Journal of Medical Internet Research最新文献

{"title":"Navigating the Boundaries of Teleconsultation-Capabilities, Limitations, and Pathways for Improvement: Qualitative Study of the Experiences of Patients With Stroke.","authors":"Arkers Kwan Ching Wong, Xiaomin Lu, Joyce Xiaoli Wang, Rose Sin Yi Lin, Jing Jing Su, Robbie Mian Wang, Vivian Wai Yan Kwok","doi":"10.2196/75841","DOIUrl":"10.2196/75841","url":null,"abstract":"<p><strong>Background: </strong>Survivors of stroke often face persistent challenges accessing postdischarge care due to mobility limitations, transportation burdens, and inflexible scheduling. Teleconsultation has emerged as a potential solution to improve continuity of care, but its perceived strengths and limitations from the patient perspective remain insufficiently understood.</p><p><strong>Objective: </strong>This study aimed to explore the experiences of survivors of stroke with a nurse-led teleconsultation program to (1) identify perceived capabilities; (2) understand limitations in usability, accessibility, and clinical function; and (3) generate patient-informed recommendations for improvement.</p><p><strong>Methods: </strong>A qualitative study was embedded within a 3-month nurse-led teleconsultation intervention delivered by advanced practice nurses. A total of 21 survivors of ischemic stroke (aged 45-76 y; female: n=11, 52%) who had preserved cognitive function (Montreal Cognitive Assessment score ≥22) and smartphone access participated in 6 focus groups conducted via Zoom. Data were analyzed thematically using an established framework. Data saturation was achieved.</p><p><strong>Results: </strong>Participants widely valued teleconsultation for reducing logistical burdens; enhancing access; and offering a more comfortable, emotionally supportive setting for follow-up care. Many reported increased awareness and motivation for self-monitoring. However, limitations included an inability to perform physical assessments or respond to emergencies; digital and usability barriers, especially among older users; and scheduling inflexibility. Participants emphasized the need for patient-initiated follow-up mechanisms, physician collaboration for medication management, and greater support for users considered digitally marginalized. They also highlighted the potential of teleconsultation to serve as a triage tool, reserving in-person care for complex cases.</p><p><strong>Conclusions: </strong>Nurse-led teleconsultation was perceived as a convenient and supportive modality for poststroke care, particularly for stable follow-ups and psychosocial support. However, its long-term viability depends on addressing clinical and technical limitations, enhancing user autonomy, and integrating interdisciplinary input. By centering the lived experiences of survivors of stroke, this study offers concrete recommendations to guide the development of more inclusive, responsive, and patient-centered teleconsultation models.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e75841"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086281","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}

{"title":"Remotely Delivered Cognitive Behavioral Therapy for Adults With an Eating Disorder: Retrospective Analysis of a Real-World Patient Sample.","authors":"Jessica H Baker, Nickolas M Jones, David Freestone, Lara Effland, Cara Bohon","doi":"10.2196/76464","DOIUrl":"10.2196/76464","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Enhanced cognitive behavioral therapy (CBT-E) is the prevailing treatment approach for adult eating disorders. CBT-E is a variant of cognitive behavioral therapy, modified specifically to treat an eating disorder. Systematic reviews have established the effectiveness of CBT-E for adults when delivered face to face. However, few studies have evaluated evidence-based eating disorder treatment outcomes for programs intentionally designed to be delivered remotely.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to examine the clinical utility of CBT-E for adults with eating disorders using data from a national treatment program designed specifically for remote delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a pre-post observational cohort study conducted in a naturalistic setting where patients received treatment through standard clinical pathways, including typical referral, intake, and treatment processes. The participant sample for the study was identified through retrospective chart review and included adult patients (aged ≥18 y) diagnosed with anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified feeding or eating disorder. For adult patients with these diagnoses, CBT-E is generally the first line of care in the program. CBT-E was developed to be transdiagnostic, and rather than focusing on a specific diagnosis, treatment focuses on treating the problematic beliefs related to weight, shape, and eating that maintain the eating disorder. CBT-E is highly individualized, and the treatment provider creates a treatment plan to match the specific eating disorder symptoms experienced by the patient. The recommended cadence of sessions is weekly. The criterion of utility was the magnitude and consistency of symptom change in weight gain and eating disorder, depression, and anxiety symptoms during CBT-E treatment. Survival analyses assessed patient and treatment characteristics. Multilevel models assessed the changes in outcomes both over time and at weeks 20 and 40, as these time points generally aligned with CBT-E clinical trial end points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The patient sample (N=1629) predominantly consisted of White (n=1166, 71.6%), cisgender women (n=1403, 86.1%), with a mean age of 30 (SD 12) years. The overall median length of stay was 22 (95% CI 20-25) weeks. In all, 416 (25.5%) patients required weight restoration. The estimated probability of achieving weight restoration was 0.50 (95% CI 0.43-0.57) just before week 40 of treatment. By 40 weeks of treatment, the probability of achieving subclinical status for eating disorder symptoms was 0.48 (95% CI 0.44-0.51); for depression, the probability was 0.55 (95% CI 0.51-0.59), and for anxiety, the probability was 0.56 (95% CI 0.51-0.60). Time in treatment was significantly associated with improved symptoms across all outcomes (all P&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CBT-E delivered via telehealth is clin","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e76464"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086334","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}

{"title":"Self-Harm and Suicide-Related Content on TikTok: Thematic Analysis.","authors":"Gillian Grant-Allen, Lezhi Wang, Jasmine Amini, Simran Dhaliwal, Mark Sinyor, Rachel Hb Mitchell","doi":"10.2196/77828","DOIUrl":"10.2196/77828","url":null,"abstract":"<p><strong>Background: </strong>Social media platforms, such as TikTok, may be powerful vectors for transmission of both harmful and helpful self-harm and suicide-related content; however, this has not been rigorously studied.</p><p><strong>Objective: </strong>This study aims to identify and understand the themes and overall characteristics of videos related to self-harm and suicide on TikTok.</p><p><strong>Methods: </strong>Snowball sampling was used to identify the 10 most-viewed TikTok hashtags related to self-harm and suicide, which were then used to select the most-viewed English-language posts up to June 2023. An inductive coding reliability approach to thematic analysis was iteratively applied by 2 independent coders to identify and analyze common themes within the videos.</p><p><strong>Results: </strong>In total, 188 videos were included in the thematic analysis. Five main themes and 2 subthemes were identified: emotional distress, hope and recovery-based messaging, grief and memorialization of those who died by suicide, social functions associated with self-harm and suicide-related content (subthemes: gallows humor and sarcasm; glamorization of self-harm and suicide-related behavior), and shame and guilt associated with self-harm and suicide-related behavior.</p><p><strong>Conclusions: </strong>Self-harm and suicide-related content on TikTok was diverse, encompassing both potentially harmful (eg, normalization of self-harm behavior) and helpful (eg, recovery-focused messaging) characteristics. Therefore, a multifaceted and collaborative approach is needed to address the risks of potentially harmful content while leveraging the positive characteristics to promote the safety and well-being of TikTok users.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":" ","pages":"e77828"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855563","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}

{"title":"Diagnostic Performance of Computed Tomography-Based Artificial Intelligence for Early Recurrence of Cholangiocarcinoma: Systematic Review and Meta-Analysis.","authors":"Jie Chen, Jianxin Xi, Tianyu Chen, Lulu Yang, Kaijia Liu, Xiaobo Ding","doi":"10.2196/78306","DOIUrl":"10.2196/78306","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite artificial intelligence (AI) models demonstrating high predictive accuracy for early cholangiocarcinoma recurrence, their clinical application faces challenges, such as reproducibility, generalizability, hidden biases, and uncertain performance across diverse datasets and populations, raising concerns about their practical applicability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This meta-analysis aims to systematically assess the diagnostic performance of AI models using computed tomography (CT) imaging to predict early recurrence of cholangiocarcinoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search was conducted in PubMed, Embase, and Web of Science for studies published up to May 2025. Studies were selected based on the Participants, Index test, Target condition, Reference standard, Outcomes, and Setting (PITROS) framework. Participants included patients diagnosed with cholangiocarcinoma (including intrahepatic and extrahepatic locations). The index test was AI techniques applied to CT imaging for early recurrence prediction (defined as within 1 year), while the target condition was early recurrence of cholangiocarcinoma (positive group: recurrence; negative group: no recurrence). The reference standard was pathological diagnosis or imaging follow-up confirming recurrence. Outcomes included sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC), assessed in both internal and external validation cohorts. The setting comprised retrospective or prospective studies using hospital datasets. Methodological quality was assessed using an optimized version of the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Heterogeneity was assessed using the I² statistic. Pooled sensitivity, specificity, DOR, and AUC were calculated using a bivariate random-effects model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 9 studies with 30 datasets involving 1537 patients were included. In internal validation cohorts, CT-based AI models showed a pooled sensitivity of 0.87 (95% CI 0.81-0.92), specificity of 0.85 (95% CI 0.79-0.89), DOR of 37.71 (95% CI 18.35-77.51), and AUC of 0.93 (95% CI 0.90-0.94). In external validation cohorts, pooled sensitivity was 0.87 (95% CI 0.81-0.91), specificity was 0.82 (95% CI 0.77-0.86), DOR was 30.81 (95% CI 18.79-50.52), and AUC was 0.85 (95% CI 0.82-0.88). The AUC was significantly lower in external validation cohorts compared to internal validation cohorts (P&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our results show that CT-based AI models predict early cholangiocarcinoma recurrence with high performance in internal validation sets and moderate performance in external validation sets. However, the high heterogeneity observed may impact the robustness of these results. Future research should focus on prospective studies and establishing standardized gold standards to further validate the clinical applicability and gen","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":" ","pages":"e78306"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992823","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}

{"title":"Developing an Evaluation System for Quality of Health Educational Short Videos on Social Media (LassVQ) Using Nominal Group Technique and Analytic Hierarchy Process: Qualitative Study.","authors":"Yang Hu, Yiran Yang, Wei Li, Yan Zhou, Jing Sun","doi":"10.2196/72661","DOIUrl":"10.2196/72661","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;With the increasing use of social media platforms for health communication, the quality of health educational short videos (HESVs) has become a key concern. However, no standardized framework exists to evaluate the quality of health videos on social media, highlighting the need for a comprehensive evaluation system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to develop a valid and structured evaluation tool for assessing the quality of HESVs on social media.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The initial evaluation indicators obtained from the literature review and brainstorming undertaken in the study group were provided to the nominal group reference Lasswell's 5W communication model, and 2 rounds of nominal group technique (NGT) were carried out to screen, add, revise, and adjust indicators, and reach a consensus of evaluation system. The indicators were then ranked based on their significance, as scored by the experts using the analytic hierarchy process. The content validity was assessed by experts who rated the relevance of each indicator on a 4-point Likert scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The primary indicators include communicator, communication content, communication channel, and communication effect, along with 13 secondary indicators and 34 tertiary indicators. In total, 11 experts were enrolled in the NGT, 45% (5/11) of experts had a doctoral degree, and 80% (9/11) of them were ranked as an associate professor or professor. The average values of the expert judgment coefficient and authority coefficient were 0.93 (SD 0.08) and 0.85 (SD 0.10), respectively. In round 1 of NGT, the \"communication target\" of 5 primary indicators, 7 of 20 secondary indicators, and 66 of 94 tertiary indicators did not reach a consensus, and therefore, they were not deleted and proceeded to the next round of NGT. In round 2 of NGT, 1 primary indicator, 7 secondary indicators, and 59 tertiary indicators were deleted based on the consensus criteria. Among primary indicators, communication content was found to be the most influential, accounting for 45.68%. Among secondary indicators, credibility, scientificity, availability, and social attention were the most influential indicators, with priorities of 56.67%, 24.26%, 74.62%, and 39.89% in their respective categories. Among tertiary indicators, \"become a hot search recommended by the platform\" was the most influential indicator with a weight of 0.07. The content validity of all the evaluation indicators was 0.73-1.0, and the scale-level content validity index (average) was 0.87 (SD 0.15), which was indicated as acceptable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The evaluation system for the quality of HESVs on social media (LassVQ; the Lasswell's Video Quality scale) was developed, and its validity was acceptable. The proposed evaluation system can be used in conjunction with qualitative methods to gain a holistic perspective on the multidimensional quality of HESVs on so","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e72661"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086236","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}

{"title":"Cost-Effectiveness of App-Guided Self-Management for Posttraumatic Stress: Trial-Based Economic Evaluation.","authors":"Jonathan Siverskog, Johannes Andersson, Ida Hensler, Erik Grönqvist, Filip K Arnberg","doi":"10.2196/69426","DOIUrl":"10.2196/69426","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;App interventions show promise as effective interventions for trauma-related distress, but evaluations of their cost-effectiveness are scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to assess the cost-effectiveness of an app-based intervention for self-management of posttraumatic stress compared to no guided self-management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An economic evaluation from a Swedish public health care perspective was conducted alongside a randomized controlled trial in which participants (N=179) were randomly assigned to either immediate exposure (intervention group; n=89, 49.7%) or delayed exposure at 3 months (waitlist group; n=90, 50.3%). The number of quality-adjusted life years (QALYs) gained or lost, increases or decreases in the use of different types of health care, and the monetary costs (in SEK; 2023 price level) saved or incurred with the intervention versus the comparator at 9 months after exposure were estimated based on functional disability and health care consumption reported by participants via a web-based written questionnaire at baseline and at 3, 6, and 9 months of follow-up. Estimation was done via linear regression with clustering at the participant level. The probability of the intervention being cost-effective was calculated over a range of cost-effectiveness thresholds up to SEK 1 million per QALY (US $94,225 per QALY; 2023 average exchange rate, US $1=SEK 10.61), and value of information analysis was used to interpret statistical uncertainty in the cost-effectiveness results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was no statistically significant difference between the intervention and comparator at 9 months after exposure when QALYs and all categories of health care consumption were analyzed jointly (P=.46). When analyzed separately, there was a significant increase in the number of consultations made in private mental health care (P=.03). The intervention was associated with 0.0065 (95% CI -0.0219 to 0.0349) QALYs gained per user and an increment in costs of SEK -46,359 (95% CI -111,696 to 18,977; US $-4368, 95% CI -10,525 to 1788) per user compared to no guided self-management. Cost savings were due to fewer consultations and care days per user in public health care (-5.50, 95% CI -14.83 to 3.83). The intervention had a 62% probability of both gaining QALYs and saving costs, and the probability that it would be cost-effective remained constant at 92% over our threshold range. The total expected value of perfect information was SEK 5.4 million (US $510,480) and was largely attributable to statistical uncertainty in incremental costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The use of a mobile app for self-management of posttraumatic stress was found to be cost-effective in a Swedish setting. A value-of-information analysis suggests that current research is sufficient to support the use of the app in Swedish practice from a cost-effectiveness perspective. However, to sup","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e69426"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086178","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}

{"title":"Large Language Models' Clinical Decision-Making on When to Perform a Kidney Biopsy: Comparative Study.","authors":"Michael Toal, Christopher Hill, Michael Quinn, Ciaran O'Neill, Alexander P Maxwell","doi":"10.2196/73603","DOIUrl":"10.2196/73603","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Artificial intelligence (AI) and large language models (LLMs) are increasing in sophistication and are being integrated into many disciplines. The potential for LLMs to augment clinical decision-making is an evolving area of research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study compared the responses of over 1000 kidney specialist physicians (nephrologists) with the outputs of commonly used LLMs using a questionnaire determining when a kidney biopsy should be performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This research group completed a large online questionnaire for nephrologists to determine when a kidney biopsy should be performed. The questionnaire was co-designed with patient input, refined through multiple iterations, and piloted locally before international dissemination. It was the largest international study in the field and demonstrated variation among human clinicians in biopsy propensity relating to human factors such as sex and age, as well as systemic factors such as country, job seniority, and technical proficiency. The same questions were put to both human doctors and LLMs in an identical order in a single session. Eight commonly used LLMs were interrogated: ChatGPT-3.5, Mistral Hugging Face, Perplexity, Microsoft Copilot, Llama 2, GPT-4, MedLM, and Claude 3. The most common response given by clinicians (human mode) for each question was taken as the baseline for comparison. Questionnaire responses on the indications and contraindications for biopsy generated a score (0-44) reflecting biopsy propensity, in which a higher score was used as a surrogate marker for an increased tolerance of potential associated risks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The ability of LLMs to reproduce human expert consensus varied widely with some models demonstrating a balanced approach to risk in a similar manner to humans, while other models reported outputs at either end of the spectrum for risk tolerance. In terms of agreement with the human mode, ChatGPT-3.5 and GPT-4 (OpenAI) had the highest levels of alignment, agreeing with the human mode on 6 out of 11 questions. The total biopsy propensity score generated from the human mode was 23 out of 44. Both OpenAI models produced similar propensity scores between 22 and 24. However, Llama 2 and MS Copilot also scored within this range but with poorer response alignment to the human consensus at only 2 out of 11 questions. The most risk-averse model in this study was MedLM, with a propensity score of 11, and the least risk-averse model was Claude 3, with a score of 34.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The outputs of LLMs demonstrated a modest ability to replicate human clinical decision-making in this study; however, performance varied widely between LLM models. Questions with more uniform human responses produced LLM outputs with higher alignment, whereas questions with lower human consensus showed poorer output alignment. This may limit the practical use of LLMs in real-","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e73603"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086341","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}

{"title":"Digital Stress Induction in Daily Life Using the Salzburg Mobile Stress Induction (SMSI): Development and Ambulatory Evaluation Study.","authors":"Thomas Vikoler, Heike Ganesch, Jasmina Dubravac, Eva Traut-Mattausch","doi":"10.2196/75785","DOIUrl":"10.2196/75785","url":null,"abstract":"<p><strong>Background: </strong>The use of digital technology enabled examining stress in everyday life. However, ambulatory research depends on the natural occurrence of stressful situations while most standardized stress inductions rely on cost- and labor-expensive laboratory experiments, which are limited in their infrequent applicability.</p><p><strong>Objective: </strong>We developed the Salzburg Mobile Stress Induction (SMSI), a newly conceptualized toolbox including 6 different stress-inducing paradigms (Matrices test, Cube Net test, Arithmetic test, Number Series test, Word Scramble test, and Word Pair test) and 1 control paradigm (Caesar Cipher test), which are based on cognitive performance tests. These 7 tests aim to provide researchers with an open-access, standardized method to repeatedly induce stress in an ambulatory setting.</p><p><strong>Methods: </strong>We recruited university students from a local university and through a crowdsourcing platform for a preregistered ambulatory study. After completing a web-based survey, participants used the m-path app on their smartphones to conduct the 7 SMSI tests in a randomized order over 4 days. By comparing the stress-inducing tests with the control test, we investigated changes in momentary negative and positive affect from baseline (t0) to between (t1) and after (t2) each test using the International Positive and Negative Affect Schedule Short Form.</p><p><strong>Results: </strong>A total of 100 participants (60/100 women; mean age 24.43, SD 6.21 years; 69/100 local sample; 31/100 crowdsourcing sample) completed all 7 SMSI tests. Participants' negative affect significantly increased during all 6 stress-inducing tests compared to the control test from t0 to t1 (Ps<.001) and from t0 to t2 (Ps<.001) with medium to large effect sizes (η_p²s=0.10 to 0.30). Post hoc pairwise comparisons showed significant increases of negative affect during all stress-inducing tests from t0 to t1 (Ps<.001) and from t0 to t2 (Ps<.001) and a slight increase in the control test from t0 to t2 (P=.006). Reported positive affect significantly differed between the stress-inducing tests and the control test from t0 to t1 (Ps<.001) and from t0 to t2 (Ps<.001) with medium to large effect sizes (η_p²s=0.14 to 0.33). Post hoc pairwise comparisons revealed a significant increase in positive affect in the control test from t0 to t1 (P<.001) and from t0 to t2 (P<.001) and varying significant decreases to nonsignificant changes in the stress-inducing tests over time (Ps>.99 to <.001).</p><p><strong>Conclusions: </strong>The SMSI presents novel and easy-to-implement standardized stress induction procedures to repeatedly induce stress in ambulatory research. We discussed new opportunities for positive eustress inductions and outlined subsequent validation studies combining physiological stress assessment and ambulatory methods. The development of additional language versions of the SMSI is illustrated.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e75785"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086292","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}

{"title":"Correction: Schema-Informed Digital Mental Health Intervention for Maladaptive Cognitive-Emotional Patterns: Randomized Controlled Trial.","authors":"Seohyun Jeong, Hyeonseong Kim, Silvia Kyungjin Lho, Inae Hwang, Seongjun Mun, Soohyun Kim, Hyejin Lim, Hyeonhee Kim, Min-Sup Shin, Woori Moon","doi":"10.2196/83135","DOIUrl":"10.2196/83135","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/65892.].</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e83135"},"PeriodicalIF":6.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080574","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}

{"title":"Bridging Technology and Pretest Genetic Services: Quantitative Study of Chatbot Interaction Patterns, User Characteristics, and Genetic Testing Decisions.","authors":"Yang Yi, Lauren Kaiser-Jackson, Jemar R Bather, Melody S Goodman, Daniel Chavez-Yenter, Richard L Bradshaw, Rachelle Lorenz Chambers, Whitney F Espinel, Rachel Hess, Devin M Mann, Rachel Monahan, David W Wetter, Ophira Ginsburg, Meenakshi Sigireddi, Kensaku Kawamoto, Guilherme Del Fiol, Saundra S Buys, Kimberly A Kaphingst","doi":"10.2196/73391","DOIUrl":"10.2196/73391","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Among the alternative solutions being tested to improve access to genetic services, chatbots (or conversational agents) are being increasingly used for service delivery. Despite the growing number of studies on the accessibility and feasibility of chatbot genetic service delivery, limited attention has been paid to user interactions with chatbots in a real-world health care context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We examined users' interaction patterns with a pretest cancer genetics education chatbot as well as the associations between users' clinical and sociodemographic characteristics, chatbot interaction patterns, and genetic testing decisions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed data from the experimental arm of Broadening the Reach, Impact, and Delivery of Genetic Services, a multisite genetic services pragmatic trial in which participants eligible for hereditary cancer genetic testing based on family history were randomized to receive a chatbot intervention or standard care. In the experimental chatbot arm, participants were offered access to core educational content delivered by the chatbot with the option to select up to 9 supplementary informational prompts and ask open-ended questions. We computed descriptive statistics for the following interaction patterns: prompt selections, open-ended questions, completion status, dropout points, and postchat decisions regarding genetic testing. Logistic regression models were used to examine the relationships between clinical and sociodemographic factors and chatbot interaction variables, examining how these factors affected genetic testing decisions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 468 participants who initiated a chat, 391 (83.5%) completed it, with 315 (80.6%) of the completers expressing a willingness to pursue genetic testing. Of the 391 completers, 336 (85.9%) selected at least one informational prompt, 41 (10.5%) asked open-ended questions, and 3 (0.8%) opted for extra examples of risk information. Of the 77 noncompleters, 57 (74%) dropped out before accessing any informational content. Interaction patterns were not associated with clinical and sociodemographic factors except for prompt selection (varied by study site) and completion status (varied by family cancer history type). Participants who selected ≥3 prompts (odds ratio 0.33, 95% CI 0.12-0.91; P=.03) or asked open-ended questions (odds ratio 0.46, 95% CI 0.22-0.96; P=.04) were less likely to opt for genetic testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Findings highlight the chatbot's effectiveness in engaging users and its high acceptability, with most participants completing the chat, opting for additional information, and showing a high willingness to pursue genetic testing. Sociodemographic factors were not associated with interaction patterns, potentially indicating the chatbot's scalability across diverse populations provided they have internet access. Future efforts should addr","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e73391"},"PeriodicalIF":6.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080647","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}