JMIR Formative Research最新文献

{"title":"Home-Based Connected Devices Combined With Statistical Process Control for the Early Detection of Respiratory Exacerbations by Patients With Cystic Fibrosis: Pilot Interventional Study With a Pre-Post Design.","authors":"Enora Le Roux, Moreno Ursino, Ivana Milovanovic, Paul Picq, Jeremie Haignere, Gilles Rault, Dominique Pougheon Bertrand, Corinne Alberti","doi":"10.2196/51753","DOIUrl":"10.2196/51753","url":null,"abstract":"<p><strong>Background: </strong>Currently, patients with cystic fibrosis do not routinely monitor their respiratory function at home.</p><p><strong>Objective: </strong>This study aims to assess the clinical validity of using different connected health devices at home to measure 5 physiological parameters to help prevent exacerbations on a personalized basis from the perspective of patient empowerment.</p><p><strong>Methods: </strong>A multicenter interventional pilot study including 36 patients was conducted. Statistical process control-the cumulative sum control chart (CUSUM)-was used with connected health device measures with the objective of sending patients alerts at a relevant time in order to identify their individual risk of exacerbations. Associated patient education was delivered. Quantitative and qualitative data were collected.</p><p><strong>Results: </strong>One-half (18/36) of the patients completed the protocol through the end of the study. During the 12-month intervention, 6162 measures were collected with connected health devices, 387 alerts were sent, and 33 exacerbations were reported. The precision of alerts to detect exacerbations was weak for all parameters, which may be partly related to the low compliance of patients with the measurements. However, a decrease in the median number of exacerbations from 12 months before the study to after the 12-month intervention was observed for patients.</p><p><strong>Conclusions: </strong>The use of connected health devices associated with statistical process control showed that it was not acceptable for all patients, especially because of the burden related to measurements. However, the results suggest that it may be promising, after adaptations, for early identification and better management of exacerbations.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/study/NCT03304028.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Potential of Electronic Patient-Generated Health Data for Evaluating Treatment Response to Intramuscular Steroids in Rheumatoid Arthritis: Case Series.","authors":"Mariam Al-Attar, Kesmanee Assawamartbunlue, Julie Gandrup, Sabine N van der Veer, William G Dixon","doi":"10.2196/55715","DOIUrl":"10.2196/55715","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mobile health devices are increasingly available, presenting exciting opportunities to remotely collect high-frequency, electronic patient-generated health data (ePGHD). This novel data type may provide detailed insights into disease activity outside usual clinical settings. Assessing treatment responses, which can be hampered by the infrequency of appointments and recall bias, is a promising, novel application of ePGHD. Drugs with short treatment effects, such as intramuscular steroid injections, illustrate the challenge, as patients are unlikely to accurately recall treatment responses at follow-ups, which often occur several months later. Retrospective assessment means that responses may be over- or underestimated. High-frequency ePGHD, such as daily, app-collected, patient-reported symptoms between clinic appointments, may bridge this gap. However, the potential of ePGHD remains untapped due to the absence of established definitions for treatment response using ePGHD or established methodological approaches for analyzing this type of data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to explore the feasibility of evaluating treatment responses to intramuscular steroid therapy in a case series of patients with rheumatoid arthritis tracking daily symptoms using a smartphone app.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We report a case series of patients who collected ePGHD through the REmote Monitoring Of Rheumatoid Arthritis (REMORA) smartphone app for daily remote symptom tracking. Symptoms were tracked on a 0-10 scale. We described the patients' longitudinal pain scores before and after intramuscular steroid injections. The baseline pain score was calculated as the mean pain score in the 10 days prior to the injection. This was compared to the pain scores in the days following the injection. \"Response\" was defined as any improvement from the baseline score on the first day following the injection. The response end time was defined as the first date when the pain score exceeded the pre-steroid baseline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 6 patients who, between them, received 9 steroid injections. Average pre-injection pain scores ranged from 3.3 to 9.3. Using our definitions, 7 injections demonstrated a response. Among the responders, the duration of response ranged from 1 to 54 days (median 9, IQR 7-41), average pain score improvement ranged from 0.1 to 5.3 (median 3.3, IQR 2.2-4.0), and maximum pain score improvement ranged from 0.1 to 7.0 (median 4.3, IQR 1.7 to 6.0).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This case series demonstrates the feasibility of using ePGHD to evaluate treatment response and is an important exploratory step toward developing more robust methodological approaches for analysis of this novel data type. Issues highlighted by our analysis include the importance of accounting for one-off data points, varying response start times, and confounders such as other medications. Future analy","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study.","authors":"Jennifer D Marler, Craig A Fujii, MacKenzie T Utley, Daniel J Balbierz, Joseph A Galanko, David S Utley","doi":"10.2196/57376","DOIUrl":"10.2196/57376","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app-based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks-4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P&lt;.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change -3.2, SD 3.9; P&lt;.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were &gt;90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study.","authors":"Susanna Strandberg, Mirjam Ekstedt, Cecilia Fagerström, Sofia Backåberg","doi":"10.2196/57219","DOIUrl":"10.2196/57219","url":null,"abstract":"<p><strong>Background: </strong>Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs.</p><p><strong>Objective: </strong>This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home.</p><p><strong>Methods: </strong>This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework.</p><p><strong>Results: </strong>The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, \"Breathing exercises\" and \"Picking up from the floor,\" revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested.</p><p><strong>Conclusions: </strong>This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Client Perspectives of Case Stories in Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Study.","authors":"Jill Ab Price, Julia Gregory, Hugh C McCall, Caeleigh A Landry, Janine D Beahm, Heather D Hadjistavropoulos","doi":"10.2196/64454","DOIUrl":"10.2196/64454","url":null,"abstract":"<p><strong>Background: </strong>Internet-delivered cognitive behavioral therapy (ICBT) is an effective and convenient means of offering cognitive behavioral therapy to the general population. To increase access to ICBT among Canadian public safety personnel (PSP)-a group that experiences elevated rates of mental health concerns and barriers to mental health care-a clinical research unit called PSPNET has tailored ICBT to PSP, primarily through offering case stories and PSP-specific examples within an ICBT program. PSPNET's first and most frequently used ICBT program, called the PSP Wellbeing Course, has been found to reduce symptoms of mental disorders (eg, anxiety, depression, and posttraumatic stress) among PSP. Little research, however, has investigated clients' perceptions of the case stories in this course.</p><p><strong>Objective: </strong>This study was designed to expand the literature on the use and evaluation of case stories in ICBT among PSP. Specifically, this study investigated (1) PSP's perceptions of the case stories using the theoretical model provided by Shaffer and Zikmund-Fisher and (2) PSP feedback on the case stories in the PSP Wellbeing Course.</p><p><strong>Methods: </strong>This study included 41 clients who completed the PSP Wellbeing Course. Of these, 27 clients completed a bespoke questionnaire called the Stories Questionnaire, 10 of whom also participated in a semistructured interview.</p><p><strong>Results: </strong>Findings show that perceptions of the case stories in the PSP Wellbeing Course were largely positive and that the case stories were generally successful in achieving the 5 purposes of case stories (ie, informing, comforting, modeling, engaging, and persuading) proposed by Shaffer and Zikmund-Fisher. Client feedback also identified 3 tangible areas for story improvement: characters, content, and delivery. Each area highlights the need for and potential benefits of story development. Not all PSP engaged with the case stories, though, so results must be interpreted with caution.</p><p><strong>Conclusions: </strong>Overall, this study adds to the growing body of research supporting the use of case stories in internet-delivered interventions among PSP.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study.","authors":"Zara Dana, Harpreet Nagra, Kimberly Kilby","doi":"10.2196/59501","DOIUrl":"10.2196/59501","url":null,"abstract":"<p><strong>Background: </strong>Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users' autonomy, competence, and relatedness.</p><p><strong>Objective: </strong>This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism.</p><p><strong>Methods: </strong>Participants were each prompted with a single question: \"What's your struggle?\" Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts.</p><p><strong>Results: </strong>Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively.</p><p><strong>Conclusions: </strong>Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of Stigmatizing Documentation Among Hospital Medicine Encounters With Opioid-Related Diagnosis Codes: Cohort Study.","authors":"William S Bradford, Reed W R Bratches, Hollie Porras, David R Chen, Kelly W Gagnon, Simon B Ascher","doi":"10.2196/53510","DOIUrl":"10.2196/53510","url":null,"abstract":"<p><strong>Background: </strong>Physician use of stigmatizing language in the clinical documentation of hospitalized adults with opioid use is common. However, patient factors associated with stigmatizing language in this setting remain poorly characterized.</p><p><strong>Objective: </strong>This study aimed to determine whether specific demographic factors and clinical outcomes are associated with the presence of stigmatizing language by physicians in the clinical documentation of encounters with opioid-related ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes.</p><p><strong>Methods: </strong>Hospital encounters with one or more associated opioid-related ICD-10 admission diagnoses on the hospital medicine service during the 2020 calendar year were analyzed for the presence of stigmatizing language in history and physical and discharge summaries. Multivariable adjusted logistic regression models were used to determine associations of age, race, gender, medication for addiction treatment use, against medical advice discharge, homelessness, comorbid polysubstance use, comorbid psychiatric disorder, comorbid chronic pain, cost, and 30-day readmission with the presence of stigmatizing language.</p><p><strong>Results: </strong>A total of 221 encounters were identified, of which 64 (29%) encounters had stigmatizing language present in physician documentation. Most stigmatizing language was due to use of \"substance abuse\" rather than the preferred term \"substance use\" (63/66 instances). Polysubstance use and homelessness were independently associated with the presence of stigmatizing language (adjusted odds ratio [aOR] 7.83; 95% CI 3.42-19.24 and aOR 2.44; 95% CI 1.03-5.90) when controlling for chronic pain and other covariates.</p><p><strong>Conclusions: </strong>Among hospital medicine encounters with an opioid-related diagnosis, stigmatizing language by physicians in clinical documentation was common and independently associated with comorbid polysubstance use and homelessness.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cadence-Based Pedometer App With Financial Incentives to Enhance Moderate-to-Vigorous Physical Activity: Development and Single-Arm Feasibility Study.","authors":"Kosuke Hayashi, Hiromitsu Imai, Ichiro Oikawa, Yugo Ishihara, Hirokazu Wakuda, Iori Miura, Shingo Uenohara, Asuka Kuwae, Megumi Kai, Ken'ichi Furuya, Naoto Uemura","doi":"10.2196/56376","DOIUrl":"10.2196/56376","url":null,"abstract":"<p><strong>Background: </strong>High levels of physical activity are key to improving health outcomes, yet many people fail to take action. Using pedometers to target steps per day and providing financial incentives is a simple and scalable approach to promoting public health. However, conventional pedometers do not account for \"intensity\" and \"duration,\" making it challenging to efficiently increase people's moderate-to-vigorous physical activity (MVPA), which is expected to improve health outcomes. Based on these rationales, we developed a smartphone app that sets step cadence as a goal (defined as a daily challenge of walking more than 1500 steps in 15 minutes twice a day, which is a heuristic threshold for moderate physical activity) and provides financial incentive when the challenge is met.</p><p><strong>Objective: </strong>This study aimed to evaluate the feasibility of our novel app and explore whether its use can increase users' daily MVPA.</p><p><strong>Methods: </strong>A single-arm pre-post study evaluated the feasibility and efficacy of the app. A total of 15 participants used app 1 (an app without financial incentives) for the first period (4 weeks) and then switched to app 2 (an app with financial incentives) for the second period (4 weeks). The primary outcome was the difference between the first and second periods in the number of successful challenge attempts per week. Secondary outcomes were differences between the first and second periods in daily steps and distance walked. Exploratory outcomes included the difference between the first and second periods in daily \"heart points\" as measured by Google Fit, a publicly available app that measures users' daily MVPA.</p><p><strong>Results: </strong>The number of successful challenge attempts per week increased significantly compared to the first period (5.6 times per week vs 0.7 times per week; P<.001). Although not statistically significant, there was a trend toward an increase in the mean steps per day and distance walked per day (6586 steps per day vs 5950 steps per day; P=.19; and 4.69 km per day vs 3.85 km per day; P=.09, respectively). An exploratory end point examining daily MVPA by \"heart points\" collected from Google Fit also showed a significant increase compared to the first period (22.7 points per day vs 12.8 points per day; P=.02).</p><p><strong>Conclusions: </strong>Our app using step cadence as a goal and providing financial incentives seemed feasible and could be an effective app to increase users' daily MVPA. Based on the results of this study, we are motivated to conduct a confirmatory study with a broader and larger number of participants.</p><p><strong>Trial registration: </strong>UMIN 000050518; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057420.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study.","authors":"Jae Heon Kim, Ui Cheol Lee, Byeong Hun Jeong, Byeong Uk Kang, Sung Ryul Shim, In Gab Jeong","doi":"10.2196/58583","DOIUrl":"10.2196/58583","url":null,"abstract":"<p><strong>Background: </strong>Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers.</p><p><strong>Objective: </strong>The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults.</p><p><strong>Methods: </strong>From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user's movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods.</p><p><strong>Results: </strong>The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was -0.045 of the standardized mean difference, and all measurements were located within the 95% CI, so this confirms that the 2 test methods are equivalent.</p><p><strong>Conclusions: </strong>Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aligning Large Language Models for Enhancing Psychiatric Interviews Through Symptom Delineation and Summarization: Pilot Study.","authors":"Jae-Hee So, Joonhwan Chang, Eunji Kim, Junho Na, JiYeon Choi, Jy-Yong Sohn, Byung-Hoon Kim, Sang Hui Chu","doi":"10.2196/58418","DOIUrl":"10.2196/58418","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recent advancements in large language models (LLMs) have accelerated their use across various domains. Psychiatric interviews, which are goal-oriented and structured, represent a significantly underexplored area where LLMs can provide substantial value. In this study, we explore the application of LLMs to enhance psychiatric interviews by analyzing counseling data from North Korean defectors who have experienced traumatic events and mental health issues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to investigate whether LLMs can (1) delineate parts of the conversation that suggest psychiatric symptoms and identify those symptoms, and (2) summarize stressors and symptoms based on the interview dialogue transcript.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Given the interview transcripts, we align the LLMs to perform 3 tasks: (1) extracting stressors from the transcripts, (2) delineating symptoms and their indicative sections, and (3) summarizing the patients based on the extracted stressors and symptoms. These 3 tasks address the 2 objectives, where delineating symptoms is based on the output from the second task, and generating the summary of the interview incorporates the outputs from all 3 tasks. In this context, the transcript data were labeled by mental health experts for the training and evaluation of the LLMs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;First, we present the performance of LLMs in estimating (1) the transcript sections related to psychiatric symptoms and (2) the names of the corresponding symptoms. In the zero-shot inference setting using the GPT-4 Turbo model, 73 out of 102 transcript segments demonstrated a recall mid-token distance d&lt;20 for estimating the sections associated with the symptoms. For evaluating the names of the corresponding symptoms, the fine-tuning method demonstrates a performance advantage over the zero-shot inference setting of the GPT-4 Turbo model. On average, the fine-tuning method achieves an accuracy of 0.82, a precision of 0.83, a recall of 0.82, and an F1-score of 0.82. Second, the transcripts are used to generate summaries for each interviewee using LLMs. This generative task was evaluated using metrics such as Generative Evaluation (G-Eval) and Bidirectional Encoder Representations from Transformers Score (BERTScore). The summaries generated by the GPT-4 Turbo model, utilizing both symptom and stressor information, achieve high average G-Eval scores: coherence of 4.66, consistency of 4.73, fluency of 2.16, and relevance of 4.67. Furthermore, it is noted that the use of retrieval-augmented generation did not lead to a significant improvement in performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;LLMs, using either (1) appropriate prompting techniques or (2) fine-tuning methods with data labeled by mental health experts, achieved an accuracy of over 0.8 for the symptom delineation task when measured across all segments in the transcript. Additionally, they attained a G-Eval score of","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}