Journal of Medical Internet Research最新文献

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Impacts of Using Peer Online Forums in Mental Health: Realist Evaluation Using Mixed Methods. 使用同伴在线论坛对心理健康的影响:使用混合方法的现实主义评估。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-10-01 DOI: 10.2196/79289
Fiona Lobban, Neil Caton, Anna Lindroos Cermakova, Gee Collins, Zoe Glossop, Jade Haines, Steven Jones, Christopher Lodge, Karen Machin, Paul Marshall, Rachel Meacock, Tamara Rakić, Paul Rayson, Heather Robinson, Jo Rycroft-Malone, Elena Semino, Nick Shryane, Karin Tusting
{"title":"Impacts of Using Peer Online Forums in Mental Health: Realist Evaluation Using Mixed Methods.","authors":"Fiona Lobban, Neil Caton, Anna Lindroos Cermakova, Gee Collins, Zoe Glossop, Jade Haines, Steven Jones, Christopher Lodge, Karen Machin, Paul Marshall, Rachel Meacock, Tamara Rakić, Paul Rayson, Heather Robinson, Jo Rycroft-Malone, Elena Semino, Nick Shryane, Karin Tusting","doi":"10.2196/79289","DOIUrl":"10.2196/79289","url":null,"abstract":"<p><strong>Background: </strong>Peer online forums offer people experiencing mental health challenges easily accessible and anonymous support. However, little is known about the impacts of using forums, how these impacts are generated, or who might benefit from which type of forum.</p><p><strong>Objective: </strong>We aimed to develop a program theory to understand how peer online mental health forums work to help potential users, health professionals, service providers, and commissioners to decide whether to use forums and which to choose.</p><p><strong>Methods: </strong>A realist evaluation using a mixed methods, case series design in collaboration with 7 peer online mental health forums was conducted. We triangulated analysis of a large web-based survey (n=791) with in-depth realist interviews (n=52) to test and refine previously developed program theories about the impacts of using online forums. We then analyzed forum posts to identify in situ evidence for our revised theories. We only used forum posts from individuals who had freely consented to posts being shared for research. Data collection and analysis involved extensive input from our patient and public involvement group, including forum users, moderators, and senior forum staff (n=22), which met monthly for 22 two-hour-long workshops throughout the study.</p><p><strong>Results: </strong>Impacts of using peer online mental health forums were largely positive. Forums that are easy to navigate, make users feel safe to post, and are supported by well-trained moderators offering timely and sensitive responses can help people find new ways to make sense of their mental health challenges, feel understood, and accepted in the forum. This can lead to an increase in self-efficacy, a reduction in self-stigma, and increased mental well-being. Writing about experiences in a forum can itself be cathartic, but when posts have evidently been helpful to other members, posters also benefit from a sense of greater purpose and value. Negative impacts can occur if forums are difficult to navigate or if moderation is unresponsive, insensitive, or inadequate, as users can be left feeling unheard, misunderstood, or overly responsible for the welfare of others.</p><p><strong>Conclusions: </strong>Forums offer accessible and inclusive ways to effectively support mental health for many people, some of whom may have limited access to other forms of help. The impacts on users are largely positive, but care is needed to ensure forums are well designed and moderators are well trained and supported. These findings are being used to inform the co-design of a web-based moderator toolkit and design guidelines, which will be made freely available.</p><p><strong>Trial registration: </strong>ISRCTN 62469166; https://www.isrctn.com/ISRCTN62469166.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e79289"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stakeholder Perspectives on Early Feasibility Studies for Digital Health Technologies in the European Union: Qualitative Interview Study. 利益相关者对欧盟数字卫生技术早期可行性研究的看法:定性访谈研究。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-10-01 DOI: 10.2196/77982
Marlen Peseke, Ilja Michaelis, Ornella Tangila Kayembe, Majella Geraghty, Ali McDonnell, Franco Luigi Zurlo, Zoe Sophie Oftring, Nicolas Martelli, Tom Melvin, Sebastian Kuhn
{"title":"Stakeholder Perspectives on Early Feasibility Studies for Digital Health Technologies in the European Union: Qualitative Interview Study.","authors":"Marlen Peseke, Ilja Michaelis, Ornella Tangila Kayembe, Majella Geraghty, Ali McDonnell, Franco Luigi Zurlo, Zoe Sophie Oftring, Nicolas Martelli, Tom Melvin, Sebastian Kuhn","doi":"10.2196/77982","DOIUrl":"10.2196/77982","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Early feasibility studies (EFSs) are small-scale clinical investigations conducted during the early development of medical devices to assess initial safety and performance, especially when bench or in-silico testing is insufficient. While EFSs are well established for hardware devices, their application to digital health technologies (DHTs) including artificial intelligence (AI)-enabled medical devices remains limited. The rapidly evolving regulatory landscape, including the European Union Medical Device Regulation (EU MDR 2017/745) and the phased introduction of the European Union Artificial Intelligence (EU AI) Act, creates additional complexity for DHT developers. Despite the recognized potential of EFSs to support iterative, user-centered innovation, little is known about how European DHT companies and contract research organizations (CROs) perceive and implement EFSs, or what barriers and opportunities exist for broader adoption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore stakeholder perspectives on the use, barriers, and opportunities of EFSs for DHTs in the European Union, and to generate stakeholder-driven recommendations for a harmonized EU-wide EFS framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A qualitative descriptive study was conducted using semistructured interviews with representatives from 12 DHT companies and 3 CROs across a range of company sizes, MDR device risk classes, and clinical domains. Participants were recruited through purposive maximum-variation sampling until saturation was reached to capture diverse experiences in regulatory and clinical evidence generation. Interviews, conducted in November 2024 and January 2025, were transcribed and analyzed using thematic analysis, combining deductive and inductive coding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Interviews revealed that while EFSs are valued for providing early human-factor feedback and facilitating iterative design improvements, their current use in DHT development is limited. Key barriers include unclear and hardware-centric regulatory requirements under MDR, fragmented and inconsistent interpretations across EU member states, resource and expertise constraints, and limited dialog with regulatory authorities. The anticipated introduction of the EU AI Act is expected to further increase regulatory complexity, with stakeholders expressing uncertainty about overlapping obligations and the risk of slowed innovation. Some companies, particularly larger or AI-focused ones, have proactively prepared for these changes, while others, especially small and medium-sized enterprises, face significant resource challenges. Several companies reported prioritizing the US Food and Drug Administration pathway due to clearer guidance for DHTs and structured timelines. Stakeholders advocated for a harmonized EU EFS program with DHT-specific guidelines, standardized documentation, predictable timelines, and improved communication channels. Sev","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e77982"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prediction of Moderate-to-Severe Sepsis-Associated Acute Kidney Injury Using a Dual-Timepoint Machine Learning Model: Development, Multiregional Validation, and Clinical Deployment Study. 使用双时间点机器学习模型预测中重度败血症相关急性肾损伤:开发、多地区验证和临床部署研究
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-30 DOI: 10.2196/73840
Xinbo Ge, Weiwei Chen, Jianshan Shi, Jiaqiang Zhang, Hao Tai, Ying Zhang, Biao Wang, Wei Liu, Song Chen, Huirui Han
{"title":"Prediction of Moderate-to-Severe Sepsis-Associated Acute Kidney Injury Using a Dual-Timepoint Machine Learning Model: Development, Multiregional Validation, and Clinical Deployment Study.","authors":"Xinbo Ge, Weiwei Chen, Jianshan Shi, Jiaqiang Zhang, Hao Tai, Ying Zhang, Biao Wang, Wei Liu, Song Chen, Huirui Han","doi":"10.2196/73840","DOIUrl":"https://doi.org/10.2196/73840","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis-associated acute kidney injury (SA-AKI) is a frequent and life-threatening complication in patients in the intensive care unit (ICU), significantly increasing both mortality rates and the risk of chronic kidney dysfunction. However, existing prediction models have often focused on overall risk and lack severity-based stratification, which limits their clinical applicability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to identify critical time points in SA-AKI progression development and validate dynamic, stratified machine learning prediction models for moderate-to-severe (Kidney Disease: Improving Global Outcomes guideline stages 2-3) SA-AKI through multicenter, multiregional external validation, ultimately deploying them as publicly accessible, interpretable clinical decision support tools.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study used three independent ICU databases: Medical Information Mart for Intensive Care-IV v3.0 (n=12,842; model development and internal validation), electronic ICU collaborative research database v2.0 (n=15,767; North American multicenter external validation), and the First Affiliated Hospital of Hainan Medical University ICU (n=210; Chinese single-center external validation). We identified 48 hours (acute phase) and 7 days (subacute phase) as critical time points. Based on clinical data from the first 24 hours of ICU admission, we used a two-stage feature selection process combining light gradient boosting machine (LightGBM) and Shapley additive explanation (SHAP) cross-validation analysis with clinical expert review, followed by modeling using 8 machine learning algorithms. The optimal model was selected based on the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Internal validation used 5-fold cross-validation, while external validation and subgroup analyses assessed generalizability across different regions and populations. SHAP values and partial dependence plots were used to interpret the influence of key features on predictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our dual-timepoint LightGBM model demonstrated robust predictive performance. For the 48-hour prediction task, the model achieved an AUC of 0.839 (95% CI 0.824-0.854) in the internal test set, with AUCs of 0.770 (95% CI 0.762-0.779) and 0.793 (95% CI 0.726-0.856) in the external validation cohorts, respectively. For the 7-day prediction task, the corresponding AUCs across the three cohorts were 0.834 (95% CI 0.818-0.850), 0.720 (95% CI 0.711-0.729), and 0.773 (95% CI 0.687-0.851), respectively. Subgroup analyses confirmed robust model performance across different age, gender, and comorbidity subgroups. SHAP analysis identified urine output, mechanical ventilation, Sequential Organ Failure Assessment score, creatinine, Glasgow Coma Scale score, and nephrotoxic drug use as core predictive features. Decision curve analysis confirmed that LightGBM prov","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e73840"},"PeriodicalIF":6.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Large Language Models in Lung Cancer: Systematic Review. 肺癌的大型语言模型:系统综述。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-30 DOI: 10.2196/74177
Ruikang Zhong, Siyi Chen, Zexing Li, Tangke Gao, Yisha Su, Wenzheng Zhang, Dianna Liu, Lei Gao, Kaiwen Hu
{"title":"Large Language Models in Lung Cancer: Systematic Review.","authors":"Ruikang Zhong, Siyi Chen, Zexing Li, Tangke Gao, Yisha Su, Wenzheng Zhang, Dianna Liu, Lei Gao, Kaiwen Hu","doi":"10.2196/74177","DOIUrl":"10.2196/74177","url":null,"abstract":"<p><strong>Background: </strong>In the era of data and intelligence, artificial intelligence has been widely applied in the medical field. As the most cutting-edge technology, the large language model (LLM) has gained popularity due to its extraordinary ability to handle complex tasks and interactive features.</p><p><strong>Objective: </strong>This study aimed to systematically review current applications of LLMs in lung cancer (LC) care and evaluate their potential across the full-cycle management spectrum.</p><p><strong>Methods: </strong>Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a comprehensive literature search across 6 databases up to January 1, 2025. Studies were included if they satisfied the following criteria: (1) journal articles, conference papers, and preprints; (2) studies that reported the content of LLMs in LC; (3) including original data and LC-related data presented separately; and (4) studies published in English. The exclusion criteria were as follows: (1) books and book chapters, letters, reviews, conference proceedings; (2) studies that did not report the content of LLMs in LC; and (3) no original data, and LC-related data that are not presented separately. Studies were screened independently by 2 authors (SC and ZL) and assessed for quality using Quality Assessment of Diagnostic Accuracy Studies-2, Prediction Model Risk of Bias Assessment Tool, and Risk Of Bias in Non-randomized Studies - of Interventions tools, selected based on study type. Key data items extracted included model type, application scenario, prompt method, input and output format, outcome measures, and safety considerations. Data analysis was conducted using descriptive statistics.</p><p><strong>Results: </strong>Out of 706 studies screened, 28 were included (published between 2023 and 2024). The ability of LLMs to automatically extract medical records, popularize general knowledge about LC, and assist clinical diagnosis and treatment has been demonstrated through the systematic review, emerging visual ability, and multimodal potential. Prompt engineering was a critical component, with varying degrees of sophistication from zero-shot to fine-tuned approaches. Quality assessments revealed overall acceptable methodological rigor but noted limitations in bias control and data security reporting.</p><p><strong>Conclusions: </strong>LLMs show considerable potential in improving LC diagnosis, communication, and decision-making. However, their responsible use requires attention to privacy, interpretability, and human oversight.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e74177"},"PeriodicalIF":6.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preferences, Perceptions, and Use of Online Nutrition Content Among Young Australian Adults: Qualitative Study. 澳大利亚年轻人对在线营养内容的偏好、认知和使用:定性研究。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-29 DOI: 10.2196/67640
Bill Tiger Lam, Ewa A Szymlek-Gay, Christel Larsson, Claire Margerison
{"title":"Preferences, Perceptions, and Use of Online Nutrition Content Among Young Australian Adults: Qualitative Study.","authors":"Bill Tiger Lam, Ewa A Szymlek-Gay, Christel Larsson, Claire Margerison","doi":"10.2196/67640","DOIUrl":"https://doi.org/10.2196/67640","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Nutrition misinformation is pervasive on frequently accessed online sources such as social media platforms and websites. Young adults are at a high risk of viewing or engaging with this content due to their high internet and social media usage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to understand young adults' preferences, perceptions, and use of online nutrition content.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Young Australian adults (aged 18-25 years) were recruited and interviewed individually via video calling (Zoom; Zoom Video Communications) between December 2023 and February 2024. Participants were recruited via convenience sampling using Facebook advertising. The interviewer followed a semistructured format, and questions were guided using a piloted template. Reflexive thematic analysis was conducted using NVivo (Lumivero) to explore the preferences, perceptions, and use of online nutrition content among the sample.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The sample (N=20; mean age 22.9 y, SD 2.3 y) was predominantly female (n=13, 65%) and had, or was studying toward, a tertiary qualification (16/17, 94%). Most participants used social media (19/20, 95%) and internet websites (16/20, 80%) to access nutrition content. Other platforms used included generative artificial intelligence (n=1), apps (n=1), eBooks (n=1), newsletters (n=1), and podcasts (n=1). When exploring perceptions, most participants agreed that online nutrition content was quick and easy to find and informative. Furthermore, perceived reliability and engagement depended on several factors such as the creator's credentials, length and format of content, consensus on topics, and sponsorships. Short-form content was not considered reliable, despite its engaging nature. Content containing sponsorships or product endorsements was met with skepticism. However, participants were more likely to trust content reportedly created by health professionals, but it was unknown whether they were accessing verified professionals. The oversaturation of content demotivated participants from evaluating the reliability of content. When asked about preferences, participants valued both short- and long-form content, and evidence-based content such as statistics and references and preferred casual and entertaining content that incorporated high-quality and dynamic editing techniques such as voiceovers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study identified the online nutrition content sources and topics young Australian adults access and the key factors that influence their perceptions and preferences. Young Australian adults acknowledge that misinformation is not exclusive to certain platforms. The accessibility and engagement of content and the ambiguity of professional \"credentials\" may lead them to trust information that is potentially of low quality and accuracy. Findings also show that there needs to be a balance between engaging formats and presenting evidence-b","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e67640"},"PeriodicalIF":6.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Online e-Cigarette Retailers' Use of Price Incentives and Product Features to Attract Adolescent and Young Adult Purchases: Cross-Sectional Choice-Based Study. 在线电子烟零售商使用价格激励和产品特征来吸引青少年和年轻人购买:基于横断面选择的研究。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-29 DOI: 10.2196/75128
Shivani Mathur Gaiha, Catherine Stamoulis
{"title":"Online e-Cigarette Retailers' Use of Price Incentives and Product Features to Attract Adolescent and Young Adult Purchases: Cross-Sectional Choice-Based Study.","authors":"Shivani Mathur Gaiha, Catherine Stamoulis","doi":"10.2196/75128","DOIUrl":"10.2196/75128","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There are reports of several adolescents and young adults purchasing electronic cigarettes (e-cigarettes) from e-cigarette retailer websites. However, there is a lack of consumer research on how e-cigarette retailer websites' content influences adolescent and young adult purchases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to examine whether seeing specific characteristics on e-cigarette retailer websites encourages or discourages e-cigarette purchase by adolescents and young adults and to further assess whether such influences vary by age and e-cigarette use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using a web-based survey, we conducted a cross-sectional choice-based experiment in 5326 individuals (aged 13-24 years). We examined associations between e-cigarette retailer websites' content, reflected in 18 keywords, and the likelihood of e-cigarette purchase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Female and sexual minority (nonheterosexual) adolescents and young adults were more likely to purchase e-cigarettes if websites had a clearance or sale (female individuals: adjusted odds ratio [aOR] 1.19, 95% CI 1.04-1.35; P=.02; sexual minority individuals: aOR 1.48, 95% CI 1.21-1.82; P&lt;.01), deals (sexual minority individuals: aOR 1.28, 95% CI 1.04-1.57; P=.02), or direct discounts (female individuals: aOR 1.26, 95% CI 1.09-1.45; P&lt;.01; sexual minority individuals: aOR 1.29, 95% CI 1.03-1.61; P=.03); if they could shop by flavor (female individuals: aOR 1.49, 95% CI 1.30-1.71; P&lt;.01); or if they saw new and trending products (female individuals: aOR 1.18, 95% CI 1.03-1.34; P=.03). Female individuals were less likely to purchase e-cigarettes if required to register or sign-in (aOR 0.66, 95% CI 0.58-0.76; P&lt;.01) or upload an ID (aOR 0.84, 95% CI 0.74-0.96; P=.02), and similarly, sexual minority individuals were less likely to purchase e-cigarettes if required to register or sign-in (aOR 0.77, 95% CI 0.63-0.96; P=.02). Older participants were more likely to purchase from authorized dealers (aOR 1.06, 95% CI 1.03-1.08; P&lt;.01) if required to enter an email (aOR 1.03, 95% CI 1.01-1.06; P=.01) or a photo ID (aOR 1.11, 95% CI 1.08-1.13; P&lt;.01) but less likely to purchase based on seeing new and trending products (aOR 0.94, 95% CI 0.92-0.96; P&lt;.01) or vape guides or blogs (aOR 0.97, 95% CI 0.95-0.99; P=.04). Participants who had never used e-cigarettes were more susceptible to purchase if they saw a starter kit (aOR 1.27, 95% CI 1.07-1.51; P=.01), if they saw new and trending products (aOR 1.28, 95% CI 1.08-1.52; P&lt;.01), or if they could shop by flavor (aOR 1.67, 95% CI 1.39-2.00; P&lt;.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The findings show that adolescents and young adults are attracted to several aspects of e-cigarette retailer website content. Providing tailored prevention education about price incentives, flavors, and starter kits to vulnerable groups at risk of purchase and ensuring effective age verification could discourage e-ci","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e75128"},"PeriodicalIF":6.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Application of Behavioral Science in Digital Therapeutics for Individuals With Prediabetes: Scoping Review. 行为科学在前驱糖尿病患者数字治疗中的应用:范围综述。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-29 DOI: 10.2196/78891
Zhuyanyang Pan, Xueli Li, Qiaoyuan Yan, Na Zeng
{"title":"Application of Behavioral Science in Digital Therapeutics for Individuals With Prediabetes: Scoping Review.","authors":"Zhuyanyang Pan, Xueli Li, Qiaoyuan Yan, Na Zeng","doi":"10.2196/78891","DOIUrl":"10.2196/78891","url":null,"abstract":"<p><strong>Background: </strong>Digital therapeutics are increasingly used to manage prediabetes due to their accessibility and potential for personalization. Their success depends heavily on applying behavioral science and integrating theoretical models into digital platforms. However, there has not been a comprehensive account of how behavioral science has been used in digital therapeutics for individuals with prediabetes.</p><p><strong>Objective: </strong>This scoping review aimed to examine the use of behavioral theories and techniques in digital therapeutic interventions for individuals with prediabetes, and to identify opportunities to optimize theory-driven and technology-supported strategies.</p><p><strong>Methods: </strong>A scoping review was conducted following the Arksey and O'Malley framework and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, Scopus, CNKI, and VIP Database for Chinese Technical Periodicals for studies published up to March 10, 2025. Eligible studies included adults (≥18 years) with prediabetes, as defined by the American Diabetes Association, and examined digital therapeutic interventions informed by behavioral science. All study designs were eligible; included studies were screened, and key characteristics were charted.</p><p><strong>Results: </strong>Of the 21 included studies, 17 were randomized controlled trials. The most frequently used behavioral theories were social cognitive theory, theory of planned behavior, and transtheoretical model; however, 11 studies applied behavior change techniques without explicitly stating a theoretical framework. In terms of delivery, digital modalities often comprised smartphone apps (14/21, 67%), human coaching (13/21, 62%), messaging tools (9/21, 43%), wearable devices (9/21, 43%), and web platforms (3/21, 14%). About behavior change techniques, the most frequently used were self-monitoring of behavior (19/21), instruction on performing the behavior (16/21), goal setting (15/21), information about health consequences (15/21), and unspecified social support (11/21). Across studies, outcomes were typically assessed for metabolic and body composition (19/21), glycemic control metrics (17/21), cardiovascular risk and physiological function metrics (16/21), behavioral and cognitive intervention indicators (11/21), and, less frequently, comprehensive health outcome measures (2/21).</p><p><strong>Conclusions: </strong>Behavioral science plays a crucial role in developing effective digital therapeutics for individuals with prediabetes. However, greater clarity in theory selection, better integration between models and digital functions, and more culturally inclusive research are needed to improve the scalability and impact of these interventions.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e78891"},"PeriodicalIF":6.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Critical Success Factors Influencing the Acceptance of a Casemix-Based Hospital Information System: Cross-Sectional Study. 影响基于casemix的医院信息系统接受度的关键成功因素:横断面研究。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-29 DOI: 10.2196/74226
Noor Khairiyah Mustafa, Roszita Ibrahim, Syed Mohamed Aljunid, Azimatun Noor Aizuddin, Zainudin Awang
{"title":"Critical Success Factors Influencing the Acceptance of a Casemix-Based Hospital Information System: Cross-Sectional Study.","authors":"Noor Khairiyah Mustafa, Roszita Ibrahim, Syed Mohamed Aljunid, Azimatun Noor Aizuddin, Zainudin Awang","doi":"10.2196/74226","DOIUrl":"https://doi.org/10.2196/74226","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Ministry of Health Malaysia integrated the Casemix System into the Total Hospital Information System (THIS) to improve care delivery, resource efficiency, and cost-effectiveness. Casemix, a patient classification tool, supports clinical documentation, hospital financing, and management by grouping patients according to diagnoses and resource use. Within THIS, it enables automated coding, streamlined workflows, and better hospital performance. Its success, however, relies on acceptance by medical doctors who ensure accurate documentation and coding. Despite its importance, limited empirical research has examined factors influencing Casemix acceptance in Malaysia's hospital information system context. Understanding these factors is critical for effective implementation and sustained use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to investigate the interrelationships between critical success factors namely system quality (SY), information quality (IQ), service quality (SQ), organizational characteristic (ORG), perceived ease of use (PEOU), perceived usefulness (PU), and intention to use (ITU) on user acceptance of the Casemix system in hospitals equipped with THIS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study used a cross-sectional design, using a self-administered digital questionnaire that was developed by adopting and adapting previously validated instruments, grounded in the Human-Organization-Technology Fit and Technology Acceptance Model (TAM) frameworks. The instrument underwent rigorous validation and reliability procedures, including content and criterion validation through expert review, exploratory factor analysis to assess item appropriateness, and confirmatory factor analysis to establish construct, convergent, and discriminant validity. Proportionate stratified random sampling was used to ensure equitable representation of medical doctors across 5 Ministry of Health hospitals, each representing 1 of Malaysia's geographical zones. The minimum required sample size of 375 was proportionally distributed across 4 categories of medical doctors within these hospitals. Based on structural equation modeling standards, a total of 343 valid responses were obtained, yielding a response rate of 91.5%. Path analysis was conducted using covariance-based structural equation modeling with SPSS Amos (version 24.0; IBM Corp) to assess the direct relationships among the constructs in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Path analysis revealed that SY (β=-0.262, P=.043) and IQ (β=0.307, P=.01) significantly influenced PEOU. PEOU (β=0.105, P=.02) and PU (β=0.580, P&lt;.001) significantly influenced ITU, which strongly predicted user acceptance (β=0.788, P&lt;.001). PEOU did not substantially impact PU (β=0.086, P=.07), nor did SQ (β=0.146, P=.19) and ORG (β=0.197, P=.21) significantly influence PEOU. Based on the β coefficients and statistical significance, the critical success factors were categorized into 2 group","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e74226"},"PeriodicalIF":6.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Real-World Use of Topical Ruxolitinib in Vitiligo: A Retrospective Cross-Sectional Mixed-Methods Infodemiology Study of the r/Vitiligo Subreddit. 局部Ruxolitinib在白癜风中的实际应用:r/白癜风版块的回顾性横截面混合方法信息流行病学研究。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-28 DOI: 10.2196/78247
Michael Constantin Kirchberger, Carola Berking, Andreas Eisenried
{"title":"Real-World Use of Topical Ruxolitinib in Vitiligo: A Retrospective Cross-Sectional Mixed-Methods Infodemiology Study of the r/Vitiligo Subreddit.","authors":"Michael Constantin Kirchberger, Carola Berking, Andreas Eisenried","doi":"10.2196/78247","DOIUrl":"https://doi.org/10.2196/78247","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Vitiligo significantly impairs quality of life. Topical ruxolitinib is a novel Janus kinase inhibitor approved for non-segmental vitiligo, but real-world patient experiences, particularly regarding efficacy, side effects, and access challenges following approval, are not fully captured by clinical trials. Online patient forums like Reddit offer valuable insights into these aspects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyse discussions on the r/Vitiligo subreddit regarding topical ruxolitinib to understand real-world patient experiences, perceived treatment success, side effects, access barriers, and overall sentiment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective, cross-sectional infodemiology study of posts and comments mentioning ruxolitinib or Opzelura® on r/Vitiligo (January 2022-December 2024) was conducted. After filtering and preprocessing, 2,950 entries were analysed. Computational linguistics (all-MiniLM-L6-v2), including sentence-transformer embeddings for semi-supervised topic classification into Therapy Success, Side Effects, Insurance & Cost plus Off-topic were employed. Valence Aware Dictionary and sEntiment Reasoner (VADER) (-1 to +1) for sentiment analysis was assessed. Temporal trends were analysed, and model performance was validated manually against blinded manual annotation of n=500 entries. Representative qualitative data were reviewed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Discussions increased following regulatory approvals. \"Therapy Success\" was the largest cluster (1765/2950 entries, 59.8% [95% confidence interval (CI) 58.1-61.6]) with positive sentiment (avg. 0.473 [95% CI 0.46-0.48]), frequently describing facial repigmentation and adjunctive use with phototherapy. Users also reported encouraging hair repigmentation within treated areas and success even on vitiligo spots present for over 20 years, while noting that areas like hands and feet were particularly treatment-resistant. The \"Side Effects\" cluster (558/2950 entries, 18.9% [95% CI 17.5-20.3]) had negative sentiment (avg. -0.110 [95% CI -0.14-0.07]), frequently mentioning application-site acne but also fatigue and in rare anecdotal reports, more severe events like panic attacks or anemia. The \"Insurance & Cost\" cluster (491/2950 entries, 16.6% [95% CI 15.3-18.0]) had positive sentiment (avg. 0.349 [95% CI 0.31-0.39]), dominated by discussions on high costs and access difficulties, alongside strategies like co-pay programs but also noting insurance denials that often classified the treatment as cosmetic. Manual model validation showed substantial agreement (Accuracy 88.4% [95% CI 86-91], F1 0.893 [95% CI, 0.865-0.918], Cohen's Kappa 0.801 [95% CI, 0.760-0.840]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Real-world Reddit narratives broadly corroborate clinical trial efficacy signals, particularly facial repigmentation and utility alongside phototherapy, while highlighting practical barriers: frequent application-site acne and c","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Using Large Language Models to Assess the Consistency of Randomized Controlled Trials on AI Interventions With CONSORT-AI: Cross-Sectional Survey. 使用大型语言模型评估人工智能干预随机对照试验的一致性与concur -AI:横断面调查。
IF 6 2区 医学
Journal of Medical Internet Research Pub Date : 2025-09-26 DOI: 10.2196/72412
Xufei Luo, Zeming Li, Zhenhua Yang, Bingyi Wang, Yanfang Ma, Fengxian Chen, Qi Wang, Long Ge, James Zou, Lu Zhang, Yaolong Chen, Zhaoxiang Bian
{"title":"Using Large Language Models to Assess the Consistency of Randomized Controlled Trials on AI Interventions With CONSORT-AI: Cross-Sectional Survey.","authors":"Xufei Luo, Zeming Li, Zhenhua Yang, Bingyi Wang, Yanfang Ma, Fengxian Chen, Qi Wang, Long Ge, James Zou, Lu Zhang, Yaolong Chen, Zhaoxiang Bian","doi":"10.2196/72412","DOIUrl":"10.2196/72412","url":null,"abstract":"<p><strong>Background: </strong>Chatbots based on large language models (LLMs) have shown promise in evaluating the consistency of research. Previously, researchers used LLM to assess if randomized controlled trial (RCT) abstracts adhered to the CONSORT-Abstract guidelines. However, the consistency of artificial intelligence (AI) interventional RCTs aligning with the CONSORT-AI (Consolidated Standards of Reporting Trials-Artificial Intelligence) standards by LLMs remains unclear.</p><p><strong>Objective: </strong>The aim of this study is to identify the consistency of RCTs on AI interventions with CONSORT-AI using chatbots based on LLMs.</p><p><strong>Methods: </strong>This cross-sectional study employed 6 LLM models to assess the consistency of RCTs on AI interventions. The sample selection is based on articles published in JAMA Network Open, which included a total of 41 RCTs. All queries were submitted to LLMs through an application programming interface with a temperature setting of 0 to ensure deterministic responses. One researcher posed the questions to each model, while another independently verified the responses for validity before recording the results. The Overall Consistency Score (OCS), recall, inter-rater reliability, and consistency of contents were analyzed.</p><p><strong>Results: </strong>We found gpt-4-0125-preview has the best average OCS on the basis of the results obtained by JAMA Network Open authors and by us (86.5%, 95% CI 82.5%-90.5% and 81.6%, 95% CI 77.6%-85.6%, respectively), followed by gpt-4-1106-preview (80.3%, 95% CI 76.3%-84.3% and 78.0%, 95% CI 74.0%-82.0%, respectively). The model with the worst average OCS is gpt-3.5-turbo-0125 on the basis of the results obtained by JAMA Network Open authors and by us (61.9%, 95% CI 57.9%-65.9% and 63.0%, 95% CI 59.0%-67.0%, respectively). Among the 11 unique items of CONSORT-AI, Item 2 (\"State the inclusion and exclusion criteria at the level of the input data\") received the poorest overall evaluation across the 6 models, with an average OCS of 48.8%. For other items, those with an average OCS greater than 80% across the 6 models included Items 1, 5, 8, and 9.</p><p><strong>Conclusions: </strong>GPT-4 variants demonstrate strong performance in assessing the consistency of RCTs with CONSORT-AI. Nonetheless, refining the prompts could enhance the precision and consistency of the outcomes. While AI tools like GPT-4 variants are valuable, they are not yet fully autonomous in addressing complex and nuanced tasks such as adherence to CONSORT-AI standards. Therefore, integrating AI with higher levels of human supervision and expertise will be crucial to ensuring more reliable and efficient evaluations, ultimately advancing the quality of medical research.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e72412"},"PeriodicalIF":6.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12466798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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