glucose metabolism in patients with type 2 diabetes. In the absence of diabetes, AGE-mediated decreases in insulin sensitivity and signaling have been postulated. However, randomized studies to test this relationship in humans are limited. Objective: The primary aim of this trial is to determine whether dietary consumption of AGEs will decrease insulin sensitivity in healthy overweight adults. A secondary aim is to determine the effects of dietary AGEs on insulin secretion, circulating soluble receptor for AGEs (sRAGE), and inflammation markers. Methods: Overweight, but otherwise healthy, non-diabetic adults (N=20) aged 18-50 years old will complete a randomized cross-over design intervention study alternating low and high (4-fold increase) AGE diets (2-week duration). At baseline, participants will undergo a medical review including an intravenous glucose tolerance test (IVGTT), a hyperinsulinemic-euglycemic clamp, and anthropometric measures and questionnaires assessing diet, physical activity, and general wellness. Each test diet will be followed for 14 days, followed by a 4-week washout period before commencement of the second alternate dietary period. Energy, macronutrient, and AGE intake will be calculated for each dietary period. Additionally, the AGE content of foods used in the study will be measured by ultra performance liquid chromatography mass spectrometry. All measurements will be repeated at the beginning and end of each dietary period. Primary and secondary outcomes will be expressed as a change over the dietary period for insulin sensitivity, secretion, anthropometric parameters, sRAGE, and inflammation markers and compared by paired t test and analysis of variance (ANOVA). Results: The study will be completed in early 2016. Conclusion: The proposed trial will provide much needed clinical evidence on the impact of excess dietary AGE consumption on insulin sensitivity and will indicate whether lowering dietary AGE intake can improve insulin sensitivity and/or secretion, thereby decreasing risk for type 2 diabetes. Trial Registration: Clinicaltrials.gov NCT00422253; https://clinicaltrials.gov/ct2/show/NCT00422253 (Archived by Webcite at http://www.webcitation.org/6ZXLhT89c)

  • Own image of the authors.

    Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: A Systematic Review Protocol

    Abstract:

    Background: Despite social marketing campaigns and behavior change interventions, young adults remain among the lowest consumers of vegetables. The digital era offers potential new avenues for both social marketing and individually tailored programs, through texting, web, and mobile applications. The effectiveness and generalizability of such programs have not been well documented. Objective: The aim of this systematic review is to evaluate the efficacy and external validity of social marketing, electronic, and mobile phone-based (mHealth) interventions aimed at increasing vegetable intake in young adults. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol will be used to conduct this systematic review. The search strategy will be executed across eleven electronic databases using combinations of the following search terms: “online intervention”, “computer-assisted therapy”, “internet”, “website”, “cell phones”, “cyber”, “telemedicine”, “email”, “social marketing”, “social media”, “mass media”, “young adult”, and “fruit and vegetables”. The reference lists of included studies will also be searched for additional citations. Titles and abstracts will be screened against inclusion criteria and full texts of potentially eligible papers will be assessed by two independent reviewers. Data from eligible papers will be extracted. Quality and risk of bias will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and The Cochrane Collaboration Risk of Bias assessment tool respectively. The external validity of the studies will be determined based on components such as reach, adoption, and representativeness of participants; intervention implementation and adaption; and program maintenance and institutionalization. Results will be reported quantitatively and qualitatively. Results: Our research is in progress. A draft of the systematic review is currently being produced for publication by the end of 2015. Conclusions: The review findings will assist the design and implementation of future eHealth and mHealth programs aimed at improving vegetable consumption in young adults. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42015017763; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015017763#.VVKtqfmqqko (Archived by WebCite at http://www.webcitation.org/6YU2UYrTn).

  • (c) Dollar Photo Club. Permission to use this image has been purchased.

    Mapping a Decade of Physical Activity Interventions for Primary Prevention: A Protocol for a Scoping Review of Reviews

    Abstract:

    Background: Physical activity is a key behavioral component for the primary prevention of noncommunicable disease. The uptake of physical activity is influenced by individual and broader factors including social, economic, and environmental conditions. Objective: The purpose of this paper is to describe a protocol for a scoping review of reviews (SRR) that aims to map a decade of research focused on physical activity interventions within the domain of primary prevention. Methods: The 5 stages of our SRRs design were adapted from a seminal scoping review methodology. Our search strategy was developed for the following databases: SPORTDiscus, PubMed, Scopus, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Educational Resources Information Centre. Two reviewers (LG and AK) independently screened eligible studies and compared results to determine the final study selection. One reviewer will conduct the data extraction (LG); a second reviewer (AK) will assess the results to ensure comprehensiveness and accuracy of the scoping review synthesis. Results: The SRRs will provide a broad overview of the physical activity research literature specific to primary prevention, and will describe key features of physical activity interventions. Potential gaps in the physical activity action areas will be identified, and thus, the results will inform future research directions. Conclusions: This paper describes an innovative approach for comprehensively mapping an important topic’s research trends in the last decade.

  • Generic

    Social Media Use in Research: Engaging Communities in Cohort Studies to Support Recruitment and Retention

    Abstract:

    Background: This paper presents the first formal evaluation of social media (SM) use in the National Children’s Study (NCS). The NCS is a prospective, longitudinal study of the effects of environment and genetics on children’s health, growth and development. The Study employed a multifaceted community outreach campaign in combination with a SM campaign to educate participants and their communities about the Study. SM essentially erases geographic differences between people due to its omnipresence, which was an important consideration in this multi-site national study. Using SM in the research setting requires an understanding of potential threats to confidentiality and privacy and the role that posted content plays as an extension of the informed consent process. Objective: This pilot demonstrates the feasibility of creating linkages and databases to measure and compare SM with new content and engagement metrics. Methods: Metrics presented include basic use metrics for Facebook as well as newly created metrics to assist with Facebook content and engagement analyses. Results: Increasing Likes per month demonstrates that online communities can be quickly generated. Content and Engagement analyses describe what content of posts NCS Study Centers were using, what content they were posting about, and what the online NCS communities found most engaging. Conclusions: These metrics highlight opportunities to optimize time and effort while determining the content of future posts. Further research about content analysis, optimal metrics to describe engagement in research, the role of localized content and stakeholders, and social media use in participant recruitment is warranted.

  • The Motivate4Change program menu.

    Development of Motivate4Change Using the Intervention Mapping Protocol: An Interactive Technology Physical Activity and Medication Adherence Promotion...

    Abstract:

    Background: It is important that heart failure (HF) patients adhere to their medication regimen and engage in physical activity. Evidence shows that adherence to these HF self-management behaviors can be improved with appropriate interventions. Objective: To further promote medication adherence and physical activity among HF patients, we developed an intervention for hospitalized HF patients. Methods: The intervention mapping protocol was applied in the development of the intervention. This entailed performing a needs assessment, defining change objectives, selecting determinants and strategies, and developing the materials. Results: The resulting intervention, Motivate4Change, makes use of interactive technology and provides HF patients with personalized feedback and advice. Specific change objectives were defined. The relevant behavioral determinants for the physical activity program were practical knowledge on physical activity performance and self-efficacy for, and perceived benefits of, physical activity. For medication-taking, the selected determinants were practical knowledge on medication-taking, perceived barriers to medication-taking, beliefs about the necessity and harm regarding the medication prescribed, and beliefs about overprescribing and harm of medication in general. The change objectives and behavior change determinants were translated in feedback and advice strategies in an interactive technology program that included tailored feedback and advice, and role models in videos in which the behaviors and overcoming barriers were demonstrated. Relevant stakeholders were involved in the interventions development process. The intervention was pretested among HF patients and adjustments were made accordingly. Conclusions: The interactive technology physical activity and medication adherence promotion program for hospitalized HF patients was systematically developed using the intervention mapping protocol and was based on the available theory and evidence regarding HF self-management behavior change. The intervention’s efficacy is yet to be determined in evaluation research.

  • CBT-I Coach Thumbnail.

    Mobile App-Delivered Cognitive Behavioral Therapy for Insomnia: Feasibility and Initial Efficacy Among Veterans With Cannabis Use Disorders

    Abstract:

    Background: Cannabis is the most frequently used illicit substance in the United States resulting in high rates of cannabis use disorders. Current treatments for cannabis use are often met with high rates of lapse/relapse, tied to (1) behavioral health factors that impact cannabis use such as poor sleep, and (2) access, stigma, supply, and cost of receiving a substance use intervention. Objective: This pilot study examined the feasibility, usability, and changes in cannabis use and sleep difficulties following mobile phone–delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) in the context of a cannabis cessation attempt. Methods: Four male veterans with DSM-5 cannabis use disorder and sleep problems were randomized to receive a 2-week intervention: CBT-I Coach mobile app (n=2) or a placebo control (mood-tracking app) (n=2). Cannabis and sleep measures were assessed pre- and post-treatment. Participants also reported use and helpfulness of each app. Changes in sleep and cannabis use were evaluated for each participant individually. Results: Both participants receiving CBT-I used the app daily over 2 weeks and found the app user-friendly, helpful, and would use it in the future. In addition, they reported decreased cannabis use and improved sleep efficiency; one also reported increased sleep quality. In contrast, one participant in the control group dropped out of the study, and the other used the app minimally and reported increased sleep quality but also increased cannabis use. The mood app was rated as not helpful, and there was low likelihood of future participation. Conclusions: This pilot study examined the feasibility and initial patient acceptance of mobile phone delivery of CBT-I for cannabis dependence. Positive ratings of the app and preliminary reports of reductions in cannabis use and improvements in sleep are both encouraging and support additional evaluation of this intervention.

  • Picture of the GENEA accelerometer. (cc) Bon et al. CC-BY-SA 2.0, please cite as http://www.researchprotocols.org/article/viewFile/3896/1/58339.

    A Validation Study of the Web-Based Physical Activity Questionnaire Active-Q Against the GENEA Accelerometer

    Abstract:

    Background: Valid physical activity assessment in epidemiological studies is essential to study associations with various health outcomes. Objective: To validate the Web-based physical activity questionnaire Active-Q by comparing results of time spent at different physical activity levels with results from the GENEA accelerometer and to assess the reproducibility of Active-Q by comparing two admissions of the questionnaire. Methods: A total of 148 men (aged 33 to 86 years) responded to Active-Q twice and wore the accelerometer during seven consecutive days on two occasions. Time spent on six different physical activity levels including sedentary, light (LPA), moderate (MPA), and vigorous (VPA) as well as additional combined categories of sedentary-to-light and moderate-to-vigorous (MVPA) physical activity was assessed. Validity of Active-Q was determined using Spearman correlation coefficients with 95% confidence intervals (CI) and the Bland-Altman method. Reproducibility was assessed using intraclass correlation coefficients (ICCs) comparing two admissions of the questionnaire. Results: The validity correlation coefficients were statistically significant for time spent at all activity levels; sedentary (r=0.19, 95% CI: 0.04-0.34), LPA (r=0.15, 95% CI: 0.00-0.31), sedentary-to-light (r=0.35, 95% CI: 0.19-0.51), MPA (r=0.27, 95% CI: 0.12-0.42), VPA (r=0.54, 95% CI: 0.42-0.67), and MVPA (r=0.35, 95% CI: 0.21-0.48). The Bland-Altman plots showed a negative mean difference for time in LPA and positive mean differences for time spent in MPA, VPA and MVPA. The ICCs of test-retest reliability ranged between r=0.51-0.80 for the different activity levels in Active-Q. Conclusions: More moderate and vigorous activities and less light activities were reported in Active-Q compared to accelerometer measurements. Active-Q shows comparable validity and reproducibility to other physical activity questionnaires used today.

  • (cc) Moreland et al. CC-BY-SA 2.0, please cite as (http://www.researchprotocols.org/article/viewFile/4010/1/61910).

    The Prevalence of Online Health Information Seeking Among Patients in Scotland: A Cross-Sectional Exploratory Study

    Abstract:

    Background: Online health information seeking is an activity that needs to be explored in Scotland. While there are a growing number of studies that adopt a qualitative approach to this issue and attempt to understand the behaviors associated with online health information seeking, previous studies focusing on quantifying the prevalence and pattern of online health seeking in the United Kingdom have been based on Internet users in general. Objective: This exploratory study sought to describe the prevalence of online health information seeking in a rural area of Scotland based on primary data from a patient population. Methods: A survey design was employed utilizing self-completed questionnaires, based on the Pew Internet and American Life Project; questionnaires were distributed among adult patients in 10 primary care centers in a rural community in Scotland. Results: A convenience sample of 571 (0.10% of the total population in Grampian, N=581,198) patients completed the questionnaire. A total of 68.4% (379/554) of patients had previously used the Internet to acquire health information. A total of 25.4% (136/536) of patients consulted the Internet for health information regarding their current appointment on the day surveyed; 34.6% (47/136) of these patients were influenced to attend their appointment as a result of that online health information. A total of 43.2% (207/479) of patients stated the health information helped improve their health and 67.1% (290/432) indicated that they had learned something new. A total of 34.0% (146/430) of patients talked to a health professional about the information they had found and 90.0% (376/418) reported that the information was useful. In total, 70.4% (145/206) of patients were concerned about obtaining health information online from reliable sources. A total of 67.1% (139/207) of patients were concerned that a health site may sell their personal information, yet only 6.7% (36/535) checked the privacy policy of the site visited. However, 27.9% (55/197) of patients were not concerned about their employer finding out what health sites they visited, whereas 37.5% (78/208) were concerned that others would find out. Conclusions: The results suggest that online health information-seeking behavior influences offline health-related behavior among the population surveyed. Patient attitudes to online health information seeking were focused on issues relating to trust, reliability, privacy, and confidentiality. This study provides support for the growing phenomenon of an empowered, computer-literate, health information consumer, and the impact of this phenomenon must be considered in the context of the patient-health professional dynamic. The unpredictable nature of human thought and action in relation to this field of study requires an ongoing program of ethnographic research, both physical and virtual, within a Health Web Science framework. This study has provided a baseline of the prevalence of online health information seeking in the Grampian region of Scotland.

  • This image is from Flickr: https://www.flickr.com/photos/leyrlo/8478181095/in/photolist-dVbTS8-donaVt-4nZswe-zoD7S-5enoC2-3aJF9W-SNMW-3JSkQD-4cWRn6-5uyQXW-4s6q3J-bRVAok-4RXXGD-bZxi9L-6TMw4d-4kvbo8-qoayFf-c1gwmq-5Ljs5w-9ZA2Jx-5ULpjm-4eUmhd-cRoLr-bezX9t-6JT4Bs-cB6m9J-6XMQds-bjY7Wv-b2q4KX-2h53ab-757uaa-5j5weB-dkbsDW-6oUZJg-C4V6-Aenyx-4g7uid-89NEv7-4JQeqA-fKu9Y3-9Cv3HE-dj25sC-7tTD5q-8kYzNr-rkTsnx-4k8dTw-qMfsXW-c1gvDC-xkufg-81E6sc

It's an attribution non-commerical license, the author has asked it be attributed to Leyrlo or Laia Ros and would prefer if it could also be linked it to their flickr.

    Measuring Life Events and Their Association With Clinical Disorder: A Protocol for Development of an Online Approach

    Abstract:

    Background: Severe life events are acknowledged as important etiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared with checklist questionnaire methods and arguments for interview approaches have resurfaced because choosing the appropriate assessment tool provides clarity of information about gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions. Objective: (1) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (2) To review life-events measures and key findings related to disorder, exemplifying depression. (3) To describe an ongoing study with a new online measure and to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes. Methods: The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties, and utilize calendar-based timing, to improve upon checklist approaches. Results: The CLEAR study is in the preliminary stages and its results are expected to be made available by the end of 2015. Conclusions: There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life-event data while combating the limitations of interviews (eg, time consuming and costly) and life-event checklists (eg, inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice, and interventions are discussed.

  • This is a royalty free image by stockdevil (http://www.freedigitalphotos.net/images/film-x-ray-knee-of-osteoarthritis-knee-patient-and-artificial-joint-photo-p321615).

    Web-Based Study of Risk Factors for Pain Exacerbation in Osteoarthritis of the Knee (SPARK-Web): Design and Rationale

    Abstract:

    Background: Knee osteoarthritis (OA) is the most frequent cause of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Many persons with symptomatic knee OA experience recurrent pain exacerbations. Knowledge and clarification of risk factors for pain exacerbation may allow those affected to minimize reoccurrence of these episodes. Objective: The aim of this study is to use a Web-based case-crossover design to identify risk factors for knee pain exacerbations in persons with symptomatic knee OA. Methods: Web-based case-crossover design is used to study persons with symptomatic knee OA. Participants with knee pain and radiographic knee OA will be recruited and followed for 90 days. Participants will complete an online questionnaire at the baseline and every 10 days thereafter (totaling up to 10 control-period questionnaires); participants will also be asked to report online when they experience an episode of increased knee pain. Pain exacerbation will be defined as an increase in knee pain severity of two points from baseline on a numeric rating scale (NRS 0-10). Physical activity, footwear, knee injury, medication use, climate, psychological factors, and their possible interactions will be assessed as potential triggers for pain exacerbation using conditional logistic regression models. Results: This project has been funded by the National Health and Medical Research Council (NHMRC). The enrollment for the study has started. So far, 343 participants have been enrolled. The study is expected to be finished in October 2015. Conclusions: This study will identify risk factors for pain exacerbations in knee OA. The identification and possible modification/elimination of such risk factors will help to prevent the reoccurrence of pain exacerbation episodes and therefore improve knee OA management.

  • MenSS homepage with carousel of personalised tailored content.

    Defining the Content of an Online Sexual Health Intervention: The MenSS Website

    Abstract:

    Background: Health promotion and risk reduction are essential components of sexual health care. However, it can be difficult to prioritize these within busy clinical services. Digital interventions may provide a new method for supporting these. Objective: The MenSS (Men’s Safer Sex) website is an interactive digital intervention developed by a multidisciplinary team, which aims to improve condom use in men who have sex with women (MSW). This paper describes the content of this intervention, and the rationale for it. Methods: Content was informed by a literature review regarding men’s barriers to condom use, workshops with experts in sexual health and technology (N=16) and interviews with men in sexual health clinics (N=20). Data from these sources were analyzed thematically, and synthesized using the Behavior Change Wheel framework. Results: The MenSS intervention is a website optimized for delivery via tablet computer within a clinic waiting room setting. Key targets identified were condom use skills, beliefs about pleasure and knowledge about risk. Content was developed using behavior change techniques, and interactive website features provided feedback tailored for individual users. Conclusions: This paper provides a detailed description of an evidence-based interactive digital intervention for sexual health, including how behavior change techniques were translated into practice within the design of the MenSS website. Triangulation between a targeted literature review, expert workshops, and interviews with men ensured that a range of potential influences on condom use were captured.

  • Untitled.

    Collecting and Analyzing Patient Experiences of Health Care From Social Media

    Abstract:

    Background: Social Media, such as Yelp, provides rich information of consumer experience. Previous studies suggest that Yelp can serve as a new source to study patient experience. However, the lack of a corpus of patient reviews causes a major bottleneck for applying computational techniques. Objective: The objective of this study is to create a corpus of patient experience (COPE) and report descriptive statistics to characterize COPE. Methods: Yelp reviews about health care-related businesses were extracted from the Yelp Academic Dataset. Natural language processing (NLP) tools were used to split reviews into sentences, extract noun phrases and adjectives from each sentence, and generate parse trees and dependency trees for each sentence. Sentiment analysis techniques and Hadoop were used to calculate a sentiment score of each sentence and for parallel processing, respectively. Results: COPE contains 79,173 sentences from 6914 patient reviews of 985 health care facilities near 30 universities in the United States. We found that patients wrote longer reviews when they rated the facility poorly (1 or 2 stars). We demonstrated that the computed sentiment scores correlated well with consumer-generated ratings. A consumer vocabulary to describe their health care experience was constructed by a statistical analysis of word counts and co-occurrences in COPE. Conclusions: A corpus called COPE was built as an initial step to utilize social media to understand patient experiences at health care facilities. The corpus is available to download and COPE can be used in future studies to extract knowledge of patients’ experiences from their perspectives. Such information can subsequently inform and provide opportunity to improve the quality of health care.

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  • Application of Web-enabled leg training system for the objective monitoring and quantitative analysis of exercise-induced fatigue

    Date Submitted: Jul 29, 2015

    Open Peer Review Period: Jul 29, 2015 - Aug 12, 2015

    Background: Sustained cardiac rehabilitation is the key intervention in prevention and treatment of many human diseases, but implementation of exercise programs can be challenging because of early fat...

    Background: Sustained cardiac rehabilitation is the key intervention in prevention and treatment of many human diseases, but implementation of exercise programs can be challenging because of early fatigability in patients with chronic diseases, overweight individuals and aged people. Current methods of fatigability assessment are based on subjective self-reporting such as rating of perceived exertion or require specialised laboratory conditions and sophisticated equipment. A practical approach allowing objective measurement of exercise-induced fatigue would be useful for the optimisation of sustained delivery of cardiac rehabilitation to improve patient outcomes. Objective: In this work we aimed to develop and validate an innovative approach, allowing objective assessment of exercise-induced fatigue using the Web-enabled leg rehabilitation system. Methods: MedExercise® training devices were equipped with wireless temperature sensors in order to monitor their usage by temperature rise in the resistance unit (Δt°). Since Δt° correlated with the intensity and duration of exercise, this parameter was used to characterise participants’ leg work output (LWO). Personal smart devices such as laptop computers with wireless gateways and relevant software were used for monitoring of self-control training. Connection of smart devices to the Internet and cloud-based software allowed remote monitoring of LWO in participants training at home. The heart rates were measured by fingertip pulse-oximeters simultaneously with Δt° in overall seven healthy volunteers. Results: It was shown that exercise-induced fatigue manifested as the decline of LWO and/or raising the heart rate, which could be observed in real time. Conversely, training at the steady-state LWO and heart rate for the entire duration of exercise bout was considered as fatigue-free. The amounts of recommended daily physical activity were expressed as the individual Δt° values reached during 30-minute fatigue-free exercise of moderate intensity and averaged at 8.1±1.5C° (n=7). These Δt° values were applied as the thresholds for sending automatic notifications upon taking the personalised LWO doses by self-control training at home. While the average time of taking LWO doses was 30.3±4.1 minutes (n=25), analysis of times required to reach the same Δt° by the same participant revealed that longer durations were due to fatigability, manifesting as reduced LWO at the later stages of training bouts. Typically, exercising in the afternoons associated with no fatigue, although longer durations of evening sessions suggested a diurnal fatigability pattern. Conclusions: This pilot study demonstrated the feasibility of objective monitoring of fatigue development in real time and online as well as retrospective fatigability quantification by the duration of training bouts to reach the same exercise dose. This simple method of leg training at home accompanied by routine fatigue monitoring might be useful for the optimisation of exercise interventions in primary care and special populations.

  • Title: Cost-effectiveness of “National Program on Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS)” and efficiency analysis of various scale up scenarios in a low middle income country.

    Date Submitted: Jul 23, 2015

    Open Peer Review Period: Jul 24, 2015 - Aug 7, 2015

    Background: Introduction: India has responded to rising burden of Non-Communicable Diseases by initiating a national programme for non-communicable disease control. Mid and long term targets under the...

    Background: Introduction: India has responded to rising burden of Non-Communicable Diseases by initiating a national programme for non-communicable disease control. Mid and long term targets under the program have been laid down for controlling NCDs. Though financial estimates have been prepared for implementation of program but how much will be the effects of implementing the program at current costs in current scenarios and will country be able to achieve the set targets at current level of spending are the key questions that need to be answered. We have therefore proposed to conduct a Markov model based cost effectiveness analysis of this programme. Objective: 1. To assess the existing cost of delivery of interventions under the NPCDCS in two states of North India. 2. To conduct a review of the effectiveness of various interventions being delivered under the programme in developing countries. 3. To develop an economic model to estimate the cost- effectiveness of various interventions for NCD control. 4. To estimate the incremental cost per DALY averted for the NPCDCS in its current form compared to a ‘no-program’ scenario. 5. To evaluate from an efficiency viewpoint, various scenarios for scale up of interventions under the programme to achieve the 25X25 targets. Methods: Methodology: The research question will be answered from a societal perspective. Effectiveness of different interventions will be reviewed from literature. Effectiveness will be modelled in terms of gain in DALYs. Interventions will be evaluated relative to a counterfactual epidemiological situation of doing nothing as against implementing the specified-interventions at the specified levels of coverage. The simulation exercise will be applied to the period 2010-2025, coinciding with the end year of achieving 25X25 targets. Results: 1. Incremental cost per patient, under program against a comparator of “No program”. 2. Incremental cost per unit reduction in DALYs, under program against a comparator of “No program”. 3. Incremental costs by year from 2013-2025 for different intervention packages, in all the scenarios of scale up. Conclusions: The proposed research is highly policy relevant in light of current nature of debate on achievement of MDGs. The cost estimates and cost effectiveness analysis can act as a way forward to successful achievement of NCD 25×25 targets in coming years.

  • Study protocol exploring a new simulation approach to improve clinical reasoning teaching and assessment.

    Date Submitted: Jul 14, 2015

    Open Peer Review Period: Jul 16, 2015 - Jul 30, 2015

    Background: Helping trainees develop appropriate clinical reasoning abilities is a challenging goal in an environment such as neonatology where clinical situations are marked by high levels of complex...

    Background: Helping trainees develop appropriate clinical reasoning abilities is a challenging goal in an environment such as neonatology where clinical situations are marked by high levels of complexity and unpredictability. The benefit of simulation-based education to assess clinical reasoning skills has rarely been reported. More specifically, it is unclear if clinical reasoning is better acquired if the instructor’s input occurs entirely after or is integrated during the scenario. Based on educational principles of clinical reasoning and a taxonomy of clinical reasoning difficulties, a new simulation approach (Simulation with Iterative Discussions) where the instructor interrupts the flow of the scenario at 3 key moments of the reasoning process (data gathering, integration and confirmation) is introduced. At each stop, the instructor explores the student’s clinical reasoning by self-verbalization of the reasoning process similarly to a think aloud approach, and without providing feedback. After each stop, the scenario is continued where it was interrupted. Finally, a brief general debriefing ends the session. Objective: The aim of this study is to evaluate the effectiveness of Simulation with Iterative Discussions versus the classical approach of simulation in developing reasoning skills of General Pediatrics and Neonatal-Perinatal Medicine residents. Methods: This will be a prospective exploratory, randomized study conducted at Sainte-Justine hospital in Montreal, Qc, between September and November, 2015. All PGY-1 to 6 residents will be invited to complete one (Simulation with Iterative Discussions or classical simulation) 30 minutes audio video-recorded complex high-fidelity simulations covering a similar neonatology topic. A student satisfaction questionnaire will be completed and a semi-structured interview will be conducted after each simulation. Data analyses will use SPSS and NVivo softwares. Results: This study is in the preliminary stages and its results are expected to be made available by the end of 2015. Conclusions: This will be the first study to explore a new simulation approach designed to enhance clinical reasoning. By assessing more closely the reasoning process throughout a simulation session, we believe that Simulation with Iterative Discussions will be an interesting and more effective approach for students. The findings of the study will benefit medical educators, education programs and medical students.