Journal of Medical Internet Research最新文献

{"title":"Effectiveness of Digital Health Interventions for Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.","authors":"Miaoqing Zhuang, Intan Idiana Hassan, Wan Muhamad Amir W Ahmad, Azidah Abdul Kadir, Xiaodong Liu, Furong Li, Yinuo Gao, Yang Guan, Shuting Song","doi":"10.2196/76323","DOIUrl":"10.2196/76323","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD), marked by dyspnea, cough, and sputum production, significantly impairs patients' quality of life and functionality. Effective management strategies, particularly those empowering patients to manage their condition, are essential to reduce this burden and health care use. Digital health interventions-such as mobile apps for symptom tracking, wearable sensors for vital sign monitoring, and web-based pulmonary rehabilitation programs-can enhance self-efficacy and promote greater patient engagement. By improving self-management skills, these interventions also help alleviate pressure on health care systems.</p><p><strong>Objective: </strong>This systematic review and meta-analysis assesses the clinical effectiveness of smartphone apps, wearable monitors, and web-delivered platforms in four COPD management areas: (1) quality of life (measured by the COPD Assessment Test [CAT] and St George's Respiratory Questionnaire), (2) self-efficacy (assessed by the General Self-Efficacy Scale), (3) functional capacity (evaluated via the 6-minute walk test and Modified Medical Research Council Dyspnea Scale), and (4) health care use (indicated by hospital and emergency department visits).</p><p><strong>Methods: </strong>A systematic review was conducted using predefined search terms in PubMed, Embase, Cochrane, and Web of Science up to January 26, 2025, to identify randomized trials on digital health interventions for COPD. Two reviewers independently screened studies and extracted data. Outcomes included quality of life, self-efficacy, functional status, and health care use.</p><p><strong>Results: </strong>This review included 17 studies with 2027 participants from 11 countries. Eleven trials involved health care professionals in digital platform use, and 12 reported adherence strategies. Digital tools for COPD primarily focused on telerehabilitation (eg, video-guided exercises) and self-management systems (eg, artificial intelligence-driven exacerbation alerts). The study participants were predominantly older adults. Meta-analysis results indicated that digital health interventions significantly improved quality of life at 3 months on the CAT (mean difference [MD] -1.65, 95% CI -3.17 to -0.14; P=.03); at 6 months on the CAT (MD -2.43, 95% CI -3.93 to -0.94; P=.001) and St George's Respiratory Questionnaire (MD 3.25, 95% CI 0.69-5.81; P=.01); at 12 months on the CAT (MD -2.53, 95% CI -3.91 to -1.16; P<.001), EQ-5D (MD 0.04, 95% CI 0.01-0.07; P=.02), and EQ-5D visual analogue scale (MD 5.88, 95% CI 0.38-11.37; P=.04); the General Self-Efficacy Scale at 3 months (MD 1.65, 95% CI 0.62-2.69; P=.002) and 6 months (MD 1.94, 95% CI 0.83-3.05; P<.001); and the Modified Medical Research Council Dyspnea Scale at more than 3 months (MD -0.23, 95% CI -0.36 to -0.11; P=.003). However, no significant differences were observed in the 6-minute walk test, emergency department admissions, hospital admiss","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e76323"},"PeriodicalIF":5.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142689","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}

{"title":"The Impact of Internet Hospital Follow-Up on the Quality of Life of Patients With Epilepsy: Randomized Controlled Trial.","authors":"Ting Ting Liu, Min Zhang, Hong Ying Li, Yu Wen Zhang, Lu Liang, Xin Yue Huang, Xia Gan, Lan Mou, Chen Shi Liu, Ming Ming Zhang, Jie Liu","doi":"10.2196/70665","DOIUrl":"10.2196/70665","url":null,"abstract":"<p><strong>Background: </strong>As the second most common neurological disorder, epilepsy requires long-term management to ensure better seizure control and improved patient outcomes. Health education and sustained care significantly help people with epilepsy manage their condition effectively. Internet hospitals (IHs) have emerged as a promising approach to enhancing health care accessibility. These digital platforms can significantly improve the quality of life for patients with epilepsy. However, despite their growing adoption, research on the application of IHs in the follow-up management of epilepsy remains limited, highlighting the need for further investigation.</p><p><strong>Objective: </strong>This study has 2 primary aims. The first aim was to assess and compare the differences in quality of life, anxiety, and depression between IH follow-up and traditional outpatient follow-up for patients with epilepsy. The second aim was to explore chronic disease management models that are tailored to meet the needs of patients with epilepsy, improving their overall care.</p><p><strong>Methods: </strong>Eligible patients diagnosed with epilepsy were recruited at Sichuan Provincial People's Hospital and randomly assigned to the intervention or control group. Data collected included demographic information, clinical characteristics, and scores from the Quality of Life in Epilepsy-31 (QOLIE-31), Generalized Anxiety Disorder-7 Scale (GAD-7), and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). The control group received traditional outpatient follow-up, while the intervention group was managed via the IH. Both groups received epilepsy health education. After 6 months, changes in quality of life, anxiety, and depression were assessed using the same scales. Data analysis followed the intention-to-treat principle, and a linear mixed model was used to examine the intervention effect on primary and secondary outcomes. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and ≥0.8: large).</p><p><strong>Results: </strong>A total of 214 patients with epilepsy participated in the study (intervention group: N=107; control group: N=107). At the end of the study, 94.4% (101/107) in the intervention group and 93.5% (100/107) in the control group had completed the follow-up visits. After the intervention, the intention-to-treat analysis revealed evidence for improved quality of life (QOLIE-31 total score; F<sub>216.53</sub>=13.10, P<.001) with small between-group effects (Hedges g=0.49, 95% CI 0.22-0.76) in favor of the intervention group. We also found evidence of reduced depression, as well as improved seizure worry, overall quality of life, emotional well-being, energy or fatigue, medication side effects, with effects ranging from small to medium (Hedges g=0.42-0.79).</p><p><strong>Conclusions: </strong>Long-term follow-up through IHs can effectively improve the quality of life and reduce anxiety ","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e70665"},"PeriodicalIF":5.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142151","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}

{"title":"Eleven-Year Trajectories of Internet Usage Time and Depression Scores Among Middle-Aged and Older Adults in China: Latent Class Mixed Model Analysis.","authors":"Mengyao Li, Zhongliang Zhou, Jing Wang, Dan Wang, Rebecca Mitchell, Wenhua Wang","doi":"10.2196/64581","DOIUrl":"https://doi.org/10.2196/64581","url":null,"abstract":"<p><strong>Background: </strong>Mental health issues have emerged as a global challenge, particularly affecting middle-aged and older adults. Research has shown that internet use can potentially promote mental health. Substantial research investigated the relationship between mental health and internet usage time or purposes. However, few studies have examined the association between internet usage time trajectories and mental health.</p><p><strong>Objective: </strong>The objective of this study was to identify distinct trajectories of internet usage time over a span of 11 years and assess their relationship with depressive scores among middle-aged and older adults.</p><p><strong>Methods: </strong>Using longitudinal data from the China Family Panel Studies spanning from 2010 to 2020 and consisting of 5 waves. Participants older than 45 years with internet usage data available for at least 3 waves, including wave 5, were included in the analysis. Internet usage time was operationalized as the number of hours spent on the internet per week, while depressive scores were assessed using the 8-item Center for Epidemiologic Studies Depression Scale (CES-D 8). A latent class mixed model was used to identify distinct trajectories of internet usage time over the course of this period. Mixed-effect models were used to test the relationship between distinct trajectories of internet usage time and depressive scores.</p><p><strong>Results: </strong>Among 9163 middle-aged and older adults were included in the analysis. The trajectory analysis identified 3 clusters: \"Never use,\" \"Slow increase,\" and \"Rapid increase.\" The \"Never use\" cluster indicated no internet use for one decade. In the slow increase cluster, internet use rose slowly with an average of 7.69 hours per week in 2020. In contrast, the \"Rapid increase\" cluster exhibited a sharp increase, reaching 15.13 hours per week in 2020. Compared to the \"Never use\" cluster, the \"Slow increase\" cluster was significantly negatively associated with depressive scores among middle-aged and older adults (coefficient -0.20, 95% CI -0.34 to -0.06), while the \"Rapid increase\" cluster showed no significant association. The benefits of internet use were more pronounced among females and older adults with chronic diseases than among their male and older adult counterparts without chronic diseases. The sensitive analysis confirmed the robustness of the results.</p><p><strong>Conclusions: </strong>This study identified 3 trajectory clusters of internet usage time among middle-aged and older adults in China from 2010 to 2020. Compared to the older adults who never used the internet, those whose internet usage increases gradually over time exhibited slightly lower depressive scores. Notably, the \"Slow increase\" cluster exhibited a negative association with depressive scores, with this association being statistically significant in females and older adults with chronic diseases, but not in males or those without chronic diseas","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e64581"},"PeriodicalIF":5.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150616","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}

{"title":"Developing a Core Outcome Set for Pediatric and Adult Acute and Chronic Pain Extended Reality Trials: Delphi Consensus-Building Process.","authors":"Courtney W Hess, Deirdre E Logan, Brittany N Rosenbloom, Giulia Mesaroli, Laura E Simons, Carley Ouellette, Cynthia Nguyen, Fahad Alam, Jennifer N Stinson","doi":"10.2196/58947","DOIUrl":"10.2196/58947","url":null,"abstract":"<p><strong>Background: </strong>Appropriate outcome assessment strategies and high-quality trials are critical to advancing care of patients with acute and chronic pain. Using extended reality (XR), namely, virtual and augmented reality, as a nonpharmacological treatment for pain has accelerated in the last decade. XR allows users to engage completely in immersive, gamified, sensorial digital experiences. Currently, no standardized approach to assessing outcomes of XR-based interventions for pain exists.</p><p><strong>Objective: </strong>Our aim was to recommend a core set of outcomes for pediatric and adult acute and chronic pain XR intervention trials.</p><p><strong>Methods: </strong>To identify core outcomes, we conducted a multiphase process. In phase 1, we conducted systematic reviews on XR in pediatric and adult acute and chronic pain trials to identify the most common core outcome domains assessed in existing published studies. Primary outcome domains were identified and informed the development of the survey for phase 2, a Delphi survey of clinicians and researchers who were actively researching or using XR for pain treatment. Together, results from the systematic reviews and Delphi survey responses were collated, and in phase 3, a 2-day in-person meeting was held to reach consensus on recommended outcome domains for adult and pediatric acute and chronic pain XR clinical trials. This was followed by 2 additional rounds of the Delphi survey to broaden consensus and refine the domains and definitions. Following the Outcome Measures in Rheumatology guidelines for consensus building, outcomes were organized into 3 categories: mandatory, important to consider but optional, and research agenda.</p><p><strong>Results: </strong>A systematic review including XR trials for adult and pediatric acute and chronic pain was conducted in March 2023, and 90 pediatric and 104 adult studies were included. The round 1 Delphi survey, completed by 66 respondents, revealed the following commonly measured outcomes: pain intensity or quality, distraction, anxiety or fear, satisfaction, and adverse events. Respondents indicated the following domains to be of highest importance to measure in studies: safety, feasibility, and acceptability; pain intensity or quality; pain interference or functioning; emotional functioning; and user experience or immersion. By unanimous vote at the consensus conference, pain severity, adverse events, user experience, and psychological constructs were identified as mandatory domains to be assessed in all XR trials for acute and chronic pain, with the addition of pain interference for chronic pain trials. Physiological markers and physical function were deemed important-to-consider but optional domains. Additional emerging areas for future research did not obtain sufficient support in the consensus process but were noted.</p><p><strong>Conclusions: </strong>An established core outcome set will help strengthen the emerging evidence base","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e58947"},"PeriodicalIF":5.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127654","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}

{"title":"The Effectiveness of Social Media Campaigns in Improving Knowledge and Attitudes Toward Mental Health and Help-Seeking in High-Income Countries: Scoping Review.","authors":"Ruth Plackett, Jessica-Mae Steward, Angelos P Kassianos, Marvin Duenger, Patricia Schartau, Jessica Sheringham, Silvie Cooper, Lucy Biddle, Judi Kidger, Kate Walters","doi":"10.2196/68124","DOIUrl":"10.2196/68124","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of mental health problems is increasing, particularly among young people, making the prevention of mental health problems and improvements in care a public health priority. Social media, with its wide reach and low-cost information dissemination, has emerged as an important tool for public mental health campaigns in high-income countries. However, there is a limited understanding of the reach of public mental health social media campaigns and their impact on mental health knowledge, attitudes, stigma, and behaviors, such as help-seeking.</p><p><strong>Objective: </strong>This review aimed to assess the effectiveness of social media campaigns in high-income countries in improving knowledge and attitudes toward mental health, reducing stigma, promoting help-seeking behavior, and reaching underserved communities.</p><p><strong>Methods: </strong>A scoping review was conducted, involving a comprehensive search of 5 databases (MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL) and gray literature from January 2004 to May 2024. We included quantitative evaluations of social media public mental health campaigns from high-income countries with comparable social media use and public health care systems. A narrative synthesis summarized the study characteristics, campaign exposure, reach, and effectiveness by outcomes.</p><p><strong>Results: </strong>The review included 26 studies for analysis. Less than half of the studies (11/26, 42%) reported on the reach of mental health campaigns, but for those that did, younger age groups and women were more likely to be aware of campaigns. The most frequently reported outcomes were attitudes about mental health (17/23, 74%) and stigma (17/23, 74%), followed by mental health knowledge (16/23, 70%) and behavior change (15/23, 65%), such as seeking help for a mental health condition. While stigma and attitudes showed the most improvement before and after the campaigns (5/11, 45%), behavior change showed the least positive change over time (1/8, 13%). However, behavior change was the most improved outcome for those who were campaign aware compared to those unaware (12/12, 100%), whereas positive attitudes often did not differ. In fact, some studies showed campaign awareness was associated with negative stereotypes.</p><p><strong>Conclusions: </strong>The evidence highlights the potential of social media campaigns in improving mental health knowledge, attitudes, stigma, and behavior change. However, due to the methodological limitations of these evaluations, it is challenging to determine if the positive changes in these outcomes are a result of the campaigns or other factors. Campaign awareness seems to be important for initiating behavior change, but these changes are often short-lived. Sustainable impact on mental health requires both individual behavior change and service improvements. Targeting more mental health campaigns at underserved groups could help to reduce s","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e68124"},"PeriodicalIF":5.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132439","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}

{"title":"Immersive virtual reality improves several side effects during paclitaxel/carboplatin or paclitaxel/carboplatin plus bevacizumab therapy: A two-arm randomized controlled trial.","authors":"Kazuyuki Niki, Satoshi Nakagawa, Misaki Arai, Ayaka Morimoto, Yutaka Ueda","doi":"10.2196/65924","DOIUrl":"https://doi.org/10.2196/65924","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic drug treatment is generally used to treat various side effects associated with paclitaxel/carboplatin (TC) or TC plus bevacizumab (TC+Bev). However, this can lead to increased adverse effects from additional drugs. Immersive virtual reality (iVR) reduces pain and anxiety.</p><p><strong>Objective: </strong>This study aimed to investigate the efficacy of iVR in managing side effects associated with TC or TC+Bev therapy.</p><p><strong>Methods: </strong>This two-arm randomized controlled trial included patients with gynecologic cancer scheduled to undergo their first course of TC/TC+Bev. Patients in the intervention group received iVR for approximately 10 min/day for 7 consecutive days, starting on the first day of treatment. The primary endpoint was the severity of physical and psychiatric symptoms measured using the Japanese version of the revised Edmonton Symptom Rating System (ESAS-r-J). The secondary endpoint included the proportion of patients who used additional antiemetic medications, the complete response (CR) rate to nausea and the severity of anxiety, measured using the state-trait anxiety inventory-JYZ (STAI) Y-1. Patients in the non-intervention group received supportive and symptomatic treatments.</p><p><strong>Results: </strong>The analysis included 28 and 30 patients in the intervention and non-intervention groups, respectively. The change in ESAS-r-J scores between days 1 and 7 and nausea were significantly worse in the intervention group on day 4 only (p<0·001); however, the non-intervention group showed significantly worse scores on days 3, 4, and 5. Depression was not significantly worse in the intervention group on any day other than on day 1; however, the non-intervention group showed significantly worse scores on day 4. The proportion of patients who used additional antiemetic medications from days 2 to 7 was significantly lower in the intervention group than in the non-intervention group (p=0.024). Regarding the change in STAI Y-1 on day 1 of TC or TC+Bev therapy, the mean score was significantly lower after the iVR experience than before the experience in the intervention group (from 43.8 to 34.8, p<0.001), whereas in the non-intervention group, no significant difference was observed before and after anticancer drug administration (from 44.9 to 43.9, p=0.536).</p><p><strong>Conclusions: </strong>iVR may reduce deterioration of nausea and depression more effectively in patients with gynecologic cancer undergoing TC or TC+Bev therapy than in those undergoing non-intervention, especially in delaying the onset of nausea and accelerating recovery.</p><p><strong>Clinicaltrial: </strong>UMIN Clinical Trials Registry (UMIN000041067; https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000046892).</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136198","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}

{"title":"Effectiveness of Neurofeedback-Assisted and Conventional 6-Week Web-Based Mindfulness Interventions on Mental Health of Chinese Nursing Students: Randomized Controlled Trial.","authors":"Shu Jing, Zhenwei Dai, Xiaoyang Liu, Xuelin Yang, Jinglei Cheng, Tianming Chen, Zihang Feng, Xin Liu, Fenghe Dong, You Xin, Zhuoyan Han, Haiyan Hu, Xiaoyou Su, Chen Wang","doi":"10.2196/71741","DOIUrl":"10.2196/71741","url":null,"abstract":"<p><strong>Background: </strong>Nursing students experience disproportionately high rates of mental health challenges, underscoring the urgent need for innovative, scalable interventions. Web-based mindfulness programs, and more recently, neurofeedback-enhanced approaches, present potentially promising avenues for addressing this critical issue.</p><p><strong>Objective: </strong>This study aimed to explore the effectiveness of the neurofeedback-assisted online mindfulness intervention (NAOM) and the conventional online mindfulness intervention (COM) in reducing mental health symptoms among Chinese nursing students.</p><p><strong>Methods: </strong>A 3-armed randomized controlled trial was conducted among 147 nursing students in Beijing, China, using a 6-week web-based mindfulness program. Participants received NAOM, COM, or general mental health education across 6 weeks. Electroencephalogram and validated tools such as the Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire were used to primarily assess symptoms of depression and anxiety at baseline, immediately after the intervention, and at 1 and 3 months after the intervention. Generalized estimating equations were used to evaluate the effects of intervention and time.</p><p><strong>Results: </strong>A total of 155 participants enrolled in the study, and 147 finished all assessments. Significant reductions in the symptoms of depression, anxiety, and fatigue were observed in the NAOM (mean difference [MD]=-3.330, Cohen d=0.926, P<.001; MD=-3.468, Cohen d=1.091, P<.001; MD=-2.620, Cohen d=0.743, P<.001, respectively) and the COM (MD=-1.875, Cohen d=0.490, P=.03; MD=-1.750, Cohen d=0.486, P=.02; MD=-2.229, Cohen d=0.629, P=.01, respectively) groups compared with the control group at postintervention assessment. Moreover, the NAOM group showed significantly better effects than the COM group in alleviating depressive symptoms (MD=-1.455; Cohen d=0.492; P=.04) and anxiety symptoms (MD=-1.718; Cohen d=0.670; P=.04) and improving the level of mindfulness (MD=-3.765; Cohen d=1.245; P<.001) at the postintervention assessment. However, no significant difference except for the anxiety symptoms was observed across the 3 groups at the 1- and 3-month follow-ups.</p><p><strong>Conclusions: </strong>This 6-week web-based mindfulness intervention, both conventional and neurofeedback-assisted, effectively alleviated mental health problems in the short term among nursing students. The addition of neurofeedback demonstrated greater short-term benefits; however, but these effects were not sustained over the long term. Future research should focus on long-term interventions using a more robust methodological approach.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR) ChiCTR2400080314; https://www.chictr.org.cn/bin/project/edit?pid=211845.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e71741"},"PeriodicalIF":5.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132433","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}

{"title":"A Business Model Framework for Software as a Medical Device Startups in the European Union: Mixed Methods Study.","authors":"Rahel Sophie Martjan, Sascha Noel Weimar, Orestis Terzidis","doi":"10.2196/67328","DOIUrl":"10.2196/67328","url":null,"abstract":"<p><strong>Background: </strong>With the introduction of Regulation (EU) 2017/745, also known as the Medical Device Regulation (MDR), startups aiming to develop software as a medical device (SaMD) in the European Union are confronted with stringent and complex regulations, and many of them struggle with them. Complying with the MDR is a costly, time-consuming endeavor requiring expertise and substantial financial resources. However, it opens the door for new revenue models, such as reimbursement pathways. Consequently, the MDR significantly shapes the business model of startups. Early on, the regulation needs to be considered for business modeling to survive the conformity assessment process financially. Business model frameworks are tools that reduce complexity by focusing on the key aspects of a business model. Thereby, the risk of overlooking essential elements can be minimized. A framework directly integrating the MDR could alleviate the intricate circumstances in which SaMD startups are entangled.</p><p><strong>Objective: </strong>This study focused on deriving a business model framework for startups aiming to develop SaMD under the MDR. With the framework, we strived to facilitate business modeling for SaMD startups.</p><p><strong>Methods: </strong>The study is based on a 3-step approach. First, a systematic literature review was carried out, resulting in a concept matrix and an overview of business model frameworks developed and applied in the digital health sector. Subsequently, 13 interviews were conducted with experts and startups in the SaMD industry. On the basis of the literature analysis and expert interviews, along with the MDR requirements for SaMD, we developed the SaMD business model framework.</p><p><strong>Results: </strong>The SaMD business model framework consists of 13 interrelated components, with the MDR being a pivotal component. The centerpiece of the framework is the \"regulatory value arc,\" which is the trio of intended purpose, value propositions, and customer segments. For each component, valuable input is provided, making the framework tailored to startups aiming to develop SaMD.</p><p><strong>Conclusions: </strong>The findings highlight the crucial role of regulations in business modeling. Notably, the MDR is a central regulation for startups aiming to develop SaMD. The study uncovers the impact of the MDR on business modeling for SaMD startups. Our research provides a framework that integrates this regulation, thereby reducing its complexity and facilitating startups in deriving a sustainable business model. Concurrently, this research integrates the domains of business modeling and the MDR. Therefore, it contributes to the academic discourse in both fields and addresses a notable gap in the existing literature.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e67328"},"PeriodicalIF":5.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127589","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}

{"title":"Impact of Telemedicine Adoption on Hemiplegia in Patients With Stroke in Florida: Longitudinal Observational Study.","authors":"Yao Li, Mingshan Zhang, Weiling Ke, Wenwen Li","doi":"10.2196/72315","DOIUrl":"https://doi.org/10.2196/72315","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Telemedicine has emerged as a critical tool in the management of acute stroke; yet, its impact on clinical decision-making, particularly in the administration of tissue plasminogen activator (tPA), remains underexplored. Understanding how telemedicine influences tPA use and subsequent patient outcomes, such as hemiplegia, is critical for optimizing stroke care protocols.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to assess whether the adoption of telemedicine influences treatment decisions regarding tPA administration in patients with stroke. In addition, we used a causal mediation framework to examine the causal path between telemedicine adoption and the occurrence of hemiplegia via tPA use. Furthermore, we conducted a moderated mediation analysis to investigate the extent to which regional differences (metropolitan vs nonmetropolitan locations) impact this mediated relationship.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed data of patients with stroke from Florida's State Emergency Department Database (SEDD), State Inpatient Database (SID), and the Healthcare Information and Management Systems Society (HIMSS) database, covering the years 2010 to 2017, with a focus on telemedicine adoption. The final sample includes 314,665 visits from patients with stroke. A fixed-effects model was used to examine the relationship between telemedicine adoption and tPA use and between tPA use and hemiplegia occurrence. A causal mediation framework was then applied to estimate the average direct effect and the average causal mediation effect of telemedicine on hemiplegia through tPA use. In addition, a moderated mediation analysis was performed to explore how metropolitan status influences the mediation process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We found that telemedicine adoption is associated with a 1% decrease in tPA use (coefficient=-0.010; 95% CI -0.013 to -0.007; P&lt;.001), and that the use of tPA is associated with a 23.7% increased probability of hemiplegia (coefficient=0.237, 95% CI 0.231-0.243; P&lt;.001). Consequently, telemedicine adoption was found to reduce the likelihood of hemiplegia by decreasing tPA usage. The causal mediation analysis shows a negative average causal mediation effect (average causal mediation effect=-0.002, 95% CI -0.003 to -0.002; P&lt;.001), suggesting that telemedicine adoption reduces hemiplegia occurrence, while the average direct effect is not statistically significant (average direct effect=-0.002, 95% CI -0.007 to 0.004; P&gt;.10). Importantly, the positive effect of telemedicine on reducing hemiplegia is observed only among metropolitan patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study provides evidence that telemedicine adoption can improve stroke care by reducing tPA administration, thereby lowering the risk of hemiplegia. However, the benefits appear more pronounced in metropolitan areas, highlighting potential regional disparities in stroke care. These findings underscore the importan","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e72315"},"PeriodicalIF":5.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132435","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}

{"title":"Retraction: \"Evaluating the Clinical Efficacy of an Exergame-Based Training Program for Enhancing Physical and Cognitive Functions in Older Adults With Mild Cognitive Impairment and Dementia Residing in Rural Long-Term Care Facilities: Randomized Controlled Trial\".","authors":"","doi":"10.2196/77638","DOIUrl":"10.2196/77638","url":null,"abstract":"","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e77638"},"PeriodicalIF":5.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132438","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}