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Journal Description

i-JMR is a general medical journal with a focus on innovation in health, health care, and medicine - through new medical techniques and innovative ideas and/or research, including—but not limited to—technology, clinical informatics, sociotechnical and organizational health care innovations, or groundbreaking research.

i-JMR is indexed in PubMed and archived in PubMed Central.

i-JMR is also indexed in Clarivate Analytics (formerly the IP and Science Division of Thomson Reuters) new Emerging Sources Citation Index (ESCI).


Recent Articles:

  • Source: Unsplash; Copyright: Mark Paton; URL:; License: Licensed by JMIR.

    Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Jeddah, Saudi Arabia: Cross-Sectional Survey-Based Study


    Background: Obstruction of the Eustachian tube is a common condition that is unpleasant and might lead to various middle ear disorders. Objective: This study aimed to estimate the prevalence of Eustachian tube dysfunction (ETD) among the public in Jeddah, Saudi Arabia. Methods: This cross-sectional survey-based study was conducted in Jeddah during August 2018 by distributing an electronic survey form to participants from different districts of the city. All male and female residents of Jeddah aged 10 years and above had the chance to participate in this study. Results: A total of 2372 participants (female, 1535/2372, 64.71%; male, 837/2372, 35.28%; mean age 31.31 years, SD 11.85 years) agreed to contribute to our study. Upon analysis of their answers to the questionnaire, the overall prevalence of ETD in our sample was found to be 42.49% (1008/2372). The prevalence was higher among participants who reported a previous diagnosis of ETD and hearing loss (1897/2372, 80.00% and 1902/2372, 80.21%, respectively). Additionally, participants with a family history of hearing loss had a significantly higher prevalence (1136/2372, 47.92%) of ETD than those with no family history of hearing loss. Our analysis also showed that females were at a greater risk of developing ETD than males (P=.01). Conclusions: As per our prevalence data, ETD is a common disease in Jeddah, pointing to the need for more attention, awareness, and research.

  • A man walking with his bag, indicating the relevance with the working environment. Walking rhythms could indicate work-related fatigue. Source: Unsplash; Copyright: Marten Bjork; URL:; License: Creative Commons Attribution (CC-BY).

    Leveraging Walking Performance to Understand Work Fatigue Among Young Adults: Mixed-Methods Study


    Background: Work fatigue negatively impacts personal health in the long term. Prior research has indicated the possibility of leveraging both walking parameters and perceptual measures to assess a person’s fatigue status. However, an effective and ubiquitous approach to assessing work fatigue in young adults remains unexplored. Objective: The goals of this paper were to (1) explore how walking rhythms and multiple streams of data, including reaction time, self-reports, and an activity diary, reflect work-induced fatigue in the lab setting; (2) identify the relationship between objective performance and subjective perception in indicating fatigue status and fatigability; and (3) propose a mobile-based assessment for work-induced fatigue that uses multiple measurements. Methods: We conducted a 2-day in-lab study to measure participants’ fatigue status using multiple measurements, including the stair climb test (SCT), the 6-minute walk test (6MWT), and the reaction time test. Both the SCT and the 6MWT were conducted at different points in time and under 2 conditions (measurement time, including prior to and after work, and pace, including normal and fast). Participants reported their fatigue perception through questionnaires completed before conducting walking tests and in an activity diary recorded over a week. Walking performance data were collected by a smartphone with a built-in 3-axis accelerometer. To examine the effect of fatigability on walking performance, we first clustered participants into 2 groups based on their reported mental fatigue level in the entry surveys and then compared their walking performance using a generalized linear model (GLM). The reaction time was examined using a 2-way repeated-measures GLM. We conducted semistructured interviews to understand participants’ fatigue perception after each day’s walking tests. Results: All participants (N=26; mean age 24.68 years) were divided into 2 groups—the fatigue-sensitive group (11/26, 42%) and the fatigue-nonsensitive group (15/26, 58%)—based on their mental subscores from 3 entry surveys: Fatigue Scale-14, Three-Dimensional Work Fatigue Inventory, and Fatigue Self-Assessment Scale (FSAS). The fatigue-sensitive group reported a significantly higher FSAS score in the before-work setting (t50=–3.361; P=.001). The fatigue-sensitive group covered fewer steps than the fatigue-nonsensitive group (β1=–0.099; SE 0.019; t1=–5.323; P<.001) and had a higher step-to-step time variability in the 6MWT (β1=9.61 × 10–4; t1=2.329; P=.02). No strong correlation between subjective and objective measurements was observed in the study. Conclusions: Walking parameters, including step counts and step-to-step time variability, and some selected scales (eg, FSAS) were found to reflect participants’ work-induced fatigue. Overall, our work suggests the opportunity of employing mobile-based walking measurements to indicate work fatigue among young adults.

  • Source: Rawpixel; Copyright:; URL:; License: Licensed by JMIR.

    Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites


    Background: The internet is becoming increasingly more important in the new era of patient self-education. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are recognized interventions to treat patients with carotid artery stenosis. Using the Google search platform, patients encounter many websites with conflicting information, which are sometimes difficult to understand. This lack of accessibility creates uncertainty or bias toward interventions for carotid artery disease. The quality, readability, and treatment preference of carotid artery disease (CAD) websites have not yet been evaluated. Objective: This study aimed to explore the quality, readability, and treatment preference of CAD websites. Methods: We searched Google Canada for 10 CAD-related keywords. Returned links were assessed for publication date, medical specialty and industry affiliation, presence of randomized controlled trial data, differentiation by symptomatic status, and favored treatment. Website quality and readability were rated by the DISCERN instrument and Gunning Fog Index. Results: We identified 54 unique sites: 18 (33.3%) by medical societies or individual physicians, 11 (20.4%) by government organizations, 9 (16.7%) by laypersons, and 1 (1.9%) that was industry-sponsored. Of these sites, 26 (48.1%) distinguished symptomatic from asymptomatic CAD. A majority of sites overall (57.4%) and vascular-affiliated (72.7%) favored CEA. In contrast, radiology- and cardiology-affiliated sites demonstrated the highest proportion of sites favoring CAS, though they were equally likely to favor CEA. A large proportion (21/54, 38.9%) of sites received poor quality ratings (total DISCERN score <48), and the majority (41/54, 75.9%) required a reading level greater than a high school senior. Conclusions: CAD websites are often produced by government organizations, medical societies, or physicians, especially vascular surgeons. Sites ranged in quality, readability, and differentiation by symptomatic status. Google searches of CAD-related terms are more likely to yield sites favoring CEA. Future research should determine the extent of website influence on CAD patients’ treatment decisions. Trial Registration:

  • Source: Freepik; Copyright: Freepik; URL:; License: Licensed by JMIR.

    Exploring the Usage Intentions of Wearable Medical Devices: A Demonstration Study

    Authors List:


    Background: In the face of an aging society, an immediate and preventive medical system urgently needs to be established, and the application of wearable devices is essential. However, the application of smart medical care in Taiwan is still not widespread, and few studies have explored the related issues of wearable medical device usage. Thus, determining the success of a wearable medical device mainly depends on the degree of user adoption and use. Objective: The purpose of this study was to examine the factors that influence the intention to use wearable medical devices. Methods: This study applied the unified theory of acceptance and use of technology (UTAUT) to build a comprehensive model that explains intentions to use wearable medical devices. Results: The research findings showed that health consciousness and trust were the strongest predictors of intentions to use wearable medical devices. Conclusions: The results reveal the magnitudes of the impacts of the variables in a well-accepted revised UTAUT model in the context of the medical industry, particularly in the setting of wearable medical devices. Several important implications for academics and industry decision-makers can be formulated from these results.

  • Source: Pixabay; Copyright: HansMartinPau; URL:; License: Licensed by JMIR.

    Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review


    Background: Coagulopathy associated with COVID-19 infection and venous thromboembolism (VTE) have emerged as significant contributors to morbidity among patients infected with SARS-CoV-2. Objective: We performed a systematic review to estimate VTE incidence in hospitalized patients and to analyze characteristic factors in the VTE cohort. Methods: We searched PubMed and Google Scholar using specified title search terms “SARS-CoV-2” or “COVID-19” and “venous thromboembolism” and “anticoagulation” among others to identify peer-reviewed journal articles published between June 22, 2019, and June 22, 2020. Data were systematically extracted and synthesized using Microsoft Excel for analysis. The main outcome was VTE incidence, and measures included patient characteristics, anticoagulation, and clinical outcomes with assessment for associations. Results: In total, 14 studies were included comprising 1677 patients. Most patients (n=1306, 82.4%) received anticoagulation (either VTE prophylaxis or treatment). VTE incidence was 26.9% (SE 3.1; 95% CI 20.8-33.1) and was correlated with systematic screening (r2=0.34, P=.03) and study duration (r2=–0.33, P=.03). D-dimer was higher for the VTE cohort (5.62 [SD 0.9] vs 1.43 [SD 0.6]; P<.001). Odds of VTE were higher at the intensive care unit (odds ratio [OR] 6.38, 95% CI 3.67-11.11; P<.001) but lower with anticoagulation (OR 0.58, 95% CI 0.36-0.92; P=.02). Conclusions: Despite the utilization of background anticoagulation, VTE incidence was historically high. Future studies are needed to provide additional data to guide optimal VTE prophylaxis and diagnostic strategies.

  • Source: Adobe Stock; Copyright: Tyler Olsen; URL:; License: Licensed by JMIR.

    Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study


    Background: The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective: The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods: This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results: A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions: Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

  • Source: Flickr; Copyright: IAEA Imagebank; URL:; License: Creative Commons Attribution (CC-BY).

    Protection of Health Care Professionals During an Epidemic: Medical, Ethical, and Legal Ramifications

    Authors List:


    The welfare of health care professionals working in hazardous environments is a concerning issue. Personal protective equipment such as face masks, disposable gowns, hair covers, gloves, and shoe covers is often used to prevent contamination from patient contact and droplets. This is especially relevant during an epidemic, when health care professionals are at elevated risk of infection. Failure to provide adequate protection to health care workers during epidemics has medical, ethical, and legal ramifications.

  • Source: Burst; Copyright: Matthew Henry; URL:; License: Licensed by JMIR.

    Public Awareness of Sepsis Compared to Acute Myocardial Infarction and Stroke in Jeddah, Saudi Arabia: Questionnaire Study


    Background: Sepsis is a state of organ dysfunction caused by an impaired host response to infection. It is one of the leading causes of death globally. Sepsis, acute myocardial infarction (AMI), and stroke share the primary management requirement of rapid intervention. This could be achieved through early presentation to the hospital, which demands previous knowledge of the disease to ensure better outcomes. Objective: Our study aimed to assess the level of public awareness of sepsis compared with AMI and stroke. Methods: This was a cross-sectional survey study performed in June and July 2018, with 1354 participants from Jeddah, Saudi Arabia, aged ≥18 years. Data entry was performed using Microsoft Excel and statistical analysis including chi-square tests and multilogistic regression was performed using SPSS software. Results: A total of 1354 participants were included. Only 56.72% (768/1354) had heard of the term “sepsis” and 48.44% (372/768) of these participants were able to correctly identify it. In addition, 88.33% (1196/1354) had heard the term “myocardial infarction” and 64.63% (773/1196) knew the correct definition of that condition. Stroke was recognized by 81.46% (1103/1354) of participants and 59.20% (653/1103) of these participants correctly identified the condition. The difference between those who had heard of these diseases and those who knew the correct definition significantly differed from the values for awareness of sepsis and its definition. Conclusions: We found that public awareness and knowledge of sepsis are poor amongst the population of Jeddah compared with the awareness and knowledge of AMI and stroke. This lack of knowledge may pose a serious obstruction to the prompt management needed to limit fatal outcomes.

  • Mesh nebulizer for home nebulization. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Health-Related Effects of Home Nebulization With Glycopyrronium on Difficult-to-Treat Asthma: Post-Hoc Analyses of an Observational Study


    Background: Bronchial asthma remains a clinical enigma with poorly controlled symptoms or exacerbations despite regular use of inhaled corticosteroids. Home nebulization offers a simplified solution for the delivery of rescue and maintenance bronchodilators, which is especially true for patients with frequent exacerbations during management of uncontrolled or difficult-to-treat asthma. Objective: We aimed to assess the clinical impact and outcomes associated with home nebulization—delivered long-acting bronchodilators for uncontrolled or difficult-to-treat asthma. Methods: This observational, concurrent study was conducted with 60 patients at 2 centers during November 2018. Statistical analyses for prebronchodilator forced expiratory volume in one second (FEV1) and Global Initiative for Asthma (GINA) asthma control score in patients on long-acting bronchodilators and corticosteroids were conducted, with two-tailed P values <.05 considered statistically significant. Results: Per protocol analyses (53/60) for consecutive cases receiving home nebulization with long-acting bronchodilators and corticosteroids were conducted. The baseline demographics included a male-to-female ratio of 30:23 and mean values of the following: age, 60.3 years (SD 11.8 years); weight, 64 kg (SD 16.8 kg); FEV1, 43% (SD 16%); GINA asthma control score, 3.0 points (SD 0.8 points); serum eosinophil level, 4% (SD 3%); fractional exhaled nitric oxide (FeNO), 12.1 ppb (SD 6 ppb). Of the patients, 100% (53/53) had uncontrolled symptoms, 69.8% (37/53) had prior exacerbations, 100% (53/53) used formoterol/budesonide, and 75.5% (40/53) used glycopyrronium. The per protocol group (n=53) had significantly improved mean prebronchodilator FEV1 (23.7%, SD 29.8%; 0.46 L, SD 0.58 L; P<.001) and GINA asthma control score (2.1 points, SD 0.8 points, P<.001). At baseline, patients (n=40) receiving glycopyrronium/formoterol/budesonide (25/20/500 mcg) nebulization admixture had the following mean values: prebronchodilator FEV1, 38% (SD 15%); GINA asthma control score, 3.0 points (SD 0.8 points); reversibility, 12% (SD 6%); peripheral eosinophil level, 4% (SD 3%); FeNO, 12 ppb (SD 5.7 ppb). In the post hoc analyses, these patients had significantly improved mean prebronchodilator FEV1 of 27.7% (SD 26.2%; 0.54 L, SD 0.51 L; P<.001) at 8 weeks compared with baseline. At baseline, patients (n=13) receiving formoterol/budesonide (20/500 mcg) nebulization had the following mean values: FEV1, 55% (SD 12%); GINA asthma control score, 3.0 points (SD 1.2 points); reversibility, 14% (SD 7%); serum eosinophil level, 4% (SD 3%); FeNO, 13.3 ppb (SD 6.8 ppb). In the post hoc analyses, these patients showed a significant improvement in prebronchodilator FEV1 of 11.2% (SD 13.1%; 0.22 L, SD 0.25 L; P<.001) from baseline. Breathlessness of mild to moderate intensity was reported by 10 cases (10/53, 18.9%), with no other treatment-emergent adverse events or serious adverse events. Conclusions: Home nebulization remains a viable option for symptomatic difficult-to-treat asthma cases with frequent use of rescue medications. Glycopyrronium as add-on therapy offers a synergistic response in patients on corticosteroids with difficult-to-treat asthma. Trial Registration: Clinical Trial Registry of India CTRI/2018/11/016319;

  • Source: Freepik; Copyright: master1305; URL:; License: Licensed by JMIR.

    The Influence of Gender on the Choice of Radiology as a Specialty Among Medical Students in Saudi Arabia: Cross-Sectional Study


    Background: Medical undergraduates are the future doctors of the country. Therefore, determining how medical students choose their areas of specialty is essential to obtain a balanced distribution of physicians among all specialties. Although gender is a significant factor that affects specialty choice, the factors underlying gender differences in radiology are not fully elucidated. Objective: This study examined the factors that attracted medical students to and discouraged them from selecting diagnostic radiology and analyzed whether these factors differed between female and male medical students. Methods: This cross-sectional study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, used an electronic questionnaire sent to medical students from all medical years during February 2018. Subgroup analyses for gender and radiology interest were performed using the chi-square test and Cramér’s V test. Results: In total, 539 students (276 women; 263 men) responded. The most common factor preventing students from choosing radiology as a career was the lack of direct patient contact, which deterred approximately 47% who decided against considering this specialty. Negative perceptions by other physicians (P<.001), lack of acknowledgment by patients (P=.004), and lack of structured radiology rotations (P=.007) dissuaded significantly more male students than female students. Among those interested in radiology, more female students were attracted by job flexibility (P=.01), while more male students were attracted by focused patient interactions with minimal paperwork (P<.001). Conclusions: No significant difference was found between the genders in terms of considering radiology as a specialty. Misconception plays a central role in students’ judgment regarding radiology. Hence, early exposure to radiology, assuming a new teaching method, and using a curriculum that supports the active participation of students in a radiology rotation are needed to overcome this misconception.

  • Source: Pexels; Copyright: Bongkarn Thanyakij; URL:; License: Licensed by JMIR.

    Improving Patient Preference Elicitation by Applying Concepts From the Consumer Research Field: Narrative Literature Review


    Background: Although preference research finds its origins in consumer research, preference elicitation methods have increasingly attracted attention in different decision-making contexts in health care. Simulating real-life decision making is believed to be important during consumer preference elicitation. Objective: The aims of this study were to compare the process of decision making between patients and consumers and to identify methods from the consumer research field that could be applied in patient preference elicitation. Methods: A narrative literature review was performed to identify preference elicitation concepts from a consumer context that could offer improvements in health care. Results: The process of decision making between patients and consumers was highly comparable. The following five concepts from the consumer research field that could effectively simulate a real-life decision-making process for applications in health care were identified: simulating alternatives, self-reflection, feedback-driven exploration, separated (adaptive) dual response, and arranging profiles in blocks. Conclusions: Owing to similarities in the decision-making process, patients could be considered as a subgroup of consumers, suggesting that preference elicitation concepts from the consumer field may be relevant in health care. Five concepts that help to simulate real-life decision making have the potential to improve patient preference elicitation. However, the extent to which real decision-making contexts can be mimicked in health care remains unknown.

  • Source: Image created by the Authors; Copyright: Dominik Schoeb; URL:; License: Creative Commons Attribution (CC-BY).

    Use of Artificial Intelligence for Medical Literature Search: Randomized Controlled Trial Using the Hackathon Format


    Background: Mapping out the research landscape around a project is often time consuming and difficult. Objective: This study evaluates a commercial artificial intelligence (AI) search engine (IRIS.AI) for its applicability in an automated literature search on a specific medical topic. Methods: To evaluate the AI search engine in a standardized manner, the concept of a science hackathon was applied. Three groups of researchers were tasked with performing a literature search on a clearly defined scientific project. All participants had a high level of expertise for this specific field of research. Two groups were given access to the AI search engine IRIS.AI. All groups were given the same amount of time for their search and were instructed to document their results. Search results were summarized and ranked according to a predetermined scoring system. Results: The final scoring awarded 49 and 39 points out of 60 to AI groups 1 and 2, respectively, and the control group received 46 points. A total of 20 scientific studies with high relevance were identified, and 5 highly relevant studies (“spot on”) were reported by each group. Conclusions: AI technology is a promising approach to facilitate literature searches and the management of medical libraries. In this study, however, the application of AI technology lead to a more focused literature search without a significant improvement in the number of results.

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