@Article{info:doi/10.2196/56318,
author="Glynn, Lisa
and Moloney, Eddie
and Lane, Stephen
and McNally, Emma
and Buckley, Carol
and McCann, Margaret
and McCabe, Catherine",
title="A Smartphone App Self-Management Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial of Clinical Outcomes",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="23",
volume="13",
pages="e56318",
keywords="COPD",
keywords="self-management",
keywords="smartphone application",
keywords="clinical health outcomes",
keywords="chronic obstructive pulmonary disease",
keywords="clinical health",
keywords="patient",
keywords="patients",
keywords="randomised controlled trial",
keywords="RCT",
keywords="smartphone",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="mhealth",
keywords="mobile health",
keywords="effectiveness",
keywords="intervention",
keywords="interventions",
keywords="hospital setting",
keywords="quality of life",
keywords="self-efficacy",
keywords="hospital",
keywords="hospitals",
keywords="mobile phone",
abstract="Background: Chronic obstructive pulmonary disease (COPD) negatively impacts clinical health outcomes, resulting in frequent exacerbations, increased hospitalizations, reduced physical activity, deteriorated quality of life, and diminished self-efficacy. Previous studies demonstrated that a self-management program tailored for adults with COPD improves self-management decisions, resulting in a positive effect on clinical health outcomes. Limitations of these studies include issues regarding heterogeneity among interventions used, patient population characteristics, outcome measures, and longitudinal studies. Limited studies focused on the use of a comprehensive self-management program using a smartphone app for adults with COPD over 12 months. Objective: This study aimed to explore the effectiveness of a smartphone app self-management program and monthly phone calls compared with standard respiratory outpatient care on clinical health outcomes in adults with COPD. Methods: This was a 3-arm parallel pilot randomized controlled trial (RCT) that included 92 participants. Participants were randomized into intervention arm 1, which included a self-management smartphone app and monthly phone calls (n=31); intervention arm 2, which included a self-management smartphone app (n=31); and arm 3, which was standard respiratory outpatient care (n=30). All arms received standard respiratory outpatient care. The primary outcome was a binary indicator equal to 1 if participants reported attendance to a general practitioner (GP) and or a hospital setting as a result of an exacerbation and 0 otherwise. This indicator was recorded at 6 months and 12 months from the baseline. Secondary outcomes included engagement, breathlessness, physical activity, health-related quality of life, and self-efficacy. Results: There was a statistically significant difference (P=.03), indicating fewer exacerbations in the intervention arm 2 compared with the control arm at 6 months in the hospital setting. The intervention arms had a statistically significant difference indicating a lower risk of developing an exacerbation at 6 months in both the GP (P=.01) and hospital setting (P=.006) compared to the control arm. Furthermore, intervention arm 1 demonstrated a statistically significant difference in exercise capacity at 6 and 12 months (P=.02 and P=.03). The intervention arm 2 illustrated a statistically significant difference in step count (P=.009) compared to the control arm. The majority of participants (60\%, 33/55) used the app over the 12-month period. Conclusions: This study demonstrated that a smartphone app self-management program had a positive effect on clinical health outcomes for participants with COPD in comparison to standard respiratory outpatient care. This study illustrated benefits such as reduced exacerbations resulting in fewer hospitalizations, improved exercise capacity, and physical activity among the intervention arms. This was a single-center study, which was limited in power to demonstrate significant effects on all measured outcomes but paves the way for a larger, fully powered multicenter trial exploring the effect of a smartphone app self-management program on clinical health outcomes in adults with COPD. Trial Registration: ClinicalTrials.gov NCT05061810; https://clinicaltrials.gov/study/NCT05061810 ",
doi="10.2196/56318",
url="https://mhealth.jmir.org/2025/1/e56318"
}


@Article{info:doi/10.2196/66491,
author="Park, Soo Ji
and Park, Sa-Yoon
and Moon, Won Jae
and Kim, Kwangsoo
and Suh, In Dong",
title="Artificial Intelligence Models for Pediatric Lung Sound Analysis: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="18",
volume="27",
pages="e66491",
keywords="machine learning",
keywords="respiratory disease classification",
keywords="wheeze detection",
keywords="auscultation",
keywords="mel-spectrogram",
keywords="abnormal lung sound detection",
keywords="artificial intelligence",
keywords="pediatric",
keywords="lung sound analysis",
keywords="systematic review",
keywords="asthma",
keywords="pneumonia",
keywords="children",
keywords="morbidity",
keywords="mortality",
keywords="diagnostic",
keywords="respiratory pathology",
abstract="Background: Pediatric respiratory diseases, including asthma and pneumonia, are major causes of morbidity and mortality in children. Auscultation of lung sounds is a key diagnostic tool but is prone to subjective variability. The integration of artificial intelligence (AI) and machine learning (ML) with electronic stethoscopes offers a promising approach for automated and objective lung sound. Objective: This systematic review and meta-analysis assess the performance of ML models in pediatric lung sound analysis. The study evaluates the methodologies, model performance, and database characteristics while identifying limitations and future directions for clinical implementation. Methods: A systematic search was conducted in Medline via PubMed, Embase, Web of Science, OVID, and IEEE Xplore for studies published between January 1, 1990, and December 16, 2024. Inclusion criteria are as follows: studies developing ML models for pediatric lung sound classification with a defined database, physician-labeled reference standard, and reported performance metrics. Exclusion criteria are as follows: studies focusing on adults, cardiac auscultation, validation of existing models, or lacking performance metrics. Risk of bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies (version 2) framework. Data were extracted on study design, dataset, ML methods, feature extraction, and classification tasks. Bivariate meta-analysis was performed for binary classification tasks, including wheezing and abnormal lung sound detection. Results: A total of 41 studies met the inclusion criteria. The most common classification task was binary detection of abnormal lung sounds, particularly wheezing. Pooled sensitivity and specificity for wheeze detection were 0.902 (95\% CI 0.726-0.970) and 0.955 (95\% CI 0.762-0.993), respectively. For abnormal lung sound detection, pooled sensitivity was 0.907 (95\% CI 0.816-0.956) and specificity 0.877 (95\% CI 0.813-0.921). The most frequently used feature extraction methods were Mel-spectrogram, Mel-frequency cepstral coefficients, and short-time Fourier transform. Convolutional neural networks were the predominant ML model, often combined with recurrent neural networks or residual network architectures. However, high heterogeneity in dataset size, annotation methods, and evaluation criteria were observed. Most studies relied on small, single-center datasets, limiting generalizability. Conclusions: ML models show high accuracy in pediatric lung sound analysis, but face limitations due to dataset heterogeneity, lack of standard guidelines, and limited external validation. Future research should focus on standardized protocols and the development of large-scale, multicenter datasets to improve model robustness and clinical implementation. ",
doi="10.2196/66491",
url="https://www.jmir.org/2025/1/e66491"
}


@Article{info:doi/10.2196/64742,
author="Chen, Yuyin
and Zhang, Yuanyuan
and Long, Xiuhong
and Tu, Huiqiong
and Chen, Jibing",
title="Effectiveness of Virtual Reality--Complemented Pulmonary Rehabilitation on Lung Function, Exercise Capacity, Dyspnea, and Health Status in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="7",
volume="27",
pages="e64742",
keywords="virtual reality",
keywords="video games",
keywords="exergaming",
keywords="pulmonary rehabilitation",
keywords="chronic obstructive pulmonary disease",
keywords="lung function",
keywords="exercise capacity",
keywords="dyspnea",
keywords="health status",
keywords="randomized controlled trial",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by persistent airflow obstruction. Pulmonary rehabilitation (PR) is a cornerstone of COPD management but remains underutilized due to barriers such as low motivation and accessibility issues. Virtual reality (VR)--complemented PR offers a novel approach to overcoming these barriers by enhancing patient engagement and rehabilitation outcomes. Objective: This review aims to evaluate the effect of VR-complemented PR compared with comparators on lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD. Additionally, the study aimed to identify which comparator type (active exercise vs nonactive exercise control group) and intervention duration would result in the greatest improvements in rehabilitation outcomes. The study also assessed patient-reported experience measures, including acceptability and engagement. Methods: A comprehensive search of 11 international and Chinese databases identified randomized controlled trials (RCTs) published up to November 2024. Data were analyzed using RevMan 5.4, with pooled effect sizes reported as mean differences (MDs) and 95\% CIs. Results: A total of 16 RCTs involving 1052 participants were included. VR-complemented PR significantly improved lung function (forced expiratory volume in 1 second [FEV1] [L], MD 0.25, P<.001; FEV1/forced vital capacity [FVC], MD 6.12, P<.001; FVC, MD 0.28, P<.001) compared with comparators. Exercise capacity, assessed by the 6MWD, significantly improved (MD 23.49, P<.001) compared with comparators; however, it did not reach the minimally clinically important difference of 26 m, indicating limited clinical significance despite statistical significance. VR-complemented PR also significantly reduced dyspnea measured by the modified British Medical Research Council scale (MD --0.28, P<.001), improved health status measured by the COPD Assessment Test (MD --2.95, P<.001), and enhanced oxygenation status measured by SpO2 (MD 1.35, P=.04) compared with comparators. Subgroup analyses revealed that VR-complemented PR had a significantly greater effect on FEV1 (L) (MD 0.32, P=.005) and 6MWD (MD 40.93, P<.001) compared with the nonactive exercise control group. Additionally, VR-complemented PR showed a greater improvement in FEV1/FVC (MD 6.15, P<.001) compared with the active exercise control group. Intervention duration influenced outcomes, with 5-12-week programs showing the greatest improvement in 6MWD (MD 38.96, P<.001). VR-complemented PR was well-accepted, with higher adherence and engagement rates than comparators. Conclusions: VR-complemented PR significantly improves lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD compared with comparators, while enhancing adherence and engagement. Subgroup analyses showed greater effects on FEV1 (L) and 6MWD compared with the nonactive exercise control group, and a larger improvement in FEV1/FVC compared with the active exercise control group. Interventions (5-12 weeks) yielded the most significant benefits in exercise capacity. These findings highlight VR as a promising adjunct to traditional PR, with future research focusing on long-term outcomes and standardized protocols. ",
doi="10.2196/64742",
url="https://www.jmir.org/2025/1/e64742"
}


@Article{info:doi/10.2196/53142,
author="Sun, Chao
and Dai, Huohuo
and M.J.J. van der Kleij, Rianne
and Li, Rong
and Wu, Hengchang
and Hallensleben, Cynthia
and Willems, H. Sofie
and Chavannes, H. Niels",
title="Digital Health Education for Chronic Lung Disease: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="18",
volume="27",
pages="e53142",
keywords="digital health education",
keywords="digital health interventions",
keywords="chronic lung disease",
keywords="eHealth",
keywords="scoping review",
abstract="Background: Chronic lung disease (CLD) is one of the most prevalent noncommunicable diseases globally, significantly burdening patients and increasing health care expenditures. Digital health education (DHE) is increasingly important in chronic disease prevention and management. However, DHE characteristics and impacts in CLD are rarely reported. Objective: This study aimed to provide an overview of the existing literature on DHE for CLD, with a focus on exploring the DHE mediums, content, mechanisms, and reported outcomes in patients with CLD. Methods: We searched PubMed, Web of Science, Embase, PsycINFO, and The Cochrane Library with the assistance of a librarian specialist. Articles were screened by the reviewer team with ASReview (Utrecht University) and EndNote X9 (Clarivate Analytics) based on predefined inclusion and exclusion criteria and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Quality assessment was conducted with the Critical Appraisal Skills Program tool. A descriptive analysis was used to summarize the study characteristics, DHE characteristics, and outcomes. Results: A total of 22 studies were included in this review with medium or high quality. They were published between 2000 and 2022, showing an increasing publication trend with the year, mostly in developed countries (16/22, 73\%). Websites and mobile apps (10/22, 45\%) were the most widely used DHE medium. Education on self-management skills of CLD was the primary topic (21/22, 95\%), 4/22 (18\%) of which mentioned DHE mechanisms. The majority of studies reported positive changes in CLD awareness (14/16, 88\%), clinical outcomes (3/6, 50\%), DHE feasibility, acceptability, and satisfaction (6/8, 75\%), lifestyle outcomes (3/3, 100\%), and psychosocial outcomes (7/8, 88\%). Only 2 studies reported cost-effectiveness (2/22, 9\%). Conclusions: Despite the heterogeneity of the study situation, some aspects can be concluded. DHE can improve disease awareness and clinical outcomes in patients with chronic lung disease, with good feasibility, acceptability, and satisfaction through different mediums and learning content. There is still relatively little research among people in low- and middle-income countries. Future research should consider the impact on cost-effectiveness, duration, frequency, and theoretical mechanisms of the DHE to maximize the potential impact. It should also be conducted in the context of health services research to better reflect the real world. ",
doi="10.2196/53142",
url="https://www.jmir.org/2025/1/e53142"
}


@Article{info:doi/10.2196/65794,
author="Fedele, A. David
and Ray, M. Jessica
and Mallela, L. Jaya
and Bian, Jiang
and Chen, Aokun
and Qin, Xiao
and Salloum, G. Ramzi
and Kelly, Maria
and Gurka, J. Matthew
and Hollenbach, Jessica",
title="Development of a Clinical Decision Support Tool to Implement Asthma Management Guidelines in Pediatric Primary Care: Qualitative Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="18",
volume="9",
pages="e65794",
keywords="clinical decision support",
keywords="asthma",
keywords="primary care",
keywords="guidelines",
keywords="pediatric",
keywords="asthma care",
keywords="morbidity",
keywords="health information technology",
keywords="electronic health record",
keywords="EHR",
keywords="user-centered design",
keywords="inductive approach",
keywords="digital health",
keywords="health technology",
abstract="Background: There is a longstanding gap between national asthma guidelines and their implementation in primary care. Primary care providers (PCPs) endorse numerous provider and practice or clinic-related barriers to providing guidelines-based asthma care. To reduce asthma morbidity in primary care, PCPs need access to tools that facilitate adherence to national guidelines, which can be delivered at the point of care, are minimally burdensome, and fit within the clinic workflow. Clinical decision support (CDS) tools are health IT systems that can be housed in the electronic health record (EHR) system. Objective: This study aimed to follow user-centered design principles and describe the formative qualitative work with target stakeholders (ie, PCPs and IT professionals) to inform our design of an EHR-embedded CDS tool that adheres to recent, significant changes in asthma management guidelines. Methods: Purposive sampling was used to recruit three separate subgroups of professionals (n=15) between (1) PCPs with previous experience using a paper-based CDS tool for asthma management, (2) PCPs without previous experience using CDS tools for asthma management, and (3) health care IT professionals. The PCP interview guide focused on their practice, familiarity with national asthma guidelines, and how a CDS tool embedded in the EHR might help them provide guideline-based care. The health care IT professional guide included questions on the design and implementation processes of CDS tools into the EHR. Qualitative data were audio-recorded, transcribed, and then analyzed using an inductive approach to develop themes. Results: Themes were organized into 2 domains, current practice and CDS tool development. The themes that emerged from PCPs included descriptions of assessments conducted to make an asthma diagnosis, previous attempts or opportunities to implement updated national asthma guidelines, and how a CDS tool could be implemented using the EHR and fit into the current asthma management workflow. The themes that emerged from health care IT professionals included processes used to design CDS tools and strategies to collect evidence that indicated a tool's value to a practice and the broader health system. Conclusions: In this study, user-centered design principles were used to guide a qualitative study on perceived barriers and facilitators to a primary care--based, EHR-integrated asthma CDS tool. PCPs expressed their interest in adopting an asthma CDS tool that was low burden and efficient but could help them adhere to national asthma guidelines and improve clinic workflow. Similarly, health care IT professionals perceived an asthma CDS tool to be useful, if it adhered to EHR design standards. Implementation of a CDS tool to improve adherence of PCPs to recently updated national asthma guidelines could be beneficial in reducing pediatric asthma morbidity. ",
doi="10.2196/65794",
url="https://formative.jmir.org/2025/1/e65794"
}


@Article{info:doi/10.2196/63230,
author="Egmose, Julie
and Kronborg, Thomas
and Hejlesen, Ole
and Hangaard, Stine",
title="Contactless Sleep Monitoring for the Detection of Exacerbations in People With Chronic Obstructive Pulmonary Disease: Protocol for a Longitudinal Observational Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="14",
volume="14",
pages="e63230",
keywords="disease exacerbation",
keywords="chronic obstructive pulmonary disease",
keywords="contactless measurements",
keywords="sleep monitoring systems",
keywords="heart rate measurement",
keywords="respiration rate measurement",
keywords="radar technology",
keywords="health literacy",
keywords="patient remote monitoring",
abstract="Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are one of the main causes of mortality, and early detection of exacerbations is thus essential. Telemedicine solutions have shown promising results for the detection of exacerbations in COPD and have increasingly been used. However, the effect of telemedicine is divergent. According to several studies, respiration rate (RR) increases before, during, and after an exacerbation and the change is measurable with several contactless devices. Despite this, RR is rarely measured, and telemedicine solutions only use wearable devices for measuring RR, even though wearable respiratory monitoring devices have been associated with certain drawbacks. Contactless devices are often used during sleep, as measurements conducted during sleep minimize the risk of disturbance from physical activities. However, the potential of measuring RR and heart rate (HR) during sleep for the detection of exacerbations in COPD remains unclear. Objective: The aim of this observational study is to investigate whether contactless measurement of RR, HR, and sleep stages can be used to detect exacerbations in people with COPD. Methods: An observational study including 50 participants with COPD will be conducted. The participants reside in Aalborg municipality, located in the North Denmark Region. Participants will use a contactless monitor (Sleepiz One+) near their bed during sleep for a period of 4 months. After data collection, descriptive statistics will be used to identify any extremes or variations in RR, HR, or sleep stages in the nights preceding an exacerbation. Correlation analysis will be performed to evaluate the relationship between the number of exacerbations and extremes or variations in RR, HR, or sleep stages. Finally, qualitative interviews will be conducted with 12 participants to explore their experiences of sleeping with the monitor nearby. Results: Recruitment started at the end of April 2024. A total of 12 participants have been recruited, and the remaining participants are expected to be recruited during March and April 2025. Six out of 12 participants have completed the data collection and qualitative interview stages. Overall data collection is expected to be completed by September 2025. The results are expected to provide insight into the potential for identifying extremes or variations in RR, HR, or sleep stages in the days preceding an exacerbation. Additionally, the results are expected to assess the correlation between the number of exacerbations and extremes or variations in RR, HR, and sleep stages. Conclusions: The findings from this study may clarify the possibility of using a contactless monitor to detect exacerbations in COPD. Furthermore, the results may have the potential to improve the ability to predict exacerbations in the future. International Registered Report Identifier (IRRID): DERR1-10.2196/63230 ",
doi="10.2196/63230",
url="https://www.researchprotocols.org/2025/1/e63230"
}


@Article{info:doi/10.2196/57649,
author="te Braake, Eline
and Vaseur, Roswita
and Gr{\"u}nloh, Christiane
and Tabak, Monique",
title="The State of the Art of eHealth Self-Management Interventions for People With Chronic Obstructive Pulmonary Disease: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="10",
volume="27",
pages="e57649",
keywords="eHealth",
keywords="self-management",
keywords="interventions",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="review",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a common chronic incurable disease. Treatment of COPD often focuses on symptom management and progression prevention using pharmacological and nonpharmacological therapies (eg, medication, inhaler use, and smoking cessation). Self-management is an important aspect of managing COPD. Self-management interventions are increasingly delivered through eHealth, which may help people with COPD engage in self-management. However, little is known about the actual content of these eHealth interventions. Objective: This literature review aimed to investigate the state-of-the-art eHealth self-management technologies for COPD. More specifically, we aimed to investigate the functionality, modality, technology readiness level, underlying theories of the technology, the positive health dimensions addressed, the target population characteristics (ie, the intended population, the included population, and the actual population), the self-management processes, and behavior change techniques. Methods: A scoping review was performed to answer the proposed research questions. The databases PubMed, Scopus, PsycINFO (via EBSCO), and Wiley were searched for relevant articles. We identified articles published between January 1, 2012, and June 1, 2022, that described eHealth self-management interventions for COPD. Identified articles were screened for eligibility using the web-based software Rayyan.ai. Eligible articles were identified, assessed, and categorized by the reviewers, either directly or through a combination of methods, using Atlas.ti version 9.1.7.0. Thereafter, data were charted accordingly and presented with the purpose of giving an overview of currently available literature while highlighting existing gaps. Results: A total of 101 eligible articles were included. This review found that most eHealth technologies (91/101, 90.1\%) enable patients to self-monitor their symptoms using (smart) measuring devices (39/91, 43\%), smartphones (27/91, 30\%), or tablets (25/91, 27\%). The self-management process of ``taking ownership of health needs'' (94/101, 93.1\%), the behavior change technique of ``feedback and monitoring'' (88/101, 87\%), and the positive health dimension of ``bodily functioning'' (101/101, 100\%) were most often addressed. The inclusion criteria of studies and the actual populations reached show that a subset of people with COPD participate in eHealth studies. Conclusions: The current body of literature related to eHealth interventions has a strong tendency toward managing the physical aspect of COPD self-management. The necessity to specify inclusion criteria to control variables, combined with the practical challenges of recruiting diverse participants, leads to people with COPD being included in eHealth studies that only represent a subgroup of the whole population. Therefore, future research should be aware of this unintentional blind spot, make efforts to reach the underrepresented population, and address multiple dimensions of the positive health paradigm. ",
doi="10.2196/57649",
url="https://www.jmir.org/2025/1/e57649"
}


@Article{info:doi/10.2196/54543,
author="Zhang, Chunyan
and Wang, Ting
and Dong, Caixia
and Dai, Duwei
and Zhou, Linyun
and Li, Zongfang
and Xu, Songhua",
title="Exploring Psychological Trends in Populations With Chronic Obstructive Pulmonary Disease During COVID-19 and Beyond: Large-Scale Longitudinal Twitter Mining Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="5",
volume="27",
pages="e54543",
keywords="COVID-19",
keywords="chronic obstructive pulmonary disease (COPD)",
keywords="psychological trends",
keywords="Twitter",
keywords="data mining",
keywords="deep learning",
abstract="Background: Chronic obstructive pulmonary disease (COPD) ranks among the leading causes of global mortality, and COVID-19 has intensified its challenges. Beyond the evident physical effects, the long-term psychological effects of COVID-19 are not fully understood. Objective: This study aims to unveil the long-term psychological trends and patterns in populations with COPD throughout the COVID-19 pandemic and beyond via large-scale Twitter mining. Methods: A 2-stage deep learning framework was designed in this study. The first stage involved a data retrieval procedure to identify COPD and non-COPD users and to collect their daily tweets. In the second stage, a data mining procedure leveraged various deep learning algorithms to extract demographic characteristics, hashtags, topics, and sentiments from the collected tweets. Based on these data, multiple analytical methods, namely, odds ratio (OR), difference-in-difference, and emotion pattern methods, were used to examine the psychological effects. Results: A cohort of 15,347 COPD users was identified from the data that we collected in the Twitter database, comprising over 2.5 billion tweets, spanning from January 2020 to June 2023. The attentiveness toward COPD was significantly affected by gender, age, and occupation; it was lower in females (OR 0.91, 95\% CI 0.87-0.94; P<.001) than in males, higher in adults aged 40 years and older (OR 7.23, 95\% CI 6.95-7.52; P<.001) than in those younger than 40 years, and higher in individuals with lower socioeconomic status (OR 1.66, 95\% CI 1.60-1.72; P<.001) than in those with higher socioeconomic status. Across the study duration, COPD users showed decreasing concerns for COVID-19 and increasing health-related concerns. After the middle phase of COVID-19 (July 2021), a distinct decrease in sentiments among COPD users contrasted sharply with the upward trend among non-COPD users. Notably, in the post-COVID era (June 2023), COPD users showed reduced levels of joy and trust and increased levels of fear compared to their levels of joy and trust in the middle phase of COVID-19. Moreover, males, older adults, and individuals with lower socioeconomic status showed heightened fear compared to their counterparts. Conclusions: Our data analysis results suggest that populations with COPD experienced heightened mental stress in the post-COVID era. This underscores the importance of developing tailored interventions and support systems that account for diverse population characteristics. ",
doi="10.2196/54543",
url="https://www.jmir.org/2025/1/e54543",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053739"
}


@Article{info:doi/10.2196/63512,
author="Pearkao, Chatkhane
and Apiratwarakul, Korakot
and Wicharit, Lerkiat
and Potisopha, Wiphawadee
and Jaitieng, Arunnee
and Homvisetvongsa, Sukuman
and Namwaing, Puthachad
and Pudtuan, Peerapon",
title="Development of a Mobile App Game for Practicing Lung Exercises: Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Mar",
day="4",
volume="12",
pages="e63512",
keywords="mobile app game",
keywords="practice lung exercises",
keywords="feasibility study",
keywords="mobile phone",
keywords="pulmo device",
keywords="app",
abstract="Background: Chest injuries are a leading cause of death and disability, accounting for 10\% of hospital admissions and 25\% of injury-related deaths. About two-thirds of patients with thoracic injuries experience complications such as blood or air in the pleural space, causing lung deflation and poor gas exchange. Proper breathing management, using tools like incentive spirometers, improves lung function and recovery. However, there is a gap in mobile-based gaming apps designed for lung exercise, which could benefit both the general population and patients recovering from lung injuries. Objective: This research aimed to develop and evaluate a mobile app game for practicing lung exercises, accompanied by a prototype device called the Pulmo device. Methods: The study involved a sample group of 110 participants from the general public. It followed a research and development methodology comprising 4 steps. The research instruments included a mobile app game, a prototype lung exercise device, and questionnaires to assess users' satisfaction and the feasibility of both the app and the device. Results: The findings revealed that the participants demonstrated a high level of overall satisfaction with both the mobile app game and the prototype lung exercise device (mean 4.4, SD 0.4). The feasibility for the mobile app game and the prototype lung exercise device connected to the game was evaluated. The results indicated that the sample group perceived the overall feasibility to be at a high level (mean 4.4, SD 0.5). Conclusions: The research results reflected that the sample group believed the mobile app game for practicing lung exercises and the prototype device developed in this project have a high potential for practical application in promoting lung rehabilitation through gameplay. The mobile app game and the Pulmo device prototype received positive user feedback, indicating potential practical use; however, further validation is required among patients in need of pulmonary rehabilitation. ",
doi="10.2196/63512",
url="https://rehab.jmir.org/2025/1/e63512"
}


@Article{info:doi/10.2196/59532,
author="Hari, Arnav
and Kumar, Ravishankar
and Kumbhani, Brijesh
and Darshi, Sam
and Agarwal, Satyam
and Sahambi, Singh Jyotindra
and Jain, Suksham
and Chawla, Deepak",
title="Contactless Breathing Monitoring at Home and in the Hospital: Protocol for a Low-Cost Frequency-Modulated Continuous-Wave Radar-Based Device",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="25",
volume="14",
pages="e59532",
keywords="radar",
keywords="contactless vital monitoring",
keywords="breathing rate monitoring",
keywords="vital signs",
keywords="health monitoring",
abstract="Background: Contactless monitoring of vital signs, especially the breathing of children, in the hospital is performed on a priority basis because their organs and immune system are immature. Therefore, continuous monitoring of their vital signs with a sensor that is directly attached to their body is not possible, as it irritates the sensitive newborn skin and causes discomfort. A contactless frequency-modulated continuous-wave (FMCW) radar-based device can wirelessly monitor the breathing rate and pattern of a child in the hospital or at home. Signal-processing capability can be added to this device to process breathing data and analyze the apnea condition arising due to irregular breathing patterns. Objective: This study will develop a contactless FMCW radar-based system to accurately monitor the breathing rate and pattern of neonates and infants in hospitals and at home in order to provide a noninvasive, nonintrusive and contactless alternative to conventional sensor-based methods and address a critical need in neonatal care, potentially improving health outcomes for vulnerable infants. Methods: The radar transmits a signal toward the body, and the time taken by the signal received to travel from the body to the receiving antenna is analyzed. This time is proportional to the distance between the radar and the body, and the breathing pattern is recognized as a slight, periodic variation in this distance. We will use this concept with multiple antenna systems to monitor the breathing of neonates with improved sensitivity. The radar-based device will be installed, in addition to conventional breathing monitors, in the neonatal intensive care unit. The signals received at the radar and the respiration signals from conventional monitors will be recorded in a database. Signal-processing techniques will be applied to extract breathing signals from the signals received at the radar. Results: This study was funded in January 2023 by the Science and Engineering Research Board (SERB) of India. The device was designed by May 2024, and a working proof-of concept was verified in the Indian Institute of Technology (IIT) Ropar laboratory. Implementation of the proposed method for initial study began in December 2024. Results are expected to be published in the first quarter of 2025. Conclusions: The contactless FMCW radar-based system will provide reliable estimation of the breathing rate and pattern, which is close to the conventional reference device values most of the time. Our device will also provide a seamless breathing-monitoring system to be used both in hospitals and at home for newborns and premature babies until they are fully healthy and fit. International Registered Report Identifier (IRRID): PRR1-10.2196/59532 ",
doi="10.2196/59532",
url="https://www.researchprotocols.org/2025/1/e59532"
}


@Article{info:doi/10.2196/59533,
author="Ummels, Darcy
and Bols, Esther
and Frantzen, Anna Roel Johannes
and Frantzen, Tim
and Robeerts, Levy
and Beekman, Emmylou",
title="Activity Trackers in Physical Therapy for People With Chronic Obstructive Pulmonary Disease in the Netherlands: Cross-Sectional Study on Current Use and Implementation Determinants",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="12",
volume="9",
pages="e59533",
keywords="physical therapy",
keywords="activity tracker",
keywords="implementation",
keywords="technology",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="eHealth",
keywords="meaningful use",
keywords="health measurement",
keywords="active lifestyle",
keywords="Netherlands",
keywords="physical activity",
keywords="barriers",
keywords="therapy",
abstract="Background: In the Netherlands, 545,900 people experienced chronic obstructive pulmonary disease (COPD) in 2022. Physical therapy following the Royal Dutch Society for Physiotherapy (Koninklijk Nederlands Genootschap voor Fysiotherapie) guidelines for COPD treatment is a proven effective treatment for people with COPD. The revised guidelines include a new recommendation: a patient's physical activity level should be assessed with an activity tracker (AT). Literature shows that the implementation of eHealth in clinical practice, in this case, ATs, is challenging. Objective: This study aims (1) to assess how and why ATs are currently used in physical therapy in patients with COPD and (2) to determine which barriers and facilitators are of relevance for optimal implementation of ATs during the clinical reasoning process of physical therapists in patients with COPD. Methods: A cross-sectional study was used to evaluate the implementation of ATs in physical therapy. Included participants were physical therapists who were affiliated with Chronisch ZorgNet and had a specialization in COPD treatment. The survey content was based on the Consolidated Framework for Implementation Research, the theory of planned behavior, the framework ``experiences of patients with commercially available ATs,'' and the Koninklijk Nederlands Genootschap voor Fysiotherapie guidelines for COPD. Physical therapists were questioned via a digital survey. Results: In total, 211 completed surveys were analyzed. Of the 211 participating physical therapists, 108 (51.2\%) used ATs, whereas most of them (n=82, 75.9\%) already used ATs before it was advised in the guidelines. Physical therapists indicated that the most important reason to use ATs is that they experience it as an added health care value. Both users and nonusers indicated that the most important reason why they do not use ATs is because their patients do not want to use an AT. The second reason was a lack of knowledge in the nonuser group. Moreover, both users and nonusers indicated that the implementation of ATs was not prepared and planned for within their center. Conclusions: Overall, these results show that ATs are not yet fully implemented in the Dutch general physical therapy practice in patients with COPD, as recommended by current evidence-based guidelines. Physical therapists need guidance for the successful implementation of ATs. This could be accomplished by providing training for physical therapists, integrating ATs into the education of (future) physical therapists, and providing support during the implementation process of ATs for both the physical therapists and management. ",
doi="10.2196/59533",
url="https://formative.jmir.org/2025/1/e59533"
}


@Article{info:doi/10.2196/63660,
author="Chien, Shih-Ying
and Hu, Han-Chung
and Cho, Hsiu-Ying",
title="Long-Term Monitoring of Individuals With Chronic Obstructive Pulmonary Disease Using Digital Health Technology: Qualitative Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="5",
volume="27",
pages="e63660",
keywords="digital health",
keywords="chronic obstructive pulmonary disease",
keywords="digital health technology",
keywords="barriers and facilitators",
keywords="Taiwan",
abstract="Background: Digital health adoption in clinical practice has been widespread, yet there remains further potential for optimizing care specifically for chronic obstructive pulmonary disease (COPD). This study therefore conducted qualitative research involving 35 health care professionals from a range of hospitals in Taiwan. Objective: This study aims to investigate barriers and facilitators related to the implementation of digital health technology (DHT) in the long-term monitoring of individuals with COPD based on clinical experiences in Taiwan. The perspectives of Taiwanese health care professionals provided valuable insights into the challenges and opportunities associated with using DHT for the management and enhancement of respiratory rehabilitation and long-term monitoring of patients with COPD. Methods: Several key themes related to the development of DHT were identified. Barriers encompassed concerns pertaining to digital safety, insurance coverage, constraints related to medical resources, and the presence of a digital divide. Facilitators included the potential for cost reduction, personalized prescriptions, and instilling motivation in users. Results: To enhance the acceptance and use of DHT, embracing a user-centered approach that prioritizes the distinct needs of all parties involved is recommended. Moreover, optimizing and leveraging the effective use of DHT in managing the health of individuals with COPD promises to deliver care characterized by greater precision and efficiency. Conclusions: Overall, the benefits of using DHT for the long-term care of patients with COPD outweigh the disadvantages. After the COVID-19 pandemic, there has been an increased emphasis in Taiwan on the effectiveness of DHT in managing chronic diseases. Relevant studies including this paper have suggested that web-based exercise management systems could benefit patients with COPD in rehabilitation and tracking. Our findings provide meaningful directions for future research endeavors and practical implementation. By addressing identified barriers and capitalizing on facilitators, advancements can be made in the development and use of DHT, especially in overcoming challenges such as information security and operational methods. The implementation of the recommended strategies will likely lead to improved COPD care outcomes. ",
doi="10.2196/63660",
url="https://www.jmir.org/2025/1/e63660"
}


@Article{info:doi/10.2196/66179,
author="Cintora-Sanz, Mar{\'i}a Ana
and Horrillo-Garc{\'i}a, Cristina
and Quesada-Cubo, V{\'i}ctor
and P{\'e}rez-Alonso, Mar{\'i}a Ana
and Guti{\'e}rrez-Misis, Alicia",
title="Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="16",
volume="11",
pages="e66179",
keywords="acute respiratory failure",
keywords="COVID-19",
keywords="chronic obstructive respiratory insufficiency",
keywords="congestive heart failure",
keywords="bronchospasm",
keywords="emergency medical services costs",
keywords="ambulances",
keywords="SARS-CoV-2",
keywords="coronavirus",
keywords="respiratory",
keywords="pulmonary",
keywords="pandemic",
keywords="economic impact",
keywords="observational",
keywords="Madrid",
keywords="community",
keywords="medical records",
keywords="health records",
keywords="medical advanced life support",
keywords="ALS",
keywords="acute pulmonary edema",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="prevalence",
abstract="Background: Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid's medical advanced life supports (ALSs) allows us to analyze this little-studied problem. Objectives: Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry. Methods: A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated. Results: The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07\% in 2014; it decreased to 0.03\% in 2020. CHF followed at 0.06\% in 2014 and 0.03\% in 2020. APE had a prevalence of 0.01\% in 2014, decreasing to 0.005\% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of {\texteuro}2,726,893 (which equals to US \$2,864,628). Conclusions: COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was {\texteuro}58,791,031 (US \$61,832,879). ",
doi="10.2196/66179",
url="https://publichealth.jmir.org/2025/1/e66179"
}


@Article{info:doi/10.2196/60689,
author="Bertram, Pia
and Oppelaar, C. Martinus
and Bannier, AGE Michiel
and Reijers, HE Monique
and van der Vaart, Hester
and van der Meer, Renske
and Altenburg, Josje
and Conemans, Lennart
and Rottier, L. Bart
and Nuijsink, Marianne
and van den Wijngaart, S. Lara
and Merkus, JFM Peter
and Roukema, Jolt",
title="The Long-Term Uptake of Home Spirometry in Regular Cystic Fibrosis Care: Retrospective Multicenter Observational Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e60689",
keywords="telemonitoring",
keywords="eHealth",
keywords="spirometry",
keywords="adherence",
keywords="pulmonary medicine",
keywords="home spirometers",
keywords="cystic fibrosis",
keywords="autosomal disease",
keywords="treatment",
keywords="remote monitoring",
keywords="survival analyses",
keywords="frequency",
keywords="digital health",
keywords="telehealth",
abstract="Background: Home spirometers have been widely implemented in the treatment of people with cystic fibrosis (CF). Frequent spirometry measurements at home could lead to earlier detection of exacerbations. However, previous research indicates that the long-term use of home spirometry is not well maintained by people with CF. Objective: We aimed to gain insight into the long-term uptake of home spirometry in regular multicenter CF care. Methods: Home spirometers combined with a remote monitoring platform were introduced in the treatment of people with CF in 5 Dutch CF centers starting in April 2020. Usage data from April 2020 to December 2022 were analyzed retrospectively. Survival analyses were conducted to assess use consistency over time, and t tests were used to evaluate the impact of increased pulmonary symptoms on home spirometry frequency. The effect of the initiation of a new treatment, Elexacaftor/Tezacaftor/Ivacaftor, on use frequency over time was assessed in a subgroup of participants with repeated measures ANOVA. Results: During the observation period, a total of 604 people with CF were enrolled in the remote monitoring platform and 9930 home spirometry measurements were performed. After the initiation of home spirometry use, the number of users declined rapidly. One year after the initiation, 232 (54.2\%) people with CF stopped using home spirometry. During the observation period, 67 (11.1\%) users performed more than 20 measurements. Furthermore, the number of consistent home spirometry users decreased over time. After 600 days, only 1\% of users had measured their lung function consistently every 31 days. Use frequency slightly increased during periods with increased pulmonary symptoms ($\Delta$Mean=0.45, t497.278=--4,197; P<.001) and showed an initial rise followed by a decrease after starting treatment with Elexacaftor/Tezacaftor/Ivacaftor ($\Delta$Mean=0.45, t497.278=--4,197; P<.001). Conclusions: Consistent uptake of home spirometry in people with CF is low but increases around periods of changing symptoms. A clear strategy for the organization of remote care seemed to improve the long-term uptake of home spirometry. Nevertheless, home spirometry and its intensity are not a goal on their own but should be used as a tool to reach individual goals within local contexts. ",
doi="10.2196/60689",
url="https://www.jmir.org/2025/1/e60689"
}


@Article{info:doi/10.2196/65197,
author="Huang, Kewu
and Wang, Wenjun
and Wang, Ying
and Li, Yanming
and Feng, Xiaokai
and Shen, Huahao
and Wang, Chen",
title="Evaluation of a Global Initiative for Asthma Education and Implementation Program to Improve Asthma Care Quality (CARE4ALL): Protocol for a Multicenter, Single-Arm Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="8",
volume="14",
pages="e65197",
keywords="asthma",
keywords="management",
keywords="quality improvement program",
keywords="Global Initiative for Asthma",
keywords="GINA",
keywords="guidelines",
keywords="implementation",
keywords="health care",
keywords="delivery",
abstract="Background: Poor symptom control and exacerbations of asthma diminish quality of life and pose a significant burden to patients and society. Implementing evidence-based management as recommended by the Global Initiative for Asthma (GINA), especially introducing inhaled corticosteroid--containing treatments, has the potential to vastly reduce exacerbations and the high burden of asthma in China. However, domestic implementation of the GINA recommendations has been unsatisfactory, especially in lower-level hospitals; thus, an enhancement to the awareness of and adherence to the GINA recommendations among Chinese physicians is needed to improve patient outcomes. Objective: This study aims to bridge the gap between the GINA recommendations and the current clinical practice in China by demonstrating the benefits of an asthma quality improvement program (QIP). Methods: A single-arm study will be conducted at around 30 hospitals across China to assess the impact of a specially designed asthma QIP. Approximately 1500 patients with asthma aged ?14 years will be enrolled in participating hospitals and followed up for 48 weeks. The QIP---targeted at all pulmonologists and specialist nurses---will include an initial comprehensive training (including a pretraining questionnaire and posttraining quizzes) provided by a dedicated, qualified training team based on the GINA 2021 recommendations, followed by regular reinforcement learnings (integrated into the regular department lectures delivered by department directors), with multiple offline and online approaches (eg, an online patient management platform) provided as supportive tools. During this study, GINA implementation performance will be continuously monitored to inform necessary adjustments at the hospital level. The primary end point is change from baseline in the proportion of participants with an inhaled corticosteroid--based maintenance or reliever treatment at week 48. Secondary end points and exploratory end points include changes in clinical practice and patient outcomes such as treatment patterns, asthma control, and hospitalization rates due to exacerbations. Results: This study has been completed, with 1500 patients enrolled and 1271 patients completing the study. The last visit of the last patient was on September 3, 2024, and the database lock was on September 28, 2024. Final analysis of data has started in October 2024. Conclusions: The Change Asthma Clinical Practice through GINA Education and Implementation for All Patients With Asthma (CARE4ALL) study will hopefully help improve asthma management and patient outcomes in China by bridging the gap between evidence-based GINA recommendations and the current clinical practice. Trial Registration: ClinicalTrials.gov NCT05440097; https://clinicaltrials.gov/study/NCT05440097 International Registered Report Identifier (IRRID): DERR1-10.2196/65197 ",
doi="10.2196/65197",
url="https://www.researchprotocols.org/2025/1/e65197"
}


@Article{info:doi/10.2196/65888,
author="Naranjo-Rojas, Anisbed
and Perula-de Torres, {\'A}ngel Luis
and Cruz-Mosquera, Eccehomo Freiser
and Molina-Recio, Guillermo",
title="Efficacy and Acceptability of a Mobile App for Monitoring the Clinical Status of Patients With Chronic Obstructive Pulmonary Disease Receiving Home Oxygen Therapy: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65888",
keywords="m-Health",
keywords="chronic obstructive pulmonary disease",
keywords="quality of life",
keywords="mobile health applications",
keywords="home oxygen therapy",
keywords="mobile phone",
abstract="Background: Chronic obstructive pulmonary disease (COPD) primarily originates from exposure to tobacco smoke, although factors, such as air pollution and exposure to chemicals, also play a role. One of the primary treatments for COPD is oxygen therapy, which helps manage dyspnea and improve survival rates. Mobile health (mHealth) technologies have demonstrated significant potential in monitoring patients with chronic diseases, offering new avenues for enhancing patient care and disease management. Objective: The purpose of this study was to evaluate the efficacy and acceptability of a mobile app designed for the clinical monitoring of patients with COPD and home oxygen (HO) therapy, compared with conventional monitoring in real-world community settings. Methods: A parallel-group, nonblinded, multicenter randomized controlled trial was conducted with 45 participants; the intervention group (IG), which used the mobile app in addition to conventional monitoring (n=23) and the control group, which received only conventional monitoring (n=22), administered by therapists over a duration of 3 months. The primary outcomes included the chronic obstructive pulmonary disease assessment test (CAT) score, the level of dyspnea measured by the Borg scale, and oxygen saturation percentage, assessed at both the beginning and end of the trial. Secondary outcomes included the frequency of app use, the number of hospitalizations, and survival rates. In addition, a satisfaction survey and an interview were conducted with the IG. Results: The median use of the mobile app was 21 (IQR 16-28) days. At the end of the follow-up, the Borg dyspnea scale was significantly lower in patients who used the mobile app for HO therapy monitoring (mean 0.6, SD 0.8 vs mean 4.1, SD 1.4; P=.001). Regarding the impact of COPD on quality of life, as measured by the CAT, no differences were found in the scores between baseline and end-of-follow-up within the control group. However, a significant decrease was observed in the IG (baseline median CAT 27, IQR 23-31 vs final median CAT 22, IQR 14-28; P<.001). In addition, the CAT score was significantly higher in patients receiving conventional monitoring compared with those monitored with the mobile app (median 30, IQR 23-32 vs median 22, IQR 14-28; P=.02). Conclusions: The use of the mobile app, AppO2 (SINCO), designed for the clinical monitoring of patients with COPD and HO therapy, is associated with improved quality of life. In addition, the app is highly accepted by users, promotes self-care, and fosters patient confidence in managing their own condition. Trial Registration: ClinicalTrials NCT04820790; https://clinicaltrials.gov/study/NCT04820790 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1186/s12875-021-01450-8 ",
doi="10.2196/65888",
url="https://www.jmir.org/2025/1/e65888"
}


@Article{info:doi/10.2196/54389,
author="Groenveld, D. Tjitske
and Smits, GM Indy
and Scholten, Naomi
and de Vries, Marjan
and van Goor, Harry
and Stirler, MA Vincent",
title="Pulmonary and Physical Virtual Reality Exercises for Patients With Blunt Chest Trauma: Randomized Clinical Trial",
journal="JMIR Serious Games",
year="2024",
month="Dec",
day="9",
volume="12",
pages="e54389",
keywords="virtual reality",
keywords="pain",
keywords="pulmonary",
keywords="chest trauma",
keywords="blunt thorax trauma",
keywords="pain relief",
keywords="breathing",
keywords="mobilization",
keywords="randomized clinical trial",
keywords="clinicians",
keywords="rehabilitation",
keywords="physical activity",
keywords="exercise",
keywords="interview",
abstract="Background: Adequate pain relief, early restoration of breathing, and rapid mobilization pose a clinical challenge in patients with blunt chest trauma. Virtual reality (VR) has the potential to achieve these 3 interrelated treatment objectives with enhanced self-efficacy and autonomy of patients and limited support by clinicians. Objective: This study aimed to assess the effectivity of breathing and physical exercises using VR on the pulmonary recovery of patients with blunt chest trauma at the ward. Methods: A pilot randomized controlled trial was performed. The control group received usual physiotherapy consisting of protocolized breathing exercises (8 times daily for 10 minutes) and physical exercises (2 times daily for 10 minutes). The VR group was instructed to perform these exercises using VR. The primary outcome was vital lung capacity at day 5 or earlier at discharge. Secondary outcomes were patient mobility (time standing, lying, and sitting), clinical outcomes (length of hospital stay, pulmonary complications, transfer to intensive care unit, and readmission within 30 days), pain, activities of daily living, patient-reported outcome measures (satisfaction and quality of recovery). Patient experiences and barriers and facilitators toward implementation were assessed through interviews. Results: The study was prematurely ended due to enrollment failure combined with poor protocol adherence to exercises in both groups. A total of 27 patients were included, of which 19 patients completed 3 or more days. Vital lung capacity at 5 days (or last measurement) was equal between groups with 1830 (SD 591) mL and 1857 (SD 435) mL in the control and VR groups, respectively. No marked differences were observed in secondary outcomes. Patient interviews showed positive attitudes toward the use of VR, describing that visualization of the exercises helped patients to perform the exercises correctly and to continue the exercises for a longer duration. Also, patients experienced the immersiveness of VR as an analgesic. However, patients did not experience added value over usual care and reported that better integration in treatment and the hectic hospital environment could improve the use of the VR exercises. Conclusions: The suitability of patients to use virtual reality therapy (VRx) in a hospital (trauma) ward setting is lower than generally expected. Effective application of VRx requires professional guidance and needs thorough alignment with clinical practice. For future research, we recommend to chart adherence to study protocol before designing a VR clinical trial. Patient-reported experiences need to be prioritized in evaluating VR acceptance, usability, and effectiveness. In line, we recommend performing a systematic analysis (eg, using the technology acceptance model) on the acceptance before pilot or main effectiveness studies. Finally, the eligibility of patients and exclusion of patients due to the inability to use VRx should be routinely reported. Trial Registration: ClinicalTrials.gov NCT05194176; https://tinyurl.com/2bzh4tzx ",
doi="10.2196/54389",
url="https://games.jmir.org/2024/1/e54389"
}


@Article{info:doi/10.2196/60892,
author="Oppelaar, C. Martinus
and van Helvoort, AC Hanneke
and Bannier, AGE Michiel
and Reijers, HE Monique
and van der Vaart, Hester
and van der Meer, Renske
and Altenburg, Josje
and Conemans, Lennart
and Rottier, L. Bart
and Nuijsink, Marianne
and van den Wijngaart, S. Lara
and Merkus, JFM Peter
and Roukema, Jolt",
title="Accuracy, Reproducibility, and Responsiveness to Treatment of Home Spirometry in Cystic Fibrosis: Multicenter, Retrospective, Observational Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e60892",
keywords="telemonitoring",
keywords="digital health",
keywords="telespirometry",
keywords="remote monitoring",
keywords="cystic fibrosis",
keywords="pediatrics",
keywords="reliability",
keywords="mobile phone",
keywords="hereditary",
keywords="chronic pulmonary inflammation",
keywords="pulmonary infections",
keywords="morbidity",
keywords="mortality",
keywords="chronic respiratory disease",
abstract="Background: Portable spirometers are increasingly used to measure lung function at home, but doubts about the accuracy of these devices persist. These doubts stand in the way of the digital transition of chronic respiratory disease care, hence there is a need to address the accuracy of home spirometry in routine care across multiple settings and ages. Objective: This study aimed to assess the accuracy, reproducibility, and responsiveness to the treatment of home spirometry in long-term pediatric and adult cystic fibrosis care. Methods: This retrospective observational study was carried out in 5 Dutch cystic fibrosis centers. Home spirometry outcomes (forced expiratory volume in one second [FEV1], and forced vital capacity [FVC]) for 601 anonymized users were collected during 3 years. For 81 users, data on clinic spirometry and elexacaftor/tezacaftor/ivacaftor (ETI) use were available. Accuracy was assessed using Bland-Altman plots for paired clinic-home measurements on the same day and within 7 days of each other (nearest neighbor). Intratest reproducibility was assessed using the American Thoracic Society/European Respiratory Society repeatability criteria, the coefficient of variation, and spirometry quality grades. Responsiveness was measured by the percentage change in home spirometry outcomes after the start of ETI. Results: Bland-Altman analysis was performed for 86 same-day clinic-home spirometry pairs and for 263 nearest neighbor clinic-home spirometry pairs (n=81). For both sets and for both FEV1 and FVC, no heteroscedasticity was present and hence the mean bias was expressed as an absolute value. Overall, home spirometry was significantly lower than clinic spirometry (mean $\Delta$FEV1clinic-home 0.13 L, 95\% CI 0.10 to 0.19; mean $\Delta$FVCclinic-home 0.20 L, 95\% CI 0.14 to 0.25) and remained lower than clinic spirometry independent of age and experience. One-way ANOVA with post hoc comparisons showed significantly lower differences in clinic-home spirometry in adults than in children ($\Delta$mean 0.11, 95\% CI --0.20 to --0.01) and teenagers ($\Delta$mean 0.14, 95\% CI --0.25 to --0.02). For reproducibility analyses, 2669 unique measurement days of 311 individuals were included. Overall, 87.3\% (2331/2669) of FEV1 measurements and 74.3\% (1985/2669) of FVC measurements met reproducibility criteria. Kruskal-Wallis with pairwise comparison demonstrated that for both FVC and FEV1, coefficient of variation was significantly lower in adults than in children and teenagers. A total of 5104 unique home measurements were graded. Grade E was given to 2435 tests as only one home measurement was performed. Of the remaining 2669 tests, 43.8\% (1168/2669) and 43.6\% (1163/2669) received grade A and B, respectively. The median percentage change in FEV1 from baseline after initiation of ETI was 19.2\% after 7-14 days and remained stable thereafter (n=33). Conclusions: Home spirometry is feasible but not equal to clinic spirometry. Home spirometry can confirm whether lung functions remain stable, but the context of measurement and personal trends are more relevant than absolute outcomes. ",
doi="10.2196/60892",
url="https://www.jmir.org/2024/1/e60892"
}


@Article{info:doi/10.2196/59138,
author="Kang, Ye Ji
and Jung, Weon
and Kim, Ji Hyun
and An, Hyun Ji
and Yoon, Hee
and Kim, Taerim
and Chang, Hansol
and Hwang, Yeon Sung
and Park, Eun Jong
and Lee, Tak Gun
and Cha, Chul Won
and Heo, Sejin
and Lee, Uk Se",
title="Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="20",
volume="10",
pages="e59138",
keywords="telemedicine",
keywords="public health",
keywords="medication adherence",
keywords="COVID-19",
keywords="chronic diseases",
abstract="Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. ",
doi="10.2196/59138",
url="https://publichealth.jmir.org/2024/1/e59138"
}


@Article{info:doi/10.2196/49123,
author="Yu, Shanshan
and Zhan, Meirong
and Li, Kangguo
and Chen, Qiuping
and Liu, Qiao
and Gavotte, Laurent
and Frutos, Roger
and Chen, Tianmu",
title="Analysis of Tuberculosis Epidemiological Distribution Characteristics in Fujian Province, China, 2005-2021: Spatial-Temporal Analysis Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="18",
volume="10",
pages="e49123",
keywords="tuberculosis",
keywords="TB",
keywords="epidemiology",
keywords="Fujian Province",
keywords="temporal-spatial pattern",
keywords="spatial-temporal analysis",
keywords="surveillance",
keywords="pulmonary tuberculosis",
keywords="epidemic status",
keywords="detection",
abstract="Background: Tuberculosis (TB) is a chronic infectious disease that harms human health for a long time. TB epidemiological distribution analysis can help governments to control TB in high TB incidence areas. The distribution trend of TB cases varies in different regions. The unbalanced temporal and spatial trends of pulmonary TB (PTB) risk at a fine level in Fujian Province remain unclear. Objective: The purpose was to analyze different distribution characteristics, explore the prevalence of TB in this region, and provide a scientific basis for further guidance of TB control work in Fujian Province, China. Methods: Prefectural-level and county-level notified PTB case data were collected in Fujian Province. A joinpoint regression model was constructed to analyze the unbalanced temporal patterns of PTB notification rates from 2005 to 2021 at prefecture-level city scales. The spatial clustering analysis and spatial autocorrelation analysis were performed to assess the inequality of the locations of PTB cases. Demographical characteristics were explored by the method of descriptive analysis. Results: TB cases reported in Fujian showed an overall downward trend from 2005 to 2021 (in 2005: n=32,728 and in 2021: n=15,155). TB case numbers showed obvious seasonal changes. The majority of TB cases were middle-aged and older adult male patients (45 years and older; n=150,201, 42.6\%). Most of the TB cases were farmers (n=166,186, 47.1\%), followed by houseworkers and the unemployed (n=48,828, 13.8\%) and workers (n=34,482, 9.8\%). Etiologically positive TB cases continue to be the main source of TB cases (n=159,702, 45.3\%). Spatially, the reported TB cases were mainly distributed in cities in southeastern Fujian, especially at the county level. TB case numbers showed 2 spatial groups; cases within each group shared similar case characteristics. In terms of geographical distribution, TB showed obvious spatial correlation, and local areas showed high aggregation. Conclusions: The TB incidence trend decreased annually in Fujian Province. TB cases distributed commonly in the male population, middle-aged and older people, and farmers. Etiologically positive cases are still the main source of Mycobacterium tuberculosis infection. TB incidence is higher in the cities with a developed economy and large population in the southeast. TB control should be strengthened in these populations and areas, such as via early screening of cases and management of confirmed cases. ",
doi="10.2196/49123",
url="https://publichealth.jmir.org/2024/1/e49123"
}


@Article{info:doi/10.2196/60049,
author="Chien, Shih-Ying",
title="Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="15",
volume="11",
pages="e60049",
keywords="digital health",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="usability",
keywords="telerehabilitation",
keywords="mobile health app",
abstract="Background: Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure. Objective: This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home. Methods: This study used a mixed methods approach involving two key stakeholders---patients with chronic obstructive pulmonary disease and HCPs---across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Results: The research indicated a notable difference in app usability perceptions: 66\% (8/12) of HCPs found tasks ``very easy,'' compared to only 22\% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non--native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation. Conclusions: Most HCPs (11/12, 91\%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62\% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care. ",
doi="10.2196/60049",
url="https://humanfactors.jmir.org/2024/1/e60049"
}


@Article{info:doi/10.2196/44845,
author="Cheng, Xuelin
and Wu, Xiaoling
and Ye, Wenjing
and Chen, Yichen
and Fu, Peihua
and Jia, Wenchang
and Zhang, Wei
and Xu, Xiaoyun
and Gong, Di
and Mou, Changhua
and Gu, Wen
and Luo, Zheng
and Jiang, Sunfang
and Li, Xiaopan",
title="All-Cause and Cause-Specific Burden of Asthma in a Transitioning City in China: Population Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="14",
volume="10",
pages="e44845",
keywords="asthma",
keywords="mortality",
keywords="years of life lost",
keywords="trend analysis",
keywords="decomposition method",
keywords="Pudong",
abstract="Background: Understanding the impact of asthma on public health is crucial for evidence-based prevention and treatment strategies. Objective: This study aimed to identify the causes of asthma-related mortality in Pudong, Shanghai, China, offering insights for managing similar regions or countries in transition. Methods: Mortality statistics were obtained from the Vital Statistics System of Pudong for 2005?2021. Temporal patterns for the burden of asthma were examined. The crude mortality rate (CMR), age-standardized mortality rate by Segi's world standard population (ASMRW), and years of life lost (YLL) for both all-cause and asthma-specific deaths were computed. Mortality rates associating with aging and other variables were categorized using the decomposition technique. The autoregressive integrated moving average model was used to forecast the asthma-related death mortality rate by 2035. Results: A total of 1568 asthma-related deaths occurred during the follow-up period, with the CMR and ASMRW being 3.25/105 and 1.22/105 person-years, respectively. The primary underlying causes of death were chronic lower respiratory diseases, coronary heart diseases, and cerebrovascular disease. The YLL due to total asthma-related deaths added up to 14,837.76 years, with a YLL rate of 30.73/105 person-years. Male individuals had more YLL (8941.81 vs 5895.95 y) and a higher YLL rate (37.12/105 vs 24.38/105 person-years) than female individuals. From 2005 to 2021, the ASMRW declined by 3.48\%, and both the CMR and YLL rate decreased in the 0?29, 70?79, and ?80 years age groups (all P<.01). However, asthma-related deaths increased from 329 people between 2005 and 2008 to 472 people between 2017 and 2021. The proportion of the population aged 80 years and older gradually increased by 1.43\% (95\% CI 0.20\%-2.68\%; P=.03), and the mortality rates of asthma deaths attributable to population aging rose by 21.97\% (95\% CI, 11.58\%-33.32\%; P<.001) annually. Conclusions: Asthma remains a significant public health challenge in transitioning countries, requiring increased attention and resource allocation. ",
doi="10.2196/44845",
url="https://publichealth.jmir.org/2024/1/e44845"
}


@Article{info:doi/10.2196/56027,
author="Hermans, Fien
and Arents, Eva
and Blondeel, Astrid
and Janssens, Wim
and Cardinaels, Nina
and Calders, Patrick
and Troosters, Thierry
and Derom, Eric
and Demeyer, Heleen",
title="Validity of a Consumer-Based Wearable to Measure Clinical Parameters in Patients With Chronic Obstructive Pulmonary Disease and Healthy Controls: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Nov",
day="6",
volume="12",
pages="e56027",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="wearable",
keywords="Fitbit",
keywords="clinical parameters",
keywords="physical activity",
keywords="validity",
keywords="observational study",
keywords="wrist-worn wearable",
keywords="heart rate",
keywords="heart rate variability",
keywords="respiratory rate",
keywords="oxygen saturation",
keywords="devices",
keywords="monitoring",
abstract="Background: Consumer-based wearables are becoming more popular and provide opportunities to track individual's clinical parameters remotely. However, literature about their criterion and known-groups validity is scarce. Objective: This study aimed to assess the validity of the Fitbit Charge 4, a wrist-worn consumer-based wearable, to measure clinical parameters (ie, daily step count, resting heart rate [RHR], heart rate variability [HRV], respiratory rate [RR], and oxygen saturation) in patients with chronic obstructive pulmonary disease (COPD) and healthy controls in free-living conditions in Belgium by comparing it with medical-grade devices. Methods: Participants wore the Fitbit Charge 4 along with three medical-grade devices: (1) Dynaport MoveMonitor for 7 days, retrieving daily step count; (2) Polar H10 for 5 days, retrieving RHR, HRV, and RR; and (3) Nonin WristOX2 3150 for 4 nights, retrieving oxygen saturation. Criterion validity was assessed by investigating the agreement between day-by-day measures of the Fitbit Charge 4 and the corresponding reference devices. Known-groups validity was assessed by comparing patients with COPD and healthy controls. Results: Data of 30 patients with COPD and 25 age- and gender-matched healthy controls resulted in good agreement between the Fitbit Charge 4 and the corresponding reference device for measuring daily step count (intraclass correlation coefficient [ICC2,1]=0.79 and ICC2,1=0.85, respectively), RHR (ICC2,1=0.80 and ICC2,1=0.79, respectively), and RR (ICC2,1=0.84 and ICC2,1=0.77, respectively). The agreement for HRV was moderate (healthy controls: ICC2,1=0.69) to strong (COPD: ICC2,1=0.87). The agreement in measuring oxygen saturation in patients with COPD was poor (ICC2,1=0.32). The Fitbit device overestimated the daily step count and underestimated HRV in both groups. While RHR and RR were overestimated in healthy controls, no difference was observed in patients with COPD. Oxygen saturation was overestimated in patients with COPD. The Fitbit Charge 4 detected significant differences in daily step count, RHR, and RR between patients with COPD and healthy controls, similar to those identified by the reference devices, supporting known-groups validity. Conclusions: Although the Fitbit Charge 4 shows mainly moderate to good agreement, measures of clinical parameters deviated from the reference devices, indicating that monitoring patients remotely and interpreting parameters requires caution. Differences in clinical parameters between patients with COPD and healthy controls that were measured by the reference devices were all detected by the Fitbit Charge 4. ",
doi="10.2196/56027",
url="https://mhealth.jmir.org/2024/1/e56027"
}


@Article{info:doi/10.2196/59811,
author="Jayamini, Darsha Widana Kankanamge
and Mirza, Farhaan
and Bidois-Putt, Marie-Claire
and Naeem, Asif M.
and Chan, Yan Amy Hai",
title="Perceptions Toward Using Artificial Intelligence and Technology for Asthma Attack Risk Prediction: Qualitative Exploration of M?ori Views",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="30",
volume="8",
pages="e59811",
keywords="asthma risk prediction",
keywords="artificial intelligence",
keywords="machine learning",
keywords="m?ori perceptions",
keywords="health system development",
keywords="mobile phone",
abstract="Background: Asthma is a significant global health issue, impacting over 500,000 individuals in New Zealand and disproportionately affecting M?ori communities in New Zealand, who experience worse asthma symptoms and attacks. Digital technologies, including artificial intelligence (AI) and machine learning (ML) models, are increasingly popular for asthma risk prediction. However, these AI models may underrepresent minority ethnic groups and introduce bias, potentially exacerbating disparities. Objective: This study aimed to explore the views and perceptions that M?ori have toward using AI and ML technologies for asthma self-management, identify key considerations for developing asthma attack risk prediction models, and ensure M?ori are represented in ML models without worsening existing health inequities. Methods: Semistructured interviews were conducted with 20 M?ori participants with asthma, 3 male and 17 female, aged 18-76 years. All the interviews were conducted one-on-one, except for 1 interview, which was conducted with 2 participants. Altogether, 10 web-based interviews were conducted, while the rest were kanohi ki te kanohi (face-to-face). A thematic analysis was conducted to identify the themes. Further, sentiment analysis was carried out to identify the sentiments using a pretrained Bidirectional Encoder Representations from Transformers model. Results: We identified four key themes: (1) concerns about AI use, (2) interest in using technology to support asthma, (3) desired characteristics of AI-based systems, and (4) experience with asthma management and opportunities for technology to improve care. AI was relatively unfamiliar to many participants, and some of them expressed concerns about whether AI technology could be trusted, kanohi ki te kanohi interaction, and inadequate knowledge of AI and technology. These concerns are exacerbated by the M?ori experience of colonization. Most of the participants were interested in using technology to support their asthma management, and we gained insights into user preferences regarding computer-based health care applications. Participants discussed their experiences, highlighting problems with health care quality and limited access to resources. They also mentioned the factors that trigger their asthma control level. Conclusions: The exploration revealed that there is a need for greater information about AI and technology for M?ori communities and a need to address trust issues relating to the use of technology. Expectations in relation to computer-based applications for health purposes were expressed. The research outcomes will inform future investigations on AI and technology to enhance the health of people with asthma, in particular those designed for Indigenous populations in New Zealand. ",
doi="10.2196/59811",
url="https://formative.jmir.org/2024/1/e59811"
}


@Article{info:doi/10.2196/60147,
author="Polivka, Barbara
and Krueger, Kathryn
and Bimbi, Olivia
and Huntington-Moskos, Luz
and Nyenhuis, Sharmilee
and Cramer, Emily
and Eldeirawi, Kamal",
title="Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="10",
volume="8",
pages="e60147",
keywords="indoor air quality",
keywords="asthma",
keywords="real-time assessment",
keywords="EMA",
keywords="ecological momentary assessment",
keywords="mobile phone",
keywords="monitoring",
keywords="air quality",
keywords="real time",
keywords="spirometry",
keywords="acceptability",
keywords="usability",
keywords="residential toxins",
keywords="volatile organic compounds",
keywords="VOC",
keywords="adult",
keywords="female",
keywords="women",
keywords="college student",
abstract="Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90\%), White (n=26, 67\%), college graduates (n=25, 66\%), and residing in a single-family home (n=30, 75\%). Most indicated that the air quality monitor (n=23, 58\%), the EMA (n=20, 50\%), and the spirometer (n=17, 43\%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies. ",
doi="10.2196/60147",
url="https://formative.jmir.org/2024/1/e60147"
}


@Article{info:doi/10.2196/63222,
author="Wegener, Kauffeldt Emilie
and M Bergsch{\"o}ld, Jenny
and Kramer, Tina
and Schmidt, Wong Camilla
and Borgnakke, Karen",
title="Co-Designing a Conversational Agent With Older Adults With Chronic Obstructive Pulmonary Disease Who Age in Place: Qualitative Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="8",
volume="11",
pages="e63222",
keywords="eHealth",
keywords="aging in place",
keywords="digital health technology",
keywords="health literacy",
keywords="everyday life",
keywords="co-design",
keywords="co-designing",
keywords="conversational agent",
keywords="older adults",
keywords="elderly",
keywords="COPD",
keywords="thematic analysis",
keywords="design",
keywords="development",
keywords="interview data",
keywords="cocreation",
keywords="chronic obstructive pulmonary disease",
keywords="mobile phone",
abstract="Background: As a reaction to the global demographic increase in older adults (aged 60+ years), policy makers call for initiatives to enable healthy aging. This includes a focus on person-centered care and access to long-term care for older adults, such as developing different services and digital health technologies. This can enable patients to engage in their health and reduce the burden on the health care systems and health care professionals. The European Union project Smart Inclusive Living Environments (SMILE) focuses on well-being and aging in place using new digital health technologies. The novelty of the SMILE project is the use of a cocreational approach focused on the needs and preferences of older adults with chronic obstructive pulmonary disease (COPD) in technology development, to enhance access, adaptation, and usability and to reduce stigma. Objective: The study aimed to describe the perspective, needs, and preferences of older adults living with COPD in the context of the design and development of a conversational agent. Methods: This study carried out a data-driven thematic analysis of interview data from 11 cocreation workshops with 33 older adults living with COPD. Results: The three particular features that the workshop participants wanted to implement in a new technology were (1) a ``my health'' function, to use technology to manage and learn more about their condition; (2) a ``daily activities'' function, including an overview and information about social and physical activities in their local area; and (3) a ``sleep'' function, to manage circadian rhythm and enhance sleep quality, for example, through online video guides. In total, 2 overarching themes were identified for the 3 functions: measurements, which were actively discussed and received mixed interest among the participants, and health literacy, due to an overall interest in learning more about their condition in relation to everyday life. Conclusions: The future design of digital health technology must embrace the complexities of the everyday life of an older adult living with COPD and cater to their needs and preferences. Measurements should be optional and personalized, and digital solutions should be used as a supplement to health care professionals, not as substitute. ",
doi="10.2196/63222",
url="https://humanfactors.jmir.org/2024/1/e63222",
url="http://www.ncbi.nlm.nih.gov/pubmed/39378067"
}


@Article{info:doi/10.2196/44397,
author="Jones, Llewelyn Thomas
and Roberts, Claire
and Elliott, Scott
and Glaysher, Sharon
and Green, Ben
and Shute, K. Janis
and Chauhan, J. Anoop",
title="Predictive Value of Physiological Values and Symptom Scores for Exacerbations in Bronchiectasis and Chronic Obstructive Pulmonary Disease With Frequent Exacerbations: Longitudinal Observational Cohort Study",
journal="Interact J Med Res",
year="2024",
month="Oct",
day="8",
volume="13",
pages="e44397",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="bronchiectasis",
keywords="predictive models",
keywords="airway disease",
keywords="symptom score",
abstract="Background: COPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity. Objective: This study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event. Methods: We performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated. Results: A total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P<.001), but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in the overall or individually adjusted model. Symptom scores tended to worsen for 10 days on either side of an exacerbation but were of insufficient magnitude for prediction, with area under the receiver operating characteristic curve values of ranging from 0.4 to 0.6. Conclusions: Within this small cohort with bronchiectasis, COPD, or both and airway colonization, physiological and symptom variables did not show sufficient predictive value for exacerbations to be of clinical utility. The self-management education provided as standard of care may be superior to either of these approaches, but benefit in another or larger cohort cannot be excluded. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6636  ",
doi="10.2196/44397",
url="https://www.i-jmr.org/2024/1/e44397",
url="http://www.ncbi.nlm.nih.gov/pubmed/39378078"
}


@Article{info:doi/10.2196/56059,
author="Wang, Ying
and Wang, Zhuohao
and Jiang, Jie
and Guo, Tong
and Chen, Shimin
and Li, Zhiqiang
and Yuan, Zhupei
and Lin, Qiaoxuan
and Du, Zhicheng
and Wei, Jing
and Hao, Yuantao
and Zhang, Wangjian",
title="The Effect of Long-Term Particulate Matter Exposure on Respiratory Mortality: Cohort Study in China",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="24",
volume="10",
pages="e56059",
keywords="respiratory disease",
keywords="mortality",
keywords="particulate matter",
keywords="causal inference",
keywords="cohort study",
abstract="Background: Particulate matter (PM), which affects respiratory health, has been well documented; however, substantial evidence from large cohorts is still limited, particularly in highly polluted countries and for PM1. Objective: Our objective was to examine the potential causal links between long-term exposure to PMs (PM2.5, PM10, and more importantly, PM1) and respiratory mortality. Methods: A total of 580,757 participants from the Guangzhou area, China, were recruited from 2009 to 2015 and followed up through 2020. The annual average concentrations of PMs at a 1-km spatial resolution around the residential addresses were estimated using validated spatiotemporal models. The marginal structural Cox model was used to estimate the associations of PM exposure with respiratory mortality, accounting for time-varying PM exposure. Results were stratified by demographics and lifestyle behaviors factors. Results: Among the participants, the mean age was 48.33 (SD 17.55) years, and 275,676 (47.47\%) of them were men. During the follow-up period, 7260 deaths occurred due to respiratory diseases. The annual average concentrations of PM1, PM2.5, and PM10 showed a declining trend during the follow-up period. After adjusting for confounders, a 6.6\% (95\% CI 5.6\%?7.6\%), 4.2\% (95\% CI 3.6\%?4.7\%), and 4.0\% (95\% CI 3.6\%?4.5\%) increase in the risk of respiratory mortality was observed following each 1-$\mu$g/m3 increase in concentrations of PM1, PM2.5, and PM10, respectively. In addition, older participants, nonsmokers, participants with higher exercise frequency, and those exposed to a lower normalized difference vegetation index tended to be more susceptible to the effects of PMs. Furthermore, participants in the low-exposure group tended to be at a 7.6\% and 2.7\% greater risk of respiratory mortality following PM1 and PM10 exposure, respectively, compared to the entire cohort. Conclusions: This cohort study provides causal clues of the respiratory impact of long-term ambient PM exposure, indicating that PM reduction efforts may continuously benefit the population's respiratory health. ",
doi="10.2196/56059",
url="https://publichealth.jmir.org/2024/1/e56059"
}


@Article{info:doi/10.2196/57334,
author="Quarton, Samuel
and Livesey, Alana
and Jeff, Charlotte
and Hatton, Christopher
and Scott, Aaron
and Parekh, Dhruv
and Thickett, David
and McNally, Alan
and Sapey, Elizabeth",
title="Metagenomics in the Diagnosis of Pneumonia: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="18",
volume="13",
pages="e57334",
keywords="pneumonia",
keywords="metagenomics",
keywords="CAP",
keywords="community-acquired pneumonia",
keywords="HAP",
keywords="hospital-acquired pneumonia",
keywords="VAP",
keywords="ventilator-associated pneumonia",
keywords="diagnosis",
keywords="respiratory tract infection",
keywords="systematic review",
abstract="Background: Causative pathogens are currently identified in only a minority of pneumonia cases, which affects antimicrobial stewardship. Metagenomic next-generation sequencing (mNGS) has potential to enhance pathogen detection due to its sensitivity and broad applicability. However, while studies have shown improved sensitivity compared with conventional microbiological methods for pneumonia diagnosis, it remains unclear whether this can translate into clinical benefit. Most existing studies focus on patients who are ventilated, readily allowing for analysis of bronchoalveolar lavage fluid (BALF). The impact of sample type on the use of metagenomic analysis remains poorly defined. Similarly, previous studies rarely differentiate between the types of pneumonia involved---community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), or ventilator-associated pneumonia (VAP)---which have different clinical profiles. Objective: This study aims to determine the clinical use of mNGS in CAP, HAP, and VAP, compared with traditional microbiological methods. Methods: We aim to review all studies (excluding case reports of a series of fewer than 10 people) of adult patients with suspected or confirmed pneumonia that compare metagenomic analysis with traditional microbiology techniques, including culture, antigen-based testing, and polymerase chain reaction--based assays. Relevant studies will be identified through systematic searches of the Embase, MEDLINE, Scopus, and Cochrane CENTRAL databases. Screening of titles, abstracts, and subsequent review of eligible full texts will be done by 2 separate reviewers (SQ and 1 of AL, CJ, or CH), with a third clinician (ES) providing adjudication in case of disagreement. Our focus is on the clinical use of metagenomics for patients with CAP, HAP, and VAP. Data extracted will focus on clinically important outcomes---pathogen positivity rate, laboratory turnaround time, impact on clinical decision-making, length of stay, and 30-day mortality. Subgroup analyses will be performed based on the type of pneumonia (CAP, HAP, or VAP) and sample type used. The risk of bias will be assessed using the QUADAS-2 tool for diagnostic accuracy studies. Outcome data will be combined in a random-effects meta-analysis, and where this is not possible, a narrative synthesis will be undertaken. Results: The searches were completed with the assistance of a medical librarian on January 13, 2024, returning 5750 records. Screening and data extraction are anticipated to be completed by September 2024. Conclusions: Despite significant promise, the impact of metagenomic analysis on clinical pathways remains unclear. Furthermore, it is unclear whether the use of this technique will alter depending on whether the pneumonia is a CAP, HAP, or VAP or the sample type that is collected. This systematic review will assess the current evidence base to support the benefit of clinical outcomes for metagenomic analysis, depending on the setting of pneumonia diagnosis or specimen type used. It will identify areas where further research is needed to advance this methodology into routine care. Trial Registration: PROSPERO CRD42023488096; https://tinyurl.com/3suy7cma International Registered Report Identifier (IRRID): DERR1-10.2196/57334 ",
doi="10.2196/57334",
url="https://www.researchprotocols.org/2024/1/e57334"
}


@Article{info:doi/10.2196/57108,
author="Debeij, M. Suzanne
and Aardoom, J. Jiska
and Haaksma, L. Miriam
and Stoop, M. Wieteke A.
and van Dam van Isselt, F. El{\'e}onore
and Kasteleyn, J. Marise",
title="The Potential Use and Value of a Wearable Monitoring Bracelet for Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study Investigating the Patient and Health Care Professional Perspectives",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="13",
volume="8",
pages="e57108",
keywords="eHealth",
keywords="Chronic Obstructive Pulmonary Disease",
keywords="COPD",
keywords="wearable",
keywords="exacerbation",
keywords="self-management",
keywords="monitoring bracelet",
keywords="remote monitoring",
keywords="mobile phone",
abstract="Background: The occurrence of exacerbations has major effects on the health of people with chronic obstructive pulmonary disease (COPD). Monitoring devices that measure (vital) parameters hold promise for timely identification and treatment of exacerbations. Stakeholders' perspectives on the use of monitoring devices are of importance for the successful development and implementation of a device. Objective: This study aimed to explore the potential use and value of a wearable monitoring bracelet (MB) for patients with COPD at high risk for exacerbation. The perspectives of health care professionals as well as patients were examined, both immediately after hospitalization and over a longer period. Furthermore, potential facilitators and barriers to the use and implementation of an MB were explored. Methods: Data for this qualitative study were collected from January to April 2023. A total of 11 participants (eg, n=6 health care professionals [HCPs], 2 patients, and 3 additional patients) participated. In total, 2 semistructured focus groups were conducted via video calls; 1 with HCPs of various professional backgrounds and 1 with patients. In addition, 3 semistructured individual interviews were held with patients. The interviews and focus groups addressed attitudes, wishes, needs, as well as factors that could either support or impede the potential MB use. Data from interviews and focus groups were coded and analyzed according to the principles of the framework method. Results: HCPs and patients both predominantly emphasized the importance of an MB in terms of promptly identifying exacerbations by detecting deviations from normal (vital) parameters, and subsequently alerting users. According to HCPs, this is how an MB should support the self-management of patients. Most participants did not anticipate major differences in value and use of an MB between the short-term and the long-term periods after hospitalization. Facilitators of the potential use and implementation of an MB that participants highlighted were ease of use and some form of support for patients in using an MB and interpreting the data. HCPs as well as patients expressed concerns about potential costs as a barrier to use and implementation. Another barrier that HCPs mentioned, was the prerequisite of digital literacy for patients to be able to interpret and react to the data from an MB. Conclusions: HCPs and patients both recognize that an MB could be beneficial and valuable to patients with COPD at high risk for exacerbation, in the short as well as the long term. In particular, they perceived value in supporting self-management of patients with COPD. Stakeholders would be able to use the obtained insights in support of the effective implementation of MBs in COPD patient care, which can potentially improve health care and the overall well-being of patients with COPD. ",
doi="10.2196/57108",
url="https://formative.jmir.org/2024/1/e57108"
}


@Article{info:doi/10.2196/52143,
author="Glyde, Granger Henry Mark
and Morgan, Caitlin
and Wilkinson, A. Tom M.
and Nabney, T. Ian
and Dodd, W. James",
title="Remote Patient Monitoring and Machine Learning in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Dual Systematic Literature Review and Narrative Synthesis",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="9",
volume="26",
pages="e52143",
keywords="acute exacerbations of COPD",
keywords="chronic obstructive pulmonary disease",
keywords="exacerbate",
keywords="exacerbation",
keywords="exacerbations",
keywords="remote patient monitoring",
keywords="RPM",
keywords="predict",
keywords="prediction",
keywords="predictions",
keywords="predictive",
keywords="machine learning",
keywords="monitoring",
keywords="remote",
keywords="COPD",
keywords="pulmonary",
keywords="respiratory",
keywords="lung",
keywords="lungs",
keywords="literature review",
keywords="literature reviews",
keywords="synthesis",
keywords="narrative review",
keywords="narrative reviews",
keywords="review methods",
keywords="review methodology",
abstract="Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high mortality, morbidity, and poor quality of life and constitute a substantial burden to patients and health care systems. New approaches to prevent or reduce the severity of AECOPD are urgently needed. Internationally, this has prompted increased interest in the potential of remote patient monitoring (RPM) and digital medicine. RPM refers to the direct transmission of patient-reported outcomes, physiological, and functional data, including heart rate, weight, blood pressure, oxygen saturation, physical activity, and lung function (spirometry), directly to health care professionals through automation, web-based data entry, or phone-based data entry. Machine learning has the potential to enhance RPM in chronic obstructive pulmonary disease by increasing the accuracy and precision of AECOPD prediction systems. Objective: This study aimed to conduct a dual systematic review. The first review focuses on randomized controlled trials where RPM was used as an intervention to treat or improve AECOPD. The second review examines studies that combined machine learning with RPM to predict AECOPD. We review the evidence and concepts behind RPM and machine learning and discuss the strengths, limitations, and clinical use of available systems. We have generated a list of recommendations needed to deliver patient and health care system benefits. Methods: A comprehensive search strategy, encompassing the Scopus and Web of Science databases, was used to identify relevant studies. A total of 2 independent reviewers (HMGG and CM) conducted study selection, data extraction, and quality assessment, with discrepancies resolved through consensus. Data synthesis involved evidence assessment using a Critical Appraisal Skills Programme checklist and a narrative synthesis. Reporting followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: These narrative syntheses suggest that 57\% (16/28) of the randomized controlled trials for RPM interventions fail to achieve the required level of evidence for better outcomes in AECOPD. However, the integration of machine learning into RPM demonstrates promise for increasing the predictive accuracy of AECOPD and, therefore, early intervention. Conclusions: This review suggests a transition toward the integration of machine learning into RPM for predicting AECOPD. We discuss particular RPM indices that have the potential to improve AECOPD prediction and highlight research gaps concerning patient factors and the maintained adoption of RPM. Furthermore, we emphasize the importance of a more comprehensive examination of patient and health care burdens associated with RPM, along with the development of practical solutions. ",
doi="10.2196/52143",
url="https://www.jmir.org/2024/1/e52143"
}


@Article{info:doi/10.2196/60325,
author="La Rosa, Maria Giusy Rita
and Polosa, Riccardo
and O'Leary, Ren{\'e}e",
title="Patterns of Use of e-Cigarettes and Their Respiratory Effects: Protocol for an Umbrella Review",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="4",
volume="13",
pages="e60325",
keywords="dual use",
keywords="electronic nicotine delivery systems",
keywords="na{\"i}ve use",
keywords="respiratory",
keywords="smoking cessation",
keywords="umbrella review",
abstract="Background: Electronic nicotine delivery systems (ENDS)---e-cigarettes or vapes---have been shown to substantially reduce or eliminate many toxins compared with cigarette smoke, but simultaneously ENDS use also produces their own unique toxins. Yet the patterns of use among people who use ENDS are not homogeneous. Some people who use ENDS also smoke cigarettes (dual use). Other people who formerly smoked cigarettes are completely substituting ENDS (exclusive use). A small number of people who have never smoked cigarettes are using ENDS (na{\"i}ve use of nicotine). Each of these patterns of use results in different exposures to toxins. Unfortunately, epidemiological studies routinely group together any ENDS use regardless of other tobacco use. Objective: This umbrella review primarily aims to present all the evidence available on the respiratory effects of ENDS use by adults based on their pattern of use: dual use, exclusive use, and na{\"i}ve use. With each of these patterns of use, are there benefits, no changes, or harmful effects on respiratory functioning? Our objective is to provide clinicians with a detailed analysis of how different patterns of ENDS use impact respiratory functioning and to point to the best sources of evidence. Methods: This umbrella review follows the Methods for Overviews of Reviews framework and the PRIOR (Preferred Reporting Items for Overviews of Reviews) statement. Systematic reviews published since 2019 will be searched across 4 databases and 3 gray literature sources. Additional searches will include citation chasing, references lists, and referrals from respiratory specialists. The quality of included reviews will be evaluated using the AMSTAR2 (A Measurement Tool to Assess Systematic Reviews) checklist. We will document biases in 3 areas: protocol deviations, biases from the Oxford Catalogue of Bias, and internal data discrepancies. Two reviewers will independently conduct the search and quality assessments. Our analysis will focus on reviews rated as moderate or high confidence by AMSTAR2. We will use the Vote Counting Direction of Effect method to manage expected data heterogeneity, assessing whether ENDS use is beneficial or detrimental, or has no effect on respiratory functions based on the pattern of use. Results: The review is expected to be completed by December 2024. The database search was concluded in April 2024, and data extraction and bias assessment were completed in June 2024. The analysis phase is planned to be completed by October 2024. Conclusions: A thorough and comprehensive assessment of the evidence will better inform the contentious debate over the respiratory effects of ENDS providing much needed clarity by linking their effects to specific usage patterns. This analysis is particularly crucial in understanding the risks associated with continued cigarette smoking. Trial Registration: PROSPERO CRD42024540034; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=540034 International Registered Report Identifier (IRRID): DERR1-10.2196/60325 ",
doi="10.2196/60325",
url="https://www.researchprotocols.org/2024/1/e60325",
url="http://www.ncbi.nlm.nih.gov/pubmed/39230946"
}


@Article{info:doi/10.2196/56594,
author="Wang, Qinqin
and Liu, Lingjun
and Li, Hong
and Zhang, Qiao
and Ma, Qianli",
title="Quality of Chronic Obstructive Pulmonary Disease Information on the Chinese Internet: Website Evaluation Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="1",
volume="8",
pages="e56594",
keywords="chronic obstructive pulmonary disease",
keywords="internet",
keywords="information quality",
keywords="DISCERN",
keywords="websites",
keywords="health information",
keywords="DISCERN instrument",
keywords="pulmonary disease",
keywords="chronic pulmonary disease",
keywords="cross-sectional study",
keywords="website information",
keywords="treatment",
keywords="COPD",
keywords="China",
keywords="evaluation",
keywords="pulmonary",
keywords="chronic",
abstract="Background: The development of internet technology has greatly increased the ability of patients with chronic obstructive pulmonary disease (COPD) to obtain health information, giving patients more initiative in the patient-physician decision-making process. However, concerns about the quality of website health information will affect the enthusiasm of patients' website search behavior. Therefore, it is necessary to evaluate the current situation of Chinese internet information on COPD. Objective: This study aims to evaluate the quality of COPD treatment information on the Chinese internet. Methods: Using the standard disease name ``????????'' (``chronic obstructive pulmonary disease'' in Chinese) and the commonly used public search terms ``???'' (``COPD'') and ``???'' (``emphysema'') combined with the keyword ``??'' (``treatment''), we searched the PC client web page of Baidu, Sogou, and 360 search engines and screened the first 50 links of the website from July to August 2021. The language was restricted to Chinese for all the websites. The DISCERN tool was used to evaluate the websites. Results: A total of 96 websites were included and analyzed. The mean overall DISCERN score for all websites was 30.4 (SD 10.3; range 17.3-58.7; low quality), no website reached the maximum DISCERN score of 75, and the mean score for each item was 2.0 (SD 0.7; range 1.2-3.9). There were significant differences in mean DISCERN scores between terms, with ``chronic obstructive pulmonary disease'' having the highest mean score. Conclusions: The quality of COPD information on the Chinese internet is poor, which is mainly reflected in the low reliability and relevance of COPD treatment information, which can easily lead consumers to make inappropriate treatment choices. The term ``chronic obstructive pulmonary disease'' has the highest DISCERN score among commonly used disease search terms. It is recommended that consumers use standard disease names when searching for website information, as the information obtained is relatively reliable. ",
doi="10.2196/56594",
url="https://formative.jmir.org/2024/1/e56594"
}


@Article{info:doi/10.2196/48595,
author="Ben Yehuda, Ori
and Itelman, Edward
and Vaisman, Adva
and Segal, Gad
and Lerner, Boaz",
title="Early Detection of Pulmonary Embolism in a General Patient Population Immediately Upon Hospital Admission Using Machine Learning to Identify New, Unidentified Risk Factors: Model Development Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="30",
volume="26",
pages="e48595",
keywords="pulmonary embolism",
keywords="deep vein thrombosis",
keywords="venous thromboembolism",
keywords="imbalanced data",
keywords="clustering",
keywords="risk factors",
keywords="Wells score",
keywords="revised Genova score",
keywords="hospital admission",
keywords="machine learning",
abstract="Background: Under- or late identification of pulmonary embolism (PE)---a thrombosis of 1 or more pulmonary arteries that seriously threatens patients' lives---is a major challenge confronting modern medicine. Objective: We aimed to establish accurate and informative machine learning (ML) models to identify patients at high risk for PE as they are admitted to the hospital, before their initial clinical checkup, by using only the information in their medical records. Methods: We collected demographics, comorbidities, and medications data for 2568 patients with PE and 52,598 control patients. We focused on data available prior to emergency department admission, as these are the most universally accessible data. We trained an ML random forest algorithm to detect PE at the earliest possible time during a patient's hospitalization---at the time of his or her admission. We developed and applied 2 ML-based methods specifically to address the data imbalance between PE and non-PE patients, which causes misdiagnosis of PE. Results: The resulting models predicted PE based on age, sex, BMI, past clinical PE events, chronic lung disease, past thrombotic events, and usage of anticoagulants, obtaining an 80\% geometric mean value for the PE and non-PE classification accuracies. Although on hospital admission only 4\% (1942/46,639) of the patients had a diagnosis of PE, we identified 2 clustering schemes comprising subgroups with more than 61\% (705/1120 in clustering scheme 1; 427/701 and 340/549 in clustering scheme 2) positive patients for PE. One subgroup in the first clustering scheme included 36\% (705/1942) of all patients with PE who were characterized by a definite past PE diagnosis, a 6-fold higher prevalence of deep vein thrombosis, and a 3-fold higher prevalence of pneumonia, compared with patients of the other subgroups in this scheme. In the second clustering scheme, 2 subgroups (1 of only men and 1 of only women) included patients who all had a past PE diagnosis and a relatively high prevalence of pneumonia, and a third subgroup included only those patients with a past diagnosis of pneumonia. Conclusions: This study established an ML tool for early diagnosis of PE almost immediately upon hospital admission. Despite the highly imbalanced scenario undermining accurate PE prediction and using information available only from the patient's medical history, our models were both accurate and informative, enabling the identification of patients already at high risk for PE upon hospital admission, even before the initial clinical checkup was performed. The fact that we did not restrict our patients to those at high risk for PE according to previously published scales (eg, Wells or revised Genova scores) enabled us to accurately assess the application of ML on raw medical data and identify new, previously unidentified risk factors for PE, such as previous pulmonary disease, in general populations. ",
doi="10.2196/48595",
url="https://www.jmir.org/2024/1/e48595"
}


@Article{info:doi/10.2196/54322,
author="Ladune, Raphaelle
and Hayotte, Meggy
and Vuillemin, Anne
and d'Arripe-Longueville, Fabienne",
title="Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="30",
volume="8",
pages="e54322",
keywords="cystic fibrosis",
keywords="decisional balance",
keywords="digital app",
keywords="acceptability",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals. Objective: This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF. Methods: This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app's creation. The app's acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses. Results: In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO\_BALAD, designed for people with CF aged ?18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities. Conclusions: This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study. ",
doi="10.2196/54322",
url="https://formative.jmir.org/2024/1/e54322",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078689"
}


@Article{info:doi/10.2196/56226,
author="Chen, Xiaolan
and Zhang, Han
and Li, Zhiwen
and Liu, Shuang
and Zhou, Yuqi",
title="Continuous Monitoring of Heart Rate Variability and Respiration for the Remote Diagnosis of Chronic Obstructive Pulmonary Disease: Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="18",
volume="12",
pages="e56226",
keywords="continuous monitoring",
keywords="chronic obstructive pulmonary disease",
keywords="COPD diagnosis",
keywords="prospective study",
keywords="ROC curve",
keywords="heart rate variability",
keywords="respiratory rate",
keywords="heart rate",
keywords="noncontact bed sensors",
abstract="Background: Conventional daytime monitoring in a single day may be influenced by factors such as motion artifacts and emotions, and continuous monitoring of nighttime heart rate variability (HRV) and respiration to assist in chronic obstructive pulmonary disease (COPD) diagnosis has not been reported yet. Objective: The aim of this study was to explore and compare the effects of continuously monitored HRV, heart rate (HR), and respiration during night sleep on the remote diagnosis of COPD. Methods: We recruited patients with different severities of COPD and healthy controls between January 2021 and November 2022. Vital signs such as HRV, HR, and respiration were recorded using noncontact bed sensors from 10 PM to 8 AM of the following day, and the recordings of each patient lasted for at least 30 days. We obtained statistical means of HRV, HR, and respiration over time periods of 7, 14, and 30 days by continuous monitoring. Additionally, the effects that the statistical means of HRV, HR, and respiration had on COPD diagnosis were evaluated at different times of recordings. Results: In this study, 146 individuals were enrolled: 37 patients with COPD in the case group and 109 participants in the control group. The median number of continuous night-sleep monitoring days per person was 56.5 (IQR 32.0-113.0) days. Using the features regarding the statistical means of HRV, HR, and respiration over 1, 7, 14, and 30 days, binary logistic regression classification of COPD yielded an accuracy, Youden index, and area under the receiver operating characteristic curve of 0.958, 0.904, and 0.989, respectively. The classification performance for COPD diagnosis was directionally proportional to the monitoring duration of vital signs at night. The importance of the features for diagnosis was determined by the statistical means of respiration, HRV, and HR, which followed the order of respiration > HRV > HR. Specifically, the statistical means of the duration of respiration rate faster than 21 times/min (RRF), high frequency band power of 0.15-0.40 Hz (HF), and respiration rate (RR) were identified as the top 3 most significant features for classification, corresponding to cutoff values of 0.1 minute, 1316.3 nU, and 16.3 times/min, respectively. Conclusions: Continuous monitoring of nocturnal vital signs has significant potential for the remote diagnosis of COPD. As the duration of night-sleep monitoring increased from 1 to 30 days, the statistical means of HRV, HR, and respiration showed a better reflection of an individual's health condition compared to monitoring the vital signs in a single day or night, and better was the classification performance for COPD diagnosis. Further, the statistical means of RRF, HF, and RR are crucial features for diagnosing COPD, demonstrating the importance of monitoring HRV and respiration during night sleep. ",
doi="10.2196/56226",
url="https://mhealth.jmir.org/2024/1/e56226"
}


@Article{info:doi/10.2196/53266,
author="Dhunnoo, Pranavsingh
and Kemp, Bridie
and McGuigan, Karen
and Mesk{\'o}, Bertalan
and O'Rourke, Vicky
and McCann, Michael",
title="Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="9",
volume="26",
pages="e53266",
keywords="telemedicine",
keywords="internet-based consultation",
keywords="chronic illnesses",
keywords="cyberpsychology",
keywords="digital health",
keywords="scoping review",
abstract="Background: Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. Objective: With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. Methods: PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. Results: Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46\%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. Conclusions: For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits. ",
doi="10.2196/53266",
url="https://www.jmir.org/2024/1/e53266",
url="http://www.ncbi.nlm.nih.gov/pubmed/38980704"
}


@Article{info:doi/10.2196/57404,
author="Bass, Alec
and G{\'e}phine, Sarah
and Martin, Micka{\"e}l
and Belley, Marianne
and Robic, Manon
and Fabre, Claudine
and Grosbois, Jean-Marie
and Dion, Genevi{\`e}ve
and Saey, Didier
and Chambellan, Arnaud
and Maltais, Fran{\c{c}}ois",
title="Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="28",
volume="13",
pages="e57404",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="exercise capacity test",
keywords="interstitial lung diseases",
keywords="physiotherapy",
keywords="rehabilitation",
keywords="telerehabilitation",
keywords="validation study",
keywords="stepper test",
abstract="Background: Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases. Unfortunately, access to timely and appropriate rehabilitation remains limited. To help close this inaccessibility gap, telerehabilitation has been proposed. However, exercise testing is necessary for effective and safe exercise prescription. Current gold-standard tests, such as maximal cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT), are poorly adapted to home-based or telerehabilitation settings. This was an obstacle to the continuity of services during the COVID-19 pandemic. It is essential to validate tests adapted to these new realities, such as the 6-minute stepper test (6MST). This test, strongly inspired by 6MWT, consists of taking as many steps as possible on a ``stepper'' for 6 minutes. Objective: This study aims to evaluate the metrological qualities of 6MST by (1) establishing concurrent validity and agreement between the 6MST and CPET, as well as with the 6MWT; (2) determining test-retest reliability in a home-based setting with direct and remote (videoconferencing) monitoring; and (3) documenting adverse events and participant perspectives when performing the 6MST in home-based settings. Methods: Three centers (Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Qu{\'e}bec in Qu{\'e}bec, Groupement des H{\^o}pitaux de l'Institut Catholique de Lille in France, and FormAction Sant{\'e} in France) will be involved in this multinational project, which is divided into 2 studies. For study 1 (objective 1), 30 participants (Qu{\'e}bec, n=15; France, n=15) will be recruited. Two laboratory visits will be performed to assess anthropometric data, pulmonary function, and the 3 exercise tolerance tests (CPET, 6MWT, and 6MST). Concurrent validity (paired sample t tests and Pearson correlations) and agreement (Bland-Altman plots with 95\% agreement limits) will be evaluated. For study 2 (objectives 2 and 3), 52 participants (Qu{\'e}bec, n=26; France, n=26) will be recruited. Following a familiarization trial (trial 1), the 6MST will be conducted on 2 separate occasions (trials 2 and 3), once under direct supervision and once under remote supervision, in a randomized order. Paired sample t test, Bland-Altman plots, and intraclass correlations will be used to compare trials 2 and 3. A semistructured interview will be conducted after the third trial to collect participants' perspectives. Results: Ethical approval was received for this project (October 12, 2023, in Qu{\'e}bec and September 25, 2023, in France) and the first participant was recruited in February 2024. Conclusions: This study innovates by validating a new clinical test necessary for the development and implementation of new models of rehabilitation adapted to home and telerehabilitation contexts. This study also aligns with the United Nations Sustainable Development Goals by contributing to augmenting health care service delivery (goal 3) and reducing health care access inequalities (goal 11). Trial Registration: ClinicalTrials.gov NCT06447831; https://clinicaltrials.gov/study/NCT06447831 International Registered Report Identifier (IRRID): DERR1-10.2196/57404 ",
doi="10.2196/57404",
url="https://www.researchprotocols.org/2024/1/e57404",
url="http://www.ncbi.nlm.nih.gov/pubmed/38941132"
}


@Article{info:doi/10.2196/50980,
author="Spoladore, Daniele
and Colombo, Vera
and Fumagalli, Alessia
and Tosi, Martina
and Lorenzini, Cecilia Erna
and Sacco, Marco",
title="An Ontology-Based Decision Support System for Tailored Clinical Nutrition Recommendations for Patients With Chronic Obstructive Pulmonary Disease: Development and Acceptability Study",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="26",
volume="12",
pages="e50980",
keywords="ontology-based decision support system",
keywords="nutritional recommendation",
keywords="chronic obstructive pulmonary disease",
keywords="clinical decision support system",
keywords="pulmonary rehabilitation",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a chronic condition among the main causes of morbidity and mortality worldwide, representing a burden on health care systems. Scientific literature highlights that nutrition is pivotal in respiratory inflammatory processes connected to COPD, including exacerbations. Patients with COPD have an increased risk of developing nutrition-related comorbidities, such as diabetes, cardiovascular diseases, and malnutrition. Moreover, these patients often manifest sarcopenia and cachexia. Therefore, an adequate nutritional assessment and therapy are essential to help individuals with COPD in managing the progress of the disease. However, the role of nutrition in pulmonary rehabilitation (PR) programs is often underestimated due to a lack of resources and dedicated services, mostly because pneumologists may lack the specialized training for such a discipline. Objective: This work proposes a novel knowledge-based decision support system to support pneumologists in considering nutritional aspects in PR. The system provides clinicians with patient-tailored dietary recommendations leveraging expert knowledge. Methods: The expert knowledge---acquired from experts and clinical literature---was formalized in domain ontologies and rules, which were developed leveraging the support of Italian clinicians with expertise in the rehabilitation of patients with COPD. Thus, by following an agile ontology engineering methodology, the relevant formal ontologies were developed to act as a backbone for an application targeted at pneumologists. The recommendations provided by the decision support system were validated by a group of nutrition experts, whereas the acceptability of such an application in the context of PR was evaluated by pneumologists. Results: A total of 7 dieticians (mean age 46.60, SD 13.35 years) were interviewed to assess their level of agreement with the decision support system's recommendations by evaluating 5 patients' health conditions. The preliminary results indicate that the system performed more than adequately (with an overall average score of 4.23, SD 0.52 out of 5 points), providing meaningful and safe recommendations in compliance with clinical practice. With regard to the acceptability of the system by lung specialists (mean age 44.71, SD 11.94 years), the usefulness and relevance of the proposed solution were extremely positive---the scores on each of the perceived usefulness subscales of the technology acceptance model 3 were 4.86 (SD 0.38) out of 5 points, whereas the score on the intention to use subscale was 4.14 (SD 0.38) out of 5 points. Conclusions: Although designed for the Italian clinical context, the proposed system can be adapted for any other national clinical context by modifying the domain ontologies, thus providing a multidisciplinary approach to the management of patients with COPD. ",
doi="10.2196/50980",
url="https://medinform.jmir.org/2024/1/e50980",
url="http://www.ncbi.nlm.nih.gov/pubmed/38922666"
}


@Article{info:doi/10.2196/54497,
author="Qsous, Ghaith
and Ramaraj, Prashanth
and Avtaar Singh, Singh Sanjeet
and Herd, Philip
and Sooraj, Runveer Nayandra
and Will, Brodie Malcolm",
title="Treating Spontaneous Pneumothorax Using an Innovative Surgical Technique Called Capnodissection Pleurectomy: Case Report",
journal="Interact J Med Res",
year="2024",
month="Jun",
day="21",
volume="13",
pages="e54497",
keywords="capnodissection",
keywords="pleurectomy",
keywords="VATS",
keywords="video-assisted thorascopic surgery",
keywords="novel technique",
keywords="thoracic surgery",
keywords="surgical innovation",
keywords="pneumothorax",
keywords="spontaneous pneumothorax",
keywords="pleurodesis",
keywords="management",
keywords="bullectomy",
keywords="bullae",
keywords="young patient",
keywords="lung diseases",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="surgical treatment",
keywords="male",
keywords="capnothorax",
doi="10.2196/54497",
url="https://www.i-jmr.org/2024/1/e54497"
}


@Article{info:doi/10.2196/53131,
author="Schmidt, Wong Camilla
and Borgnakke, Karen
and Fr{\o}lich, Anne
and Kayser, Lars",
title="Preferences, Needs, and Values of Patients With Chronic Obstructive Pulmonary Disease Attending a Telehealth Service: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="21",
volume="11",
pages="e53131",
keywords="people with long-term health condition",
keywords="patient education",
keywords="COPD",
keywords="digital health",
keywords="ethnography",
keywords="inductive",
keywords="ethnographic",
keywords="chronic",
keywords="lung",
keywords="lungs",
keywords="pulmonary",
keywords="respiratory",
keywords="self-management",
keywords="interview",
keywords="interviews",
keywords="qualitative",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
abstract="Background: Digitally assisted health care services and technologies are gaining popularity. They assist patients in managing their conditions, thereby reducing the burden on health care staff. Digital health care enables individuals to receive care that is more tailored to their needs and preferences. When implemented properly, it can promote equity by considering each person's opportunities and limitations in the context of health care needs, preferences, values, and capabilities. Objective: This study aims to understand the needs, values, and preferences of individuals with chronic obstructive pulmonary disease (COPD) who are provided with a 24/7 digital health care service. Furthermore, we aim to understand the dynamics of the communities to which they belong and how these communities intersect. This will provide us with the essential knowledge to establish new methods of providing education, including the development of educational activities for health professionals to engage, train, and empower people living with COPD. Methods: The study included 7 informants diagnosed with COPD who received 24/7 digital health care service support from a regional project in Region Zealand, Denmark. The informants were visited 4 times during 2 months, including a ``Hello'' visit, a day with a semistructured interview, and 2 days with field observations. The informants participated in a semistructured interview, following participant observation and an ethnographic approach. The interview content was analyzed using an inductive methodology to categorize the empirical data. Results: Using the inductive approach, we identified 3 main categories related to the informants' needs, values, and preferences: (1) Health, (2) Value Creation, and (3) Resources. These 3 main categories were based on 9 subcategories: (1) health and barriers, (2) self-monitoring, (3) medication, (4) behavior, (5) motivation, (6) hobbies, (7) social networks, (8) health professionals, and (9) technology. These findings revealed that the informants placed value on maintaining their daily activities and preserving their sense of identity before the onset of COPD. Furthermore, they expressed a desire not to be defined by their COPD, as conversations about COPD often shifted away from the topic. Conclusions: Digital health solutions and the health care professionals who offer them should prioritize the individuals they serve, considering their needs, values, and preferences rather than solely focusing on the medical condition. This approach ensures the highest level of daily living and empowerment for those living with long-term health conditions. The communities surrounding individuals must engage in constant interaction and collaboration. They should work together to incorporate people's needs, values, and preferences into future digital health services, thereby promoting empowerment and self-management. New educational programs aimed at developing the digital health service competencies of registered nurses should facilitate collaboration between the 2 communities. This collaboration is essential for supporting patients with long-term health conditions in their daily activities. ",
doi="10.2196/53131",
url="https://humanfactors.jmir.org/2024/1/e53131"
}


@Article{info:doi/10.2196/49978,
author="Xiao, Yi-Zhen
and Chen, Xiao-Jia
and Sun, Xiao-Ling
and Chen, Huan
and Luo, Yu-Xia
and Chen, Yuan
and Liang, Ye-Mei",
title="Effect of Implementing an Informatization Case Management Model on the Management of Chronic Respiratory Diseases in a General Hospital: Retrospective Controlled Study",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="19",
volume="12",
pages="e49978",
keywords="chronic disease management",
keywords="chronic respiratory disease",
keywords="hospital information system",
keywords="informatization",
keywords="information system",
keywords="respiratory",
keywords="pulmonary",
keywords="breathing",
keywords="implementation",
keywords="care management",
keywords="disease management",
keywords="chronic obstructive pulmonary disease",
keywords="case management",
abstract="Background: The use of chronic disease information systems in hospitals and communities plays a significant role in disease prevention, control, and monitoring. However, there are several limitations to these systems, including that the platforms are generally isolated, the patient health information and medical resources are not effectively integrated, and the ``Internet Plus Healthcare'' technology model is not implemented throughout the patient consultation process. Objective: The aim of this study was to evaluate the efficiency of the application of a hospital case management information system in a general hospital in the context of chronic respiratory diseases as a model case. Methods: A chronic disease management information system was developed for use in general hospitals based on internet technology, a chronic disease case management model, and an overall quality management model. Using this system, the case managers provided sophisticated inpatient, outpatient, and home medical services for patients with chronic respiratory diseases. Chronic respiratory disease case management quality indicators (number of managed cases, number of patients accepting routine follow-up services, follow-up visit rate, pulmonary function test rate, admission rate for acute exacerbations, chronic respiratory diseases knowledge awareness rate, and patient satisfaction) were evaluated before (2019?2020) and after (2021?2022) implementation of the chronic disease management information system. Results: Before implementation of the chronic disease management information system, 1808 cases were managed in the general hospital, and an average of 603 (SD 137) people were provided with routine follow-up services. After use of the information system, 5868 cases were managed and 2056 (SD 211) patients were routinely followed-up, representing a significant increase of 3.2 and 3.4 times the respective values before use (U=342.779; P<.001). With respect to the quality of case management, compared to the indicators measured before use, the achievement rate of follow-up examination increased by 50.2\%, the achievement rate of the pulmonary function test increased by 26.2\%, the awareness rate of chronic respiratory disease knowledge increased by 20.1\%, the retention rate increased by 16.3\%, and the patient satisfaction rate increased by 9.6\% (all P<.001), while the admission rate of acute exacerbation decreased by 42.4\% (P<.001) after use of the chronic disease management information system. Conclusions: Use of a chronic disease management information system improves the quality of chronic respiratory disease case management and reduces the admission rate of patients owing to acute exacerbations of their diseases. ",
doi="10.2196/49978",
url="https://medinform.jmir.org/2024/1/e49978"
}


@Article{info:doi/10.2196/55452,
author="de Graaf, Debbie
and de Vries, M. Nienke
and van de Zande, Tessa
and Schimmel, P. Janneke J.
and Shin, Sooyoon
and Kowahl, Nathan
and Barman, Poulami
and Kapur, Ritu
and Marks Jr, J. William
and van 't Hul, Alex
and Bloem, R. Bastiaan",
title="Measuring Physical Functioning Using Wearable Sensors in Parkinson Disease and Chronic Obstructive Pulmonary Disease (the Accuracy of Digital Assessment of Performance Trial Study): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="7",
volume="13",
pages="e55452",
keywords="Parkinson disease",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="physical activity",
keywords="physical capacity",
keywords="wearable devices",
keywords="walking",
keywords="exercise",
keywords="locomotion",
keywords="home-based",
keywords="wearable",
keywords="wearables",
keywords="wearable sensor",
keywords="dementia",
keywords="smartwatch",
keywords="StepWatch",
keywords="treatment",
abstract="Background: Physical capacity and physical activity are important aspects of physical functioning and quality of life in people with a chronic disease such as Parkinson disease (PD) or chronic obstructive pulmonary disease (COPD). Both physical capacity and physical activity are currently measured in the clinic using standardized questionnaires and tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go test (TUG). However, relying only on in-clinic tests is suboptimal since they offer limited information on how a person functions in daily life and how functioning fluctuates throughout the day. Wearable sensor technology may offer a solution that enables us to better understand true physical functioning in daily life. Objective: We aim to study whether device-assisted versions of 6MWT and TUG, such that the tests can be performed independently at home using a smartwatch, is a valid and reliable way to measure the performance compared to a supervised, in-clinic test. Methods: This is a decentralized, prospective, observational study including 100 people with PD and 100 with COPD. The inclusion criteria are broad: age ?18 years, able to walk independently, and no co-occurrence of PD and COPD. Participants are followed for 15 weeks with 4 in-clinic visits, once every 5 weeks. Outcomes include several walking tests, cognitive tests, and disease-specific questionnaires accompanied by data collection using wearable devices (the Verily Study Watch and Modus StepWatch). Additionally, during the last 10 weeks of this study, participants will follow an aerobic exercise training program aiming to increase physical capacity, creating the opportunity to study the responsiveness of the remote 6MWT. Results: In total, 89 people with PD and 65 people with COPD were included in this study. Data analysis will start in April 2024. Conclusions: The results of this study will provide information on the measurement properties of the device-assisted 6MWT and TUG in the clinic and at home. When reliable and valid, this can contribute to a better understanding of a person's physical capacity in real life, which makes it possible to personalize treatment options. Trial Registration: ClinicalTrials.gov NCT05756075; https://clinicaltrials.gov/study/NCT05756075 International Registered Report Identifier (IRRID): DERR1-10.2196/55452 ",
doi="10.2196/55452",
url="https://www.researchprotocols.org/2024/1/e55452",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713508"
}


@Article{info:doi/10.2196/50855,
author="Kandola, Aaron
and Edwards, Kyra
and Straatman, Joris
and D{\"u}hrkoop, Bettina
and Hein, Bettina
and Hayes, Joseph",
title="Digital Self-Management Platform for Adult Asthma: Randomized Attention-Placebo Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="29",
volume="26",
pages="e50855",
keywords="asthma",
keywords="mobile health",
keywords="self-management",
keywords="randomized controlled trial",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="RCT",
keywords="RCTs",
keywords="respiratory",
keywords="pulmonary",
keywords="smartphone",
keywords="platform",
keywords="digital health",
keywords="chronic",
keywords="breathing",
keywords="disease management",
keywords="mHealth",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="mobile phone",
abstract="Background: Asthma is one of the most common chronic conditions worldwide, with a substantial individual and health care burden. Digital apps hold promise as a highly accessible, low-cost method of enhancing self-management in asthma, which is critical to effective asthma control. Objective: We conducted a fully remote randomized controlled trial (RCT) to assess the efficacy of juli, a commercially available smartphone self-management platform for asthma. Methods: We conducted a pragmatic single-blind, RCT of juli for asthma management. Our study included participants aged 18 years and older who self-identified as having asthma and had an Asthma Control Test (ACT) score of 19 or lower (indicating uncontrolled asthma) at the beginning of the trial. Participants were randomized (1:1 ratio) to receive juli for 8 weeks or a limited attention-placebo control version of the app. The primary outcome measure was the difference in ACT scores after 8 weeks. Secondary outcomes included remission (ACT score greater than 19), minimal clinically important difference (an improvement of 3 or more points on the ACT), worsening of asthma, and health-related quality of life. The primary analysis included participants using the app for 8 weeks (per-protocol analysis), and the secondary analysis used a modified intention-to-treat (ITT) analysis. Results: We randomized 411 participants between May 2021 and April 2023: a total of 152 (37\%) participants engaged with the app for 8 weeks and were included in the per-protocol analysis, and 262 (63.7\%) participants completed the week-2 outcome assessment and were included in the modified ITT analysis. Total attrition between baseline and week 8 was 259 (63\%) individuals. In the per-protocol analysis, the intervention group had a higher mean ACT score (17.93, SD 4.72) than the control group (16.24, SD 5.78) by week 8 (baseline adjusted coefficient 1.91, 95\% CI 0.31-3.51; P=.02). Participants using juli had greater odds of achieving or exceeding the minimal clinically important difference at 8 weeks (adjusted odds ratio 2.38, 95\% CI 1.20-4.70; P=.01). There were no between group differences in the other secondary outcomes at 8 weeks. The results from the modified ITT analyses were similar. Conclusions: Users of juli had improved asthma symptom control over 8 weeks compared with users of a version of the app with limited functionality. These findings suggest that juli is an effective digital self-management platform that could augment existing care pathways for asthma. The retention of patients in RCTs and real-world use of digital health care apps is a major challenge. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry  ISRCTN87679686; https://www.isrctn.com/ISRCTN87679686 ",
doi="10.2196/50855",
url="https://www.jmir.org/2024/1/e50855",
url="http://www.ncbi.nlm.nih.gov/pubmed/38684084"
}


@Article{info:doi/10.2196/49861,
author="Nourallah, Abdulnaser
and Alshehri, Abdulrahman
and Alhejazi, Ayman
and Usman, Binyam
and ElGohary, Ghada
and Malhan, Hafiz
and Motabi, Ibraheem
and Al Farsi, Khalil
and Alshuaibi, Mohammed
and Siddiqui, Mustaqeem
and Ghonema, Rasha
and Taha, Yasin Ruba
and Abouzeid, Tarek
and Ahmed, Wesam
and Diab, Mohanad
and Alhuraiji, Ahmad
and Rabea, Magdy
and Chouikrat, Zahir Mohamed",
title="Real-World Registry on the Pharmacotherapy of Multiple Myeloma and Associated Renal and Pulmonary Impairments in the Greater Gulf Region: Protocol for a Retrospective Real-World Data Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="24",
volume="13",
pages="e49861",
keywords="Greater Gulf region",
keywords="multiple myeloma",
keywords="pulmonary dysfunction",
keywords="renal impairment",
keywords="RRMM",
keywords="Real-world data",
abstract="Background: Multiple myeloma (MM) is the second-most common cancer among hematological malignancies. Patients with active disease may experience several comorbidities, including renal insufficiency and asthma, which may lead to treatment failure. The treatment of relapsed or refractory MM (RRMM) has been associated with multiple factors, causing a decline in progression-free survival as well as overall survival with subsequent lines of therapy. Data about the characteristics of this group of patients in the Greater Gulf region are lacking. Objective: The primary objective of this study is to describe the disease characteristics and various treatment approaches or regimens used in the management of patients with RRMM in the Greater Gulf region. Methods: We will conduct a regional, retrospective study collecting real-world and epidemiological data on patients with MM in countries of the Greater Gulf region. Medical records will be used to obtain the required data. Around 150 to 170 patients' records are planned to be retrospectively reviewed over 6 months without any cross-sectional or prospective intervention. Cases will be collected from Saudi Arabia, the United Arab Emirates, Kuwait, Oman, and Qatar. Descriptive as well as analytical statistics will be performed on the extracted data. The calculated sample size will allow us to estimate the percentages of RRMM cases with acceptable precision while complying with the challenges in light of data scarcity. We will obtain a comprehensive description of the demographic profile of patients with MM; treatment outcomes; the proportion of patients with MM with renal impairment and asthma, chronic obstructive pulmonary disease, or both at the time of diagnosis and any subsequent point; and data related to treatment lines, regimens, and MM-associated morbidities. Results: Patient medical records were reviewed between June 2022 and January 2023 for eligibility and data extraction. A total of 148 patients were eligible for study inclusion, of whom 64.2\% (n=95) were male and 35.8\% (n=53) were female. The study is currently in its final stages of data analysis. The final manuscript is expected to be published in 2024. Conclusions: Although MM is a predominant hematological disease, data on its prevalence and patients' characteristics in the Greater Gulf region are scarce. Therefore, this study will give us real-world insights into disease characteristics and various management approaches of patients with MM in the Greater Gulf region. International Registered Report Identifier (IRRID): DERR1-10.2196/49861 ",
doi="10.2196/49861",
url="https://www.researchprotocols.org/2024/1/e49861",
url="http://www.ncbi.nlm.nih.gov/pubmed/38657230"
}


@Article{info:doi/10.2196/54388,
author="Isangula, Ganka Kahabi
and Haule, John Rogers",
title="Leveraging AI and Machine Learning to Develop and Evaluate a Contextualized User-Friendly Cough Audio Classifier for Detecting Respiratory Diseases: Protocol for a Diagnostic Study in Rural Tanzania",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="23",
volume="13",
pages="e54388",
keywords="artificial intelligence",
keywords="machine learning",
keywords="respiratory diseases",
keywords="cough classifiers",
keywords="Tanzania",
keywords="Africa",
keywords="mobile phone",
keywords="user-friendly",
keywords="cough",
keywords="detecting respiratory disease",
keywords="diagnostic study",
keywords="tuberculosis",
keywords="asthma",
keywords="chronic obstructive pulmonary disease",
keywords="treatment",
keywords="management",
keywords="noninvasive",
keywords="rural",
keywords="cross-sectional research",
keywords="analysis",
keywords="cough sound",
abstract="Background: Respiratory diseases, including active tuberculosis (TB), asthma, and chronic obstructive pulmonary disease (COPD), constitute substantial global health challenges, necessitating timely and accurate diagnosis for effective treatment and management. Objective: This research seeks to develop and evaluate a noninvasive user-friendly artificial intelligence (AI)--powered cough audio classifier for detecting these respiratory conditions in rural Tanzania. Methods: This is a nonexperimental cross-sectional research with the primary objective of collection and analysis of cough sounds from patients with active TB, asthma, and COPD in outpatient clinics to generate and evaluate a noninvasive cough audio classifier. Specialized cough sound recording devices, designed to be nonintrusive and user-friendly, will facilitate the collection of diverse cough sound samples from patients attending outpatient clinics in 20 health care facilities in the Shinyanga region. The collected cough sound data will undergo rigorous analysis, using advanced AI signal processing and machine learning techniques. By comparing acoustic features and patterns associated with TB, asthma, and COPD, a robust algorithm capable of automated disease discrimination will be generated facilitating the development of a smartphone-based cough sound classifier. The classifier will be evaluated against the calculated reference standards including clinical assessments, sputum smear, GeneXpert, chest x-ray, culture and sensitivity, spirometry and peak expiratory flow, and sensitivity and predictive values. Results: This research represents a vital step toward enhancing the diagnostic capabilities available in outpatient clinics, with the potential to revolutionize the field of respiratory disease diagnosis. Findings from the 4 phases of the study will be presented as descriptions supported by relevant images, tables, and figures. The anticipated outcome of this research is the creation of a reliable, noninvasive diagnostic cough classifier that empowers health care professionals and patients themselves to identify and differentiate these respiratory diseases based on cough sound patterns. Conclusions: Cough sound classifiers use advanced technology for early detection and management of respiratory conditions, offering a less invasive and more efficient alternative to traditional diagnostics. This technology promises to ease public health burdens, improve patient outcomes, and enhance health care access in under-resourced areas, potentially transforming respiratory disease management globally. International Registered Report Identifier (IRRID): PRR1-10.2196/54388 ",
doi="10.2196/54388",
url="https://www.researchprotocols.org/2024/1/e54388",
url="http://www.ncbi.nlm.nih.gov/pubmed/38652526"
}


@Article{info:doi/10.2196/55327,
author="Yang, Cheng-hao
and Li, Xin-yu
and Lv, Jia-jie
and Hou, Meng-jie
and Zhang, Ru-hong
and Guo, Hong
and Feng, Chu",
title="Temporal Trends of Asthma Among Children in the Western Pacific Region From 1990 to 2045: Longitudinal Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="14",
volume="10",
pages="e55327",
keywords="allergic disorders",
keywords="global burden of disease",
keywords="disability-adjusted life years",
keywords="DALYs",
keywords="incidence",
keywords="prevalence",
abstract="Background: Asthma has become one of the most common chronic conditions worldwide, especially among children. Recent findings show that the prevalence of childhood asthma has increased by 12.6\% over the past 30 years, with >262 million people currently affected globally. The reasons for the growing asthma epidemic remain complex and multifactorial. Objective: This study aims to provide an up-to-date analysis of the changing global and regional asthma prevalence, mortality, disability, and risk factors among children aged <20 years by leveraging the latest data from the Global Burden of Disease Study 2019. Findings from this study can help inform priority areas for intervention to alleviate the rising burden of childhood asthma globally. Methods: The study used data from the Global Burden of Disease Study 2019, concentrating on children aged 0 to 14 years with asthma. We conducted an in-depth analysis of asthma, including its age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs), across diverse demographics, such as region, age, sex, and sociodemographic index, spanning 1990 to 2019. We also projected the future burden of the disease. Results: Overall, in the Western Pacific Region, the age-standardized prevalence rate of asthma among children increased slightly, from 3898.4 cases per 100,000 people in 1990 to 3924 per 100,000 in 2019. The age-standardized incidence rate of asthma also increased slightly, from 979.2 to 994.9 per 100,000. In contrast, the age-standardized death rate of asthma decreased from 0.9 to 0.4 per 100,000 and the age-standardized DALY rate decreased from 234.9 to 189.7 per 100,000. At the country level, Japan experienced a considerable decrease in the age-standardized prevalence rate of asthma among children, from 6669.1 per 100,000 in 1990 to 5071.5 per 100,000 in 2019. Regarding DALYs, Japan exhibited a notable reduction, from 300.6 to 207.6 per 100,000. Malaysia also experienced a DALY rate reduction, from 188.4 to 163.3 per 100,000 between 1990 and 2019. We project that the burden of disease in countries other than Japan and the Philippines will remain relatively stable up to 2045. Conclusions: The study indicates an increase in the prevalence and incidence of pediatric asthma, coupled with a decrease in mortality and DALYs in the Western Pacific Region between 1990 and 2019. These intricate phenomena appear to result from a combination of lifestyle shifts, environmental influences, and barriers to health care access. The findings highlight that nations such as Japan have achieved notable success in managing asthma. Overall, the study identified areas of improvement in view of persistent disease burden, underscoring the need for comprehensive collaborative efforts to mitigate the impact of pediatric asthma throughout the region. ",
doi="10.2196/55327",
url="https://publichealth.jmir.org/2024/1/e55327",
url="http://www.ncbi.nlm.nih.gov/pubmed/38483459"
}


@Article{info:doi/10.2196/51150,
author="Chien, Shih-Ying
and Wong, May-Kuen Alice
and Tseng, Winston
and Hu, Han-Chung
and Cho, Hsiu-Ying",
title="Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="7",
volume="11",
pages="e51150",
keywords="chronic lung diseases",
keywords="home-based pulmonary rehabilitation",
keywords="telehealth",
keywords="remote health care",
abstract="Background: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Objective: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. Methods: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. Results: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. Conclusions: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design. ",
doi="10.2196/51150",
url="https://humanfactors.jmir.org/2024/1/e51150",
url="http://www.ncbi.nlm.nih.gov/pubmed/38452366"
}


@Article{info:doi/10.2196/47441,
author="Swift, Jim
and O'Kelly, Noel
and Barker, Chris
and Woodward, Alex
and Ghosh, Sudip",
title="A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="13",
volume="8",
pages="e47441",
keywords="Covid-19",
keywords="telemedicine",
keywords="digital technology",
keywords="home transition",
keywords="length of stay",
keywords="cost-effectiveness analysis",
keywords="cost",
keywords="costs",
keywords="economic",
keywords="economics",
keywords="telehealth",
keywords="hospitalization",
keywords="hospital",
keywords="hospitals",
keywords="hospitalizations",
keywords="resource",
keywords="resources",
keywords="hospital stay",
keywords="ward",
keywords="wards",
keywords="virtual care",
keywords="remote care",
keywords="financial",
keywords="finance",
keywords="finances",
keywords="remote",
keywords="respiratory",
keywords="SARS-CoV-2",
keywords="pulmonary",
keywords="lung",
keywords="lungs",
keywords="service",
keywords="services",
keywords="delivery",
abstract="Background: The COVID-19 pandemic stressed global health care systems' acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England's National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. Objective: The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. Methods: There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90\%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10\%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. Results: In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US \$504,197 in net financial savings across the 2 key groups of patients---those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US \$1850 and US \$1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9\%, which was below comparative data. The mean cost of the intervention was US \$223.53 per patient, 12.1\% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4\% in the sensitivity analysis that the intervention was no longer cost saving. Conclusions: The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost. ",
doi="10.2196/47441",
url="https://formative.jmir.org/2024/1/e47441",
url="http://www.ncbi.nlm.nih.gov/pubmed/38349716"
}


@Article{info:doi/10.2196/47555,
author="Pierz, A. Kerri
and Locantore, Nicholas
and McCreary, Gretchen
and Calvey, J. Robert
and Hackney, Nickole
and Doshi, Pooja
and Linnell, John
and Sundaramoorthy, Abirammy
and Reed, R. Carol
and Yates, Julie",
title="Investigation of the Impact of Wellinks on the Quality of Life and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Interventional Research Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="9",
volume="8",
pages="e47555",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="health coaching",
keywords="pulmonary rehabilitation",
keywords="remote care",
keywords="disease management",
keywords="patient engagement",
keywords="Wellinks",
keywords="digital health",
keywords="adult",
keywords="mobile app",
keywords="remote model of care",
keywords="mobile phone",
abstract="Background: Wellinks is a remote disease management solution that provides novel chronic obstructive pulmonary disease (COPD) care delivery. Objective: This study evaluated the satisfaction, engagement, and clinical outcomes of Wellinks participants. This study also investigated the cadence of health coaching for patients with COPD. Methods: A 24-week interventional study was conducted by Wellinks and the COPD Foundation in 2022. Adults with COPD were recruited by the COPD Foundation in the United States and determined to be eligible if they had phone and internet access, owned a smartphone, and were not currently participating in pulmonary rehabilitation. All study participants provided written informed consent. The Wellinks solution included remote health coaching, pulmonary rehabilitation, and group education; participants were provided the Wellinks app and smart spirometry and pulse oximetry devices. Participants were offered 6 coaching sessions in the first 12 weeks. For the second 12-week period, participants either reduced frequency or discontinued coaching; all other components of the Wellinks solution remained unchanged. The COPD Self-Efficacy Scale, Modified Medical Research Council dyspnea scale, pulmonary function, pulse oximetry, and patient-reported healthcare resource utilization were the clinical outcome measures. Nonclinical outcomes included engagement and satisfaction with Wellinks and net promoter score. Results: In total, 141 adults consented and completed Wellinks onboarding; 84.4\% (n=119) of whom remained engaged throughout the 24-week study. Participants had a mean age of 70 (SD 7.8; range 48-88) years, and 55.7\% (n=78) were female. Most participants (n=119, 84.4\%) completed all 6 coaching sessions during the first 12-week period. Compliance with spirometer and pulse oximeter use was 82.3\% and 89.4\%, respectively, at week 1 but waned over the study period to 8.5\% and 9.2\%, respectively, at the end of the study. Participants indicated a high degree of satisfaction with Wellinks, with 95.5\% (n=85) and 91\% (n=81) of participants indicating that they agreed or strongly agreed that the educational content and health coaching, respectively, were valuable. At the end of the study, the net promoter score was +64 and +55 in the coaching continuation and discontinuation arms, respectively. A significant improvement from baseline to end of the study was observed in the COPD Self-Efficacy Scale total score (P<.001) and domain scores (P<.001 for each domain). In total, 35.1\% (n=27) of participants improved by at least 1 category of change on the 5-point Modified Medical Research Council dyspnea scale from baseline to week 24. Conclusions: This study confirmed the feasibility of using a remote model of care delivery to support people living with COPD. The insights gained in this study have allowed for further refinement and personalization of the Wellinks care model. Findings related to the combined use of technology and personal care delivery should be considered by others developing remote disease management tools. Trial Registration: ClinicalTrials.gov NCT05259280; https://clinicaltrials.gov/ct2/show/NCT05259280 ",
doi="10.2196/47555",
url="https://formative.jmir.org/2024/1/e47555",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335023"
}


@Article{info:doi/10.2196/48497,
author="Fuller, Joshua
and Abramov, Alexey
and Mullin, Dana
and Beck, James
and Lemaitre, Philippe
and Azizi, Elham",
title="A Deep Learning Framework for Predicting Patient Decannulation on Extracorporeal Membrane Oxygenation Devices: Development and Model Analysis Study",
journal="JMIR Biomed Eng",
year="2024",
month="Feb",
day="2",
volume="9",
pages="e48497",
keywords="extracorporeal membrane oxygenation",
keywords="ECMO",
keywords="venovenous",
keywords="VV",
keywords="machine learning",
keywords="supervised learning",
keywords="dynamic data",
keywords="time series",
keywords="clinical decision support",
keywords="artificial intelligence",
keywords="AI",
keywords="clinical AI",
keywords="health informatics",
abstract="Background: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a therapy for patients with refractory respiratory failure. The decision to decannulate someone from extracorporeal membrane oxygenation (ECMO) often involves weaning trials and clinical intuition. To date, there are limited prognostication metrics to guide clinical decision--making to determine which patients will be successfully weaned and decannulated. Objective: This study aims to assist clinicians with the decision to decannulate a patient from ECMO, using Continuous Evaluation of VV-ECMO Outcomes (CEVVO), a deep learning--based model for predicting success of decannulation in patients supported on VV-ECMO. The running metric may be applied daily to categorize patients into high-risk and low-risk groups. Using these data, providers may consider initiating a weaning trial based on their expertise and CEVVO. Methods: Data were collected from 118 patients supported with VV-ECMO at the Columbia University Irving Medical Center. Using a long short-term memory--based network, CEVVO is the first model capable of integrating discrete clinical information with continuous data collected from an ECMO device. A total of 12 sets of 5-fold cross validations were conducted to assess the performance, which was measured using the area under the receiver operating characteristic curve (AUROC) and average precision (AP). To translate the predicted values into a clinically useful metric, the model results were calibrated and stratified into risk groups, ranging from 0 (high risk) to 3 (low risk). To further investigate the performance edge of CEVVO, 2 synthetic data sets were generated using Gaussian process regression. The first data set preserved the long-term dependency of the patient data set, whereas the second did not. Results: CEVVO demonstrated consistently superior classification performance compared with contemporary models (P<.001 and P=.04 compared with the next highest AUROC and AP). Although the model's patient-by-patient predictive power may be too low to be integrated into a clinical setting (AUROC 95\% CI 0.6822-0.7055; AP 95\% CI 0.8515-0.8682), the patient risk classification system displayed greater potential. When measured at 72 hours, the high-risk group had a successful decannulation rate of 58\% (7/12), whereas the low-risk group had a successful decannulation rate of 92\% (11/12; P=.04). When measured at 96 hours, the high- and low-risk groups had a successful decannulation rate of 54\% (6/11) and 100\% (9/9), respectively (P=.01). We hypothesized that the improved performance of CEVVO was owing to its ability to efficiently capture transient temporal patterns. Indeed, CEVVO exhibited improved performance on synthetic data with inherent temporal dependencies (P<.001) compared with logistic regression and a dense neural network. Conclusions: The ability to interpret and integrate large data sets is paramount for creating accurate models capable of assisting clinicians in risk stratifying patients supported on VV-ECMO. Our framework may guide future incorporation of CEVVO into more comprehensive intensive care monitoring systems. ",
doi="10.2196/48497",
url="https://biomedeng.jmir.org/2024/1/e48497",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875691"
}


@Article{info:doi/10.2196/38064,
author="Morsa, Maxime
and Perrin, Am{\'e}lie
and David, Val{\'e}rie
and Rault, Gilles
and Le Roux, Enora
and Alberti, Corinne
and Gagnayre, R{\'e}mi
and Pougheon Bertrand, Dominique",
title="Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="23",
volume="8",
pages="e38064",
keywords="cystic fibrosis",
keywords="mobile health",
keywords="mHealth",
keywords="patient education",
keywords="chronic disease",
keywords="empowerment",
keywords="devices",
keywords="patients",
keywords="detection",
keywords="treatment",
keywords="respiratory",
keywords="education",
keywords="monitoring",
keywords="care",
abstract="Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. Objective: This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users' point of view to detect PEx early and treat it. This study focused on the patients' experiences as the first and main users of home monitoring. Methods: A qualitative study was conducted to explore patients' and professionals' experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. Results: A total of 20 patients completed the study. Three main categories emerged from the patients' verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients' learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. Conclusions: We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 ",
doi="10.2196/38064",
url="https://formative.jmir.org/2024/1/e38064",
url="http://www.ncbi.nlm.nih.gov/pubmed/38261372"
}


@Article{info:doi/10.2196/52517,
author="Evans, Laura
and Evans, Jay
and Fletcher, Monica
and Abdullah, Adina
and Ahmed, Zakiuddin",
title="Mapping Respiratory Health Digital Interventions in South and Southeast Asia: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="12",
volume="13",
pages="e52517",
keywords="digital health",
keywords="respiratory health",
keywords="Asia",
keywords="scoping review",
keywords="landscape mapping",
keywords="digital health intervention",
keywords="digital health environment",
keywords="mobile health",
keywords="mHealth",
abstract="Background: The last 2 decades have been a time of exponential growth and maturation for digital health, while the global burden of respiratory disease continues to grow worldwide. Leveraging digital health interventions (DHIs) to manage and mitigate respiratory disease and its adverse health effects presents itself as an obvious path forward. Objective: We aimed to understand the current digital landscape and enabling environment around respiratory health to reduce costs, avoid duplication, and understand the comprehensiveness of DHIs. Methods: This study will follow a scoping review methodology as outlined by Arksey and O'Malley, the Joanna Briggs Institute, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, PakiMedNet, and MyMedR databases will be searched along with key websites, repositories, and gray literature databases. The terms ``respiratory health,'' ``digital health,'' ``South Asia,'' and ``Southeast Asia,'' as well as related terms will be searched. The results will be screened for duplicates and then against the inclusion and exclusion criteria. For the studies included, data will be extracted, collated, and analyzed. Results: The scoping review was started in July 2023 and will be finalized by February 2024. Results will be presented following the World Health Organization's classification of DHIs to categorize interventions in a standardized format and the mobile health evidence reporting and assessment checklist to report on the effectiveness of interventions. Further exposition of the evidence extracted will be presented through narrative synthesis. Conclusions: As DHIs continue to proliferate, the need to understand the current landscape becomes more pertinent. In this scoping review, we will seek to more clearly understand what digital health tools and technologies are being used in the current landscape of digital health in South and Southeast Asia for respiratory health and to what extent they are addressing the respiratory health needs of the region. The results will inform recommendations on digital health tools for respiratory health in South and Southeast Asia will help funders and implementers of DHIs leverage existing technologies and accelerate innovations that address documented gaps in the studied countries. International Registered Report Identifier (IRRID): DERR1-10.2196/52517 ",
doi="10.2196/52517",
url="https://www.researchprotocols.org/2024/1/e52517",
url="http://www.ncbi.nlm.nih.gov/pubmed/38214954"
}


@Article{info:doi/10.2196/49705,
author="Fleischman, Alyssa
and Lerner, Carlos
and Kloster, Heidi
and Chung, Paul
and Klitzner, Thomas
and Cushing, Christopher
and Gerber, Danielle
and Katz, Barbara
and Warner, Gemma
and Singh-Verdeflor, Devi Kristina
and Delgado-Martinez, Roxana
and Porras-Javier, Lorena
and Ia, Siem
and Wagner, Teresa
and Ehlenbach, Mary
and Coller, Ryan",
title="Adaptive Intervention to Prevent Respiratory Illness in Cerebral Palsy: Protocol for a Feasibility Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="8",
volume="13",
pages="e49705",
keywords="just-in-time adaptive intervention",
keywords="respiratory illness",
keywords="cerebral palsy",
keywords="action planning",
keywords="digital health",
abstract="Background: This study will pilot-test an innovative just-in-time adaptive intervention to reduce severe respiratory illness among children with severe cerebral palsy (CP). Our intervention program, Respiratory Exacerbation--Plans for Action and Care Transitions (RE-PACT), delivers timely customized action planning and rapid clinical response when hospitalization risk is elevated. Objective: This study aims to establish RE-PACT's feasibility, acceptability, and fidelity in up to 90 children with severe CP. An additional aim is to preliminarily estimate RE-PACT's effect size. Methods: The study will recruit up to 90 caregivers of children with severe CP aged 0 to 17 years who are cared for by a respiratory specialist or are receiving daily respiratory treatments. Participants will be recruited from pediatric complex care programs at the University of Wisconsin--Madison (UW) and the University of California, Los Angeles (UCLA). Study participants will be randomly assigned to receive usual care through the complex care clinical program at UW or UCLA or the study intervention, RE-PACT. The intervention involves action planning, rapid clinical response to prevent and manage respiratory illness, and weekly SMS text messaging surveillance of caregiver confidence for their child to avoid hospitalization. RE-PACT will be run through 3 successively larger 6-month trial waves, allowing ongoing protocol refinement according to prespecified definitions of success for measures of feasibility, acceptability, and fidelity. The feasibility measures include recruitment and intervention time. The acceptability measures include recruitment and completion rates as well as intervention satisfaction. The fidelity measures include observed versus expected rates of intervention and data collection activities. The primary clinical outcome is a severe respiratory illness, defined as a respiratory diagnosis requiring hospitalization. The secondary clinical outcomes include?hospital days and emergency department visits, systemic steroid courses, systemic antibiotic courses, and death from severe respiratory illness. Results: The recruitment of the first wave began on April 27, 2022. To date, we have enrolled 30 (33\%) out of 90 participants, as projected. The final wave of recruitment will end by October 31, 2023, and the final participant will complete the study by April 30, 2024. We will start analyzing the complete responses by April 30, 2024, and the publication of results is expected at the end of 2024. Conclusions: This pilot intervention, using adaptive just-in-time strategies, represents a novel approach to reducing the incidence of significant respiratory illness for children with severe CP. This protocol may be helpful to other researchers and health care providers caring for patients at high risk for acute severe illness exacerbations. Trial Registration: ClinicalTrials.gov NCT05292365; https://clinicaltrials.gov/study/NCT05292365 International Registered Report Identifier (IRRID): DERR1-10.2196/49705 ",
doi="10.2196/49705",
url="https://www.researchprotocols.org/2024/1/e49705",
url="http://www.ncbi.nlm.nih.gov/pubmed/38190242"
}


@Article{info:doi/10.2196/51065,
author="Reid, Denzil
and Mehta, Jyotsna
and Anis, Karim
and Mehta, Shail",
title="Impact of Remote Patient Monitoring Platform on Patients With Moderate to Severe Persistent Asthma: Observational Study",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="28",
volume="7",
pages="e51065",
keywords="asthma",
keywords="remote patient monitoring",
keywords="virtual care solution",
keywords="respiratory care",
keywords="chronic disease management",
keywords="spirometry",
keywords="telehealth",
keywords="management",
keywords="chronic disease",
keywords="virtual care",
keywords="patient monitoring",
keywords="respiratory",
keywords="respiratory illness",
keywords="patient monitoring tool",
keywords="tool",
keywords="decision-making",
abstract="Background: Asthma is one of the most common respiratory diseases, with an ever-growing health care burden. Remote patient monitoring (RPM) has gained increasing importance in the respiratory care area with the outbreak of the COVID-19 pandemic. In this pilot study, we introduced a novel platform that remotely monitors patients with chronic respiratory illnesses using Centers for Disease Control and Prevention guidelines to reduce hospitalizations and emergency department visits. Objective: This study aimed to understand patient and physician engagement with a new virtual care solution (KevaTalk app and Keva365 platform) and the value, for both patients and providers, of using an RPM tool. We assessed real-world use of the platform from both physician and patient perspectives and the impact of devices on engagement and monitoring. Methods: Participants with a history of moderate to severe persistent asthma, seen by a pulmonologist at a hospital, were included in this study. The inclusion criteria involved being aged ?18 years and having access to an Android or iOS mobile device with internet. We provided patient questionnaires to assess the app's usefulness and evaluate its features. We monitored remote spirometry and oximetry data, app check-ins, alerts, and escalations during this study's time window. Data were reviewed daily and predetermined criteria were set to escalate for physician review based on the patient's symptoms and objective data. Results: Overall, 25 patients were included in this pilot. The mean age was 57 (SD 10.7) years and a majority (n=23, 92\%) were female. A baseline questionnaire, which was used to rate the app, indicated that the ease of check-in and ease of modification to the patient's asthma plan were the 2 highest rated features. In total, 2066 check-ins (1550 green, 506 yellow, and 10 red check-ins) and 1155 spirometry sessions were recorded during this 3-month period. Further, 64\% (14/22) and 91\% (20/22) of patients were found to have peak flows in their red and yellow zones at least once, respectively. During the course of this study, 484 alerts were recorded and evaluated by the team, of which 37.2\% (n=180) required an escalation to the physician; this included a transfer to a medical facility, change in respiratory medication, or further education. Conclusions: In this pilot study, we demonstrated the feasibility of implementing a novel RPM platform in patients with asthma. Our platform showed high patient engagement and satisfaction and provided physicians with real-time subjective data to evaluate patients remotely that aids in clinical decision-making. The escalations prevented patients from having an exacerbation or flare up, which led to the prevention of an emergency department visit. Continuous monitoring of chronic disease has benefits over episodic monitoring. It allows for improved quality of life, better outcomes, and huge health care savings. ",
doi="10.2196/51065",
url="https://formative.jmir.org/2023/1/e51065",
url="http://www.ncbi.nlm.nih.gov/pubmed/38153783"
}


@Article{info:doi/10.2196/41549,
author="Arnaert, Antonia
and Sumbly, Pia
and da Costa, Daniel
and Liu, Yuxin
and Debe, Zoumanan
and Charbonneau, Sylvain",
title="Acceptance of the Apple Watch Series 6 for Telemonitoring of Older Adults With Chronic Obstructive Pulmonary Disease: Qualitative Descriptive Study Part 1",
journal="JMIR Aging",
year="2023",
month="Dec",
day="26",
volume="6",
pages="e41549",
keywords="Apple Watch",
keywords="chronic obstructive pulmonary disease",
keywords="digital health",
keywords="older adults",
keywords="qualitative descriptive",
keywords="technology acceptance",
keywords="telemonitoring",
abstract="Background: The Apple Watch is not a medical device per se; it is a smart wearable device that is increasingly being used for health monitoring. Evidence exists that the Apple Watch Series 6 can reliably measure blood oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease under controlled circumstances. Objective: This study aimed to better understand older adults' acceptance of the Watch as a part of telemonitoring, even with these advancements. Methods: This study conducted content analysis on data collected from 10 older adults with chronic obstructive pulmonary disease who consented to wear the Watch. Results: Using the Extended Unified Theory of Acceptance and Use of Technology model, results showed that participants experienced potential health benefits; however, the inability of the Watch to reliably measure SpO2 when in respiratory distress was concerning. Participants' level of tech savviness varied, which caused some fear and frustration at the start, yet all felt supported by family and would have explored more features if they owned the Watch. All agreed that the Watch is mainly a medical tool and not a gadget. Conclusions: To conclude, although the Watch may enhance their physical health and well-being, results indicated that participants are more likely to accept the Watch if it ultimately proves to be useful when experiencing respiratory distress. ",
doi="10.2196/41549",
url="https://aging.jmir.org/2023/1/e41549",
url="http://www.ncbi.nlm.nih.gov/pubmed/38147371"
}


@Article{info:doi/10.2196/52553,
author="Lindstedt, Sandra
and Silverborn, Martin
and Lannemyr, Lukas
and Pierre, Leif
and Larsson, Hillevi
and Grins, Edgars
and Hyllen, Snejana
and Dellgren, Goran
and Magnusson, Jesper",
title="Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="13",
volume="12",
pages="e52553",
keywords="lung transplantation",
keywords="cytokine filtration",
keywords="primary graft dysfunction",
keywords="chronic lung allograft dysfunction",
keywords="randomized controlled clinical trial",
abstract="Background: Lung transplantation (LTx) is the only treatment option for end-stage lung disease. Despite improvements, primary graft dysfunction (PGD) remains the leading cause of early mortality and precipitates chronic lung allograft dysfunction, the main factor in late mortality after LTx. PGD develops within the first 72 hours and impairs the oxygenation capacity of the lung, measured as partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2). Increasing the PaO2/FiO2 ratio is thus critical and has an impact on survival. There is a general lack of effective treatments for PGD. When a transplanted lung is not accepted by the immune system in the recipient, a systemic inflammatory response starts where cytokines play a critical role in initiating, amplifying, and maintaining the inflammation leading to PGD. Cytokine filtration can remove these cytokines from the circulation, thus reducing inflammation. In a proof-of-concept preclinical porcine model of LTx, cytokine filtration improved oxygenation and decreased PGD. In a feasibility study, we successfully treated patients undergoing LTx with cytokine filtration (ClinicalTrials.gov; NCT05242289). Objective: The purpose of this clinical trial is to demonstrate the superiority of cytokine filtration in improving LTx outcome, based on its effects on oxygenation ratio, plasma levels of inflammatory markers, PGD incidence and severity, lung function, kidney function, survival, and quality of life compared with standard treatment with no cytokine filtration. Methods: This study is a Swedish national interventional randomized controlled trial involving 116 patients. Its primary objective is to investigate the potential benefits of cytokine filtration when used in conjunction with LTx. Specifically, this study aims to determine whether the application of cytokine filtration, administered for a duration of 12 hours within the initial 24 hours following a LTx procedure, can lead to improved patient outcomes. This study seeks to assess various aspects of patient recovery and overall health to ascertain the potential positive impact of this intervention on the posttransplantation course. Results: The process of patient recruitment for this study is scheduled to commence subsequent to a site initiation visit, which was slated to take place on August 28, 2023. The primary outcome measure that will be assessed in this research endeavor is the oxygenation ratio, a metric denoted as the highest PaO2/FiO2 ratio achieved by patients within a 72-hour timeframe following their LTx procedure. Conclusions: We propose that cytokine filtration could enhance the overall outcomes of LTx. Our hypothesis suggests potential improvements in LTx outcome and patient care. Trial Registration: ClinicalTrials.gov NCT05526950; https://www.clinicaltrials.gov/study/NCT05526950 International Registered Report Identifier (IRRID): PRR1-10.2196/52553 ",
doi="10.2196/52553",
url="https://www.researchprotocols.org/2023/1/e52553",
url="http://www.ncbi.nlm.nih.gov/pubmed/37855706"
}


@Article{info:doi/10.2196/49639,
author="Matthias, Katja
and Honekamp, Ivonne
and Heinrich, Monique
and De Santis, Karolina Karina",
title="Consideration of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Overview of Systematic Reviews",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="29",
volume="25",
pages="e49639",
keywords="digital technologies",
keywords="digital intervention",
keywords="COPD",
keywords="AMSTAR 2",
keywords="chronic obstructive pulmonary disease",
keywords="gender",
keywords="sex",
keywords="age",
keywords="overview",
keywords="systematic review",
keywords="treatment",
keywords="monitoring",
keywords="chronic disease",
keywords="chronic illness",
keywords="outcome reporting",
keywords="review methodology",
keywords="critical appraisal",
abstract="Background: Several systematic reviews have addressed digital technology use for treatment and monitoring of chronic obstructive pulmonary disease (COPD). Objective: This study aimed to assess if systematic reviews considered the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD through an overview of such systematic reviews. The objectives of this overview were to (1) describe the definitions of sex or gender used in reviews; (2) determine whether the consideration of sex, gender, or age was planned in reviews; (3) determine whether sex, gender, or age was reported in review results; (4) determine whether sex, gender, or age was incorporated in implications for clinical practice in reviews; and (5) create an evidence map for development of individualized clinical recommendations for COPD based on sex, gender, or age diversity. Methods: MEDLINE, the Cochrane Library, Epistemonikos, Web of Science, and the bibliographies of the included systematic reviews were searched to June 2022. Inclusion was based on the PICOS framework: (1) population (COPD), (2) intervention (any digital technology), (3) comparison (any), (4) outcome (any), and (5) study type (systematic review). Studies were independently selected by 2 authors based on title and abstract and full-text screening. Data were extracted by 1 author and checked by another author. Data items included systematic review characteristics; PICOS criteria; and variables related to sex, gender, or age. Systematic reviews were appraised using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data were synthesized using descriptive statistics. Results: Of 1439 records, 30 systematic reviews published between 2010 and 2022 were included in this overview. The confidence in the results of 25 of the 30 (83\%) reviews was critically low according to AMSTAR 2. The reviews focused on user outcomes that potentially depend on sex, gender, or age, such as efficacy or effectiveness (25/30, 83\%) and acceptance, satisfaction, or adherence (3/30, 10\%) to digital technologies for COPD. Reviews reported sex or gender (19/30 systematic reviews) or age (25/30 systematic reviews) among primary study characteristics. However, only 1 of 30 reviews included age in a subgroup analysis, and 3 of 30 reviews identified the effects of sex, gender, or age as evidence gaps. Conclusions: This overview shows that the effects of sex, gender, or age were rarely considered in 30 systematic reviews of digital technologies for COPD treatment and monitoring. Furthermore, systematic reviews did not incorporate sex, gender, nor age in their implications for clinical practice. We recommend that future systematic reviews should (1) evaluate the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD and (2) better adhere to reporting guidelines to improve the confidence in review results. Trial Registration: PROSPERO CRD42022322924; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=322924 International Registered Report Identifier (IRRID): RR2-10.2196/40538 ",
doi="10.2196/49639",
url="https://www.jmir.org/2023/1/e49639/"
}


@Article{info:doi/10.2196/41811,
author="Candelo, Estephania
and Arias-Valderrama, Oriana
and Trivi{\~n}o-Arias, Jacobo
and Quiroz, Felipe
and Isaza-Pierotti, Francisco Daniel
and Victoria, William
and Tintinago, F. Luis",
title="Airway Sequelae After Mechanical Ventilation for COVID-19: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="29",
volume="12",
pages="e41811",
keywords="airway",
keywords="sequelae",
keywords="COVID-19",
keywords="mechanical ventilation",
keywords="SARS-CoV-2",
keywords="scoping review",
keywords="pulmonary",
keywords="mortality",
keywords="voice production",
keywords="health care cost",
keywords="health intervention",
abstract="Background: The epidemiology, morbidity, and burden of disease related to airway sequelae associated with invasive mechanical ventilation in the context of the COVID-19 pandemic remain unclear. Objective: This scoping review aims to summarize the current knowledge regarding airway sequelae after severe SARS-CoV-2 infection. This knowledge will help guide research endeavors and decision-making in clinical practice. Methods: This scoping review will include participants of all genders, and no particular age group who developed post--COVID-19 airway-related complication will be excluded. No exclusion criteria will be applied from country, language, or document type. The information source will include analytical observational studies. Unpublished data will not be completely covered as gray literature will be covered. A total of 2 independent reviewers will participate in the process of screening, selection, and data extraction, and the whole process will be performed blindly. Conflict between the reviewers will be solved through discussion and an additional reviewer. The results will be reported by using descriptive statistics, and information will be displayed on RedCap (Research Electronic Data Capture). Results: The literature search was conducted in May 2022 in the following databases: PubMed, Embase, SCOPUS, Cochrane Library, as well as LILACS and gray literature to identify observational studies; a total of 738 results were retrieved. The scoping review will be finished by March 2023. Conclusions: This scoping review will describe current knowledge on the most frequently encountered laryngeal or tracheal sequelae in patients exposed to mechanical ventilation due to SARS-CoV-2 infection. This scoping review will find the incidence of airway sequelae post COVID-19 and the most common sequelae such as airway granuloma, vocal fold paralysis, and airway stenoses. Future studies should evaluate the incidence of these disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/41811 ",
doi="10.2196/41811",
url="https://www.researchprotocols.org/2023/1/e41811",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191952"
}


@Article{info:doi/10.2196/51507,
author="Althobiani, A. Malik
and Ranjan, Yatharth
and Jacob, Joseph
and Orini, Michele
and Dobson, Butler Richard James
and Porter, C. Joanna
and Hurst, R. John
and Folarin, A. Amos",
title="Evaluating a Remote Monitoring Program for Respiratory Diseases: Prospective Observational Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="24",
volume="7",
pages="e51507",
keywords="remote monitoring",
keywords="home health care",
keywords="mHealth",
keywords="mobile health",
keywords="apps",
keywords="applications",
keywords="wearables",
keywords="passive data collection",
keywords="data collection",
keywords="retention",
keywords="engagement",
keywords="attrition",
keywords="dropout",
keywords="spirometry",
keywords="oximetry",
keywords="home based",
keywords="machine learning",
keywords="artificial intelligence",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="pulmonary",
keywords="lungs",
keywords="respiratory",
keywords="interstitial lung disease",
keywords="ILD",
keywords="COVID-19",
keywords="respiratory diseases",
keywords="lung",
keywords="chronic",
keywords="SARS-CoV-2",
keywords="monitoring",
keywords="observational",
keywords="cohort",
keywords="feasibility",
keywords="usability",
keywords="acceptability",
keywords="community based",
keywords="self-management",
abstract="Background: Patients with chronic respiratory diseases and those in the postdischarge period following hospitalization because of COVID-19 are particularly vulnerable, and little is known about the changes in their symptoms and physiological parameters. Continuous remote monitoring of physiological parameters and symptom changes offers the potential for timely intervention, improved patient outcomes, and reduced health care costs. Objective: This study investigated whether a real-time multimodal program using commercially available wearable technology, home-based Bluetooth-enabled spirometers, finger pulse oximeters, and smartphone apps is feasible and acceptable for patients with chronic respiratory diseases, as well as the value of low-burden, long-term passive data collection. Methods: In a 3-arm prospective observational cohort feasibility study, we recruited 60 patients from the Royal Free Hospital and University College Hospital. These patients had been diagnosed with interstitial lung disease, chronic obstructive pulmonary disease, or post--COVID-19 condition (n=20 per group) and were followed for 180 days. This study used a comprehensive remote monitoring system designed to provide real-time and relevant data for both patients and clinicians. Data were collected using REDCap (Research Electronic Data Capture; Vanderbilt University) periodic surveys, Remote Assessment of Disease and Relapses--base active app questionnaires, wearables, finger pulse oximeters, smartphone apps, and Bluetooth home-based spirometry. The feasibility of remote monitoring was measured through adherence to the protocol, engagement during the follow-up period, retention rate, acceptability, and data integrity. Results: Lowest-burden passive data collection methods, via wearables, demonstrated superior adherence, engagement, and retention compared with active data collection methods, with an average wearable use of 18.66 (SD 4.69) hours daily (77.8\% of the day), 123.91 (SD 33.73) hours weekly (72.6\% of the week), and 463.82 (SD 156.70) hours monthly (64.4\% of the month). Highest-burden spirometry tasks and high-burden active app tasks had the lowest adherence, engagement, and retention, followed by low-burden questionnaires. Spirometry and active questionnaires had the lowest retention at 0.5 survival probability, indicating that they were the most burdensome. Adherence to and quality of home spirometry were analyzed; of the 7200 sessions requested, 4248 (59\%) were performed. Of these, 90.3\% (3836/4248) were of acceptable quality according to American Thoracic Society grading. Inclusion of protocol holidays improved retention measures. The technologies used were generally well received. Conclusions: Our findings provide evidence supporting the feasibility and acceptability of remote monitoring for capturing both subjective and objective data from various sources for respiratory diseases. The high engagement level observed with passively collected data suggests the potential of wearables for long-term, user-friendly remote monitoring in respiratory disease management. The unique piloting of certain features such as protocol holidays, alert notifications for missing data, and flexible support from the study team provides a reference for future studies in this field. International Registered Report Identifier (IRRID): RR2-10.2196/28873 ",
doi="10.2196/51507",
url="https://formative.jmir.org/2023/1/e51507",
url="http://www.ncbi.nlm.nih.gov/pubmed/37999935"
}


@Article{info:doi/10.2196/44802,
author="Rzepka-Wrona, Patrycja
and Skoczy?ski, Szymon
and Piotrowski, J. Wojciech
and Jassem, Ewa
and Ziora, Dariusz
and Barczyk, Adam",
title="Characteristics of Interstitial Pneumonia With Autoimmune Features (IPAF): Protocol for a Multicenter Prospective Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="17",
volume="12",
pages="e44802",
keywords="IPAF",
keywords="interstitial pneumonia with autoimmune features",
keywords="CTD",
keywords="connective tissue disease",
keywords="interstitial lung disease",
keywords="idiopathic interstitial pneumonia",
keywords="lung disease",
keywords="pneumonia",
keywords="respiratory",
keywords="radiology",
abstract="Background: ``Interstitial lung disease'' (ILD) is a broad term encompassing diseases of different backgrounds. ``Interstitial pneumonia with autoimmune features'' (IPAF) is a recent term that implies the presence of autoimmunity. Objective: This study aims to determine the characteristics of Polish patients with IPAF, compare them with patients with other interstitial pneumonias, and search for the prognostic and diagnostic biomarkers of IPAF in serum and bronchoalveolar lavage fluid (BALF). Methods: This multicenter prospective study plans to recruit 240 participants divided into 1 study group and 2 control groups. Biological fluid samples will be collected according to Polish Respiratory Society management guidelines and stored at --80{\textdegree}C for further tests. Prospective 5-year observations of 60 newly diagnosed individuals are planned. The study will be divided into subsections. First, we plan to characterize Polish patients with IPAF (study group) against their peers with other ILDs (2 control groups). Control group 1 will comprise patients with idiopathic ILDs, including mainly idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Control group 2 will comprise patients with connective tissue disease--associated interstitial lung diseases, such as rheumatoid arthritis, systemic sclerosis, polymyositis, dermatomyositis, Sj{\"o}gren's syndrome, mixed connective tissue disease, and systemic lupus erythematosus. Radiological and functional parameters will be analyzed. Patients will be compared in terms of high-resolution computed tomography results, the 6-minute walking test performance, and pulmonary function test parameters. The diagnosis of IPAF will be reassessed on a regular basis through multidisciplinary discussion in order to determine its clinical stability. In the laboratory arm, inflammation and fibrosis pathways will be assessed. Cytokine levels (interleukin 8, transforming growth factor beta 1, chemokine C-C motif ligand [CXCL]18, CXCL1, surfactant protein [SP]-A, SP-D, Krebs von den Lungen-6 protein, and chitinase 1) will be measured in serum and BALF. A comparative analysis of serum and BALF cytokine levels will be performed in order to establish potential differences between systemic and local inflammatory pathways. In the quality of life (QoL) arm of the study, dyspnea and cough and their impact on various aspects of the QoL will be assessed. Depression and anxiety will be measured with the Hospital Anxiety and Depression Modified Scale and the 9-item Patient Health Questionnaire, and potential correlations with symptom prevalence will be assessed. Results: This study will start recruiting patients to phase 1 in October 2023. The final results will be available in 2028. We plan to publish preliminary results after 2-3 years from the start of phase 1. Conclusions: This study will be a step toward a better understanding of IPAF etiopathogenesis and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/44802 ",
doi="10.2196/44802",
url="https://www.researchprotocols.org/2023/1/e44802",
url="http://www.ncbi.nlm.nih.gov/pubmed/37976081"
}


@Article{info:doi/10.2196/45624,
author="Padhye, Rashmi
and Sahasrabudhe, D. Shruti
and Orme, W. Mark
and Pina, Ilaria
and Dhamdhere, Dipali
and Borade, Suryakant
and Bhakare, Meenakshi
and Ahmed, Zahira
and Barton, Andy
and Modi, Mahavir
and Malcolm, Dominic
and Salvi, Sundeep
and Singh, J. Sally",
title="Perspectives of Patients With Chronic Respiratory Diseases and Medical Professionals on Pulmonary Rehabilitation in Pune, India: Qualitative Analysis",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="7",
volume="7",
pages="e45624",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="asthma",
keywords="patients' suffering",
keywords="self-management",
keywords="digital mode of PR",
keywords="integrating yoga with PR",
keywords="thematic qualitative analysis",
keywords="knowledge about PR",
keywords="barriers to PR",
keywords="chronic respiratory diseases",
keywords="CRD",
keywords="India",
keywords="pulmonary rehabilitation",
keywords="medical professional",
keywords="treatment",
keywords="inhaler",
abstract="Background: Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality worldwide and in India. Access to nonpharmacological options, such as pulmonary rehabilitation (PR), are, however, limited. Given the difference between need and availability, exploring PR, specifically remotely delivered PR, in a resource-poor setting, will help inform future work. Objective: This study explored the perceptions, experiences, needs, and challenges of patients with CRDs and the potential of and the need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR. Methods: In-depth qualitative semistructured interviews were conducted among 20 individuals diagnosed with CRDs and 9 medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the 2 participant groups. Results: The 20 patients considered lifestyle choices (smoking and drinking), a lack of physical activity, mental stress, and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and a lack of physical strength, consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice was an inhaler. Most of them believed that yoga and exercise are good self-management strategies, and some were performing yoga postures and breathing exercises, as advised by friends or family members or learned from a televised program or YouTube videos. None of them identified with the term ``pulmonary rehabilitation,'' but many were aware of the exercise component and its benefits. Despite being naive to smartphone technology or having difficulty in reading, most of them were enthusiastic about enrolling in an application-based remotely delivered digital PR program. The 9 medical professionals were, however, reluctant to depend on a PR program delivered entirely online. They recommended that patients with CRDs be supported by their family to use technology, with some time spent with a medical professional during the program. Conclusions: Patients with CRDs in India currently manage their disease with nonguided strategies but are eager to improve and would benefit from a guided PR program to feel better. A home-based PR program, with delivery facilitated by digital solutions, would be welcomed by patients and health care professionals involved in their care, as it would reduce the need for travel, specialist equipment, and setup. However, low digital literacy, low resource availability, and a lack of expertise are of concern to health care professionals. For India, including yoga could be a way of making PR ``culturally congruent'' and more successful. The digital PR intervention should be flexible to individual patient needs and should be complemented with physical sessions and a feedback mechanism for both practitioners as well as patients for better uptake and adherence. ",
doi="10.2196/45624",
url="https://formative.jmir.org/2023/1/e45624",
url="http://www.ncbi.nlm.nih.gov/pubmed/37934558"
}


@Article{info:doi/10.2196/41539,
author="Liu, Yuxin
and Arnaert, Antonia
and da Costa, Daniel
and Sumbly, Pia
and Debe, Zoumanan
and Charbonneau, Sylvain",
title="Experiences of Patients With Chronic Obstructive Pulmonary Disease Using the Apple Watch Series 6 Versus the Traditional Finger Pulse Oximeter for Home SpO2 Self-Monitoring: Qualitative Study Part 2",
journal="JMIR Aging",
year="2023",
month="Nov",
day="2",
volume="6",
pages="e41539",
keywords="Apple Watch",
keywords="chronic obstructive pulmonary disease",
keywords="pulse oximeter",
keywords="qualitative descriptive",
keywords="self-monitoring",
keywords="smartwatch",
abstract="Background: Amid the rise in mobile health, the Apple Watch now has the capability to measure peripheral blood oxygen saturation (SpO2). Although the company indicated that the Watch is not a medical device, evidence suggests that SpO2 measurements among patients with chronic obstructive pulmonary disease (COPD) are accurate in controlled settings. Yet, to our knowledge, the SpO2 function has not been validated for patients with COPD in naturalistic settings. Objective: This qualitative study explored the experiences of patients with COPD using the Apple Watch Series 6 versus a traditional finger pulse oximeter for home SpO2 self-monitoring. Methods: We conducted individual semistructured interviews with 8 female and 2 male participants with moderate to severe COPD, and transcripts were qualitatively analyzed. All received a watch to monitor their SpO2 for 5 months. Results: Due to respiratory distress, the watch was unable to collect reliable SpO2 measurements, as it requires the patient to remain in a stable position. However, despite the physical limitations and lack of reliable SpO2 values, participants expressed a preference toward the watch. Moreover, participants' health needs and their unique accessibility experiences influenced which device was more appropriate for self-monitoring purposes. Overall, all shared the perceived importance of prioritizing their physical COPD symptoms over device selection to manage their disease. Conclusions: Differing results between participant preferences and smartwatch limitations warrant further investigation into the reliability and accuracy of the SpO2 function of the watch and the balance among self-management, medical judgment, and dependence on self-monitoring technology. ",
doi="10.2196/41539",
url="https://aging.jmir.org/2023/1/e41539",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917147"
}


@Article{info:doi/10.2196/47146,
author="Vaussenat, Fabrice
and Bhattacharya, Abhiroop
and Payette, Julie
and Benavides-Guerrero, A. Jaime
and Perrotton, Alexandre
and Gerlein, Felipe Luis
and Cloutier, G. Sylvain",
title="Continuous Critical Respiratory Parameter Measurements Using a Single Low-Cost Relative Humidity Sensor: Evaluation Study",
journal="JMIR Biomed Eng",
year="2023",
month="Oct",
day="25",
volume="8",
pages="e47146",
keywords="relative humidity sensor",
keywords="design",
keywords="develop",
keywords="development",
keywords="tidal volume",
keywords="pulmonary volume",
keywords="COPD",
keywords="pulmonary",
keywords="respiratory",
keywords="sensor",
keywords="sensors",
keywords="wearables",
keywords="humidity",
keywords="medical device",
keywords="breathing",
keywords="wearable",
keywords="ventilation",
keywords="air",
abstract="Background: Accurate and portable respiratory parameter measurements are critical for properly managing chronic obstructive pulmonary diseases (COPDs) such as asthma or sleep apnea, as well as controlling ventilation for patients in intensive care units, during surgical procedures, or when using a positive airway pressure device for sleep apnea. Objective: The purpose of this research is to develop a new nonprescription portable measurement device that utilizes relative humidity sensors (RHS) to accurately measure key respiratory parameters at a cost that is approximately 10 times less than the industry standard. Methods: We present the development, implementation, and assessment of a wearable respiratory measurement device using the commercial Bosch BME280 RHS. In the initial stage, the RHS was connected to the pneumotach (PNT) gold standard device via its external connector to gather breathing metrics. Data collection was facilitated using the Arduino platform with a Bluetooth Low Energy connection, and all measurements were taken in real time without any additional data processing. The device's efficacy was tested with 7 participants (5 men and 2 women), all in good health. In the subsequent phase, we specifically focused on comparing breathing cycle and respiratory rate measurements and determining the tidal volume by calculating the region between inhalation and exhalation peaks. Each participant's data were recorded over a span of 15 minutes. After the experiment, detailed statistical analysis was conducted using ANOVA and Bland-Altman to examine the accuracy and efficiency of our wearable device compared with the traditional methods. Results: The perfused air measured with the respiratory monitor enables clinicians to evaluate the absolute value of the tidal volume during ventilation of a patient. In contrast, directly connecting our RHS device to the surgical mask facilitates continuous lung volume monitoring. The results of the 1-way ANOVA showed high P values of .68 for respiratory volume and .89 for respiratory rate, which indicate that the group averages with the PNT standard are equivalent to those with our RHS platform, within the error margins of a typical instrument. Furthermore, analysis utilizing the Bland-Altman statistical method revealed a small bias of 0.03 with limits of agreement (LoAs) of --0.25 and 0.33. The RR bias was 0.018, and the LoAs were --1.89 and 1.89. Conclusions: Based on the encouraging results, we conclude that our proposed design can be a viable, low-cost wearable medical device for pulmonary parametric measurement to prevent and predict the progression of pulmonary diseases. We believe that this will encourage the research community to investigate the application of RHS for monitoring the pulmonary health of individuals. ",
doi="10.2196/47146",
url="https://biomedeng.jmir.org/2023/1/e47146",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875670"
}


@Article{info:doi/10.2196/47114,
author="Pittara, Melpo
and Matsangidou, Maria
and Pattichis, S. Constantinos",
title="Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="Oct",
day="2",
volume="10",
pages="e47114",
keywords="breathing exercise",
keywords="breathing exercise gaming",
keywords="pulmonary rehabilitation",
keywords="respiratory biofeedback",
keywords="virtual reality",
abstract="Background: Pulmonary rehabilitation is a vital component of comprehensive care for patients with respiratory conditions, such as lung cancer, chronic obstructive pulmonary disease, and asthma, and those recovering from respiratory diseases like COVID-19. It aims to enhance patients' functional ability and quality of life, and reduce symptoms, such as stress, anxiety, and chronic pain. Virtual reality is a novel technology that offers new opportunities for customized implementation and self-control of pulmonary rehabilitation through patient engagement. Objective: This review focused on all types of virtual reality technologies (nonimmersive, semi-immersive, and fully immersive) that witnessed significant development and were released in the field of pulmonary rehabilitation, including breathing exercises, biofeedback systems, virtual environments for exercise, and educational models. Methods: The review screened 7 electronic libraries from 2010 to 2023. The libraries were ACM Digital Library, Google Scholar, IEEE Xplore, MEDLINE, PubMed, Sage, and ScienceDirect. Thematic analysis was used as an additional methodology to classify our findings based on themes. The themes were virtual reality training, interaction, types of virtual environments, effectiveness, feasibility, design strategies, limitations, and future directions. Results: A total of 2319 articles were identified, and after a detailed screening process, 32 studies were reviewed. Based on the findings of all the studies that were reviewed (29 with a positive label and 3 with a neutral label), virtual reality can be an effective solution for pulmonary rehabilitation in patients with lung cancer, chronic obstructive pulmonary disease, and asthma, and in individuals and children who are dealing with mental health--related disorders, such as anxiety. The outcomes indicated that virtual reality is a reliable and feasible solution for pulmonary rehabilitation. Interventions can provide immersive experiences to patients and offer tailored and engaging rehabilitation that promotes improved functional outcomes of pulmonary rehabilitation, breathing body awareness, and relaxation breathing techniques. Conclusions: The identified studies on virtual reality in pulmonary rehabilitation showed that virtual reality holds great promise for improving the outcomes and experiences of patients. The immersive and interactive nature of virtual reality interventions offers a new dimension to traditional rehabilitation approaches, providing personalized exercises and addressing psychological well-being. However, additional research is needed to establish standardized protocols, identify the most effective strategies, and evaluate long-term benefits. As virtual reality technology continues to advance, it has the potential to revolutionize pulmonary rehabilitation and significantly improve the lives of patients with chronic lung diseases. ",
doi="10.2196/47114",
url="https://rehab.jmir.org/2023/1/e47114",
url="http://www.ncbi.nlm.nih.gov/pubmed/37782529"
}


@Article{info:doi/10.2196/46358,
author="Huang, Houqiang
and Huang, Min
and Chen, Qi
and Hayter, Mark
and Watson, Roger",
title="Effects of Serious Games for Patients With Chronic Obstructive Pulmonary Disease: Systematic Literature Review",
journal="JMIR Serious Games",
year="2023",
month="Sep",
day="25",
volume="11",
pages="e46358",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="serious game",
keywords="rehabilitation",
keywords="review",
keywords="mobile phone",
abstract="Background: The use of serious games for rehabilitation has been an emerging intervention in health care fields, referred to as an entertaining and positive activity. Although related studies have been conducted on patients with chronic obstructive pulmonary disease (COPD), a more comprehensive study that summarizes and evaluates its effects in this area is needed. Objective: This review aimed to systematically evaluate the effects of serious games in promoting rehabilitation and related outcome measures of serious game--based engagement in patients with COPD. Methods: This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Searches were performed in the following databases: PubMed, Scopus, Embase (via Ovid), CINAHL, Science Direct, and China Biology Medicine disc. Only quantitative studies were included in this review, and the methodological quality and bias of the included studies were evaluated using related tools. Several outcomes, including clinical outcomes and serious game--based engagement outcomes, were ultimately collected in this review. The results were summarized and evaluated using descriptive methods due to significant heterogeneity. Results: In total, 11 studies were included. Serious games played a potentially positive effect on pulmonary function and exercise capacity. However, no consistent findings were reported on dyspnea and psychological status. Additionally, serious game engagement showed favorable findings on adherence, enjoyment, and acceptability. Furthermore, no serious adverse effects were identified in all included studies. Conclusions: This review preliminarily indicated the potential benefits of serious games in promoting rehabilitation for patients with COPD, despite the limited quality of the included studies. More studies with high methodological quality are needed to further explore the effects of serious games in this field. ",
doi="10.2196/46358",
url="https://games.jmir.org/2023/1/e46358",
url="http://www.ncbi.nlm.nih.gov/pubmed/37747768"
}


@Article{info:doi/10.2196/43737,
author="Molina-Luque, Rafael
and Molina-Recio, Guillermo
and de-Pedro--Jim{\'e}nez, Domingo
and {\'A}lvarez Fern{\'a}ndez, Carlos
and Garc{\'i}a--Rodr{\'i}guez, Mar{\'i}a
and Romero-Salda{\~n}a, Manuel",
title="The Impact of Metabolic Syndrome Risk Factors on Lung Function Impairment: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Sep",
day="5",
volume="9",
pages="e43737",
keywords="cardiometabolic risk factor",
keywords="lung function",
keywords="metabolic syndrome",
keywords="restrictive lung disease",
keywords="spirometry",
abstract="Background: Metabolic syndrome (MetS) is a constellation of risk factors increasingly present in the world's population. People with this syndrome are at an increased risk of cardiovascular disease and type 2 diabetes mellitus. Moreover, evidence has shown that it affects different organs. MetS and its risk factors are independently associated with impaired lung function, which can be quantified through spirometric variables. Objective: This study aims to determine whether a high number of MetS criteria is associated with increased lung function decline. Methods: We conducted a descriptive cross-sectional study with a random sample of 1980 workers. Workers with acute respiratory pathology (eg, influenza), chronic respiratory pathology (eg, chronic bronchitis), or exposure to substances harmful to the lungs (eg, organic and inorganic dust) were not included. MetS was established based on harmonized criteria, and lung function was assessed according to spirometric variables. On the basis of these, classification into restrictive lung disease (RLD), obstructive lung disease, and mixed lung disease (MLD) was performed. In addition, the association between MetS and lung function was established based on analysis of covariance, linear trend analysis, and multiple linear regression. Results: MetS was associated with worse lung function according to all the spirometric parameters analyzed (percentage of predicted forced expiratory volume in 1 second: mean 83, SD 13.8 vs mean 89.2, SD 12.8; P<.001 and percentage of predicted forced vital capacity: mean 85.9, SD 11.6 vs mean 92, SD 11.3; P<.001). Moreover, those diagnosed with MetS had a higher prevalence of lung dysfunction (41\% vs 21.9\%; P<.001), RLD (23.4\% vs 11.2\%; P<.001), and MLD (7.3\% vs 2.2\%; P<.001). Furthermore, an increasing number of MetS criteria was associated with a greater impairment of pulmonary mechanics (P<.001). Similarly, with an increasing number of MetS criteria, there was a significant linear trend (P<.001) in the growth of the prevalence ratio of RLD (0 criteria: 1, 1: 1.46, 2: 1.52, 3: 2.53, 4: 2.97, and 5: 5.34) and MLD (0 criteria: 1, 1: 2.68, 2: 6.18, 3: 9.69, and 4: 11.37). Regression analysis showed that the alteration of all MetS risk factors, adjusted for various explanatory variables, was significantly associated with a worsening of spirometric parameters, except for forced expiratory volume in 1 second/forced vital capacity. Conclusions: The findings have shown that an increase in cardiometabolic risk factors is associated with a more significant worsening of spirometric variables and a higher prevalence of RLD and MLD. As spirometry could be a crucial tool for monitoring patients at risk of developing chronic pathologies, we conclude that this inexpensive and easily accessible test could help detect changes in lung function in patients with cardiometabolic disorders. This highlights the need to consider the importance of cardiometabolic health in lung function when formulating public health policies. ",
doi="10.2196/43737",
url="https://publichealth.jmir.org/2023/1/e43737",
url="http://www.ncbi.nlm.nih.gov/pubmed/37669095"
}


@Article{info:doi/10.2196/49032,
author="de Lima, Francisco Fabiano
and Lunardi, Claudia Adriana
and Pinheiro, Ara{\'u}jo David Halen
and Carvalho-Pinto, Maria Regina
and Stelmach, Rafael
and Giavina?Bianchi, Pedro
and Agondi, C{\^a}mara Rosana
and Carvalho, RF Celso",
title="Identifying the Characteristics of Responders and Nonresponders in a Behavioral Intervention to Increase Physical Activity Among Patients With Moderate to Severe Asthma: Protocol for a Prospective Pragmatic Study",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="31",
volume="12",
pages="e49032",
keywords="asthma",
keywords="behavioral intervention",
keywords="physical activity",
keywords="responders",
abstract="Background: Previous research has suggested that most adults improve their asthma control after a short-term behavioral intervention program to increase physical activity in daily life (PADL). However, the characteristics of individuals who respond and do not respond to this intervention and the medium-term response remain unknown. Objective: This study aims to (1) identify the characteristics of adult responders and nonresponders with asthma to a behavioral intervention to increase physical activity and (2) evaluate the functional and clinical benefits in the medium term. Methods: This prospective pragmatic study will include adults with moderate to severe asthma who enroll in a behavioral intervention. All individuals will receive an educational program and an 8-week intervention to increase PADL (1 time/wk; up to 90 min/session). The educational program will be conducted in a class setting through group discussions and video presentations. Behavioral interventions will be based on the transtheoretical model using counseling, incentives, and individual feedback aiming to increase participation in physical activity. Motivational interviewing and guidelines for overcoming barriers will be used to stimulate individuals to reach their goals. Pre- and postintervention assessments will include the following: PADL (triaxial accelerometry), body composition (octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and exacerbations. ``Responders'' to the intervention will be defined as those who demonstrate an increase in the number of daily steps (?2500). Results: In December 2021, the clinical trial registration was approved. Recruitment and data collection for the trial is ongoing, and the results of this study are likely to be published in late 2024. Conclusions: The intervention will likely promote different effects according to the clinical characteristics of the individuals, including asthma control, age, anxiety and depression levels, obesity, and several comorbidities. Identifying individuals who respond or do not respond to behavioral interventions to increase PADL will help clinicians prescribe specific interventions to adults with asthma. Trial Registration: ClinicalTrials.gov NCT05159076; https://clinicaltrials.gov/ct2/show/NCT05159076 International Registered Report Identifier (IRRID): DERR1-10.2196/49032 ",
doi="10.2196/49032",
url="https://www.researchprotocols.org/2023/1/e49032",
url="http://www.ncbi.nlm.nih.gov/pubmed/37651174"
}


@Article{info:doi/10.2196/45955,
author="Kouri, Andrew
and Gupta, Samir
and Straus, E. Sharon
and Sale, M. Joanna E.",
title="Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="22",
volume="25",
pages="e45955",
keywords="older adults",
keywords="mHealth",
keywords="asthma",
keywords="chronic obstructive pulmonary disease",
keywords="qualitative research",
keywords="digital health",
keywords="qualitative study",
keywords="airway disease",
keywords="barrier",
keywords="health technology",
keywords="interview",
keywords="smartphone",
keywords="airway",
keywords="implementation",
keywords="mobile phone",
abstract="Background: The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. Objective: In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. Methods: Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults' use of airway mHealth. Results: Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults' use of asthma and COPD mHealth tools. Conclusions: Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts. ",
doi="10.2196/45955",
url="https://www.jmir.org/2023/1/e45955",
url="http://www.ncbi.nlm.nih.gov/pubmed/37606961"
}


@Article{info:doi/10.2196/47403,
author="Xu, Jiahong
and Shi, Yan
and Chen, Gongbo
and Guo, Yanfei
and Tang, Weiling
and Wu, Cuiling
and Liang, Shuru
and Huang, Zhongguo
and He, Guanhao
and Dong, Xiaomei
and Cao, Ganxiang
and Yang, Pan
and Lin, Ziqiang
and Zhu, Sui
and Wu, Fan
and Liu, Tao
and Ma, Wenjun",
title="Joint Effects of Long-Term Exposure to Ambient Fine Particulate Matter and Ozone on Asthmatic Symptoms: Prospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Aug",
day="3",
volume="9",
pages="e47403",
keywords="asthma",
keywords="joint association",
keywords="ozone",
keywords="PM2.5",
keywords="population attributable fraction",
keywords="air pollution",
keywords="long-term exposure",
abstract="Background: The associations of long-term exposure to air pollutants in the presence of asthmatic symptoms remain inconclusive and the joint effects of air pollutants as a mixture are unclear. Objective: We aimed to investigate the individual and joint associations of long-term exposure to ambient fine particulate matter (PM2.5) and daily 8-hour maximum ozone concentrations (MDA8 O3) in the presence of asthmatic symptoms in Chinese adults. Methods: Data were derived from the World Health Organization Study on Global Ageing and Adult Health (WHO SAGE) cohort study among adults aged 50 years or older, which was implemented in 1 municipality and 7 provinces across China during 2007-2018. Annual average MDA8 O3 and PM2.5 at individual residential addresses were estimated by an iterative random forest model and a satellite-based spatiotemporal model, respectively. Participants who were diagnosed with asthma by a doctor or taking asthma-related therapies or experiencing related conditions within the past 12 months were recorded as having asthmatic symptoms. The individual associations of PM2.5 and MDA8 O3 with asthmatic symptoms were estimated by a Cox proportional hazards regression model, and the joint association was estimated by a quantile g-computation model. A series of subgroup analyses was applied to examine the potential modifications of some characteristics. We also calculated the population-attributable fraction (PAF) of asthmatic symptoms attributed to PM2.5 and MDA8 O3. Results: A total of 8490 adults older than 50 years were included, and the average follow-up duration was 6.9 years. During the follow-up periods, 586 (6.9\%) participants reported asthmatic symptoms. Individual effect analyses showed that the risk of asthmatic symptoms was positively associated with MDA8 O3 (hazard ratio [HR] 1.12, 95\% CI 1.01-1.24, for per quantile) and PM2.5 (HR 1.18, 95\% CI 1.05-1.31, for per quantile). Joint effect analyses showed that per equal quantile increment of MDA8 O3 and PM2.5 was associated with an 18\% (HR 1.18, 95\% CI 1.05-1.33) increase in the risk of asthmatic symptoms, and PM2.5 contributed more (68\%) in the joint effects. The individual PAFs of asthmatic symptoms attributable to PM2.5 and MDA8 O3 were 2.86\% (95\% CI 0.17\%-5.50\%) and 4.83\% (95\% CI 1.42\%-7.25\%), respectively, while the joint PAF of asthmatic symptoms attributable to exposure mixture was 4.32\% (95\% CI 1.10\%-7.46\%). The joint associations were greater in participants with obesity, in urban areas, with lower family income, and who used unclean household cooking fuel. Conclusions: Long-term exposure to PM2.5 and MDA8 O3 may individually and jointly increase the risk of asthmatic symptoms, and the joint effects were smaller than the sum of individual effects. These findings informed the importance of joint associations of long-term exposure to air pollutants with asthma. ",
doi="10.2196/47403",
url="https://publichealth.jmir.org/2023/1/e47403",
url="http://www.ncbi.nlm.nih.gov/pubmed/37535415"
}


@Article{info:doi/10.2196/48235,
author="Ryzer, Danielle
and Bhatti, Bushra
and Streicher, Alana
and Weinberg, Paula
and Hanna, Fady
and Moretto, Jessica
and Brooks, Dina
and Quach, Shirley
and Oliveira, Ana",
title="Cognitive Interventions in Individuals With Chronic Respiratory Diseases: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="28",
volume="12",
pages="e48235",
keywords="chronic pulmonary disease",
keywords="cognitive therapy",
keywords="memory training",
keywords="brain exercise",
keywords="cognitive function",
keywords="pulmonary",
keywords="lung",
keywords="COPD",
keywords="review methodology",
keywords="systematic review",
keywords="cognitive",
keywords="cognition",
keywords="memory",
keywords="CRD",
keywords="respiratory",
abstract="Background: Chronic respiratory diseases (CRDs) may cause reduced oxygen availability to organs and body tissues, leading to an increased risk for ischemic damage, which can result in brain tissue injury. This damage can lead to a myriad of neurological symptoms contributing to cognitive decline. Cognitive interventions may attenuate cognitive deficits in people with CRDs; however, the effects have not yet been systematically summarized in the literature. Objective: The purpose of this systematic review is to assess the effects of cognitive interventions (including cognitive behavioral therapy and transcranial brain stimulation) on cognitive function (primary outcome), HRQL, self-management, symptoms, physical activity, physical function, ability to complete activities of daily living (ADLs), hospital admissions, functional capacity, functional performance, psychological and social outcomes, exacerbations, healthcare utilization, and survival in individuals with CRDs. Methods: This review will be conducted in accordance with the Cochrane handbook for systematic reviews of interventions and reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be performed in MEDLINE, Embase, Emcare, PsycINFO, Scopus, and CINAHL. Articles will be included if they focus on the effects of cognitive interventions on adults with CRDs, are published in peer-reviewed journals, and are written in English, French, or Portuguese. Risk of bias will be evaluated with the Cochrane Risk of Bias 2 tool for randomized controlled trials, and the Risk of Bias in Non-randomized Studies of Interventions tool for nonrandomized studies. Meta-analyses will be performed if at least 2 studies provided sufficient data for a specific outcome. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment will be used to evaluate the overall quality of the evidence. Results: This systematic review was initiated in November 2022 and registered with PROSPERO in February 2023, prior to title and abstract screening. Full-text screening of articles will be completed in June 2023. Data extraction and drafting of the manuscript will occur from July 2023 to August 2023, with expected publication in February 2024. Conclusions: This systematic review will summarize the effects of cognitive interventions on cognitive function in people with CRDs. It will guide health care professionals in selecting evidence-based strategies to enhance cognitive well-being and overall health outcomes for individuals with CRDs. Additionally, it will identify research gaps and highlight areas for future exploration, supporting researchers in advancing knowledge in this field. Trial Registration: PROSPERO CRD42023396234; https://tinyurl.com/mwjrfbxv International Registered Report Identifier (IRRID): PRR1-10.2196/48235 ",
doi="10.2196/48235",
url="https://www.researchprotocols.org/2023/1/e48235",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505801"
}


@Article{info:doi/10.2196/36121,
author="Mohd Hisham, Faiz Muhammad
and Lodz, Aliza Noor
and Muhammad, Nurhadzira Eida
and Asari, Noor Filza
and Mahmood, Ihsani Mohd
and Abu Bakar, Zamzurina",
title="Evaluation of 2 Artificial Intelligence Software for Chest X-Ray Screening and Pulmonary Tuberculosis Diagnosis: Protocol for a Retrospective Case-Control Study",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="25",
volume="12",
pages="e36121",
keywords="artificial intelligence",
keywords="AI",
keywords="evaluation",
keywords="pulmonary tuberculosis",
keywords="PTB",
keywords="chest x-ray",
keywords="CXR",
keywords="screening",
abstract="Background: According to the World Bank, Malaysia reported an estimated 97 tuberculosis cases per 100,000 people in 2021. Chest x-ray (CXR) remains the best conventional method for the early detection of pulmonary tuberculosis (PTB) infection. The intervention of artificial intelligence (AI) in PTB diagnosis could efficiently aid human interpreters and reduce health professionals' work burden. To date, no AI studies have been evaluated in Malaysia. Objective: This study aims to evaluate the performance of Putralytica and Qure.ai software for CXR screening and PTB diagnosis among the Malaysian population. Methods: We will conduct a retrospective case-control study at the Respiratory Medicine Institute, National Cancer Institute, and Sungai Buloh Health Clinic. A total of 1500 CXR images of patients who completed treatments or check-ups will be selected and categorized into three groups: (1) abnormal PTB cases, (2) abnormal non-PTB cases, and (3) normal cases. These CXR images, along with their clinical findings, will be the reference standard in this study. All patient data, including sociodemographic characteristics and clinical history, will be collected prior to screening via Putralytica and Qure.ai software and readers' interpretation, which are the index tests for this study. Interpretation from all 3 index tests will be compared with the reference standard, and significant statistical analysis will be computed. Results: Data collection is expected to commence in August 2023. It is anticipated that 1 year will be needed to conduct the study. Conclusions: This study will measure the accuracy of Putralytica and Qure.ai software and whether their findings will concur with readers' interpretation and the reference standard, thus providing evidence toward the effectiveness of implementing AI in the medical setting. International Registered Report Identifier (IRRID): PRR1-10.2196/36121 ",
doi="10.2196/36121",
url="https://www.researchprotocols.org/2023/1/e36121",
url="http://www.ncbi.nlm.nih.gov/pubmed/37490330"
}


@Article{info:doi/10.2196/48666,
author="Rozenberg, Dmitry
and Shore, Josh
and Camacho Perez, Encarna
and Nourouzpour, Sahar
and Ibrahim Masthan, Megha
and Santa Mina, Daniel
and Campos, L. Jennifer
and Huszti, Ella
and Green, Robin
and Khan, Hashim Mohammad
and Lau, Ambrose
and Gold, David
and Stanbrook, B. Matthew
and Reid, Darlene W.",
title="Feasibility of a Home-Based Cognitive-Physical Exercise Program in Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Feasibility and Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="12",
volume="12",
pages="e48666",
keywords="pulmonary disease",
keywords="chronic obstructive",
keywords="telerehabilitation",
keywords="physical exercise",
keywords="cognitive training",
keywords="randomized controlled trial",
keywords="pilot study",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition associated with physical and cognitive impairments contributing to difficulty in performing activities of daily living (ADLs) that require dual tasking (eg, walking and talking). Despite evidence showing that cognitive decline occurs among patients with COPD and may contribute to functional limitations and decreased health-related quality of life (HRQL), pulmonary rehabilitation continues to focus mainly on physical training (ie, aerobic and strength exercises). An integrated cognitive and physical training program compared to physical training alone may be more effective in increasing dual-tasking ability among people living with COPD, leading to greater improvements in performance of ADLs and HRQL. Objective: The aims of this study are to evaluate the feasibility of an 8-week randomized controlled trial of home-based, cognitive-physical training versus physical training for patients with moderate to severe COPD and derive preliminary estimates of cognitive-physical training intervention efficacy on measures of physical and cognitive function, dual task performance, ADLs, and HRQL. Methods: A total of 24 participants with moderate to severe COPD will be recruited and randomized into cognitive-physical training or physical training. All participants will be prescribed an individualized home physical exercise program comprising 5 days of moderate-intensity aerobic exercise (30-50 minutes/session) and 2 days of whole-body strength training per week. The cognitive-physical training group will also perform cognitive training for approximately 60 minutes, 5 days per week via the BrainHQ platform (Posit Science Corporation). Participants will meet once weekly with an exercise professional (via videoconference) who will provide support by reviewing the progression of their training and addressing any queries. Feasibility will be assessed through the recruitment rate, program adherence, satisfaction, attrition, and safety. The intervention efficacy regarding dual task performance, physical function, ADLs, and HRQL will be evaluated at baseline and at 4 and 8 weeks. Descriptive statistics will be used to summarize intervention feasibility. Paired 2-tailed t tests and 2-tailed t tests will be used to compare the changes in the outcome measures over the 8-week study period within and between the 2 randomized groups, respectively. Results: Enrollment started in January 2022. It is estimated that the enrollment period will be 24 months long, with data collection to be completed by December 2023. Conclusions: A supervised home-based cognitive-physical training program may be an accessible intervention to improve dual-tasking ability in people living with COPD. Evaluating the feasibility and effect estimates is a critical first step to inform future clinical trials evaluating this approach and its effects on physical and cognitive function, ADL performance, and HRQL. Trial Registration: ClinicalTrials.gov NCT05140226; https://clinicaltrials.gov/ct2/show/NCT05140226 International Registered Report Identifier (IRRID): DERR1-10.2196/48666 ",
doi="10.2196/48666",
url="https://www.researchprotocols.org/2023/1/e48666",
url="http://www.ncbi.nlm.nih.gov/pubmed/37436794"
}


@Article{info:doi/10.2196/43154,
author="Hansun, Seng
and Argha, Ahmadreza
and Liaw, Siaw-Teng
and Celler, G. Branko
and Marks, B. Guy",
title="Machine and Deep Learning for Tuberculosis Detection on Chest X-Rays: Systematic Literature Review",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="3",
volume="25",
pages="e43154",
keywords="chest x-rays",
keywords="convolutional neural networks",
keywords="diagnostic test accuracy",
keywords="machine and deep learning",
keywords="PRISMA guidelines",
keywords="risk of bias",
keywords="QUADAS-2",
keywords="sensitivity and specificity",
keywords="systematic literature review",
keywords="tuberculosis detection",
abstract="Background: Tuberculosis (TB) was the leading infectious cause of mortality globally prior to COVID-19 and chest radiography has an important role in the detection, and subsequent diagnosis, of patients with this disease. The conventional experts reading has substantial within- and between-observer variability, indicating poor reliability of human readers. Substantial efforts have been made in utilizing various artificial intelligence--based algorithms to address the limitations of human reading of chest radiographs for diagnosing TB. Objective: This systematic literature review (SLR) aims to assess the performance of machine learning (ML) and deep learning (DL) in the detection of TB using chest radiography (chest x-ray [CXR]). Methods: In conducting and reporting the SLR, we followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 309 records were identified from Scopus, PubMed, and IEEE (Institute of Electrical and Electronics Engineers) databases. We independently screened, reviewed, and assessed all available records and included 47 studies that met the inclusion criteria in this SLR. We also performed the risk of bias assessment using Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2) and meta-analysis of 10 included studies that provided confusion matrix results. Results: Various CXR data sets have been used in the included studies, with 2 of the most popular ones being Montgomery County (n=29) and Shenzhen (n=36) data sets. DL (n=34) was more commonly used than ML (n=7) in the included studies. Most studies used human radiologist's report as the reference standard. Support vector machine (n=5), k-nearest neighbors (n=3), and random forest (n=2) were the most popular ML approaches. Meanwhile, convolutional neural networks were the most commonly used DL techniques, with the 4 most popular applications being ResNet-50 (n=11), VGG-16 (n=8), VGG-19 (n=7), and AlexNet (n=6). Four performance metrics were popularly used, namely, accuracy (n=35), area under the curve (AUC; n=34), sensitivity (n=27), and specificity (n=23). In terms of the performance results, ML showed higher accuracy (mean {\textasciitilde}93.71\%) and sensitivity (mean {\textasciitilde}92.55\%), while on average DL models achieved better AUC (mean {\textasciitilde}92.12\%) and specificity (mean {\textasciitilde}91.54\%). Based on data from 10 studies that provided confusion matrix results, we estimated the pooled sensitivity and specificity of ML and DL methods to be 0.9857 (95\% CI 0.9477-1.00) and 0.9805 (95\% CI 0.9255-1.00), respectively. From the risk of bias assessment, 17 studies were regarded as having unclear risks for the reference standard aspect and 6 studies were regarded as having unclear risks for the flow and timing aspect. Only 2 included studies had built applications based on the proposed solutions. Conclusions: Findings from this SLR confirm the high potential of both ML and DL for TB detection using CXR. Future studies need to pay a close attention on 2 aspects of risk of bias, namely, the reference standard and the flow and timing aspects. Trial Registration: PROSPERO CRD42021277155; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=277155 ",
doi="10.2196/43154",
url="https://www.jmir.org/2023/1/e43154",
url="http://www.ncbi.nlm.nih.gov/pubmed/37399055"
}


@Article{info:doi/10.2196/46741,
author="Howell, Imran
and Mahdi, Mahdi
and Bafadhel, Mona
and Hinks, C. Timothy S.
and Ramakrishnan, Sanjay
and Melhorn, James
and Jabeen, Maisha
and Pavord, D. Ian",
title="Recovery of Breakthrough Asthma Attacks Treated With Oral Steroids While on Monoclonal Antibody Therapy: Protocol for a Prospective Observational Study (BOOST)",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="23",
volume="12",
pages="e46741",
keywords="asthma",
keywords="monoclonal antibodies",
keywords="steroids",
keywords="monoclonal antibody",
keywords="oral steroid",
keywords="asthma attack",
keywords="quality of life",
keywords="adult",
keywords="inflammatory response",
keywords="prednisolone treatment",
keywords="treatment",
abstract="Background: Asthma attacks are a common and important problem. Someone experiences an asthma attack in the United Kingdom every 10 seconds. Asthma attacks cause coughing, wheezing, breathlessness, and chest tightness and are highly stressful for patients. They result in reduced quality of life, with days lost from work or school. Asthma attacks are treated with oral corticosteroids (OCSs), but these have many short- and long-term side effects. Asthma monoclonal antibodies (mAbs) have revolutionized the treatment of severe asthma by reducing asthma attacks and OCS burden by over 50\%, but some people still experience attacks while on mAbs. The MEX study showed that residual asthma attacks are broadly eosinophilic (high fractional exhaled nitric oxide [FeNO]) or noneosinophilic (low FeNO), but it did not measure response to OCS treatment. There is an evidence gap in understanding the clinical and inflammatory responses that occur when using OCSs to treat residual asthma attacks in patients taking asthma mAbs. Objective: The primary objective is to compare the clinical recovery between high-FeNO and low-FeNO attacks after acute treatment with oral prednisolone among people established on long-term asthma mAb treatment. The exploratory objective is to compare the inflammatory response to acute treatment with oral prednisolone between high-FeNO and low-FeNO attacks. Methods: BOOST (Breakthrough Asthma Attacks Treated With Oral Steroids) is a single-center, prospective observational study of 60 adults established on long-term asthma mAb treatment who receive acute treatment with oral prednisolone (usual care) for an asthma attack. The primary outcome will be the proportion of treatment failure (the need to start oral prednisolone or antibiotics or an unscheduled health care visit for asthma, following an attack) at day 28. The secondary outcomes will be the change in forced expiratory volume in 1 second and the change in visual analogue scale symptom score between the stable state, attack, day 7, and day 28 visits. The exploratory outcomes include the changes in sputum, nasal, and blood inflammometry between the stable state, attack, day 7, and day 28 visits. Results: The last asthma attack visit is anticipated to occur in December 2023. Data analysis and publication will take place in 2024. Conclusions: We will test the hypothesis that there is a difference in the rate of recovery of clinical and inflammatory measures between high-FeNO and low-FeNO asthma attacks that occur in patients on mAb therapy. The study data will help power a future randomized placebo-controlled trial of prednisolone treatment for nonsevere attacks in patients treated with asthma mAbs and will provide important information on whether corticosteroid treatment should be FeNO-directed. International Registered Report Identifier (IRRID): DERR1-10.2196/46741 ",
doi="10.2196/46741",
url="https://www.researchprotocols.org/2023/1/e46741",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351918"
}


@Article{info:doi/10.2196/40193,
author="Lacroix, Joyca
and Tatousek, Jan
and Den Teuling, Niek
and Visser, Thomas
and Wells, Charles
and Wylie, Paul
and Rosenberg, Russell
and Bogan, Richard",
title="Effectiveness of an Intervention Providing Digitally Generated Personalized Feedback and Education on Adherence to Continuous Positive Airway Pressure: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="May",
day="22",
volume="25",
pages="e40193",
keywords="therapy adherence",
keywords="personalized feedback",
keywords="personalized education",
keywords="tailored communication",
keywords="psychological profile",
keywords="continuous positive airway pressure therapy",
keywords="CPAP therapy",
keywords="obstructive sleep apnea",
abstract="Background: Many people worldwide experience obstructive sleep apnea, which is associated with medical and psychological problems. Continuous positive airway pressure (CPAP) is an efficacious therapy for obstructive sleep apnea, but its effect is limited by nonadherence. Studies show that personalized education and feedback can increase CPAP adherence. Moreover, tailoring the style of information to the psychological profile of a patient has been shown to enhance the impact of interventions. Objective: This study aimed to assess the effect of an intervention providing digitally generated personalized education and feedback on CPAP adherence and the additional effect of tailoring the style of the education and feedback to an individual's psychological profile. Methods: This study was a 90-day, multicenter, parallel, single-blinded, and randomized controlled trial with 3 conditions: personalized content in a tailored style (PT) in addition to usual care (UC), personalized content in a nontailored style (PN) in addition to UC, and UC. To test the effect of personalized education and feedback, the PN + PT group was compared with the UC group. To test the additional effect of tailoring the style to psychological profiles, the PN and PT groups were compared. Overall, 169 participants were recruited from 6 US sleep clinics. The primary outcome measures were adherence based on minutes of use per night and on nights of use per week. Results: We found a significant positive effect of personalized education and feedback on both primary adherence outcome measures. The difference in the estimated average adherence based on minutes of use per night between the PT + PN and UC groups on day 90 was 81.3 minutes in favor of the PT + PN group (95\% CI ?134.00 to ?29.10; P=.002). The difference in the average adherence based on nights of use per week between the PT + PN and UC groups at week 12 was 0.9 nights per week in favor of the PT + PN group (difference in odds ratio 0.39, 95\% CI 0.21-0.72; P=.003). We did not find an additional effect of tailoring the style of the intervention to psychological profiles on the primary outcomes. The difference in nightly use between the PT and PN groups on day 90 (95\% CI ?28.20 to 96.50; P=.28) and the difference in nights of use per week between the PT and PN groups at week 12 (difference in odds ratio 0.85, 95\% CI 0.51-1.43; P=.054) were both nonsignificant. Conclusions: The results show that personalized education and feedback can increase CPAP adherence substantially. Tailoring the style of the intervention to the psychological profiles of patients did not further increase adherence. Future research should investigate how the impact of interventions can be enhanced by catering to differences in psychological profiles. Trial Registration: ClinicalTrials.gov NCT02195531; https://clinicaltrials.gov/ct2/show/NCT02195531 ",
doi="10.2196/40193",
url="https://www.jmir.org/2023/1/e40193",
url="http://www.ncbi.nlm.nih.gov/pubmed/37213195"
}


@Article{info:doi/10.2196/43269,
author="Nyberg, Andr{\'e}
and Sondell, Anna
and Lundell, Sara
and Marklund, Sarah
and Tistad, Malin
and Wadell, Karin",
title="Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis",
journal="JMIR Hum Factors",
year="2023",
month="Mar",
day="30",
volume="10",
pages="e43269",
keywords="COPD",
keywords="eHealth",
keywords="internet",
keywords="web based",
keywords="health care professionals",
keywords="primary care",
keywords="pulmonary",
keywords="management",
keywords="tools",
keywords="chronic",
keywords="clinical",
keywords="support",
keywords="care",
keywords="electronic",
keywords="implementation",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management. Objective: The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice. Methods: This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach. Results: The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis. Conclusions: This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis. Trial Registration: ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187 ",
doi="10.2196/43269",
url="https://humanfactors.jmir.org/2023/1/e43269",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995743"
}


@Article{info:doi/10.2196/33185,
author="Koh, Hean Jin
and Chong, Yee Lydia Ching
and Koh, Huat Gerald Choon
and Tyagi, Shilpa",
title="Telemedical Interventions for Chronic Obstructive Pulmonary Disease Management: Umbrella Review",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="16",
volume="25",
pages="e33185",
keywords="telemedicine",
keywords="telehealth",
keywords="chronic obstructive pulmonary disease",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a growing epidemic, with a heavy associated economic burden. Education, physical activity, and pulmonary rehabilitation programs are important aspects of the management of COPD. These interventions are commonly delivered remotely as part of telemedicine interventions. Several systematic reviews and meta-analyses have been conducted to assess the effectiveness of these interventions. However, these reviews often have conflicting conclusions. Objective: We aim to conduct an umbrella review to critically appraise and summarize the available evidence on telemedicine interventions for the management of COPD. Methods: In this umbrella review, the MEDLINE, Embase, PsycINFO, and Cochrane databases were searched from inception to May 2022 for systematic reviews and meta-analyses relating to telemedicine interventions for the management of COPD. We compared odds ratios, measures of quality, and heterogeneity across different outcomes. Results: We identified 7 systematic reviews that met the inclusion criteria. Telemedicine interventions used in these reviews were teletreatment, telemonitoring, and telesupport. Telesupport interventions significantly reduced the number of inpatient days and quality of life. Telemonitoring interventions were associated with significant reductions in respiratory exacerbations and hospitalization rates. Teletreatment showed significant effectiveness in reducing respiratory exacerbations, hospitalization rate, compliance (acceptance and dropout rate), and physical activity. Among studies that used integrated telemedicine interventions, there was a significant improvement in physical activity. Conclusions: Telemedicine interventions showed noninferiority or superiority over the standard of care for the management of COPD. Telemedicine interventions should be considered as a supplement to usual methods of care for the outpatient management of COPD, with the aim of reducing the burden on health care systems. ",
doi="10.2196/33185",
url="https://www.jmir.org/2023/1/e33185",
url="http://www.ncbi.nlm.nih.gov/pubmed/36795479"
}


@Article{info:doi/10.2196/39969,
author="Marklund, Sarah
and S{\"o}rlin, Ann
and Stenlund, Tobias
and Wadell, Karin
and Nyberg, Andre",
title="To Act or Not to Act---a Sense of Control Is Important for People With Chronic Obstructive Pulmonary Disease to Increase Physical Activity: Grounded Theory Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="3",
volume="7",
pages="e39969",
keywords="physical activity",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="eHealth",
keywords="interviews",
keywords="eHealth tools",
abstract="Background: Among people with chronic obstructive pulmonary disease (COPD), low level of daily physical activity (PA) is the main risk factors for developing cardiovascular, metabolic, and musculoskeletal comorbidities. Increasing PA in people with COPD is complex as PA behavior itself is complex and multifaceted, including personal, physiological, and psychological elements as well as social and environmental factors. Although eHealth solutions such as web-based support or websites have shown positive effects on PA in people with COPD, the results are inconclusive, and it is still unclear how eHealth solutions might be used to support positive changes in PA behavior in people with COPD. Objective: This study aimed to explore the perceptions of increasing objective PA when using a web-based eHealth tool among people with COPD. Methods: This study was part of a pragmatic randomized controlled trial with in-depth interviews between the 3- and 12-month follow-ups. The methodology used was constructivist grounded theory. All sampling included participants from the randomized controlled trial intervention group, that is, participants who had access to the eHealth tool in question and agreed to be contacted for an in-depth interview. Inclusion of participants continued until data saturation was reached, resulting in an inclusion of 13 (n=7, 54\% women) participants aged between 49 and 84 years and living in 8 municipalities in Middle and Northern Sweden. Two interviews were conducted face-to-face, and the remaining interviews were conducted via telephone. All interviews were recorded using a Dictaphone. Results: The analysis resulted in 3 main categories: welcoming or not welcoming action, having or lacking resources, and lowering the threshold. The first 2 categories contain barriers and facilitators, whereas the third category contains only facilitators. The categories lead to the more latent theme Perceiving enough control to enable action, meaning that it seems that perceiving the right amount of control is essential to maintain or increase the level of PA when using an eHealth tool among patients with COPD. However, the right amount of control seemed to depend on the individual (and context) in question. Conclusions: The core category indicates that a need for a certain sense of control was interpreted as necessary for increasing the PA level as well as for using an eHealth tool to help increase the PA level. The eHealth tool seemed to strengthen or weaken the perception of control by either providing support or by being too demanding on the user. Perceptions varied depending on other environmental factors. The Fogg Behavior Model illustrated how motivational levels, ability levels, and functional triggers interact within our findings. Thus, this study provides further evidence for the importance of empowering the patients to boost their level of agency and their ability to improve PA levels. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-030788 ",
doi="10.2196/39969",
url="https://formative.jmir.org/2023/1/e39969",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735302"
}


@Article{info:doi/10.2196/40700,
author="Frisk, Bente
and Nj{\o}ten, Lovise Kiri
and Aarli, Bernt
and Hystad, William Sigurd
and Rykken, Sidsel
and Kjos{\aa}s, Ane
and S{\o}fteland, Eirik
and Kvale, Gerd",
title="A Novel Concentrated, Interdisciplinary Group Rehabilitation Program for Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Nonrandomized Clinical Intervention Study",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="26",
volume="11",
number="10",
pages="e40700",
keywords="COPD",
keywords="pulmonary rehabilitation",
keywords="chronic illness",
keywords="interdisciplinary",
keywords="chronic disease",
keywords="rehabilitation model",
keywords="rehabilitation",
keywords="treatment",
keywords="group therapy",
keywords="patient outcome",
keywords="health intervention",
keywords="pulmonary disease",
keywords="intervention study",
abstract="Background: Pulmonary rehabilitation has been demonstrated to be a highly effective treatment for people with chronic obstructive pulmonary disease (COPD). However, its availability is scarce worldwide, and new and innovative rehabilitation models are highly warranted. Recently, the group behind the present study published a protocol describing a novel concentrated, interdisciplinary group rehabilitation program for patients with chronic illnesses. The current paper describes an extension of this protocol to patients with COPD. Objective: The objective of this study is to explore the acceptability of concentrated, interdisciplinary group pulmonary rehabilitation for patients with COPD. The intervention is expected to improve functional status and be highly acceptable to patients. Methods: This study will include 50 patients aged over 40 years who fulfill the diagnostic criteria for COPD: a forced expiratory volume at the first second (FEV1) <80\% of expected and a FEV1/forced vital capacity ratio below the lower limit of normal according to the Global Lung Function Initiative. An interdisciplinary team consisting of physicians, physiotherapists, psychologists, pharmacists, clinical nutritionists, and nurses will deliver the treatment to groups of 6 to 10 patients over 3 to 4 consecutive days with a 12-month follow-up. The intervention is divided into three distinct phases: (1) pretreatment preparation for change, (2) concentrated rehabilitation, where the patient is coached to focus on making health-promoting microchoices, and (3) integration of the changes into everyday living, aided by digital follow-up and 2 on-site clinical examinations. Statistical significance will be set at $\alpha$=.05. Results: The recruitment period will last from April 2022 until June 2023. Conclusions: If successful, this highly novel rehabilitation format might change the way we deliver care for patients with COPD, leading to substantial societal and socioeconomic gains. The study will expand knowledge on the concentrated treatment format as a rehabilitation model for people with COPD. Trial Registration: ClinicalTrials.gov NCT05234281; https://clinicaltrials.gov/ct2/show/NCT05234281 International Registered Report Identifier (IRRID): PRR1-10.2196/40700 ",
doi="10.2196/40700",
url="https://www.researchprotocols.org/2022/10/e40700",
url="http://www.ncbi.nlm.nih.gov/pubmed/36287602"
}


@Article{info:doi/10.2196/40538,
author="Matthias, Katja
and Honekamp, Ivonne
and De Santis, Karolina Karina",
title="The Influence of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Protocol for an Overview of Systematic Reviews",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="12",
volume="11",
number="10",
pages="e40538",
keywords="digital technologies",
keywords="digital intervention",
keywords="COPD",
keywords="AMSTAR 2",
keywords="chronic obstructive pulmonary disease",
keywords="gender",
keywords="sex",
keywords="age",
keywords="overview",
keywords="systematic review",
keywords="treatment",
keywords="monitoring",
keywords="chronic disease",
keywords="chronic illness",
keywords="outcome reporting",
keywords="review methodology",
keywords="critical appraisal",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a common chronic disease that can be treated and monitored with various digital technologies. Digital technologies offer unique opportunities for treating and monitoring people with chronic diseases, but little is known about whether the outcomes of such technologies depend on sex, gender, or age in people with COPD. Objective: The general objective of this study is to assess the possible influence of sex, gender, or age on outcomes of digital technologies for treatment and monitoring of COPD through an overview of systematic reviews. Methods: The study is planned as an overview of systematic reviews. Study reporting is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines because guidelines for overviews are not available as of this writing. The information sources for the overview will include 4 bibliographic databases (MEDLINE, Cochrane Library, Epistemonikos, and Web of Science) as well as the bibliographies of the included systematic reviews. The electronic search strategy will be developed and conducted in collaboration with an experienced database specialist. The search results will be presented in accordance with the PRISMA 2020 guidelines. The eligibility of studies is based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria: (1) people with COPD (population), (2) digital technology intervention for treatment or monitoring (intervention), (3) any control group or no control group (comparison), (4) any outcome, and (5) systematic review of randomized controlled trials or non--randomized controlled trials with or without a meta-analysis (study design). Critical appraisal of the included systematic reviews will be performed using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data will be extracted using a standardized data extraction sheet. Results: The literature search is scheduled for June 2022. We expect to select the relevant systematic reviews, code the data, and appraise the systematic reviews by December 2022. Conclusions: There is a growing recognition that the influence of sex, gender, or age should be considered in research design and outcome reporting in the context of health care interventions. Our overview will identify systematic reviews of various digital technologies for treatment or monitoring of COPD. The most interesting aspect of the overview will be to investigate if any systematic reviews considered the influence of sex, gender, or age on the outcomes of such digital technologies in COPD. Evidence from the overview could be used to guide more individualized (sex, gender, or age-based) recommendations for the use of digital technologies among people with COPD. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022322924; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=322924 ",
doi="10.2196/40538",
url="https://www.researchprotocols.org/2022/10/e40538",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222803"
}


@Article{info:doi/10.2196/37854,
author="Nikolovski, Aleksandra
and Gamgoum, Lara
and Deol, Arshpreet
and Quilichini, Shea
and Kazemir, Ethan
and Rhodenizer, Jonathan
and Oliveira, Ana
and Brooks, Dina
and Alsubheen, Sanaa",
title="Psychometric Properties of the Hospital Anxiety and Depression Scale in Individuals With Chronic Obstructive Pulmonary Disease: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2022",
month="Sep",
day="22",
volume="11",
number="9",
pages="e37854",
keywords="COPD",
keywords="HADS",
keywords="reliability",
keywords="responsiveness",
keywords="validity",
keywords="anxiety",
keywords="depression",
keywords="mental health",
keywords="pulmonary",
keywords="systematic review",
keywords="protocol",
keywords="mortality",
keywords="functioning",
keywords="quality of life",
keywords="tool",
keywords="symptoms",
keywords="database",
abstract="Background: In individuals with chronic obstructive pulmonary disease (COPD), anxiety and depression contribute to increased mortality and exacerbations, decreased physical functioning, and deteriorated health-related quality of life. The Hospital Anxiety and Depression Scale (HADS) is a patient-reported tool developed to measure symptoms of anxiety and depression in clinical settings. The HADS has been frequently used with individuals with COPD; however, its measurement properties lack critical appraisal in this population. Objective: This review aims to summarize and critically appraise the validity, reliability, and responsiveness of the HADS in individuals with COPD. Methods: Five electronic databases (MEDLINE, Embase, Scopus, PsychINFO, and Web of Science) will be systematically searched. Articles will be included if they assessed the measurement properties of the HADS in COPD; were published in a peer-reviewed journal; and were written in English. The COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) guidelines will be used to assess the methodological quality and level of evidence in the selected studies. Results: To date, 12 articles met the inclusion criteria and will be included in the systematic review. The results of the psychometric properties of HADS will be qualitatively summarized and compared against the criteria for good measurement properties. The overall quality of evidence will be graded using the modified Grading of Recommendations, Assessment, Development and Evaluation approach. We expect to complete the systematic review by December 2022. Conclusions: This systematic review will be the first to evaluate the psychometric properties of the HADS in individuals with COPD. Given the negative impact of anxiety and depression on physical functioning and health-related quality of life, this systematic review provides an opportunity to use the HADS as a validated measurement tool for the assessment and treatment of anxiety and depression in individuals with COPD. Trial Registration: PROSPERO CRD42022302064; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=302064 International Registered Report Identifier (IRRID): PRR1-10.2196/37854 ",
doi="10.2196/37854",
url="https://www.researchprotocols.org/2022/9/e37854",
url="http://www.ncbi.nlm.nih.gov/pubmed/36136379"
}


@Article{info:doi/10.2196/38663,
author="Dahne, Jennifer
and Player, S. Marty
and Strange, Charlie
and Carpenter, J. Matthew
and Ford, W. Dee
and King, Kathryn
and Miller, Sarah
and Kruis, Ryan
and Hawes, Elizabeth
and Hidalgo, E. Johanna
and Diaz, A. Vanessa",
title="Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="30",
volume="24",
number="8",
pages="e38663",
keywords="electronic visits",
keywords="e-visit",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="smoking cessation",
keywords="telehealth",
keywords="electronic health record",
keywords="patient portal",
keywords="EHR",
keywords="feasibility",
keywords="efficacy",
keywords="intervention",
keywords="screening",
keywords="diagnosis",
keywords="prevention",
keywords="treatment",
keywords="management",
keywords="acceptability",
keywords="pulmonary",
keywords="function",
abstract="Background: Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care. Objective: The aims of this study were (1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFT), and (2) to examine the efficacy of smoking cessation e-visits relative to treatment as usual (TAU), all within primary care. Methods: In a randomized clinical trial, 125 primary care patients who smoke were randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores ?2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best Food and Drug Administration--approved cessation medication to prescribe. Primary outcomes included measures related to (1) e-visit acceptability, feasibility, and treatment metrics; (2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction ?50\%, self-reported abstinence, and biochemically confirmed abstinence); and (3) COPD screening outcomes. Results: Of 85 participants assigned to the e-visits, 64 (75.3\%) were invited to complete home spirometry and in-lab PFTs based on CAPTURE. Among those eligible for spirometry, 76.6\% (49/64) completed home spirometry, and 35.9\% (23/64) completed in-lab PFTs. At 1 month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (odds ratio [OR]=3.22). At 3 months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09). Conclusions: A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad interventions within primary care. Trial Registration: ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073 ",
doi="10.2196/38663",
url="https://www.jmir.org/2022/8/e38663",
url="http://www.ncbi.nlm.nih.gov/pubmed/36040766"
}


@Article{info:doi/10.2196/37100,
author="Lewinski, A. Allison
and Walsh, Conor
and Rushton, Sharron
and Soliman, Diana
and Carlson, M. Scott
and Luedke, W. Matthew
and Halpern, J. David
and Crowley, J. Matthew
and Shaw, J. Ryan
and Sharpe, A. Jason
and Alexopoulos, Anastasia-Stefania
and Tabriz, Alishahi Amir
and Dietch, R. Jessica
and Uthappa, M. Diya
and Hwang, Soohyun
and Ball Ricks, A. Katharine
and Cantrell, Sarah
and Kosinski, S. Andrzej
and Ear, Belinda
and Gordon, M. Adelaide
and Gierisch, M. Jennifer
and Williams Jr, W. John
and Goldstein, M. Karen",
title="Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="26",
volume="24",
number="8",
pages="e37100",
keywords="telemedicine",
keywords="diabetes mellitus, type 2",
keywords="heart failure",
keywords="pulmonary disease",
keywords="chronic obstructive",
keywords="veterans",
keywords="delivery of health care",
keywords="systematic review",
abstract="Background: Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. Objective: We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? Methods: We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ?2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. Results: We identified 8662 studies, and 129 (1.49\%) were reviewed at the full-text stage. In total, 3.9\% (5/129) of the articles were retained for data extraction, all of which (5/5, 100\%) were randomized controlled trials. The CHF study (1/5, 20\%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80\% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50\% of studies and high for 2, 50\% of studies). In total, 20\% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. Conclusions: This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases. ",
doi="10.2196/37100",
url="https://www.jmir.org/2022/8/e37100",
url="http://www.ncbi.nlm.nih.gov/pubmed/36018711"
}


@Article{info:doi/10.2196/39887,
author="Nyenhuis, Sharmilee
and Cramer, Emily
and Grande, Matthew
and Huntington-Moskos, Luz
and Krueger, Kathryn
and Bimbi, Olivia
and Polivka, Barbara
and Eldeirawi, Kamal",
title="Utilizing Real-time Technology to Assess the Impact of Home Environmental Exposures on Asthma Symptoms: Protocol for an Observational Pilot Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="2",
volume="11",
number="8",
pages="e39887",
keywords="asthma",
keywords="home environment",
keywords="ecologic momentary assessment",
keywords="air quality",
keywords="spirometry",
abstract="Background: It is estimated that over 60\% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home environment and exposure to volatile organic compounds (VOCs) and fine particulate matter (PM2.5) on adults with asthma remain unknown. In addition, methods currently used to assess the home environment do not capture real-time data on potentially modifiable environmental exposures or their effect on asthma symptoms. Objective: The aims of this study are to (1) determine the feasibility and usability of ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, home monitoring of objective environmental exposures (total VOCs and PM2.5), and lung function in terms of forced expiratory volume in 1 second (FEV1\%); (2) assess the frequency and level of residential environmental exposures (eg, disinfectants/cleaners, secondhand smoke) via self-reported data and home monitoring objective measures; (3) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and (4) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control. Methods: We will recruit 50 adults with asthma who have completed our online Global COVID-19 Asthma Study, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have asthma that is not well controlled. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM2.5, and FEV1\%, respectively. EMA data will be collected using a personal smartphone and EMA software platform. Participants will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related to acceptability, appropriateness, and feasibility. Results: This study was funded in March 2021. We pilot tested our procedures and began recruitment in April 2022. The anticipated completion of the study is 2023. Conclusions: Findings from this feasibility study will support a powered study to address the impact of home environmental exposures on asthma symptoms and develop tailored, home-based asthma interventions that are responsive to the changing home environment and home routines. Trial Registration: ClinicalTrials.gov NCT05224076; https://clinicaltrials.gov/ct2/show/NCT05224076 International Registered Report Identifier (IRRID): DERR1-10.2196/39887 ",
doi="10.2196/39887",
url="https://www.researchprotocols.org/2022/8/e39887",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916686"
}


@Article{info:doi/10.2196/34277,
author="Bao, Yuhan
and Wang, Chunxiang
and Xu, Haiping
and Lai, Yongjie
and Yan, Yupei
and Ma, Yuanyuan
and Yu, Ting
and Wu, Yibo",
title="Effects of an mHealth Intervention for Pulmonary Tuberculosis Self-management Based on the Integrated Theory of Health Behavior Change: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="14",
volume="8",
number="7",
pages="e34277",
keywords="ITHBC",
keywords="mHealth",
keywords="RCT",
keywords="pulmonary tuberculosis",
abstract="Background: Improving the health self-management level of patients with tuberculosis (TB) is significant for reducing drug resistance, improving the cure rate, and controlling the prevalence of TB. Mobile health (mHealth) interventions based on behavioral science theories may be promising to achieve this goal. Objective: This study aims to explore and conduct an mHealth intervention based on the Integrated Theory of Health Behavior Change (ITHBC) in patients with pulmonary TB to increase their ability of self-care management. Methods: A prospective randomized controlled study was conducted from May to November 2020. A total of 114 patients who were admitted consecutively to the TB clinic of Harbin Chest Hospital, China from May 2020 to August 2020 were recruited by convenience sampling. Patients were divided into the control group and intervention group, and all received a 3-month intervention. Patients in the intervention group and the control group received routine medical and nursing care in the TB clinic, including the supervision of their medications. In addition, pharmacist-assisted mHealth (WeChat) intervention based on the ITHBC theory about TB management was provided to the intervention group. The primary outcome was self-management behavior, while the secondary outcomes were TB awareness, self-efficacy, social support, and degree of satisfaction with health education. The outcomes were measured using web-based self-designed and standard questionnaires administered at baseline and at the end point of the study. Intergroup data were assessed using the Mann-Whitney U test, whereas intragroup data were assessed with the Wilcoxon test (for paired samples). Results: A total of 112 patients (59 in intervention group and 53 in control group) completed the study. After the intervention, a statistically significant increase was noted in the scores of each item of self-care management behaviors compared with the scores at the baseline (P<.001) in the intervention group. The scores of all self-care management behaviors of the control group were lower than those of all self-care management behaviors in the intervention group (all P<.05), except for the item ``cover your mouth and nose when coughing or sneezing'' (P=.23) and item ``wash hands properly'' (P=.60), which had no statistically significant difference from those in the intervention group. Compared with those at baseline, TB knowledge awareness, self-efficacy, social support, and degree of satisfaction with health education in the intervention group increased significantly (P<.001), and the intervention group had significantly higher scores than the control group (P<.001). Conclusions: mHealth intervention for TB self-management based on ITHBC could deepen the understanding of patients with TB about their disease and improve their objective initiative and self-care management behaviors, which were beneficial for promoting compliance behavior and quality of prevention and control for pulmonary TB. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055557; https://tinyurl.com/4ray3xnw ",
doi="10.2196/34277",
url="https://publichealth.jmir.org/2022/7/e34277",
url="http://www.ncbi.nlm.nih.gov/pubmed/35834302"
}


@Article{info:doi/10.2196/32396,
author="Schnoor, Kyma
and Versluis, Anke
and Bakema, Robbert
and van Luenen, Sanne
and Kooij, J. Marcel
and van den Heuvel, Maurik J.
and Teichert, Martina
and Honkoop, J. Persijn
and van Boven, M. Job F.
and Chavannes, H. Niels
and Aardoom, J. Jiska",
title="A Pharmacy-Based eHealth Intervention Promoting Correct Use of Medication in Patients With Asthma and COPD: Nonrandomized Pre-Post Study",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="8",
volume="24",
number="6",
pages="e32396",
keywords="asthma",
keywords="COPD",
keywords="medication adherence",
keywords="exacerbations",
keywords="pharmacy",
keywords="eHealth",
abstract="Background: Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. While medication can control and improve disease symptoms, incorrect use of medication is a common problem. The eHealth intervention SARA (Service Apothecary Respiratory Advice) aims to improve participants' correct use of inhalation medication by providing information and as-needed tailored follow-up support by a pharmacist. Objective: The primary aim of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. Secondary aims were to investigate its effects in terms of adherence to maintenance medication and antimycotic treatment. Methods: In this nonrandomized pre-post study, medication dispensing data from 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed short-course oral corticosteroids. Medication adherence between new and chronic users was assessed by calculating the proportion of days covered from dispensed inhalation maintenance medication. Antimycotic treatment was investigated from dispensed oral antimycotics in participants who were also dispensed inhaled corticosteroids (ICS). Outcomes were assessed 1 year before and 1 year after implementation of SARA and were compared between SARA participants and control participants. More specifically, for exacerbation rates and medication adherence, a difference score was calculated (ie, 1 year after SARA minus 1 year before SARA) and was subsequently compared between the study groups with independent-samples t tests. For antimycotics, the relative number of participants who were dispensed antimycotics was calculated and subsequently analyzed with a mixed-effects logistic regression. Results: The study population comprised 9452 participants, of whom 2400 (25.39\%) were SARA participants. The mean age of the population was 60.8 (15.0) years, and approximately two-thirds (n=5677, 60.06\%) were female. The results showed an increase in mean exacerbation rates over time for both study groups (SARA: 0.05; control: 0.15). However, this increase in exacerbation rates was significantly lower for SARA participants (t9450=3.10, 95\% CI 0.04-0.16; P=.002; Cohen d=0.06). Chronic users of inhalation medication in both study groups showed an increase in mean medication adherence over time (SARA: 6.73; control: 4.48); however, this increase was significantly higher for SARA participants (t5886=--2.74, 95\% CI --3.86 to --0.84; P=.01; Cohen d=--0.07). Among new users of inhalation medication, results showed no significant difference in medication adherence between SARA and control participants in the year after implementation of SARA (t1434=--1.85, 95\% CI --5.60 to 0.16; P=.06; Cohen d=--0.10). Among ICS users, no significant differences between the study groups were found over time in terms of the proportion of participants who were dispensed antimycotics (t5654=0.29, 95\% CI --0.40 to 0.54; P=.76; Cohen d=0). Conclusions: This study provides preliminary evidence that the SARA eHealth intervention might have the potential to decrease exacerbation rates and improve medication adherence among patients with asthma and COPD. ",
doi="10.2196/32396",
url="https://www.jmir.org/2022/6/e32396",
url="http://www.ncbi.nlm.nih.gov/pubmed/35675120"
}


@Article{info:doi/10.2196/37946,
author="Baptist, Alan
and Gibson-Scipio, Wanda
and Carcone, Idalski April
and Ghosh, Samiran
and Jacques-Tiura, J. Angela
and Hall, Amy
and MacDonell, Kolmodin Karen",
title="Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="10",
volume="11",
number="5",
pages="e37946",
keywords="African American emerging adults",
keywords="asthma management",
keywords="mHealth",
keywords="mobile health",
keywords="motivational interviewing",
keywords="asthma control",
keywords="physical activity",
abstract="Background: Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective: The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods: We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant's activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing--based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results: At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions: AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID): PRR1-10.2196/37946 ",
doi="10.2196/37946",
url="https://www.researchprotocols.org/2022/5/e37946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536642"
}


@Article{info:doi/10.2196/32456,
author="Tendedez, Helena
and Ferrario, Maria-Angela
and McNaney, Roisin
and Gradinar, Adrian",
title="Exploring Human-Data Interaction in Clinical Decision-making Using Scenarios: Co-design Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="6",
volume="9",
number="2",
pages="e32456",
keywords="data-supported decision-making",
keywords="health care professionals",
keywords="respiratory care",
keywords="scenario-based design",
keywords="clinical decision-making",
keywords="decision support",
keywords="COPD",
keywords="respiratory conditions",
keywords="digital health",
keywords="user-centered design",
keywords="health technologies",
abstract="Background: When caring for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD), health care professionals (HCPs) rely on multiple data sources to make decisions. Collating and visualizing these data, for example, on clinical dashboards, holds the potential to support timely and informed decision-making. Most studies on data-supported decision-making (DSDM) technologies for health care have focused on their technical feasibility or quantitative effectiveness. Although these studies are an important contribution to the literature, they do not further our limited understanding of how HCPs engage with these technologies and how they can be designed to support specific contexts of use. To advance our knowledge in this area, we must work with HCPs to explore this space and the real-world complexities of health care work and service structures. Objective: This study aimed to qualitatively explore how DSDM technologies could support HCPs in their decision-making regarding COPD care. We created a scenario-based research tool called Respire, which visualizes HCPs' data needs about their patients with COPD and services. We used Respire with HCPs to uncover rich and nuanced findings about human-data interaction in this context, focusing on the real-world challenges that HCPs face when carrying out their work and making decisions. Methods: We engaged 9 respiratory HCPs from 2 collaborating health care organizations to design Respire. We then used Respire as a tool to investigate human-data interaction in the context of decision-making about COPD care. The study followed a co-design approach that had 3 stages and spanned 2 years. The first stage involved 5 workshops with HCPs to identify data interaction scenarios that would support their work. The second stage involved creating Respire, an interactive scenario-based web app that visualizes HCPs' data needs, incorporating feedback from HCPs. The final stage involved 11 one-to-one sessions with HCPs to use Respire, focusing on how they envisaged that it could support their work and decisions about care. Results: We found that HCPs trust data differently depending on where it came from and who recorded it, sporadic and subjective data generated by patients have value but create challenges for decision-making, and HCPs require support in interpreting and responding to new data and its use cases. Conclusions: Our study uncovered important lessons for the design of DSDM technologies to support health care contexts. We show that although DSDM technologies have the potential to support patient care and health care delivery, important sociotechnical and human-data interaction challenges influence the design and deployment of these technologies. Exploring these considerations during the design process can ensure that DSDM technologies are designed with a holistic view of how decision-making and engagement with data occur in health care contexts. ",
doi="10.2196/32456",
url="https://humanfactors.jmir.org/2022/2/e32456",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522463"
}


@Article{info:doi/10.2196/26499,
author="Chmiel, P. Francis
and Burns, K. Dan
and Pickering, Brian John
and Blythin, Alison
and Wilkinson, MA Thomas
and Boniface, J. Michael",
title="Prediction of Chronic Obstructive Pulmonary Disease Exacerbation Events by Using Patient Self-reported Data in a Digital Health App: Statistical Evaluation and Machine Learning Approach",
journal="JMIR Med Inform",
year="2022",
month="Mar",
day="21",
volume="10",
number="3",
pages="e26499",
keywords="COPD",
keywords="machine learning",
keywords="mHealth",
keywords="exacerbation events",
keywords="myCOPD",
keywords="mobile health",
keywords="digital applications",
keywords="remote monitoring",
keywords="chronic disease",
keywords="digital health",
keywords="health care applications",
abstract="Background: Self-reporting digital apps provide a way of remotely monitoring and managing patients with chronic conditions in the community. Leveraging the data collected by these apps in prognostic models could provide increased personalization of care and reduce the burden of care for people who live with chronic conditions. This study evaluated the predictive ability of prognostic models for the prediction of acute exacerbation events in people with chronic obstructive pulmonary disease by using data self-reported to a digital health app. Objective: The aim of this study was to evaluate if data self-reported to a digital health app can be used to predict acute exacerbation events in the near future. Methods: This is a retrospective study evaluating the use of symptom and chronic obstructive pulmonary disease assessment test data self-reported to a digital health app (myCOPD) in predicting acute exacerbation events. We include data from 2374 patients who made 68,139 self-reports. We evaluated the degree to which the different variables self-reported to the app are predictive of exacerbation events and developed both heuristic and machine learning models to predict whether the patient will report an exacerbation event within 3 days of self-reporting to the app. The model's predictive ability was evaluated based on self-reports from an independent set of patients. Results: Users self-reported symptoms, and standard chronic obstructive pulmonary disease assessment tests displayed correlation with future exacerbation events. Both a baseline model (area under the receiver operating characteristic curve [AUROC] 0.655, 95\% CI 0.689-0.676) and a machine learning model (AUROC 0.727, 95\% CI 0.720-0.735) showed moderate ability in predicting exacerbation events, occurring within 3 days of a given self-report. Although the baseline model obtained a fixed sensitivity and specificity of 0.551 (95\% CI 0.508-0.596) and 0.759 (95\% CI 0.752-0.767) respectively, the sensitivity and specificity of the machine learning model can be tuned by dichotomizing the continuous predictions it provides with different thresholds. Conclusions: Data self-reported to health care apps designed to remotely monitor patients with chronic obstructive pulmonary disease can be used to predict acute exacerbation events with moderate performance. This could increase personalization of care by allowing preemptive action to be taken to mitigate the risk of future exacerbation events. ",
doi="10.2196/26499",
url="https://medinform.jmir.org/2022/3/e26499",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311685"
}


@Article{info:doi/10.2196/24592,
author="Alnefaie, Majed
and Alamri, Abdullah
and Saeedi, Asalh
and Althobaiti, Awwadh
and Alosaimi, Shahad
and Alqurashi, Yousuf
and Marzouki, Hani
and Merdad, Mazin",
title="Pulmonary Screening Practices of Otolaryngology--Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study",
journal="Interact J Med Res",
year="2022",
month="Mar",
day="18",
volume="11",
number="1",
pages="e24592",
keywords="squamous cell carcinoma of head and neck",
keywords="lung neoplasms",
keywords="radiography",
keywords="otolaryngology",
keywords="surgeons",
keywords="survey",
abstract="Background: With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90\% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective: Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology--head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods: This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results: This study included 22 participants and had a 78\% (22/28) response rate. This study found that the majority of participants (9/22, 41\%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32\% (7/22) used low-dose computed tomography (CT; 7/22, 32\%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77\%) reported 5 years, and only 9\% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77\% (17/22) of participants conduct screening annually, 18\% (4/22) conduct screening half-yearly, and 5\% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36\% (8/22) of participants believed them to be very effective or somewhat effective, 18\% (4/22) did not know, and only 9\% (2/22) believed that they were not effective. Conclusions: The participants mainly used lung radiography (9/22, 41\%), low-dose CT (7/22, 32\%), or positron emission tomography/CT (6/22, 27\%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77\%) or 10 years (3/22, 14\%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9\%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective. ",
doi="10.2196/24592",
url="https://www.i-jmr.org/2022/1/e24592",
url="http://www.ncbi.nlm.nih.gov/pubmed/35302511"
}


@Article{info:doi/10.2196/28875,
author="Chaplin, Emma
and Barnes, Amy
and Newby, Chris
and Houchen-Wolloff, Linzy
and Singh, J. Sally",
title="Comparison of the Impact of Conventional and Web-Based Pulmonary Rehabilitation on Physical Activity in Patients With Chronic Obstructive Pulmonary Disease: Exploratory Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Mar",
day="10",
volume="9",
number="1",
pages="e28875",
keywords="SPACE for COPD",
keywords="internet",
keywords="web-based",
keywords="chronic obstructive pulmonary disease",
keywords="pulmonary rehabilitation",
keywords="physical activity",
keywords="exercise",
keywords="chronic disease",
keywords="COPD",
keywords="rehabilitation",
abstract="Background: Pulmonary Rehabilitation (PR) increases exercise capacity, with less clear evidence regarding physical activity (PA). The World Health Organization recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA per week to reduce the risks of chronic disease. Objective: The objective of this study was to assess the effectiveness of conventional PR versus web-based PR with respect to changes in PA. Methods: Patients with COPD were randomized to either conventional PR classes (n=51) or a web-based PR program (n=52) for 7 weeks in a feasibility study. Accelerometers (Sensewear) were worn before and after the intervention, and PA was measured as steps per day and mean bouts of moderate activity for ?2, ?5, ?10, and ?20 minutes. Measures were derived for patients with ?8 hours of data per day for ?4 days, using the R package for statistical analysis. Variables were explored to examine their relationships with bouts of activity. Results: Baseline characteristics did not differ significantly between groups. Complete PA data were available for the groups receiving web-based (n=20) and conventional (n=34) PR interventions. The web-based PR group demonstrated a nonsignificant increase in the number of steps per day, which mainly comprised short bouts of moderate to vigorous intensity PA when compared to the conventional PR group (P=.20). The conventional PR group demonstrated increased 20-minute bouts of PA by 49.1\%, although this was not significant (P=.07). At baseline, age (r=--0.21, P=.04), BMI (r=--0.311, P=.004), and FEV1 (forced expiratory volume in 1 second; \% predicted; r=--0.248, P=.048) were significantly correlated with 10-minute bouts of PA; however, this was not observed post intervention. Conclusions: The analysis revealed a nonsignificant difference in the pattern of PA between groups receiving conventional vs web-based PR---the former being associated with an increase in 20-minute bouts, while the latter having demonstrated an increase in the number of steps per day. There appears to be a differing response emerging between the two interventions. Trial Registration: International Clinical Trials Registry ISRCTN03142263; https://tinyurl.com/y4dmfyrb ",
doi="10.2196/28875",
url="https://rehab.jmir.org/2022/1/e28875",
url="http://www.ncbi.nlm.nih.gov/pubmed/35266871"
}


@Article{info:doi/10.2196/31350,
author="Penz, Dianne Erika
and Fenton, John Benjamin
and Hu, Nianping
and Marciniuk, Darcy",
title="Economic Burden of Chronic Obstructive Pulmonary Disease and Lung Cancer Between 2000 and 2015 in Saskatchewan: Study Protocol",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="4",
volume="11",
number="3",
pages="e31350",
keywords="lung cancer",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="productivity loss",
keywords="years of life lost",
keywords="premature years of life lost",
keywords="working years lost",
keywords="economic burden of disease",
keywords="lung disease",
keywords="health economics",
keywords="Stats Canada",
keywords="epidemiology",
keywords="pulmonary disease",
keywords="pulmonary health",
keywords="disease burden",
abstract="Background: Chronic obstructive pulmonary disease (COPD) and lung cancer are both detrimental diseases that present great burdens on society. Years of life lost (YLL), premature years of life lost (PYLL), working years lost (WYL), and productivity loss are all effective measures in identifying economic burden of disease. Objective: We propose a population-based study to analyze comprehensive provincial cohorts of Saskatchewan residents with COPD, lung cancer, and combined COPD and lung cancer in order to identify the burden these diseases present. Methods: Saskatchewan residents over the age of 35 years who had COPD, lung cancer, or both, between January 1, 2000, and December 31, 2015, will be identified and used in this study. Data for analysis including age, gender, and date of death, alongside Statistics Canada income estimates, will be used to estimate productivity loss and WYL. Statistics Canada life tables will be used to calculate YLL and PYLL by subtracting the patients' ages at death by their life expectancies, adjusted using sex and age at death.We will link the Saskatchewan cancer registry with Saskatchewan health administrative databases to create three cohorts: (1) COPD; (2) lung cancer; and (3) COPD and lung cancer. Individuals with lung cancer will be identified using ICDO-T (International Classification of Diseases for Oncology-Topography) codes, and those with COPD will be defined and identified as individuals who had at least 1 visit to a physician with a diagnosis of COPD or 1 hospital separation with a diagnosis of COPD. Those without a valid health care coverage for a consecutive 12 months prior to the first diagnostic code will be excluded from the study. Those with a combined diagnosis of COPD and lung cancer will be identified as individuals who were diagnosed with COPD in the 12 months following their lung cancer diagnosis or anytime preceding their lung cancer diagnosis. Results: As of April 2021, we have had access to all relevant data for this study, have received funding (January 2020), and have begun the preliminary analysis of our data set. Conclusions: It is well documented that COPD and lung cancer are both destructive diseases in terms of YLL, PYLL, WYL, and productivity loss; however, no studies have been conducted to analyze a cohort with combined COPD and lung cancer. Understanding the economic burden associated with each of our 3 cohorts is necessary in understanding and thus reducing the societal impact of COPD and lung cancer. International Registered Report Identifier (IRRID): RR1-10.2196/31350 ",
doi="10.2196/31350",
url="https://www.researchprotocols.org/2022/3/e31350",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254280"
}


@Article{info:doi/10.2196/34751,
author="Schnieders, Elena
and R{\"o}hr, Freda
and Mbewe, Misho
and Shanzi, Aubrey
and Berner-Rodoreda, Astrid
and Barteit, Sandra
and Louis, R. Val{\'e}rie
and Andreadis, Petros
and Syakantu, Gardner
and Neuhann, Florian",
title="Real-life Evaluation of an Interactive Versus Noninteractive e-Learning Module on Chronic Obstructive Pulmonary Disease for Medical Licentiate Students in Zambia: Web-Based, Mixed Methods Randomized Controlled Trial",
journal="JMIR Med Educ",
year="2022",
month="Feb",
day="24",
volume="8",
number="1",
pages="e34751",
keywords="distance education",
keywords="randomized controlled trial",
keywords="personal satisfaction",
keywords="knowledge",
keywords="user-centered design",
keywords="chronic obstructive pulmonary disease",
keywords="interactive",
keywords="noninteractive",
keywords="low- and middle-income country",
keywords="LMIC",
keywords="mobile phone",
abstract="Background: e-Learning for health professionals in many low- and middle-income countries (LMICs) is still in its infancy, but with the advent of COVID-19, a significant expansion of digital learning has occurred. Asynchronous e-learning can be grouped into interactive (user-influenceable content) and noninteractive (static material) e-learning. Studies conducted in high-income countries suggest that interactive e-learning is more effective than noninteractive e-learning in increasing learner satisfaction and knowledge; however, there is a gap in our understanding of whether this also holds true in LMICs. Objective: This study aims to validate the hypothesis above in a resource-constrained and real-life setting to understand e-learning quality and delivery by comparing interactive and noninteractive e-learning user satisfaction, usability, and knowledge gain in a new medical university in Zambia. Methods: We conducted a web-based, mixed methods randomized controlled trial at the Levy Mwanawasa Medical University (LMMU) in Lusaka, Zambia, between April and July 2021. We recruited medical licentiate students (second, third, and fourth study years) via email. Participants were randomized to undergo asynchronous e-learning with an interactive or noninteractive module for chronic obstructive pulmonary disease and informally blinded to their group allocation. The interactive module included interactive interfaces, quizzes, and a virtual patient, whereas the noninteractive module consisted of PowerPoint slides. Both modules covered the same content scope. The primary outcome was learner satisfaction. The secondary outcomes were usability, short- and long-term knowledge gain, and barriers to e-learning. The mixed methods study followed an explanatory sequential design in which rating conferences delivered further insights into quantitative findings, which were evaluated through web-based questionnaires. Results: Initially, 94 participants were enrolled in the study, of whom 41 (44\%; 18 intervention participants and 23 control participants) remained in the study and were analyzed. There were no significant differences in satisfaction (intervention: median 33.5, first quartile 31.3, second quartile 35; control: median 33, first quartile 30, second quartile 37.5; P=.66), usability, or knowledge gain between the intervention and control groups. Challenges in accessing both e-learning modules led to many dropouts. Qualitative data suggested that the content of the interactive module was more challenging to access because of technical difficulties and individual factors (eg, limited experience with interactive e-learning). Conclusions: We did not observe an increase in user satisfaction with interactive e-learning. However, this finding may not be generalizable to other low-resource settings because the post hoc power was low, and the e-learning system at LMMU has not yet reached its full potential. Consequently, technical and individual barriers to accessing e-learning may have affected the results, mainly because the interactive module was considered more difficult to access and use. Nevertheless, qualitative data showed high motivation and interest in e-learning. Future studies should minimize technical barriers to e-learning to further evaluate interactive e-learning in LMICs. ",
doi="10.2196/34751",
url="https://mededu.jmir.org/2022/1/e34751",
url="http://www.ncbi.nlm.nih.gov/pubmed/35200149"
}


@Article{info:doi/10.2196/30091,
author="Hawthorne, Grace
and Greening, Neil
and Esliger, Dale
and Briggs-Price, Samuel
and Richardson, Matthew
and Chaplin, Emma
and Clinch, Lisa
and Steiner, C. Michael
and Singh, J. Sally
and Orme, W. Mark",
title="Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="16",
volume="9",
number="1",
pages="e30091",
keywords="chronic obstructive pulmonary disease",
keywords="digital health",
keywords="physical activity",
keywords="respiratory rate",
keywords="wearable technology",
keywords="wearable device",
keywords="vital signs monitor",
abstract="Background: Vital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD). Objective: This study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology. Methods: In total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ?85\% for HR and ?80\% for RR, based on the device's proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls. Results: In total, 84\% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76\%, SD 26\%). There was greater adherence in the stable group than in the post-AECOPD group (?5 weeks wear: 71.4\% vs 45.7\%; P=.02). For all 84 participants, the median HR signal quality was 90\% (IQR 80\%-94\%) and the median RR signal quality was 93\% (IQR 92\%-95\%). The median HR data quality was 81\% (IQR 58\%-91\%), and the median RR data quality was 85\% (IQR 77\%-91\%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=--0.49, P=.009; rs=--0.44, P=.02). In total, 36 (74\%) participants in the Stable group and 21 (60\%) participants in the AECOPD group accepted the technology, but 10 participants (12\%) expressed concerns with wearing a device around their chest. Conclusions: This wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context. ",
doi="10.2196/30091",
url="https://humanfactors.jmir.org/2022/1/e30091",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171101"
}


@Article{info:doi/10.2196/31448,
author="Kohlbrenner, Dario
and Clarenbach, F. Christian
and Ivankay, Adam
and Zimmerli, Lukas
and Gross, S. Christoph
and Kuhn, Manuel
and Brunschwiler, Thomas",
title="Multisensory Home-Monitoring in Individuals With Stable Chronic Obstructive Pulmonary Disease and Asthma: Usability Study of the CAir-Desk",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="16",
volume="9",
number="1",
pages="e31448",
keywords="home monitoring",
keywords="digital health",
keywords="respiratory disease",
keywords="usability",
keywords="feasibility",
keywords="adherence",
keywords="disease management",
keywords="chronic disease",
keywords="patient monitoring",
abstract="Background: Research integrating multisensory home-monitoring in respiratory disease is scarce. Therefore, we created a novel multisensory home-monitoring device tailored for long-term respiratory disease management (named the CAir-Desk). We hypothesize that recent technological accomplishments can be integrated into a multisensory participant-driven platform. We also believe that this platform could improve chronic disease management and be accessible to large groups at an acceptable cost. Objective: This study aimed to report on user adherence and acceptance as well as system functionality of the CAir-Desk in a sample of participants with stable chronic obstructive pulmonary disease (COPD) or asthma. Methods: We conducted an observational usability study. Participants took part in 4 weeks of home-monitoring with the CAir-Desk. The CAir-Desk recorded data from all participants on symptom burden, physical activity, spirometry, and environmental air quality; data on sputum production, and nocturnal cough were only recorded for participants who experienced symptoms. After the study period, participants reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. We used descriptive statistics and visualizations to display results. Results: Ten participants, 5 with COPD and 5 with asthma took part in this study. They completed symptom burden questionnaires on a median of 96\% (25th percentile 14\%, 75th percentile 96\%), spirometry recordings on 55\% (20\%, 94\%), wrist-worn physical activity recordings on 100\% (97\%, 100\%), arm-worn physical activity recordings on 45\% (13\%, 63\%), nocturnal cough recordings on 34\% (9\%, 54\%), sputum recordings on 5\% (3\%, 12\%), and environmental air quality recordings on 100\% (99\%, 100\%) of the study days. The participants indicated that the measurements consumed a median of 13 (10, 15) min daily, and that they preferred the wrist-worn physical activity monitor to the arm-worn physical activity monitor. Conclusions: The CAir-Desk showed favorable technical performance and was well-accepted by our sample of participants with stable COPD and asthma. The obtained insights were used in a redesign of the CAir-Desk, which is currently applied in a randomized controlled trial including an interventional program. ",
doi="10.2196/31448",
url="https://humanfactors.jmir.org/2022/1/e31448",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171107"
}


@Article{info:doi/10.2196/33103,
author="Robinson, Billy
and Gong, Enying
and Oldenburg, Brian
and See, Katharine",
title="Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Protocol for a Systematic Search and Evaluation of Mobile Apps",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="9",
volume="11",
number="2",
pages="e33103",
keywords="asthma",
keywords="mHealth",
keywords="mobile phone",
keywords="applications",
keywords="self-management",
keywords="chronic disease",
keywords="respiratory",
keywords="smartphone",
keywords="asthma app",
abstract="Background: Asthma is a chronic respiratory disorder that requires long-term pharmacotherapy and patient empowerment to manage the condition and recognize and respond to asthma exacerbations. Mobile health (mHealth) apps represent a potential medium through which patients can improve their ability to self-manage their asthma. Few studies have conducted a systematic evaluation of asthma mobile apps for quality and functionality using a validated tool. None of these reviews have systematically assessed these apps for their content and evaluated them against the available international best practice guidelines. Objective: The objective of this study is to conduct a systematic search and evaluation of adult-targeted asthma mHealth apps. As part of this review, the potential of an mHealth app to improve asthma self-management and the overall quality of the app will be evaluated using the Mobile App Rating Scale framework, and the quality of the information within an app will be evaluated using the current Global Initiative for Asthma guidelines as a reference. Methods: A stepwise methodological approach was taken in creating this review. First, the most recent Global Initiative for Asthma guidelines were independently reviewed by 2 authors to identify key recommendations that could be feasibly incorporated into an mHealth app. A previously developed asthma assessment framework was identified and was modified to suit our research and ensure that all of these identified recommendations were included. In total, 2 popular app stores were reviewed to identify potential mHealth apps. These apps were screened based on predefined inclusion and exclusion criteria. Suitable apps were then evaluated. Technical information was obtained from publicly available information. The next step was to perform an app quality assessment using the validated Mobile App Rating Scale framework to objectively determine the quality of an app. App functionality was assessed using the Intercontinental Medical Statistics Institute for Health Informatics Functionality Scoring System. Finally, the mHealth apps were assessed using our developed checklist. Results: Funding has been received for the project from the Respiratory Department at Northern Health, Victoria. Three reviewers have been recruited to systematically evaluate the apps. The results of this study are expected in 2022. Conclusions: To our knowledge, this review represents the first study to examine all mHealth apps available in Australia that are targeted to adults with asthma for their functionality, quality, and consistency with international best practice guidelines. Although this review will only be conducted on mHealth apps available in Australia, many apps are available worldwide; thus, this study should be largely generalizable to other English-speaking regions and users. The results of this review will help to fill gaps in the literature and assist clinicians in providing evidence-based advice to patients wishing to use mHealth apps as part of their asthma self-management. Trial Registration: PROSPERO 269894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=269894 International Registered Report Identifier (IRRID): PRR1-10.2196/33103 ",
doi="10.2196/33103",
url="https://www.researchprotocols.org/2022/2/e33103",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138257"
}


@Article{info:doi/10.2196/30782,
author="Cooper, Rowena
and Giangreco, Adam
and Duffy, Michelle
and Finlayson, Elaine
and Hamilton, Shellie
and Swanson, Mahri
and Colligan, Judith
and Gilliatt, Joanna
and McIvor, Mairi
and Sage, Kathryn Elizabeth",
title="Evaluation of myCOPD Digital Self-management Technology in a Remote and Rural Population: Real-world Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="7",
volume="10",
number="2",
pages="e30782",
keywords="digital self-management",
keywords="COPD",
keywords="remote and rural",
keywords="mobile health",
keywords="application",
keywords="chronic pulmonary obstructive disease",
keywords="rural communities",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a common, costly, and incurable respiratory disease affecting 1.2 million people in the United Kingdom alone. Acute COPD exacerbations requiring hospitalization place significant demands on health services, and the incidence of COPD in poor, remote, and rural populations is up to twice that of cities. Objective: myCOPD is a commercial, digital health, self-management technology designed to improve COPD outcomes and mitigate demands on health services. In this pragmatic real-world feasibility study, we aimed to evaluate myCOPD use and its clinical effectiveness at reducing hospitalizations, inpatient bed days, and other National Health Service (NHS) resource use. Methods: myCOPD engagement and NHS resource use was monitored for up to 1 year after myCOPD activation and was compared against health service use in the year prior to activation. A total of 113 participants from predominantly remote and rural communities were recruited via community-based care settings, including scheduled home visits, outpatient appointments, pulmonary rehabilitation, and phone or group appointments. There were no predetermined age, disease severity, geographical, or socioeconomic inclusion or exclusion criteria. Results: Out of 113 participants, 89 activated myCOPD (78.8\%), with 56\% (50/89) of those participants doing so on the day of enrollment and 90\% (80/89) doing so within 1 month. There was no correlation between participant enrollment, activation, or myCOPD engagement and either age, socioeconomics, rurality, or COPD severity. Most active participants used at least one myCOPD module and entered their symptom scores at least once (79/89, 89\%). A subgroup (15/89, 17\%) recorded their symptom scores very frequently (>1 time every 5 days), 14 of whom (93\%) also used four or five myCOPD modules. Overall, there were no differences in hospital admissions, inpatient bed days, or other health service use before or after myCOPD activation, apart from a modest increase in home visits. Subgroup analysis did, however, identify a trend toward reduced inpatient bed days and hospital admissions for those participants with very high myCOPD usage. Conclusions: Our results suggest that neither age, wealth, nor geographical location represent significant barriers to using myCOPD. This finding may help mitigate perceived risks of increased health inequalities associated with the use of digital health technologies as part of routine care provision. Despite high levels of activation, myCOPD did not reduce overall demands on health services, such as hospital admissions or inpatient bed days. Subgroup analysis did, however, suggest that very high myCOPD usage was associated with a moderate reduction in NHS resource use. Thus, although our study does not support implementation of myCOPD to reduce health service demands on a population-wide basis, our results do indicate that highly engaged patients may derive benefits. ",
doi="10.2196/30782",
url="https://mhealth.jmir.org/2022/2/e30782",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129453"
}


@Article{info:doi/10.2196/28953,
author="Zeng, Siyang
and Arjomandi, Mehrdad
and Tong, Yao
and Liao, C. Zachary
and Luo, Gang",
title="Developing a Machine Learning Model to Predict Severe Chronic Obstructive Pulmonary Disease Exacerbations: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="6",
volume="24",
number="1",
pages="e28953",
keywords="chronic obstructive pulmonary disease",
keywords="machine learning",
keywords="forecasting",
keywords="symptom exacerbation",
keywords="patient care management",
abstract="Background: Chronic obstructive pulmonary disease (COPD) poses a large burden on health care. Severe COPD exacerbations require emergency department visits or inpatient stays, often cause an irreversible decline in lung function and health status, and account for 90.3\% of the total medical cost related to COPD. Many severe COPD exacerbations are deemed preventable with appropriate outpatient care. Current models for predicting severe COPD exacerbations lack accuracy, making it difficult to effectively target patients at high risk for preventive care management to reduce severe COPD exacerbations and improve outcomes. Objective: The aim of this study is to develop a more accurate model to predict severe COPD exacerbations. Methods: We examined all patients with COPD who visited the University of Washington Medicine facilities between 2011 and 2019 and identified 278 candidate features. By performing secondary analysis on 43,576 University of Washington Medicine data instances from 2011 to 2019, we created a machine learning model to predict severe COPD exacerbations in the next year for patients with COPD. Results: The final model had an area under the receiver operating characteristic curve of 0.866. When using the top 9.99\% (752/7529) of the patients with the largest predicted risk to set the cutoff threshold for binary classification, the model gained an accuracy of 90.33\% (6801/7529), a sensitivity of 56.6\% (103/182), and a specificity of 91.17\% (6698/7347). Conclusions: Our model provided a more accurate prediction of severe COPD exacerbations in the next year compared with prior published models. After further improvement of its performance measures (eg, by adding features extracted from clinical notes), our model could be used in a decision support tool to guide the identification of patients with COPD and at high risk for care management to improve outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/13783 ",
doi="10.2196/28953",
url="https://www.jmir.org/2022/1/e28953",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989686"
}


@Article{info:doi/10.2196/28318,
author="Song, Shijie
and Xue, Xiang
and Zhao, Chris Yuxiang
and Li, Jinhao
and Zhu, Qinghua
and Zhao, Mingming",
title="Short-Video Apps as a Health Information Source for Chronic Obstructive Pulmonary Disease: Information Quality Assessment of TikTok Videos",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e28318",
keywords="COPD",
keywords="information quality",
keywords="social media",
keywords="short-video apps",
keywords="TikTok",
abstract="Background: Chronic obstructive pulmonary disease (COPD) has become one of the most critical public health problems worldwide. Because many COPD patients are using video-based social media to search for health information, there is an urgent need to assess the information quality of COPD videos on social media. Recently, the short-video app TikTok has demonstrated huge potential in disseminating health information and there are currently many COPD videos available on TikTok; however, the information quality of these videos remains unknown. Objective: The aim of this study was to investigate the information quality of COPD videos on TikTok. Methods: In December 2020, we retrieved and screened 300 videos from TikTok and collected a sample of 199 COPD-related videos in Chinese for data extraction. We extracted the basic video information, coded the content, and identified the video sources. Two independent raters assessed the information quality of each video using the DISCERN instrument. Results: COPD videos on TikTok came mainly from two types of sources: individual users (n=168) and organizational users (n=31). The individual users included health professionals, individual science communicators, and general TikTok users, whereas the organizational users consisted of for-profit organizations, nonprofit organizations, and news agencies. For the 199 videos, the mean scores of the DISCERN items ranged from 3.42 to 4.46, with a total mean score of 3.75. Publication reliability (P=.04) and overall quality (P=.02) showed significant differences across the six types of sources, whereas the quality of treatment choices showed only a marginally significant difference (P=.053) across the different sources. Conclusions: The overall information quality of COPD videos on TikTok is satisfactory, although the quality varies across different sources and according to specific quality dimensions. Patients should be selective and cautious when watching COPD videos on TikTok. ",
doi="10.2196/28318",
url="https://www.jmir.org/2021/12/e28318",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931996"
}


@Article{info:doi/10.2196/26794,
author="Ali, Lilas
and Wallstr{\"o}m, Sara
and Fors, Andreas
and Barenfeld, Emmelie
and Fredholm, Eva
and Fu, Michael
and Goudarzi, Mahboubeh
and Gyllensten, Hanna
and Lindstr{\"o}m Kjellberg, Irma
and Swedberg, Karl
and Vanfleteren, W. Lowie E. G.
and Ekman, Inger",
title="Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="13",
volume="23",
number="12",
pages="e26794",
keywords="chronic heart failure",
keywords="chronic obstructive pulmonary disease",
keywords="digital platform",
keywords="eHealth",
keywords="patient-centered care",
keywords="person-centered care",
keywords="randomized controlled trial",
keywords="telehealth",
abstract="Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. Objective: The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. Methods: A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5\%) or PCC combined with usual care (110/222, 49.5\%). The intervention's main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. Results: No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. Conclusions: PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. Trial Registration: ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817 ",
doi="10.2196/26794",
url="https://www.jmir.org/2021/12/e26794",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898447"
}


@Article{info:doi/10.2196/26272,
author="Freeman, Benjamin Tobe Che
and Rodriguez-Esteban, Raul
and Gottowik, Juergen
and Yang, Xing
and Erpenbeck, Johannes Veit
and Leddin, Mathias",
title="A Neural Network Approach for Understanding Patient Experiences of Chronic Obstructive Pulmonary Disease (COPD): Retrospective, Cross-sectional Study of Social Media Content",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="11",
volume="9",
number="11",
pages="e26272",
keywords="outcomes research",
keywords="natural language processing",
keywords="neural networks (computer)",
keywords="social media",
keywords="exercise",
keywords="sleep deprivation",
keywords="social media listening",
keywords="drug development",
abstract="Background: The abundance of online content contributed by patients is a rich source of insight about the lived experience of disease. Patients share disease experiences with other members of the patient and caregiver community and do so using their own lexicon of words and phrases. This lexicon and the topics that are communicated using words and phrases belonging to the lexicon help us better understand disease burden. Insights from social media may ultimately guide clinical development in ways that ensure that future treatments are fit for purpose from the patient's perspective. Objective: We sought insights into the patient experience of chronic obstructive pulmonary disease (COPD) by analyzing a substantial corpus of social media content. The corpus was sufficiently large to make manual review and manual coding all but impossible to perform in a consistent and systematic fashion. Advanced analytics were applied to the corpus content in the search for associations between symptoms and impacts across the entire text corpus. Methods: We conducted a retrospective, cross-sectional study of 5663 posts sourced from open blogs and online forum posts published by COPD patients between February 2016 and August 2019. We applied a novel neural network approach to identify a lexicon of community words and phrases used by patients to describe their symptoms. We used this lexicon to explore the relationship between COPD symptoms and disease-related impacts. Results: We identified a diverse lexicon of community words and phrases for COPD symptoms, including gasping, wheezy, mucus-y, and muck. These symptoms were mentioned in association with specific words and phrases for disease impact such as frightening, breathing discomfort, and difficulty exercising. Furthermore, we found an association between mucus hypersecretion and moderate disease severity, which distinguished mucus from the other main COPD symptoms, namely breathlessness and cough. Conclusions: We demonstrated the potential of neural networks and advanced analytics to gain patient-focused insights about how each distinct COPD symptom contributes to the burden of chronic and acute respiratory illness. Using a neural network approach, we identified words and phrases for COPD symptoms that were specific to the patient community. Identifying patterns in the association between symptoms and impacts deepened our understanding of the patient experience of COPD. This approach can be readily applied to other disease areas. ",
doi="10.2196/26272",
url="https://medinform.jmir.org/2021/11/e26272",
url="http://www.ncbi.nlm.nih.gov/pubmed/34762056"
}


@Article{info:doi/10.2196/30259,
author="Widmann, N. Catherine
and Wieberneit, Michelle
and Bieler, Luzie
and Bernsen, Sarah
and Gr{\"a}fenk{\"a}mper, Robin
and Brosseron, Frederic
and Schmeel, Carsten
and Tacik, Pawel
and Skowasch, Dirk
and Radbruch, Alexander
and Heneka, T. Michael",
title="Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="11",
volume="10",
number="11",
pages="e30259",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="postacute COVID-19 syndrome",
keywords="cognition",
keywords="neuropsychology",
keywords="lung",
keywords="magnetic resonance imaging",
abstract="Background: There is a dearth of information about ``brain fog,'' characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification ``U09.9 Post-COVID-19 Condition.'' Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective: This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods: A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results: At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions: To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration: International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID): DERR1-10.2196/30259 ",
doi="10.2196/30259",
url="https://www.researchprotocols.org/2021/11/e30259",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559059"
}


@Article{info:doi/10.2196/28634,
author="Herkert, Cyrille
and Graat-Verboom, Lidwien
and Gilsing-Fernhout, Judith
and Schols, Manon
and Kemps, Clemens Hareld Marijn",
title="Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="9",
volume="5",
number="11",
pages="e28634",
keywords="home-based exercise",
keywords="cardiac diseases",
keywords="pulmonary diseases",
keywords="comorbidities",
keywords="elderly",
abstract="Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50\% (5/10) were men. Of the 10 participants, 9 (90\%) completed the 8-week program. Median adherence to the exercise prescription was 75\% (IQR 37\%-88\%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86\%, IQR 51\%-100\%, and final 2 weeks: 57\%, IQR 8\%-75\%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44\%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 ",
doi="10.2196/28634",
url="https://formative.jmir.org/2021/11/e28634",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751655"
}


@Article{info:doi/10.2196/24110,
author="ter Stal, Silke
and Sloots, Joanne
and Ramlal, Aniel
and op den Akker, Harm
and Lenferink, Anke
and Tabak, Monique",
title="An Embodied Conversational Agent in an eHealth Self-management Intervention for Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Exploratory Study in a Real-life Setting",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="4",
volume="8",
number="4",
pages="e24110",
keywords="embodied conversational agent",
keywords="eHealth",
keywords="self-management",
keywords="design",
keywords="daily life evaluation",
abstract="Background: Embodied conversational agents (ECAs) have the potential to stimulate actual use of eHealth apps. An ECA's design influences the user's perception during short interactions, but daily life evaluations of ECAs in health care are scarce. Objective: This is an exploratory, long-term study on the design of ECAs for eHealth. The study investigates how patients perceive the design of the ECA over time with regard to the ECA's characteristics (friendliness, trustworthiness, involvement, expertise, and authority), small talk interaction, and likeliness of following the agent's advice. Methods: We developed an ECA within an eHealth self-management intervention for patients with both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), which we offered for 4 months. Patients rated 5 agent characteristics and likeliness of following the agent's advice before use and after 3 and 9 weeks of use. The amount of patients' small talk interaction was assessed by log data. Lastly, individual semistructured interviews were used to triangulate results. Results: Eleven patients (7 male and 4 female) with COPD and CHF participated (median age 70 years). Patients' perceptions of the agent characteristics did not change over time (P>.05 for all characteristics) and only 1 participant finished all small talk dialogues. After 3 weeks of use, the patients were less likely to follow the agent's advice (P=.01). The agent's messages were perceived as nonpersonalized and the feedback as inappropriate, affecting the agent's perceived reliability. Conclusions: This exploratory study provides first insights into ECA design for eHealth. The first impression of an ECA's design seems to remain during long-term use. To investigate future added value of ECAs in eHealth, perceived reliability should be improved by managing users' expectations of the ECA's capabilities and creating ECA designs fitting individual needs. Trial Registration: Netherlands Trial Register NL6480; https://www.trialregister.nl/trial/6480 ",
doi="10.2196/24110",
url="https://humanfactors.jmir.org/2021/4/e24110",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734824"
}


@Article{info:doi/10.2196/26556,
author="Alwashmi, F. Meshari
and Mugford, Gerald
and Vokey, Brett
and Abu-Ashour, Waseem
and Hawboldt, John",
title="Effectiveness of the BreatheSuite Device in Assessing the Technique of Metered-Dose Inhalers: Validation Study",
journal="JMIR Biomed Eng",
year="2021",
month="Nov",
day="3",
volume="6",
number="4",
pages="e26556",
keywords="digital health",
keywords="asthma",
keywords="smartphone",
keywords="mHealth",
keywords="mobile health",
keywords="effective",
keywords="observational",
keywords="treatment",
keywords="chronic obstructive pulmonary disease",
keywords="inhaler",
keywords="app",
abstract="Background: The majority of medications used in treating asthma and chronic obstructive pulmonary disease (COPD) are taken through metered-dose inhalers (MDIs). Studies have reported that most patients demonstrate poor inhaler technique, which has resulted in poor disease control. Digital Health applications have the potential to improve the technique and adherence of inhaled medications. Objective: This study aimed to validate the effectiveness of the BreatheSuite MDI device in assessing the technique of taking a dose via an MDI. Methods: The study was a validation study. Thirty participants who self-reported a diagnosis of asthma or COPD were recruited from community pharmacies in Newfoundland and Labrador, Canada. Participants used a BreatheSuite MDI device attached to a placebo MDI and resembled taking 3 doses. Pharmacists used a scoring sheet to evaluate the technique of using the MDI. An independent researcher compared the results of the pharmacist's scoring sheet with the results of the BreatheSuite device. Results: This study found that the BreatheSuite MDI can objectively detect several errors in the MDI technique. The data recorded by the BreatheSuite MDI device showed that all participants performed at least one error in using the MDI. The BreatheSuite device captured approximately 40\% (143/360) more errors compared to observation alone. The distribution of participants who performed errors in MDI steps as recorded by BreatheSuite compared to errors reported by observation alone were as follows: shaking before actuation, 33.3\% (30/90) versus 25.5\% (23/90); upright orientation of the inhaler during actuation, 66.7\% (60/90) versus 18.87\% (17/90); coordination (actuating after the start of inhalation), 76.6\% (69/90) versus 35.5\% (32/90); and duration of inspiration, 96.7\% (87/90) versus 34.4\% (31/90). Conclusions: The BreatheSuite MDI can objectively detect several errors in the MDI technique, which were missed by observation alone. It has the potential to enhance treatment outcomes among patients with chronic lung diseases. ",
doi="10.2196/26556",
url="https://biomedeng.jmir.org/2021/4/e26556"
}


@Article{info:doi/10.2196/22567,
author="Phanareth, Klaus
and Dam, Laura Astrid
and Hansen, C. Martin A. B.
and Lindskrog, Signe
and Vingtoft, S{\o}ren
and Kayser, Lars",
title="Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="19",
volume="23",
number="10",
pages="e22567",
keywords="COPD",
keywords="exacerbations",
keywords="patient-reported outcomes",
keywords="Epital Care Model",
keywords="early interventions",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate, and temperature with synchronous communication of health data may become a powerful solution as they enable health care professionals to react with a proactive and adequate response. We have taken this idea to the next level in the Epital Care Model and organized a person-centered technology-assisted ecosystem to provide health services to COPD patients. Objective: The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on patient-reported outcome data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know the following: (1) What are the incidences of mild, moderate, and severe exacerbations in a mixed population of COPD patients? (2) What are the courses of mild, moderate, and severe exacerbations? And (3) How is the activity and pattern of contacts with health professionals related to the participant conditions? Methods: Participants were recruited by convenience sampling from November 2013 to December 2015. The participants' sex, age, forced expiratory volume during the first second, pulse rate, and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, and number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering 4 questions and sending 3 semiautomated measurements. Results: Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C, and 39 in D. The number of observed days was 31,801 days with 12,470 measurements, 1397 care notes, and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D had the highest number of hospitalizations (16), exacerbations (151), and contacts (1910). The initial contacts during the first month declined within 3 months to one-third for care contacts and one-half for treatment contacts and reached a plateau after 4 months. Conclusions: The majority of COPD patients in risk factor group D can be managed virtually, and only 13\% of those with severe exacerbations required hospitalization. Contact to the health care professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings. ",
doi="10.2196/22567",
url="https://www.jmir.org/2021/10/e22567",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665151"
}


@Article{info:doi/10.2196/19307,
author="Fang, Yang
and Shepherd, A. Thomas
and Smith, E. Helen",
title="Examining the Trends in Online Health Information--Seeking Behavior About Chronic Obstructive Pulmonary Disease in Singapore: Analysis of Data From Google Trends and the Global Burden of Disease Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="18",
volume="23",
number="10",
pages="e19307",
keywords="online health information seeking",
keywords="infodemiology",
keywords="Google Trends",
keywords="Global Burden of Disease study",
keywords="chronic obstructive pulmonary disease",
keywords="respiratory health",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, and timely health care seeking is imperative for its prevention, early detection, and management. While online health information--seeking behavior (OHISB) is increasingly popular due to widespread internet connectivity, little is known about how OHISB for COPD has changed in comparison with the COPD disease burden, particularly at a country-specific level. Objective: This study aimed to examine the trends in OHISB for COPD and how that compared with the estimates of COPD disease burden in Singapore, a highly wired country with a steadily increasing COPD disease burden. Methods: To examine the trends in OHISB for COPD, we performed Prais-Winsten regression analyses on monthly search volume data for COPD from January 2004 to June 2020 downloaded from Google Trends. We then conducted cross-correlational analyses to examine the relationship between annualized search volume on COPD topics and estimates of COPD morbidity and mortality reported in the Global Burden of Disease study from 2004 to 2017. Results: From 2004 to 2020, the trend in COPD search volume was curvilinear ($\beta$=1.69, t194=6.64, P<.001), with a slope change around the end of 2006. There was a negative linear trend ($\beta$=--0.53, t33=--3.57, P=.001) from 2004 to 2006 and a positive linear trend ($\beta$=0.51, t159=7.43, P<.001) from 2007 to 2020. Cross-correlation analyses revealed positive associations between COPD search volume and COPD disease burden indicators: positive correlations between search volume and prevalence, incidence, years living with disability (YLD) at lag 0, and positive correlations between search volume and prevalence, YLD at lag 1. Conclusions: Google search volume on COPD increased from 2007 to 2020; this trend correlated with the upward trajectory of several COPD morbidity estimates, suggesting increasing engagement in OHISB for COPD in Singapore. These findings underscore the importance of making high-quality, web-based information accessible to the public, particularly COPD patients and their carers. ",
doi="10.2196/19307",
url="https://www.jmir.org/2021/10/e19307",
url="http://www.ncbi.nlm.nih.gov/pubmed/34661539"
}


@Article{info:doi/10.2196/28873,
author="Ranjan, Yatharth
and Althobiani, Malik
and Jacob, Joseph
and Orini, Michele
and Dobson, JB Richard
and Porter, Joanna
and Hurst, John
and Folarin, A. Amos",
title="Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="7",
volume="10",
number="10",
pages="e28873",
keywords="mHealth",
keywords="COVID-19",
keywords="mobile health",
keywords="remote monitoring",
keywords="wearables",
keywords="internet of things",
keywords="lung diseases",
keywords="respiratory health",
keywords="mental health",
keywords="cardiopulmonary diseases",
abstract="Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 ",
doi="10.2196/28873",
url="https://www.researchprotocols.org/2021/10/e28873",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319235"
}


@Article{info:doi/10.2196/26314,
author="Tong, Yao
and Liao, C. Zachary
and Tarczy-Hornoch, Peter
and Luo, Gang",
title="Using a Constraint-Based Method to Identify Chronic Disease Patients Who Are Apt to Obtain Care Mostly Within a Given Health Care System: Retrospective Cohort Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="7",
volume="5",
number="10",
pages="e26314",
keywords="asthma",
keywords="chronic kidney disease",
keywords="chronic obstructive pulmonary disease",
keywords="data analysis",
keywords="diabetes mellitus",
keywords="emergency department",
keywords="health care system",
keywords="inpatients",
keywords="patient care management",
abstract="Background: For several major chronic diseases including asthma, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes, a state-of-the-art method to avert poor outcomes is to use predictive models to identify future high-cost patients for preemptive care management interventions. Frequently, an American patient obtains care from multiple health care systems, each managed by a distinct institution. As the patient's medical data are spread across these health care systems, none has complete medical data for the patient. The task of building models to predict an individual patient's cost is currently thought to be impractical with incomplete data, which limits the use of care management to improve outcomes. Recently, we developed a constraint-based method to identify patients who are apt to obtain care mostly within a given health care system. Our method was shown to work well for the cohort of all adult patients at the University of Washington Medicine for a 6-month follow-up period. It is unknown how well our method works for patients with various chronic diseases and over follow-up periods of different lengths, and subsequently, whether it is reasonable to perform this predictive modeling task on the subset of patients pinpointed by our method. Objective: To understand our method's potential to enable this predictive modeling task on incomplete medical data, this study assesses our method's performance at the University of Washington Medicine on 5 subgroups of adult patients with major chronic diseases and over follow-up periods of 2 different lengths. Methods: We used University of Washington Medicine data for all adult patients who obtained care at the University of Washington Medicine in 2018 and PreManage data containing usage information from all hospitals in Washington state in 2019. We evaluated our method's performance over the follow-up periods of 6 months and 12 months on 5 patient subgroups separately---asthma, chronic kidney disease, type 1 diabetes, type 2 diabetes, and chronic obstructive pulmonary disease. Results: Our method identified 21.81\% (3194/14,644) of University of Washington Medicine adult patients with asthma. Around 66.75\% (797/1194) and 67.13\% (1997/2975) of their emergency department visits and inpatient stays took place within the University of Washington Medicine system in the subsequent 6 months and in the subsequent 12 months, respectively, approximately double the corresponding percentage for all University of Washington Medicine adult patients with asthma. The performance for adult patients with chronic kidney disease, adult patients with chronic obstructive pulmonary disease, adult patients with type 1 diabetes, and adult patients with type 2 diabetes was reasonably similar to that for adult patients with asthma. Conclusions: For each of the 5 chronic diseases most relevant to care management, our method can pinpoint a reasonably large subset of patients who are apt to obtain care mostly within the University of Washington Medicine system. This opens the door to building models to predict an individual patient's cost on incomplete data, which was formerly deemed impractical. International Registered Report Identifier (IRRID): RR2-10.2196/13783 ",
doi="10.2196/26314",
url="https://formative.jmir.org/2021/10/e26314",
url="http://www.ncbi.nlm.nih.gov/pubmed/34617906"
}


@Article{info:doi/10.2196/26350,
author="De Vos, Ruth
and Brown, Thomas
and Longstaff, Jayne
and Lomax, Mitch
and Mackenzie, Heather
and Hicks, Alexander
and Rupani, Hitasha
and Gates, Jessica
and Fox, Lauren
and Wiffen, Laura
and Chauhan, J. Anoop",
title="A Study to Investigate the Prevalence of Device-Specific Errors in Inhaler Technique in Adults With Airway Disease (The SCORES Study): Protocol for a Single Visit Prevalence Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="27",
volume="10",
number="8",
pages="e26350",
keywords="inhaler",
keywords="inhaler technique",
keywords="inhaler technique error",
keywords="asthma",
keywords="COPD",
abstract="Background: It is a recurring theme in clinical practice that patients using inhaled medications via an inhaler do not use their device to a standard that allows for optimum therapeutic effect, and some studies have shown that up to 90\% of people do not use their inhalers properly. Observation and correction of the inhaler technique by health care professionals is advised by both national and international guidelines and should be performed at every opportunity to ensure that the optimum inhaler technique is achieved by the user. This study will provide a greater understanding of the most frequent technique errors made by people using 13 different inhaler types. Objective: This study aims to identify and compare inhaler technique errors and their prevalence in adults, using device-specific checklists in accordance with manufacturers' guidelines, for 13 specific inhaler types across all lung conditions and to correlate these errors with possible determinants of poor technique. It also aims to assess the error frequency at each step in the device-specific questionnaires and compare the error rates among device types. Methods: In a single visit, participants using an inhaler included in the inclusion criteria will have their inhaler technique observed using an identical placebo device, which will be recorded using device-specific checklists, and technique-optimized, or switched to a suitable inhaler. Results: The study is already underway, and it is anticipated that the results will be available by 2022. Conclusions: The SCORES (Study to Investigate the Prevalence of Device-Specific Errors in Inhaler Technique in Adults With Airway Disease) study will ascertain the prevalence of device-specific inhaler technique errors at each step in the device-specific checklists, compare error rates among 13 device types, and correlate these errors with possible determinants of poor technique. Future work will involve the clarification and classification of these errors into critical and noncritical categories. Trial Registration: ClinicalTrials.gov NCT04262271; https://clinicaltrials.gov/ct2/show/NCT04262271 International Registered Report Identifier (IRRID): DERR1-10.2196/26350 ",
doi="10.2196/26350",
url="https://www.researchprotocols.org/2021/8/e26350",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448728"
}


@Article{info:doi/10.2196/14552,
author="Morsa, Maxime
and Perrin, Am{\'e}lie
and David, Val{\'e}rie
and Rault, Gilles
and Le Roux, Enora
and Alberti, Corinne
and Gagnayre, R{\'e}mi
and Pougheon Bertrand, Dominique",
title="Use of Home-Based Connected Devices in Patients With Cystic Fibrosis for the Early Detection and Treatment of Pulmonary Exacerbations: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="18",
volume="10",
number="8",
pages="e14552",
keywords="cystic fibrosis",
keywords="pulmonary exacerbation",
keywords="connected devices",
keywords="patient education",
keywords="self-management",
abstract="Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF) is important to quickly trigger treatment and reduce respiratory damage. We hypothesized that using home-based and wearable connected devices (CDs) and educating patients to react in case of abnormal variations in a set of parameters would allow patients to detect and manage their PEx early with their care team. Objective: This qualitative study aimed to assess the feasibility and appropriate conditions of a new PEx management process from the users' point of view by analyzing the experience of patients and of CF center teams regarding the education program, the use of CDs, and the relationship between the patient and the care team during PEx management. Methods: We have been conducting a multicenter pilot study involving 36 patients with CF aged ?12 years. The intervention was divided into 3 phases. In phase 1 (3 months), patients were equipped with CDs, and their parameters were collected on 3 nonconsecutive days each week. Phase 2 involved the development of a ``React to PEx'' educational program aimed at providing patients with a personalized action plan. A training session to the educational program was organized for the physicians. Physicians then determined the patients' personalized alert thresholds by reviewing the data collected during phase 1 and their patients' clinical history. In phase 3 (12 months), patients were educated by the physician during a clinic visit, and their action plan for reacting in timely fashion to their PEx signs was defined. Education and action plans were revised during clinic visits. At the end of the project, the patients' experience was collected during semistructured interviews with a researcher as part of the qualitative study. The experience of CF teams was collected during focus groups using a semistructured guide once all their patients had finished the study. The interviews and focus groups were recorded and transcribed verbatim to be analyzed. Data from educational sessions were collected throughout the educational program to be put into perspective with the learnings reported by patients. Analyses are being led by 2 researchers using NVivo (QSR International). Results: The study received the favorable reception of the Committee for the Protection of Persons (CPP NORTH WEST III) on June 10, 2017 (\#2017-A00723-50). Out of the 36 patients included in phase 1, 27 were educated and entered phase 3. We completed collection of all data from the patients and care providers. Qualitative analysis will provide a better understanding of users' experience on the conditions of data collection, how useful CDs are for detecting PEx, how useful the PEx action plan is for reacting quickly, what patients learned about PEx management, and the conditions for this PEx management to be sustainable in routine care. Conclusions: This study will open new perspectives for further research into the implementation of an optimal PEx care process in the organization of care teams in order to support patient self-management. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 International Registered Report Identifier (IRRID): DERR1-10.2196/14552 ",
doi="10.2196/14552",
url="https://www.researchprotocols.org/2021/8/e14552",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406124"
}


@Article{info:doi/10.2196/29475,
author="Schulte, J. Mieke H.
and Aardoom, J. Jiska
and Loheide-Niesmann, Lisa
and Verstraete, L. Leonie L.
and Ossebaard, C. Hans
and Riper, Heleen",
title="Effectiveness of eHealth Interventions in Improving Medication Adherence for Patients With Chronic Obstructive Pulmonary Disease or Asthma: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="27",
volume="23",
number="7",
pages="e29475",
keywords="chronic obstructive pulmonary disease",
keywords="asthma",
keywords="medication adherence",
keywords="exercise adherence",
keywords="treatment adherence",
keywords="eHealth",
keywords="systematic review",
keywords="COPD",
keywords="adherence",
keywords="exercise",
keywords="treatment",
keywords="review",
abstract="Background: Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth. Objective: This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma. Methods: A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration's risk of bias tool. The results were narratively reviewed. Results: In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects. Conclusions: The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma. ",
doi="10.2196/29475",
url="https://www.jmir.org/2021/7/e29475",
url="http://www.ncbi.nlm.nih.gov/pubmed/34313593"
}


@Article{info:doi/10.2196/30244,
author="Snyder, Natalie
and Wilson, Ria
and Finch, Lian
and Gallant, Brooklyn
and Landa, Chris
and Frankel, Daniel
and Brooks, Dina
and Packham, Tara
and Oliveira, Ana",
title="The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="26",
volume="10",
number="7",
pages="e30244",
keywords="chronic respiratory disease",
keywords="COPD",
keywords="lung diseases",
keywords="occupational therapy",
keywords="pulmonary rehabilitation program",
abstract="Background: Chronic respiratory diseases are highly prevalent and compromise an individual's ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual's exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful ``occupations,'' improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines. Objective: The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs. Methods: The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic. Results: The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022. Conclusions: The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes. Trial Registration: OSF Registries ZH63W; https://osf.io/zh63w International Registered Report Identifier (IRRID): DERR1-10.2196/30244 ",
doi="10.2196/30244",
url="https://www.researchprotocols.org/2021/7/e30244",
url="http://www.ncbi.nlm.nih.gov/pubmed/34309572"
}


@Article{info:doi/10.2196/22110,
author="Beaubien, Louis
and Conrad, Colin
and Music, Janet
and Toze, Sandra",
title="Evaluating Simplified Web Interfaces of Risk Models for Clinical Use: Pilot Survey Study",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="16",
volume="5",
number="7",
pages="e22110",
keywords="risk model",
keywords="electronic records",
keywords="user interface",
keywords="technology acceptance",
abstract="Background: In this pilot study, we investigated sociotechnical factors that affect intention to use a simplified web model to support clinical decision making. Objective: We investigated factors that are known to affect technology adoption using the unified theory of acceptance and use of technology (UTAUT2) model. The goal was to pilot and test a tool to better support complex clinical assessments. Methods: Based on the results of a previously published work, we developed a web-based mobile user interface, WebModel, to allow users to work with regression equations and their predictions to evaluate the impact of various characteristics or treatments on key outcomes (eg, survival time) for chronic obstructive pulmonary disease. The WebModel provides a way to combat information overload and more easily compare treatment options. It limits the number of web forms presented to a user to between 1 and 20, rather than the dozens of detailed calculations typically required. The WebModel uses responsive design and can be used on multiple devices. To test the WebModel, we designed a questionnaire to probe the efficacy of the WebModel and assess the usability and usefulness of the system. The study was live for one month, and participants had access to it over that time. The questionnaire was administered online, and data from 674 clinical users who had access to the WebModel were captured. SPSS and R were used for statistical analysis. Results: The regression model developed from UTAUT2 constructs was a fit. Specifically, five of the seven factors were significant positive coefficients in the regression: performance expectancy ($\beta$=.2730; t=7.994; P<.001), effort expectancy ($\beta$=.1473; t=3.870; P=.001), facilitating conditions ($\beta$=.1644; t=3.849; P<.001), hedonic motivation ($\beta$=.2321; t=3.991; P<.001), and habit ($\beta$=.2943; t=12.732). Social influence was not a significant factor, while price value had a significant negative influence on intention to use the WebModel. Conclusions: Our results indicate that multiple influences impact positive response to the system, many of which relate to the efficiency of the interface to provide clear information. Although we found that the price value was a negative factor, it is possible this was due to the removal of health workers from purchasing decisions.  Given that this was a pilot test, and that the system was not used in a clinical setting, we could not examine factors related to actual workflow, patient safety, or social influence. This study shows that the concept of a simplified WebModel could be effective and efficient in reducing information overload in complex clinical decision making. We recommend further study to test this in a clinical setting and gather qualitative data from users regarding the value of the tool in practice. ",
doi="10.2196/22110",
url="https://formative.jmir.org/2021/7/e22110",
url="http://www.ncbi.nlm.nih.gov/pubmed/34269692"
}


@Article{info:doi/10.2196/23831,
author="Fox, Lauren
and Gates, Jessica
and De Vos, Ruth
and Wiffen, Laura
and Hicks, Alexander
and Rupani, Hitasha
and Williams, Jane
and Brown, Thomas
and Chauhan, J. Anoop",
title="The VICTORY (Investigation of Inflammacheck to Measure Exhaled Breath Condensate Hydrogen Peroxide in Respiratory Conditions) Study: Protocol for a Cross-sectional Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="9",
volume="10",
number="7",
pages="e23831",
keywords="medical device",
keywords="diagnosis",
keywords="hydrogen peroxide",
keywords="lung diseases",
keywords="exhalation",
keywords="asthma",
keywords="COPD",
keywords="bronchiectasis",
keywords="interstitial lung disease",
keywords="lung cancer",
keywords="breathing pattern disorder",
keywords="pneumonia",
abstract="Background: More than 7\% of the world's population is living with a chronic respiratory condition. In the United Kingdom, lung disease affects approximately 1 in 5 people, resulting in over 700,000 hospital admissions each year. People with respiratory conditions have several symptoms and can require multiple health care visits and investigations before a diagnosis is made. The tests available can be difficult to perform, especially if a person is symptomatic, leading to poor quality results. A new, easy-to-perform, point-of-care test that can be performed in any health care setting and that can differentiate between various respiratory conditions would have a significant, beneficial impact on the ability to diagnose respiratory diseases. Objective: The objective of this study is to use a new handheld device (Inflammacheck) in different respiratory conditions to measure the exhaled breath condensate hydrogen peroxide (EBC H2O2) and compare these results with those of healthy controls and with each other. This study also aims to determine whether the device can measure other parameters, including breath humidity, breath temperature, breath flow dynamics, and end tidal carbon dioxide. Methods: We will perform a single-visit, cross-sectional observational study of EBC H2O2 levels, as measured by Inflammacheck, in people with respiratory disease and volunteers with no known lung disease. Participants with a confirmed diagnosis of asthma, chronic obstructive pulmonary disease, lung cancer, bronchiectasis, pneumonia, breathing pattern disorder, and interstitial lung disease as well as volunteers with no history of lung disease will be asked to breathe into the Inflammacheck device to record their breath sample. Results: The results from this study will be available in 2022, in anticipation of COVID-19--related delays. Conclusions: This study will investigate the EBC H2O2, as well as other exhaled breath parameters, for use as a future diagnostic tool. ",
doi="10.2196/23831",
url="https://www.researchprotocols.org/2021/7/e23831",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255725"
}


@Article{info:doi/10.2196/24796,
author="Muro, Shigeo
and Ishida, Masato
and Horie, Yoshiharu
and Takeuchi, Wataru
and Nakagawa, Shunki
and Ban, Hideyuki
and Nakagawa, Tohru
and Kitamura, Tetsuhisa",
title="Machine Learning Methods for the Diagnosis of Chronic Obstructive Pulmonary Disease in Healthy Subjects: Retrospective Observational Cohort Study",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="6",
volume="9",
number="7",
pages="e24796",
keywords="chronic obstructive pulmonary disease",
keywords="airflow limitation",
keywords="medical check-up",
keywords="Gradient Boosting Decision Tree",
keywords="logistic regression",
abstract="Background: Airflow limitation is a critical physiological feature in chronic obstructive pulmonary disease (COPD), for which long-term exposure to noxious substances, including tobacco smoke, is an established risk. However, not all long-term smokers develop COPD, meaning that other risk factors exist. Objective: This study aimed to predict the risk factors for COPD diagnosis using machine learning in an annual medical check-up database. Methods: In this retrospective observational cohort study (ARTDECO [Analysis of Risk Factors to Detect COPD]), annual medical check-up records for all Hitachi Ltd employees in Japan collected from April 1998 to March 2019 were analyzed. Employees who provided informed consent via an opt-out model were screened and those aged 30 to 75 years without a prior diagnosis of COPD/asthma or a history of cancer were included. The database included clinical measurements (eg, pulmonary function tests) and questionnaire responses. To predict the risk factors for COPD diagnosis within a 3-year period, the Gradient Boosting Decision Tree machine learning (XGBoost) method was applied as a primary approach, with logistic regression as a secondary method. A diagnosis of COPD was made when the ratio of the prebronchodilator forced expiratory volume in 1 second (FEV1) to prebronchodilator forced vital capacity (FVC) was <0.7 during two consecutive examinations. Results: Of the 26,101 individuals screened, 1213 met the exclusion criteria, and thus, 24,815 individuals were included in the analysis. The top 10 predictors for COPD diagnosis were FEV1/FVC, smoking status, allergic symptoms, cough, pack years, hemoglobin A1c, serum albumin, mean corpuscular volume, percent predicted vital capacity, and percent predicted value of FEV1. The areas under the receiver operating characteristic curves of the XGBoost model and the logistic regression model were 0.956 and 0.943, respectively. Conclusions: Using a machine learning model in this longitudinal database, we identified a number of parameters as risk factors other than smoking exposure or lung function to support general practitioners and occupational health physicians to predict the development of COPD. Further research to confirm our results is warranted, as our analysis involved a database used only in Japan. ",
doi="10.2196/24796",
url="https://medinform.jmir.org/2021/7/e24796",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255684"
}


@Article{info:doi/10.2196/28865,
author="Habukawa, Chizu
and Ohgami, Naoto
and Arai, Takahiko
and Makata, Haruyuki
and Tomikawa, Morimitsu
and Fujino, Tokihiko
and Manabe, Tetsuharu
and Ogihara, Yoshihito
and Ohtani, Kiyotaka
and Shirao, Kenichiro
and Sugai, Kazuko
and Asai, Kei
and Sato, Tetsuya
and Murakami, Katsumi",
title="Wheeze Recognition Algorithm for Remote Medical Care Device in Children: Validation Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jun",
day="17",
volume="4",
number="2",
pages="e28865",
keywords="asthma",
keywords="children",
keywords="infant",
keywords="wheezing",
keywords="wheeze recognition algorithm",
keywords="pediatrics",
keywords="remote",
keywords="medical devices",
keywords="validation",
keywords="home management",
keywords="algorithm",
keywords="detection",
keywords="chronic illness",
abstract="Background: Since 2020, peoples' lifestyles have been largely changed due to the COVID-19 pandemic worldwide. In the medical field, although many patients prefer remote medical care, this prevents the physician from examining the patient directly; thus, it is important for patients to accurately convey their condition to the physician. Accordingly, remote medical care should be implemented and adaptable home medical devices are required. However, only a few highly accurate home medical devices are available for automatic wheeze detection as an exacerbation sign. Objective: We developed a new handy home medical device with an automatic wheeze recognition algorithm, which is available for clinical use in noisy environments such as a pediatric consultation room or at home. Moreover, the examination time is only 30 seconds, since young children cannot endure a long examination time without crying or moving. The aim of this study was to validate the developed automatic wheeze recognition algorithm as a clinical medical device in children at different institutions. Methods: A total of 374 children aged 4-107 months in pediatric consultation rooms of 10 institutions were enrolled in this study. All participants aged ?6 years were diagnosed with bronchial asthma and patients ?5 years had reported at least three episodes of wheezes. Wheezes were detected by auscultation with a stethoscope and recorded for 30 seconds using the wheeze recognition algorithm device (HWZ-1000T) developed based on wheeze characteristics following the Computerized Respiratory Sound Analysis guideline, where the dominant frequency and duration of a wheeze were >100 Hz and >100 ms, respectively. Files containing recorded lung sounds were assessed by each specialist physician and divided into two groups: 177 designated as ``wheeze'' files and 197 as ``no-wheeze'' files. Wheeze recognitions were compared between specialist physicians who recorded lung sounds and those recorded using the wheeze recognition algorithm. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for all recorded sound files, and evaluated the influence of age and sex on the wheeze detection sensitivity. Results: Detection of wheezes was not influenced by age and sex. In all files, wheezes were differentiated from noise using the wheeze recognition algorithm. The sensitivity, specificity, positive predictive value, and negative predictive value of the wheeze recognition algorithm were 96.6\%, 98.5\%, 98.3\%, and 97.0\%, respectively. Wheezes were automatically detected, and heartbeat sounds, voices, and crying were automatically identified as no-wheeze sounds by the wheeze recognition algorithm. Conclusions: The wheeze recognition algorithm was verified to identify wheezing with high accuracy; therefore, it might be useful in the practical implementation of asthma management at home. Only a few home medical devices are available for automatic wheeze detection. The wheeze recognition algorithm was verified to identify wheezing with high accuracy and will be useful for wheezing management at home and in remote medical care. ",
doi="10.2196/28865",
url="https://pediatrics.jmir.org/2021/2/e28865",
url="http://www.ncbi.nlm.nih.gov/pubmed/33875413"
}


@Article{info:doi/10.2196/21728,
author="Houchen-Wolloff, Linzy
and Orme, Mark
and Barradell, Amy
and Clinch, Lisa
and Chaplin, Emma
and Gardiner, Nikki
and Singh, J. Sally",
title="Web-Based Self-management Program (SPACE for COPD) for Individuals Hospitalized With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Nonrandomized Feasibility Trial of Acceptability",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e21728",
keywords="COPD",
keywords="telehealth",
keywords="digital health",
keywords="internet",
keywords="rehabilitation",
keywords="quantitative",
keywords="qualitative",
keywords="exercise",
abstract="Background: Hospital admissions due to the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are costly for individuals and health services. Pulmonary rehabilitation (PR) is known to reduce hospital readmissions when delivered after hospitalization, but the uptake and completion of PR following hospitalization remains poor (<10\% of those eligible in the UK audit data). A web-based platform of the SPACE (Self-management Program of Activity Coping and Education) for COPD (chronic obstructive pulmonary disease) has previously shown promising results in patients with stable COPD but has not been tested following an AECOPD. Objective: This study aims to assess the feasibility and acceptability of a web-based self-management program. Methods: A nonrandomized feasibility study for patients with confirmed AECOPD who were deemed web literate was conducted. All patients consented during their hospitalization and received access to the website following discharge in addition to usual care. The program aims to facilitate patients to better understand and manage their condition through education and home-based exercises. Participants were asked to complete the Bristol COPD Knowledge Questionnaire at baseline and after 6 months. A total of 14 participants were also interviewed (n=8 completers; n=6 noncompleters) regarding their experiences with the web-based program and trial. The interviews were analyzed using thematic analysis. Results: In total, 2080 patients were screened for eligibility, of which 100 patients (age: mean 71.2 years, SD 9.3 years; male: 55/100, 55\%; forced expiratory volume in 1 second/forced vital capacity ratio: mean 0.46, SD 0.14; pack-years: mean 50.2, SD 31.0; current smokers: 35/100, 35\%) were recruited (4.8\% of those screened). The main reason for ineligibility was a lack of web literacy (1366/1980, 68.98\%). In total, 18\% (18/100) of patients had completed the web program by 6 months, with others still registered in the program (27/100, 27\%), and more than half did not register (55/100, 55\%). There was a mean change in Bristol COPD Knowledge Questionnaire scores at 6 months of 7.8 (SD 10.2) points. Qualitative interviews identified three main themes: preparing for, engagement with, and benefits of the study and program. A total of 57\% (57/100) accepted a referral to PR on discharge and 19\% (19/100) had completed the program after 6 months. Conclusions: On the basis of the challenges of recruiting, retaining, and engaging participants in a web-based self-management program, it is not a feasible approach to roll out widely. This study acknowledges that this is a challenging time for patients with an AECOPD to engage in exercise and self-management education. However, for patients who were able to engage in such an intervention, the completion rate of PR was double the previous audit estimates from the United Kingdom, disease knowledge improved, and the intervention was of value to patients. Trial Registration: ISRCTN Registry 13081008; https://www.isrctn.com/ISRCTN13081008 ",
doi="10.2196/21728",
url="https://mhealth.jmir.org/2021/6/e21728",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114960"
}


@Article{info:doi/10.2196/26643,
author="Gross, Christoph
and Schachner, Theresa
and Hasl, Andrea
and Kohlbrenner, Dario
and Clarenbach, F. Christian
and Wangenheim, V. Forian
and Kowatsch, Tobias",
title="Personalization of Conversational Agent-Patient Interaction Styles for Chronic Disease Management: Two Consecutive Cross-sectional Questionnaire Studies",
journal="J Med Internet Res",
year="2021",
month="May",
day="26",
volume="23",
number="5",
pages="e26643",
keywords="conversational agents",
keywords="chatbots",
keywords="human-computer interaction",
keywords="physician-patient interaction styles",
keywords="deliberative interaction",
keywords="paternalistic interaction",
keywords="digital health",
keywords="chronic conditions",
keywords="disease management",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
abstract="Background: Conversational agents (CAs) for chronic disease management are receiving increasing attention in academia and the industry. However, long-term adherence to CAs is still a challenge and needs to be explored. Personalization of CAs has the potential to improve long-term adherence and, with it, user satisfaction, task efficiency, perceived benefits, and intended behavior change. Research on personalized CAs has already addressed different aspects, such as personalized recommendations and anthropomorphic cues. However, detailed information on interaction styles between patients and CAs in the role of medical health care professionals is scant. Such interaction styles play essential roles for patient satisfaction, treatment adherence, and outcome, as has been shown for physician-patient interactions. Currently, it is not clear (1) whether chronically ill patients prefer a CA with a paternalistic, informative, interpretive, or deliberative interaction style, and (2) which factors influence these preferences. Objective: We aimed to investigate the preferences of chronically ill patients for CA-delivered interaction styles. Methods: We conducted two studies. The first study included a paper-based approach and explored the preferences of chronic obstructive pulmonary disease (COPD) patients for paternalistic, informative, interpretive, and deliberative CA-delivered interaction styles. Based on these results, a second study assessed the effects of the paternalistic and deliberative interaction styles on the relationship quality between the CA and patients via hierarchical multiple linear regression analyses in an online experiment with COPD patients. Patients' sociodemographic and disease-specific characteristics served as moderator variables. Results: Study 1 with 117 COPD patients revealed a preference for the deliberative (50/117) and informative (34/117) interaction styles across demographic characteristics. All patients who preferred the paternalistic style over the other interaction styles had more severe COPD (three patients, Global Initiative for Chronic Obstructive Lung Disease class 3 or 4). In Study 2 with 123 newly recruited COPD patients, younger participants and participants with a less recent COPD diagnosis scored higher on interaction-related outcomes when interacting with a CA that delivered the deliberative interaction style (interaction between age and CA type: relationship quality: b=?0.77, 95\% CI ?1.37 to ?0.18; intention to continue interaction: b=?0.49, 95\% CI ?0.97 to ?0.01; working alliance attachment bond: b=?0.65, 95\% CI ?1.26 to ?0.04; working alliance goal agreement: b=?0.59, 95\% CI ?1.18 to ?0.01; interaction between recency of COPD diagnosis and CA type: working alliance goal agreement: b=0.57, 95\% CI 0.01 to 1.13). Conclusions: Our results indicate that age and a patient's personal disease experience inform which CA interaction style the patient should be paired with to achieve increased interaction-related outcomes with the CA. These results allow the design of personalized health care CAs with the goal to increase long-term adherence to health-promoting behavior. ",
doi="10.2196/26643",
url="https://www.jmir.org/2021/5/e26643",
url="http://www.ncbi.nlm.nih.gov/pubmed/33913814"
}


@Article{info:doi/10.2196/25397,
author="Kerr, M. Kim
and Elliott, Greg C.
and Benza, L. Raymond
and Channick, N. Richard
and Chin, M. Kelly
and Davis, Duane R.
and Jain, Sonia
and LaCroix, Z. Andrea
and Madani, M. Michael
and McLaughlin, V. Vallerie
and Park, H. Myung
and Tapson, F. Victor
and Auger, R. William",
title="The United States Chronic Thromboembolic Pulmonary Hypertension Registry: Protocol for a Prospective, Longitudinal Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="25",
volume="10",
number="5",
pages="e25397",
keywords="CTEPH",
keywords="pulmonary hypertension",
keywords="pulmonary embolism",
keywords="registry",
keywords="surgical",
keywords="nonsurgical",
keywords="therapy",
keywords="treatment",
abstract="Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare sequela of acute pulmonary embolism that is treatable when recognized. Awareness of this disease has increased with recent advancements in therapeutic options, but delays in diagnosis remain common, and diagnostic and treatment guidelines are often not followed. Data gathered from international registries have improved our understanding of CTEPH, but these data may not be applicable to the US population owing to differences in demographics and medical practice patterns. Objective: The US CTEPH Registry (US-CTEPH-R) was developed to provide essential information to better understand the demographics, risk factors, evaluation, and treatment of CTEPH in the United States, as well as the short- and long-term outcomes of surgical and nonsurgical therapies in the modern treatment era. Methods: Thirty sites throughout the United States enrolled 750 subjects in this prospective, longitudinal, observational registry of patients newly diagnosed with CTEPH. Enrollment criteria included a mean pulmonary artery pressure ?25 mmHg by right heart catheterization and radiologic confirmation of CTEPH by a multidisciplinary adjudication committee. Following enrollment, subjects were followed biannually until the conclusion of the study. Quality of life surveys were administered at enrollment and biannually, and all other testing was at the discretion of the treating clinician. Details regarding surgical therapy, balloon pulmonary angioplasty, and medical therapy were collected at enrollment and at follow-up, as well as information related to health care utilization and survival. Results: Data from this registry will improve understanding of the demographics, risk factors, and treatment patterns of patients with CTEPH, and the longitudinal impact of therapies on quality of life, health care utilization, and survival. Conclusions: This manuscript details the methodology and design of the first large, prospective, longitudinal registry of patients with CTEPH in the United States. Trial Registration: ClinicalTrials.gov NCT02429284; https://www.clinicaltrials.gov/ct2/show/NCT02429284 International Registered Report Identifier (IRRID): DERR1-10.2196/25397 ",
doi="10.2196/25397",
url="https://www.researchprotocols.org/2021/5/e25397",
url="http://www.ncbi.nlm.nih.gov/pubmed/33848258"
}


@Article{info:doi/10.2196/27065,
author="Luo, Gang
and Stone, L. Bryan
and Sheng, Xiaoming
and He, Shan
and Koebnick, Corinna
and Nkoy, L. Flory",
title="Using Computational Methods to Improve Integrated Disease Management for Asthma and Chronic Obstructive Pulmonary Disease: Protocol for a Secondary Analysis",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="18",
volume="10",
number="5",
pages="e27065",
keywords="asthma",
keywords="chronic obstructive pulmonary disease",
keywords="decision support techniques",
keywords="forecasting",
keywords="machine learning",
abstract="Background: Asthma and chronic obstructive pulmonary disease (COPD) impose a heavy burden on health care. Approximately one-fourth of patients with asthma and patients with COPD are prone to exacerbations, which can be greatly reduced by preventive care via integrated disease management that has a limited service capacity. To do this well, a predictive model for proneness to exacerbation is required, but no such model exists. It would be suboptimal to build such models using the current model building approach for asthma and COPD, which has 2 gaps due to rarely factoring in temporal features showing early health changes and general directions. First, existing models for other asthma and COPD outcomes rarely use more advanced temporal features, such as the slope of the number of days to albuterol refill, and are inaccurate. Second, existing models seldom show the reason a patient is deemed high risk and the potential interventions to reduce the risk, making already occupied clinicians expend more time on chart review and overlook suitable interventions. Regular automatic explanation methods cannot deal with temporal data and address this issue well. Objective: To enable more patients with asthma and patients with COPD to obtain suitable and timely care to avoid exacerbations, we aim to implement comprehensible computational methods to accurately predict proneness to exacerbation and recommend customized interventions. Methods: We will use temporal features to accurately predict proneness to exacerbation, automatically find modifiable temporal risk factors for every high-risk patient, and assess the impact of actionable warnings on clinicians' decisions to use integrated disease management to prevent proneness to exacerbation. Results: We have obtained most of the clinical and administrative data of patients with asthma from 3 prominent American health care systems. We are retrieving other clinical and administrative data, mostly of patients with COPD, needed for the study. We intend to complete the study in 6 years. Conclusions: Our results will help make asthma and COPD care more proactive, effective, and efficient, improving outcomes and saving resources. International Registered Report Identifier (IRRID): PRR1-10.2196/27065 ",
doi="10.2196/27065",
url="https://www.researchprotocols.org/2021/5/e27065",
url="http://www.ncbi.nlm.nih.gov/pubmed/34003134"
}


@Article{info:doi/10.2196/22591,
author="Wu, Chia-Tung
and Li, Guo-Hung
and Huang, Chun-Ta
and Cheng, Yu-Chieh
and Chen, Chi-Hsien
and Chien, Jung-Yien
and Kuo, Ping-Hung
and Kuo, Lu-Cheng
and Lai, Feipei",
title="Acute Exacerbation of a Chronic Obstructive Pulmonary Disease Prediction System Using Wearable Device Data, Machine Learning, and Deep Learning: Development and Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="6",
volume="9",
number="5",
pages="e22591",
keywords="chronic obstructive pulmonary disease",
keywords="clinical decision support systems",
keywords="health risk assessment",
keywords="wearable device",
abstract="Background: The World Health Organization has projected that by 2030, chronic obstructive pulmonary disease (COPD) will be the third-leading cause of mortality and the seventh-leading cause of morbidity worldwide. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with an accelerated decline in lung function, diminished quality of life, and higher mortality. Accurate early detection of acute exacerbations will enable early management and reduce mortality. Objective: The aim of this study was to develop a prediction system using lifestyle data, environmental factors, and patient symptoms for the early detection of AECOPD in the upcoming 7 days. Methods: This prospective study was performed at National Taiwan University Hospital. Patients with COPD that did not have a pacemaker and were not pregnant were invited for enrollment. Data on lifestyle, temperature, humidity, and fine particulate matter were collected using wearable devices (Fitbit Versa), a home air quality--sensing device (EDIMAX Airbox), and a smartphone app. AECOPD episodes were evaluated via standardized questionnaires. With these input features, we evaluated the prediction performance of machine learning models, including random forest, decision trees, k-nearest neighbor, linear discriminant analysis, and adaptive boosting, and a deep neural network model. Results: The continuous real-time monitoring of lifestyle and indoor environment factors was implemented by integrating home air quality--sensing devices, a smartphone app, and wearable devices. All data from 67 COPD patients were collected prospectively during a mean 4-month follow-up period, resulting in the detection of 25 AECOPD episodes. For 7-day AECOPD prediction, the proposed AECOPD predictive model achieved an accuracy of 92.1\%, sensitivity of 94\%, and specificity of 90.4\%. Receiver operating characteristic curve analysis showed that the area under the curve of the model in predicting AECOPD was greater than 0.9. The most important variables in the model were daily steps walked, stairs climbed, and daily distance moved. Conclusions: Using wearable devices, home air quality--sensing devices, a smartphone app, and supervised prediction algorithms, we achieved excellent power to predict whether a patient would experience AECOPD within the upcoming 7 days. The AECOPD prediction system provided an effective way to collect lifestyle and environmental data, and yielded reliable predictions of future AECOPD events. Compared with previous studies, we have comprehensively improved the performance of the AECOPD prediction model by adding objective lifestyle and environmental data. This model could yield more accurate prediction results for COPD patients than using only questionnaire data. ",
doi="10.2196/22591",
url="https://mhealth.jmir.org/2021/5/e22591",
url="http://www.ncbi.nlm.nih.gov/pubmed/33955840"
}


@Article{info:doi/10.2196/25672,
author="Marklund, Sarah
and Tistad, Malin
and Lundell, Sara
and {\"O}strand, Lina
and S{\"o}rlin, Ann
and Bostr{\"o}m, Carina
and Wadell, Karin
and Nyberg, Andre",
title="Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="30",
volume="23",
number="4",
pages="e25672",
keywords="COPD",
keywords="qualitative content analysis",
keywords="eHealth",
keywords="self-management",
keywords="primary care",
keywords="chronic disease",
abstract="Background: Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD. Objective: This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage. Methods: The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months' access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month. Results: Three main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants' experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users. Conclusions: Findings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD. Trial Registration: ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-016851 ",
doi="10.2196/25672",
url="https://www.jmir.org/2021/4/e25672",
url="http://www.ncbi.nlm.nih.gov/pubmed/33929327"
}


@Article{info:doi/10.2196/27826,
author="Litrownik, Daniel
and Gilliam, A. Elizabeth
and Wayne, M. Peter
and Richardson, R. Caroline
and Kadri, Reema
and Rist, M. Pamela
and Moy, L. Marilyn
and Yeh, Y. Gloria",
title="Development of a Novel Intervention (Mindful Steps) to Promote Long-Term Walking Behavior in Chronic Cardiopulmonary Disease: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="29",
volume="10",
number="4",
pages="e27826",
keywords="mind--body exercise",
keywords="internet-mediated intervention",
keywords="behavior change",
keywords="physical activity",
keywords="COPD",
keywords="heart failure",
abstract="Background: Despite current rehabilitation programs, long-term engagement in physical activity remains a significant challenge for patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). Novel strategies to promote physical activity in these populations are greatly needed. Emerging literature on the benefits of both mind--body interventions and web-based interventions provide the rationale for the development of the Mindful Steps intervention for increasing walking behavior. Objective: This study aims to develop a novel multimodal mind--body exercise intervention through adaptation of an existing web-based physical activity intervention and incorporation of mind--body exercise, and to pilot test the delivery of the new intervention, Mindful Steps, in a randomized controlled feasibility trial in older adults with COPD and/or HF. Methods: In phase 1, guided by a theoretical conceptual model and review of the literature on facilitators and barriers of physical activity in COPD and HF, we convened an expert panel of researchers, mind--body practitioners, and clinicians to inform development of the novel, multimodal intervention. In phase 2, we are conducting a pilot randomized controlled feasibility trial of the Mindful Steps intervention that includes in-person mind--body exercise classes, an educational website, online mind--body videos, and a pedometer with step-count feedback and goals to increase walking behavior in patients with COPD and/or HF. Outcomes include feasibility measures as well as patient-centered measures. Results: The study is currently ongoing. Phase 1 intervention development was completed in March 2019, and phase 2 data collection began in April 2019. Conclusions: Through the integration of components from a web-based physical activity intervention and mind--body exercise, we created a novel, multimodal program to impact long-term physical activity engagement for individuals with COPD and HF. This developmental work and pilot study will provide valuable information needed to design a future clinical trial assessing efficacy of this multimodal approach. Trial Registration: ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/ct2/show/NCT03003780 International Registered Report Identifier (IRRID): DERR1-10.2196/27826 ",
doi="10.2196/27826",
url="https://www.researchprotocols.org/2021/4/e27826",
url="http://www.ncbi.nlm.nih.gov/pubmed/33913819"
}


@Article{info:doi/10.2196/24602,
author="Song, Xiaoyue
and Hallensleben, Cynthia
and Zhang, Weihong
and Jiang, Zongliang
and Shen, Hongxia
and Gobbens, J. Robbert J.
and Kleij, Der Rianne M. J. J. Van
and Chavannes, H. Niels
and Versluis, Anke",
title="Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="31",
volume="23",
number="3",
pages="e24602",
keywords="blended intervention",
keywords="COPD",
keywords="asthma",
keywords="meta-analysis",
keywords="systematic review",
abstract="Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95\% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95\% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95\% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95\% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95\% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95\% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95\% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95\% CI 0.18-0.62) and QoL (SMD 0.36; 95\% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95\% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95\% CI 0.28-2.42) and exercise capacity (d=1.50; 95\% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=119894 ",
doi="10.2196/24602",
url="https://www.jmir.org/2021/3/e24602",
url="http://www.ncbi.nlm.nih.gov/pubmed/33788700"
}


@Article{info:doi/10.2196/24323,
author="Tran, Kim-Anh
and Pollock, William Neal
and Rh{\'e}aume, Caroline
and Razdan, Sonya Payal
and Fortier, F{\'e}lix-Antoine
and Dutil-Fafard, Lara
and Morin, Camille
and Monnot, Pierre-Marie David
and Huot-Lavoie, Maxime
and Simard-Sauriol, Philippe
and Chandavong, Sam
and Le Pabic, Genevi{\`e}ve
and LeBlanc, Jean-Philippe
and Lafond, Daniel
and Marion, Andr{\'e}anne
and Archambault, Michel Patrick",
title="Evidence Supporting the Management of Medical Conditions During Long-Duration Spaceflight: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="29",
volume="10",
number="3",
pages="e24323",
keywords="spaceflight",
keywords="astronauts",
keywords="microgravity",
keywords="weightlessness",
keywords="acute coronary syndrome",
keywords="arrhythmia",
keywords="atrial fibrillation",
keywords="eye penetration",
keywords="intraocular foreign body",
keywords="herniated disk",
keywords="nephrolithiasis",
keywords="pulmonary embolism",
keywords="retinal detachment",
keywords="sepsis",
keywords="stroke",
keywords="spaceflight associated neuro-ocular syndrome",
abstract="Background: Future long-duration space exploration missions, such as traveling to Mars, will create an increase in communication time delays and disruptions and remove the viability of emergency returns to Earth for timely medical treatment. Thus, higher levels of medical autonomy are necessary. Crew selection is proposed as the first line of defense to minimize medical risk for future missions; however, the second proposed line of defense is medical preparedness and crew member autonomy. In an effort to develop a decision support system, the Canadian Space Agency mandated a team of scientists from Thales Research and Technology Canada (Qu{\'e}bec, QC) and Universit{\'e} Laval (Qu{\'e}bec, QC) to create an evidence-based medical condition database linking mission-critical human conditions with key causal factors, diagnostic and treatment information, and probable outcomes. Objective: To complement this database, we are currently conducting a scoping review to better understand the depth and breadth of evidence about managing medical conditions in space. Methods: This scoping review will adhere to quality standards for scoping reviews, employing Levac, Colquhoun, and O'Brien's 6-stage methodology; the reported results will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. In stage 1, we identified the research question in collaboration with the Canadian Space Agency (CSA), the main knowledge user. We prioritized 10 medical conditions: (1) acute coronary syndrome, (2) atrial fibrillation, (3) eye penetration, (4) herniated disk, (5) nephrolithiasis, (6) pulmonary embolism, (7) retinal detachment, (8) sepsis, (9) stroke, and (10) spaceflight associated neuro-ocular syndrome. In stage 2, with the help of an information specialist from Cochrane Canada Francophone, papers were identified through searches of the following databases: ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO, and Web of Science. In stage 3, studies will be selected and assessed using a 3-step process and emerging, refined exclusion criteria. In stage 4, the data will be charted in a table based on parameters required by the CSA and developed using Google spreadsheets for shared access. In stage 5, evidence-based descriptive summaries will be produced for each condition, as well as descriptive analyses of collected data. Finally, in stage 6, the findings will be shared with the CSA to guide the completion of this project. Results: This study was planned in December 2018. Stage 1 has been completed. The initial database search strategy with all target conditions combined identified a total of 10,403 citations to review through title and abstract screening and after duplicate removal. We plan to complete stages 2-6 by the beginning of 2021. Conclusions: This scoping review will map the literature on the management of 10 priority medical conditions in space. It will also enable us to identify knowledge gaps that must be addressed in future research, ensuring successful and medically safe future missions as humankind embarks upon new frontiers of space exploration. International Registered Report Identifier (IRRID): DERR1-10.2196/24323 ",
doi="10.2196/24323",
url="https://www.researchprotocols.org/2021/3/e24323",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779571"
}


@Article{info:doi/10.2196/24726,
author="van Buul, R. Amanda
and Derksen, Caroline
and Hoedemaker, Ouke
and van Dijk, Oscar
and Chavannes, H. Niels
and Kasteleyn, J. Marise",
title="eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="18",
volume="5",
number="3",
pages="e24726",
keywords="COPD",
keywords="eHealth",
keywords="exacerbations",
keywords="hospitalizations",
keywords="mHealth",
abstract="Background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs. Objective: This study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations. Methods: This was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use. Results: The 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) \%predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95\% CI 0.116-0.382; incidence rate ratio 0.310, 95\% CI 0.219-0.438). Adjustment for confounders did not affect the results. Conclusions: The eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD. ",
doi="10.2196/24726",
url="https://formative.jmir.org/2021/3/e24726",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734091"
}


@Article{info:doi/10.2196/18298,
author="Elghafari, Anas
and Finkelstein, Joseph",
title="Automated Identification of Common Disease-Specific Outcomes for Comparative Effectiveness Research Using ClinicalTrials.gov: Algorithm Development and Validation Study",
journal="JMIR Med Inform",
year="2021",
month="Feb",
day="8",
volume="9",
number="2",
pages="e18298",
keywords="clinical trials",
keywords="clinical outcomes",
keywords="common data elements",
keywords="data processing",
keywords="ClinicalTrials.gov",
abstract="Background: Common disease-specific outcomes are vital for ensuring comparability of clinical trial data and enabling meta analyses and interstudy comparisons. Traditionally, the process of deciding which outcomes should be recommended as common for a particular disease relied on assembling and surveying panels of subject-matter experts. This is usually a time-consuming and laborious process. Objective: The objectives of this work were to develop and evaluate a generalized pipeline that can automatically identify common outcomes specific to any given disease by finding, downloading, and analyzing data of previous clinical trials relevant to that disease. Methods: An automated pipeline to interface with ClinicalTrials.gov's application programming interface and download the relevant trials for the input condition was designed. The primary and secondary outcomes of those trials were parsed and grouped based on text similarity and ranked based on frequency. The quality and usefulness of the pipeline's output were assessed by comparing the top outcomes identified by it for chronic obstructive pulmonary disease (COPD) to a list of 80 outcomes manually abstracted from the most frequently cited and comprehensive reviews delineating clinical outcomes for COPD. Results: The common disease-specific outcome pipeline successfully downloaded and processed 3876 studies related to COPD. Manual verification indicated that the pipeline was downloading and processing the same number of trials as were obtained from the self-service ClinicalTrials.gov portal. Evaluating the automatically identified outcomes against the manually abstracted ones showed that the pipeline achieved a recall of 92\% and precision of 79\%. The precision number indicated that the pipeline was identifying many outcomes that were not covered in the literature reviews. Assessment of those outcomes indicated that they are relevant to COPD and could be considered in future research. Conclusions: An automated evidence-based pipeline can identify common clinical trial outcomes of comparable breadth and quality as the outcomes identified in comprehensive literature reviews. Moreover, such an approach can highlight relevant outcomes for further consideration. ",
doi="10.2196/18298",
url="http://medinform.jmir.org/2021/2/e18298/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33460388"
}


@Article{info:doi/10.2196/21977,
author="Kooij, Laura
and Vos, E. Petra J.
and Dijkstra, Antoon
and van Harten, H. Wim",
title="Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="4",
volume="9",
number="2",
pages="e21977",
keywords="chronic obstructive pulmonary disease",
keywords="mHealth",
keywords="self-management",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Mobile health and self-management interventions may positively affect behavioral change and reduce hospital admissions for patients with chronic obstructive pulmonary disease (COPD). However, not all patients qualify for these interventions, and systematic, comprehensive information on implementation- and compliance-related aspects of mobile self-management apps is lacking. Due to the tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on the use of these services in broad clinical practice for patients recently discharged from hospital. Objective: This study aims to evaluate the effects of a mobile health and self-management app in clinical practice for recently discharged patients with COPD on use of the app, self-management, expectations, and experiences (technology acceptance); patients' and nurses' satisfaction; and hospital readmissions. Methods: A prototype of the app was pilot tested with 6 patients with COPD. The COPD app consisted of an 8-week program including the Lung Attack Action Plan, education, medication overview, video consultation, and questionnaires (monitored by nurses). In the feasibility study, adult patients with physician-diagnosed COPD, access to a mobile device, and proficiency of the Dutch language were included from a large teaching hospital during hospital admission. Self-management (Partners in Health Scale), technology acceptance (Unified Theory Acceptance and Use of Technology model), and satisfaction were assessed using questionnaires at baseline, after 8 weeks, and 20 weeks. Use was assessed with log data, and readmission rates were extracted from the electronic medical record. Results: A total of 39 patients were included; 76.4\% (133/174) of patients had to be excluded from participation, and 48.9\% of those patients (65/133) were excluded because of lack of digital skills, access to a mobile device, or access to the internet. The COPD app was opened most often in the first week (median 6.0; IQR 3.5-10.0), but its use decreased over time. The self-management element knowledge and coping increased significantly over time (P=.04). The COPD app was rated on a scale of 1-10, with an average score by patients of 7.7 (SD 1.7) and by nurses of 6.3 (SD 1.2). Preliminary evidence about the readmission rate showed that 13\% (5/39) of patients were readmitted within 30 days; 31\% (12/39) of patients were readmitted within 20 weeks, compared with 14.1\% (48/340) and 21.8\% (74/340) in a preresearch cohort, respectively. Conclusions: The use of a mobile self-management app after hospital discharge seems to be feasible only for a small number of patients with COPD. Patients were satisfied with the service; however, use decreased over time, and only knowledge and coping changed significantly over time. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, a multidisciplinary approach, technology-related aspects (such as acceptability), and fine-tuning its adoption in clinical pathways. Trial Registration: Clinicaltrials.gov NCT04540562; https://clinicaltrials.gov/ct2/show/NCT04540562. ",
doi="10.2196/21977",
url="http://mhealth.jmir.org/2021/2/e21977/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33538699"
}


@Article{info:doi/10.2196/23548,
author="Bi, Junjie
and Yang, Wei
and Hao, Ping
and Zhao, Yongmei
and Wei, Dan
and Sun, Yipeng
and Lin, Yuhua
and Sun, Meng
and Chen, Xuan
and Luo, Xuming
and Li, Shanqun
and Zhang, Wei
and Wang, Xiongbiao",
title="WeChat as a Platform for Baduanjin Intervention in Patients With Stable Chronic Obstructive Pulmonary Disease in China: Retrospective Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="2",
volume="9",
number="2",
pages="e23548",
keywords="WeChat management",
keywords="chronic obstructive pulmonary disease",
keywords="Baduanjin rehabilitation",
abstract="Background: Pulmonary rehabilitation is a crucial part of the nonpharmacological treatment of stable chronic obstructive pulmonary disease (COPD), but management remains problematic. WeChat could serve as a useful tool in patient management. Baduanjin is a popular exercise in China that is usually applied in pulmonary rehabilitation, which has been confirmed to be effective in improving lung function and life quality. Objective: This study aimed to explore the efficiency of WeChat in the management of Baduanjin exercise in COPD patients. Methods: A total of 200 patients from the respiratory department of Putuo Hospital participated in the Baduanjin rehabilitation project from September 2018 to October 2019, and were randomly assigned to the WeChat and control groups and followed up using the WeChat platform or telephone for 12 weeks. The frequency of Baduanjin exercise, lung function (percentage of forced expiratory volume in 1 second predicted, FEV1\% predicted), and COPD assessment test (CAT) scores were collected and compared between the two groups. The number of message exchanges and a satisfaction survey on the WeChat platform were used to assess the feasibility of WeChat management outside the hospital. Results: The Baduanjin exercise frequency significantly differed between the control group and WeChat group (F=33.82, P<.001) and across various time points (F=214.87, P<.001). After the follow-up on WeChat, there were fewer patients not performing Baduanjin exercise. The FEV1\% predicted value significantly differed before and after Baduanjin exercise in the control group (Z=?3.686, P<.001) and the WeChat group (Z=?6.985, P<.001). A significant difference in the FEV1\% predicted value was observed after Baduanjin exercise between the two groups (Z=?3.679, P<.001). The CAT score significantly differed before and after Baduanjin exercise in the control group (Z=?4.937, P<.001) and the WeChat group (Z=?5.246, P<.001). A significant difference in the CAT score was observed after Baduanjin exercise between the two groups (Z=?5.246, P<.001). The number of completed Baduanjin exercises, lung function, and CAT scores in active patients were higher than those in nonactive patients. All satisfaction survey items were scored with more than 4 points. Among the items, the highest score (mean 4.54, SD 0.77) was for continued WeChat management, followed by the effective management of Baduanjin exercise (mean 4.46, SD 0.87). The patients in the WeChat group showed much higher enthusiasm for and compliance with Baduanjin exercise, resulting in better life quality and lung function. The patients were very satisfied with the WeChat management because of the obvious curative effect and home feeling. Conclusions: The WeChat platform provided a feasible, effective, and sustainable management plan for Baduanjin rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900028248; http://www.chictr.org.cn/showprojen.aspx?proj=46995 ",
doi="10.2196/23548",
url="https://mhealth.jmir.org/2021/2/e23548",
url="http://www.ncbi.nlm.nih.gov/pubmed/33528369"
}


@Article{info:doi/10.2196/23069,
author="Simmich, Joshua
and Mandrusiak, Allison
and Smith, Trevor Stuart
and Hartley, Nicole
and Russell, Glen Trevor",
title="A Co-Designed Active Video Game for Physical Activity Promotion in People With Chronic Obstructive Pulmonary Disease: Pilot Trial",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="27",
volume="9",
number="1",
pages="e23069",
keywords="fitness trackers",
keywords="chronic obstructive pulmonary disease",
keywords="physical activity",
keywords="video games",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: People with chronic obstructive pulmonary disease (COPD) who are less active have lower quality of life, greater risk of exacerbations, and greater mortality than those who are more active. The effectiveness of physical activity interventions may facilitate the addition of game elements to improve engagement. The use of a co-design approach with people with COPD and clinicians as co-designers may also improve the effectiveness of the intervention. Objective: The primary aim of this study is to evaluate the feasibility of a co-designed mobile game by examining the usage of the game, subjective measures of game engagement, and adherence to wearing activity trackers. The secondary aim of this study is to estimate the effect of the game on daily steps and daily moderate-to-vigorous physical activity (MVPA). Methods: Participants with COPD who were taking part in the co-design of the active video game (n=9) acted as the experiment group, spending 3 weeks testing the game they helped to develop. Daily steps and MVPA were compared with a control group (n=9) of participants who did not co-design or test the game. Results: Most participants (8/9, 89\%) engaged with the game after downloading it. Participants used the game to record physical activity on 58.6\% (82/141) of the days the game was available. The highest scores on the Intrinsic Motivation Inventory were seen for the value and usefulness subscale, with a mean of 6.38 (SD 0.6). Adherence to wearing Fitbit was high, with participants in both groups recording steps on >80\% of days. Usage of the game was positively correlated with changes in daily steps but not with MVPA. Conclusions: The co-designed mobile app shows promise as an intervention and should be evaluated in a larger-scale trial in this population. ",
doi="10.2196/23069",
url="http://games.jmir.org/2021/1/e23069/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502321"
}


@Article{info:doi/10.2196/15978,
author="Deng, Ning
and Chen, Juan
and Liu, Yiyuan
and Wei, Shuoshuo
and Sheng, Leiyi
and Lu, Rong
and Wang, Zheyu
and Zhu, Jiarong
and An, Jiye
and Wang, Bei
and Lin, Hui
and Wang, Xiuyan
and Zhou, Yumin
and Duan, Huilong
and Ran, Pixin",
title="Using Mobile Health Technology to Deliver a Community-Based Closed-Loop Management System for Chronic Obstructive Pulmonary Disease Patients in Remote Areas of China: Development and Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="25",
volume="8",
number="11",
pages="e15978",
keywords="COPD",
keywords="mobile health technology",
keywords="closed-loop care pathway",
keywords="chronic disease management",
keywords="exacerbations",
abstract="Background: Mobile health (mHealth) technology is an increasingly recognized and effective method for disease management and has the potential to intervene in pulmonary function, exacerbation risk, and psychological status of patients with chronic obstructive pulmonary disease (COPD). Objective: This study aimed to investigate the feasibility of an mHealth-based COPD management system designed for Chinese remote areas with many potential COPD patients but limited medical resources. Methods: The system was implemented based on a tailored closed-loop care pathway that breaks the heavy management tasks into detailed pieces to be quantified and executed by computers. Low-cost COPD evaluation and questionnaire-based psychological intervention are the 2 main characteristics of the pathway. A 6-month prospective observational study at the community level was performed to evaluate the effect of the system. Primary outcomes included changes in peak expiratory flow values, quality of life measured using the COPD assessment test scale, and psychological condition. Acute exacerbations, compliance, and adverse events were also measured during the study. Compliance was defined as the ratio of the actual frequency of self-monitoring records to the prescribed number. Results: A total of 56 patients was enrolled; 39 patients completed the 6-month study. There was no significant difference in the mean peak expiratory flow value before and after the 6-month period (366.1, SD 106.7 versus 313.1, SD 116.6; P=.11). Psychological condition significantly improved after 6 months, especially for depression, as measured using the Patient Health Questionnaire-9 scale (median 6.0, IQR 3.0-9.0 versus median 4.0, IQR 0.0-6.0; P=.001). The COPD assessment test score after 6 months of intervention was also lower than that at the baseline, and the difference was significant (median 4.0, IQR 1.0-6.0 versus median 3.0, IQR 0.0-6.0; P=.003). The median overall compliance was 91.1\% (IQR 67\%-100\%). In terms of acute exacerbation, 110 exacerbations were detected and confirmed by health care providers (per 6 months, median 2.0, IQR 1.0-5.0). Moreover, 72 adverse events occurred during the study, including 1 death, 19 hospitalizations, and 52 clinic visits due to persistent respiratory symptoms. Conclusions: We designed and validated a feasible mHealth-based method to manage COPD in remote Chinese areas with limited medical resources. The proposed closed-loop care pathway was effective at the community level. Proper education and frequent communication with health care providers may encourage patients' acceptance and use of smartphones to support COPD self-management. In addition, WeChat might play an important role in improving patient compliance and psychological distress. Further research might explore the effect of such systems on a larger scale and at a higher evidence level. ",
doi="10.2196/15978",
url="http://mhealth.jmir.org/2020/11/e15978/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33237036"
}


@Article{info:doi/10.2196/16158,
author="Edwards, Colin
and Costello, Eamonn
and Cassidy, Nicola
and Vick, Bill
and Russell, Anne-Marie",
title="Use of the patientMpower App With Home-Based Spirometry to Monitor the Symptoms and Impact of Fibrotic Lung Conditions: Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="20",
volume="8",
number="11",
pages="e16158",
keywords="idiopathic pulmonary fibrosis",
keywords="pulmonary fibrosis",
keywords="eHealth",
keywords="mHealth",
keywords="patient-reported outcome measure",
keywords="spirometry",
keywords="home spirometry",
keywords="patient experience",
keywords="digital health",
keywords="patient advocacy",
abstract="Background: Daily home-based spirometry in idiopathic pulmonary fibrosis (IPF) has been shown to be feasible and clinically informative. The patientMpower app facilitates home-based spirometry along with home-based monitoring of IPF-related symptoms. The patientMpower app can be downloaded to the user's mobile phone or tablet device, enabling the recording of objective and subjective data. Objective: The aim of this paper is to report on the 1-year experience of using patientMpower with home-based spirometry by 36 participants with self-reported pulmonary fibrosis (PF) treated with usual care. Methods: Self-selecting participants enrolled in this community-based participatory research program through a patient advocacy group in their country: Irish Lung Fibrosis Association in Ireland and PF Warriors in the United States. Disease severity was comparable with a baseline mean predicted forced vital capacity (FVC) of 64\% and 62\% in the Irish and US participants, respectively. Both groups of participants were allocated to identical, in-country, open-label, single-group observational studies and were provided with a Bluetooth-active Spirobank Smart spirometer integrated directly with patientMpower. Data collected via patientMpower included seated FVC (daily), breathlessness grade (modified Medical Research Council scale score), step count, medication adherence, and symptoms and impact of IPF on daily life, which were measured by a patient-reported outcome measure (PROM) scale that was specifically developed for IPF. Longitudinal patient-reported data on oximetry and oxygen consumption were also collected. Results: A large majority of the 36 participants reported that their experience using patientMpower was positive, and they wanted to continue its use after the initial 6-week observation. Out of 36 participants, 21 (58\%) recorded home-based spirometry without prompting for ?180 days, and 9 (25\%) participants continued with recording home-based spirometry for ?360 days. Conclusions: The patientMpower app with associated Bluetooth-connected devices (eg, spirometer and pulse oximeter) offers an acceptable and accessible approach to collecting patient-reported objective and subjective data in fibrotic lung conditions. ",
doi="10.2196/16158",
url="http://mhealth.jmir.org/2020/11/e16158/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33216007"
}


@Article{info:doi/10.2196/21577,
author="Korpershoek, JG Yvonne
and Holtrop, Tjitske
and Vervoort, CJM Sigrid
and Schoonhoven, Lisette
and Schuurmans, J. Marieke
and Trappenburg, CA Jaap",
title="Early-Stage Feasibility of a Mobile Health Intervention (Copilot) to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease: Multimethods Approach",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="19",
volume="4",
number="11",
pages="e21577",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app",
keywords="COPD",
keywords="exacerbation",
keywords="self-management",
keywords="self-care",
abstract="Background: There is an emergence of mobile health (mHealth) interventions to support self-management in patients with chronic obstructive pulmonary disease (COPD). Recently, an evidence-driven mHealth intervention has been developed to support patients with COPD in exacerbation-related self-management: the Copilot app. Health care providers (HCPs) are important stakeholders as they are the ones who have to provide the app to patients, personalize the app, and review the app. It is, therefore, important to investigate at an early stage whether the app is feasible in the daily practice of the HCPs. Objective: The aim of this study is to evaluate the perceived feasibility of the Copilot app in the daily practice of HCPs. Methods: A multimethods design was used to investigate how HCPs experience working with the app and how they perceive the feasibility of the app in their daily practice. The feasibility areas described by Bowen et al were used for guidance. HCPs were observed while performing tasks in the app and asked to think aloud. The System Usability Scale was used to investigate the usability of the app, and semistructured interviews were conducted to explore the feasibility of the app. The study was conducted in primary, secondary, and tertiary care settings in the Netherlands from February 2019 to September 2019. Results: In total, 14 HCPs participated in this study---8 nurses, 5 physicians, and 1 physician assistant. The HCPs found the app acceptable to use. The expected key benefits of the app were an increased insight into patient symptoms, more structured patient conversations, and more tailored self-management support. The app especially fits within the available time and workflow of nurses. The use of the app will be influenced by the autonomy of the professional, the focus of the organization on eHealth, costs associated with the app, and compatibility with the current systems used. Most HCPs expressed that there are conditions that must be met to be able to use the app. The app can be integrated into the existing care paths of primary, secondary, and tertiary health care settings. Individual organizational factors must be taken into account when integrating the app into daily practice. Conclusions: This early-stage feasibility study shows that the Copilot app is feasible to use in the daily practice of HCPs and can be integrated into primary, secondary, and tertiary health care settings in the Netherlands. The app was considered to best fit the role of the nurses. The app will be less feasible for those organizations in which many conditions need to be met to use the app. This study provides a new approach to evaluate the perceived feasibility of mHealth interventions at an early stage and provides valuable insights for further feasibility testing. ",
doi="10.2196/21577",
url="http://formative.jmir.org/2020/11/e21577/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33211013"
}


@Article{info:doi/10.2196/17597,
author="Al Rajeh, M. Ahmed
and Aldabayan, Saad Yousef
and Aldhahir, Abdulelah
and Pickett, Elisha
and Quaderi, Shumonta
and Alqahtani, S. Jaber
and Mandal, Swapna
and Lipman, CI Marc
and Hurst, R. John",
title="Once Daily Versus Overnight and Symptom Versus Physiological Monitoring to Detect Exacerbations of Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="13",
volume="8",
number="11",
pages="e17597",
keywords="chronic obstructive pulmonary disease",
keywords="exacerbations",
keywords="telehealth",
keywords="CAT",
keywords="heart rate",
keywords="oxygen saturation",
abstract="Background: Earlier detection of chronic obstructive pulmonary disease (COPD) exacerbations may facilitate more rapid treatment with reduced risk of hospitalization. Changes in pulse oximetry may permit early detection of exacerbations. We hypothesized that overnight pulse oximetry would be superior to once-daily monitoring for the early detection of exacerbations. Objective: This study aims to evaluate whether measuring changes in heart rate and oxygen saturation overnight is superior to once-daily monitoring of both parameters and to assess symptom changes in facilitating earlier detection of COPD exacerbations. Methods: A total of 83 patients with COPD were randomized to once-daily or overnight pulse oximetry. Both groups completed the COPD assessment test questionnaire daily. The baseline mean and SD for each pulse oximetry variable were calculated from 14 days of stable monitoring. Changes in exacerbation were expressed as Z scores from this baseline. Results: The mean age of the patients was 70.6 (SD 8.1) years, 52\% (43/83) were female, and the mean FEV1 was 53.0\% (SD 18.5\%) predicted. Of the 83 patients, 27 experienced an exacerbation. Symptoms were significantly elevated above baseline from 5 days before to 12 days after treatment initiation. Day-to-day variation in pulse oximetry during the stable state was significantly less in the overnight group than in the once-daily group. There were greater relative changes at exacerbation in heart rate than oxygen saturation. An overnight composite score of change in heart rate and oxygen saturation changed significantly from 7 days before initiation of treatment for exacerbation and had a positive predictive value for exacerbation of 91.2\%. However, this was not statistically better than examining changes in symptoms alone. Conclusions: Overnight pulse oximetry permits earlier detection of COPD exacerbations compared with once-daily monitoring. Monitoring physiological variables was not superior to monitoring symptoms, and the latter would be a simpler approach, except where there is a need for objective verification of exacerbations. Trial Registration: ClinicalTrials.gov NCT03003702; https://clinicaltrials.gov/ct2/show/NCT03003702 ",
doi="10.2196/17597",
url="https://mhealth.jmir.org/2020/11/e17597",
url="http://www.ncbi.nlm.nih.gov/pubmed/33185560"
}


@Article{info:doi/10.2196/24587,
author="Porter, Paul
and Claxton, Scott
and Brisbane, Joanna
and Bear, Natasha
and Wood, Javan
and Peltonen, Vesa
and Della, Phillip
and Purdie, Fiona
and Smith, Claire
and Abeyratne, Udantha",
title="Diagnosing Chronic Obstructive Airway Disease on a Smartphone Using Patient-Reported Symptoms and Cough Analysis: Diagnostic Accuracy Study",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="10",
volume="4",
number="11",
pages="e24587",
keywords="respiratory",
keywords="medicine",
keywords="diagnostic algorithm",
keywords="telehealth",
keywords="acute care",
abstract="Background: Rapid and accurate diagnosis of chronic obstructive pulmonary disease (COPD) is problematic in acute care settings, particularly in the presence of infective comorbidities. Objective: The aim of this study was to develop a rapid smartphone-based algorithm for the detection of COPD in the presence or absence of acute respiratory infection and evaluate diagnostic accuracy on an independent validation set. Methods: Participants aged 40 to 75 years with or without symptoms of respiratory disease who had no chronic respiratory condition apart from COPD, chronic bronchitis, or emphysema were recruited into the study. The algorithm analyzed 5 cough sounds and 4 patient-reported clinical symptoms, providing a diagnosis in less than 1 minute. Clinical diagnoses were determined by a specialist physician using all available case notes, including spirometry where available. Results: The algorithm demonstrated high positive percent agreement (PPA) and negative percent agreement (NPA) with clinical diagnosis for COPD in the total cohort (N=252; PPA=93.8\%, NPA=77.0\%, area under the curve [AUC]=0.95), in participants with pneumonia or infective exacerbations of COPD (n=117; PPA=86.7\%, NPA=80.5\%, AUC=0.93), and in participants without an infective comorbidity (n=135; PPA=100.0\%, NPA=74.0\%, AUC=0.97). In those who had their COPD confirmed by spirometry (n=229), PPA was 100.0\% and NPA was 77.0\%, with an AUC of 0.97. Conclusions: The algorithm demonstrated high agreement with clinical diagnosis and rapidly detected COPD in participants presenting with or without other infective lung illnesses. The algorithm can be installed on a smartphone to provide bedside diagnosis of COPD in acute care settings, inform treatment regimens, and identify those at increased risk of mortality due to seasonal or other respiratory ailments. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001521213; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375939 ",
doi="10.2196/24587",
url="http://formative.jmir.org/2020/11/e24587/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33170129"
}


@Article{info:doi/10.2196/20412,
author="Gross, Christoph
and Kohlbrenner, Dario
and Clarenbach, F. Christian
and Ivankay, Adam
and Brunschwiler, Thomas
and Nordmann, Yves
and v Wangenheim, Florian",
title="A Telemonitoring and Hybrid Virtual Coaching Solution ``CAir'' for Patients with Chronic Obstructive Pulmonary Disease: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Oct",
day="22",
volume="9",
number="10",
pages="e20412",
keywords="protocol",
keywords="randomized controlled trial",
keywords="chronic obstructive pulmonary disease",
keywords="telemonitoring",
keywords="virtual coaching",
keywords="disease management",
keywords="chatbot",
keywords="conversational agents",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is one of the most common disorders in the world. COPD is characterized by airflow obstruction, which is not fully reversible. Patients usually experience breathing-related symptoms with periods of acute worsening and a substantial decrease in the health-related quality-of-life. Active and comprehensive disease management can slow down the progressive course of the disease and improve patients' disabilities. Technological progress and digitalization of medicine have the potential to make elaborate interventions easily accessible and applicable to a broad spectrum of patients with COPD without increasing the costs of the intervention. Objective: This study aims to develop a comprehensive telemonitoring and hybrid virtual coaching solution and to investigate its effects on the health-related quality of life of patients with COPD. Methods: A monocentric, assessor-blind, two-arm (intervention/control) randomized controlled trial will be performed. Participants randomized to the control group will receive usual care and a CAir Desk (custom-built home disease-monitoring device to telemonitor disease-relevant parameters) for 12 weeks, without feedback or scores of the telemonitoring efforts and virtual coaching. Participants randomized to the intervention group will receive a CAir Desk and a hybrid digital coaching intervention for 12 weeks. As a primary outcome, we will measure the delta in the health-related quality of life, which we will assess with the St. George Respiratory Questionnaire, from baseline to week 12 (the end of the intervention). Results: The development of the CAir Desk and virtual coach has been completed. Recruitment to the trial started in September 2020. We expect to start data collection by December 2020 and expect it to last for approximately 18 months, as we follow a multiwave approach. We expect to complete data collection by mid-2022 and plan the dissemination of the results subsequently. Conclusions: To our knowledge, this is the first study investigating a combination of telemonitoring and hybrid virtual coaching in patients with COPD. We will investigate the effectiveness, efficacy, and usability of the proposed intervention and provide evidence to further develop app-based and chatbot-based disease monitoring and interventions in COPD. Trial Registration: ClinicalTrials.gov identifier: NCT04373070; https://clinicaltrials.gov/ct2/show/NCT04373070 International Registered Report Identifier (IRRID): DERR1-10.2196/20412 ",
doi="10.2196/20412",
url="http://www.researchprotocols.org/2020/10/e20412/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33090112"
}


@Article{info:doi/10.2196/18148,
author="van Lieshout, Florence
and Yang, Rebecca
and Stamenova, Vess
and Agarwal, Payal
and Cornejo Palma, Daniel
and Sidhu, Aman
and Engel, Katrina
and Erwood, Adam
and Bhatia, Sacha R.
and Bhattacharyya, Onil
and Shaw, James",
title="Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="9",
volume="22",
number="10",
pages="e18148",
keywords="service design",
keywords="digital health",
keywords="innovation",
keywords="implementation science",
keywords="remote monitoring",
keywords="telemedicine",
abstract="Background: Implementing digital health technologies is complex but can be facilitated by considering the features of the tool that is being implemented, the team that will use it, and the routines that will be affected. Objective: The goal of this study was to assess the implementation of a remote-monitoring initiative for patients with chronic obstructive pulmonary disease in Ontario, Canada using the Tool+Team+Routine framework and to refine this approach to conceptualize the adoption of technologies in health care. Methods: This study was a qualitative research project that took place alongside a randomized controlled trial comparing a technology-enabled self-monitoring program with a technology-enabled self- and remote-monitoring program in patients with chronic obstructive pulmonary disease and with standard care. This study included interviews with 5 remote-monitoring patients, 3 self-monitoring patients, 2 caregivers, 5 health care providers, and 3 hospital administrators. The interview questions were structured around the 3 main concepts of the Tool+Team+Routine framework. Results: Findings emphasized that (1) technologies can alter relationships between providers and patients, and that these relationships drove the development of a new service arising from the technology, in our case, and (2) technologies can create additional work that is not visible to management as a result of not being considered within the scope of the service. Conclusions: Literature on the implementation of digital health technologies has still not reconciled the importance of interpersonal relationships to conventional implementation strategies. By acknowledging the centrality of such relationships, implementation teams can better plan for the adaptations required in order to make new technologies work for patients and health care providers. Further work will need to address how specific individuals administering a remote-monitoring program work to build relationships, and how these relationships and other sources of activity might lead to technological scope creep---an unanticipated expanding scope of work activities in relation to the function of the tool. ",
doi="10.2196/18148",
url="https://www.jmir.org/2020/10/e18148",
url="http://www.ncbi.nlm.nih.gov/pubmed/33034565"
}


@Article{info:doi/10.2196/19527,
author="Robinson, A. Stephanie
and Wan, S. Emily
and Shimada, L. Stephanie
and Richardson, R. Caroline
and Moy, L. Marilyn",
title="Age and Attitudes Towards an Internet-Mediated, Pedometer-Based Physical Activity Intervention for Chronic Obstructive Pulmonary Disease: Secondary Analysis",
journal="JMIR Aging",
year="2020",
month="Sep",
day="9",
volume="3",
number="2",
pages="e19527",
keywords="aging",
keywords="COPD",
keywords="chronic conditions",
keywords="physical activity",
keywords="eHealth",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is prevalent among older adults. Promoting physical activity and increasing exercise capacity are recommended for all individuals with COPD. Pulmonary rehabilitation is the standard of care to improve exercise capacity, although there are barriers that hinder accessibility. Technology has the potential to overcome some of these barriers, but it is unclear how aging adults with a chronic disease like COPD perceive technology-based platforms to support their disease self-management. Objective: Guided by the unified theory of acceptance and use of technology, the current retrospective secondary analysis explores if age moderates multiple factors that influence an individual with COPD's openness toward an internet-mediated, pedometer-based physical activity intervention. Methods: As part of an efficacy study, participants with COPD (N=59) were randomly assigned to use an internet-mediated, pedometer-based physical activity intervention for 12 weeks. At completion, they were asked about their experience with the intervention using a survey, including their performance expectancy and effort expectancy, facilitating conditions (ie, internet use frequency and ability), and use of the intervention technology. Logistic regression and general linear modeling examined the associations between age and these factors. Results: Participants ranged in age from 49 to 89 years (mean 68.66, SD 8.93). Disease severity was measured by forced expiratory volume in the first second percent predicted (mean 60.01, SD 20.86). Nearly all participants (54/59) believed the intervention was useful. Regarding effort expectancy, increasing age was associated with reporting that it was easy to find the time to engage in the intervention. Regarding facilitating conditions, approximately half of the participants believed the automated step count goals were too high (23/59) and many did not feel comfortable reaching their goals (22/59). The probability of these perceptions increased with age, even after accounting for disease severity. Age was not associated with other facilitating conditions or use of the technology. Conclusions: Age does not influence performance expectancy or use of technology with an internet-mediated, pedometer-based physical activity intervention. Age is associated with certain expectations of effort and facilitating conditions. Consideration of age of the user is needed when personalizing step count goals and time needed to log in to the website. Trial Registration: ClinicalTrials.gov NCT01772082; https://clinicaltrials.gov/ct2/show/NCT01772082 ",
doi="10.2196/19527",
url="http://aging.jmir.org/2020/2/e19527/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32902390"
}


@Article{info:doi/10.2196/18465,
author="Jim{\'e}nez-Reguera, Bego{\~n}a
and Maroto L{\'o}pez, Eva
and Fitch, Shane
and Juarros, Lourdes
and S{\'a}nchez Cort{\'e}s, Marta
and Rodr{\'i}guez Hermosa, Luis Juan
and Calle Rubio, Myriam
and Hern{\'a}ndez Criado, Teresa Mar{\'i}a
and L{\'o}pez, Marta
and Angulo-D{\'i}az-Parre{\~n}o, Santiago
and Mart{\'i}n-Pintado-Zugasti, Aitor
and Vilar{\'o}, Jordi",
title="Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="31",
volume="8",
number="7",
pages="e18465",
keywords="adherence",
keywords="pulmonary rehabilitation",
keywords="mHealth",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
abstract="Background: Pulmonary rehabilitation is one of the main interventions to reduce the use of health resources, and it promotes a reduction in chronic obstructive pulmonary disease (COPD) costs. mHealth systems in COPD aim to improve adherence to maintenance programs after pulmonary rehabilitation by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease. Objective: This study aimed to assess the effects of an integrated care plan based on an mHealth web-based platform (HappyAir) on adherence to a 1-year maintenance program applied after pulmonary rehabilitation in COPD patients. Methods: COPD patients from three hospitals were randomized to a control group or an intervention group (HappyAir group). Patients from both groups received an 8-week program of pulmonary rehabilitation and educational sessions about their illness. After completion of the process, only the HappyAir group completed an integrated care plan for 10 months, supervised by an mHealth system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using a respiratory physiotherapy adherence self-report (CAP FISIO) questionnaire. Other variables analyzed were adherence to physical activity (Morisky-Green Test), quality of life (Chronic Obstructive Pulmonary Disease Assessment Test, St. George's Respiratory Questionnaire, and EuroQOL-5D), exercise capacity (6-Minute Walk Test), and lung function. Results: In total, 44 patients were recruited and randomized in the control group (n=24) and HappyAir group (n=20). Eight patients dropped out for various reasons. The CAP FISIO questionnaire results showed an improvement in adherence during follow-up period for the HappyAir group, which was statistically different compared with the control group at 12 months (56.1 [SD 4.0] vs 44.0 [SD 13.6]; P=.004) after pulmonary rehabilitation. Conclusions: mHealth systems designed for COPD patients improve adherence to maintenance programs as long as they are accompanied by disease awareness and patient involvement in management. Trial Registration: ClinicalTrials.gov NCT04479930; https://clinicaltrials.gov/ct2/show/NCT04479930 ",
doi="10.2196/18465",
url="http://mhealth.jmir.org/2020/7/e18465/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32513646"
}


@Article{info:doi/10.2196/18598,
author="Stamenova, Vess
and Liang, Kyle
and Yang, Rebecca
and Engel, Katrina
and van Lieshout, Florence
and Lalingo, Elizabeth
and Cheung, Angelica
and Erwood, Adam
and Radina, Maria
and Greenwald, Allen
and Agarwal, Payal
and Sidhu, Aman
and Bhatia, Sacha R.
and Shaw, James
and Shafai, Roshan
and Bhattacharyya, Onil",
title="Technology-Enabled Self-Management of Chronic Obstructive Pulmonary Disease With or Without Asynchronous Remote Monitoring: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="30",
volume="22",
number="7",
pages="e18598",
keywords="COPD",
keywords="eHealth",
keywords="telemedicine",
keywords="remote consultation",
keywords="self-care",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and leads to frequent hospital admissions and emergency department (ED) visits. COPD exacerbations are an important patient outcome, and reducing their frequency would result in significant cost savings. Remote monitoring and self-monitoring could both help patients manage their symptoms and reduce the frequency of exacerbations, but they have different resource implications and have not been directly compared. Objective: This study aims to compare the effectiveness of implementing a technology-enabled self-monitoring program versus a technology-enabled remote monitoring program in patients with COPD compared with a standard care group. Methods: We conducted a 3-arm randomized controlled trial evaluating the effectiveness of a remote monitoring and a self-monitoring program relative to standard care. Patients with COPD were recruited from outpatient clinics and a pulmonary rehabilitation program. Patients in both interventions used a Bluetooth-enabled device kit to monitor oxygen saturation, blood pressure, temperature, weight, and symptoms, but only patients in the remote monitoring group were monitored by a respiratory therapist. All patients were assessed at baseline and at 3 and 6 months after program initiation. Outcomes included self-management skills, as measured by the Partners in Health (PIH) Scale; patient symptoms measured with the St George's Respiratory Questionnaire (SGRQ); and the Bristol COPD Knowledge Questionnaire (BCKQ). Patients were also asked to self-report on health system use, and data on health use were collected from the hospital. Results: A total of 122 patients participated in the study: 40 in the standard care, 41 in the self-monitoring, and 41 in the remote monitoring groups. Although all 3 groups improved in PIH scores, BCKQ scores, and SGRQ impact scores, there were no significant differences among any of the groups. No effects were observed on the SGRQ activity or symptom scores or on hospitalizations, ED visits, or clinic visits. Conclusions: Despite regular use of the technology, patients with COPD assigned to remote monitoring or self-monitoring did not have any improvement in patient outcomes such as self-management skills, knowledge, or symptoms, or in health care use compared with each other or with a standard care group. This may be owing to low health care use at baseline, the lack of structured educational components in the intervention groups, and the lack of integration of the action plan with the technology. Trial Registration: ClinicalTrials.gov NCT03741855; https://clinicaltrials.gov/ct2/show/ NCT03741855 ",
doi="10.2196/18598",
url="http://www.jmir.org/2020/7/e18598/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32729843"
}


@Article{info:doi/10.2196/17409,
author="Alwashmi, F. Meshari
and Fitzpatrick, Beverly
and Farrell, Jamie
and Gamble, John-Michael
and Davis, Erin
and Nguyen, Van Hai
and Farrell, Gerard
and Hawboldt, John",
title="Perceptions of Patients Regarding Mobile Health Interventions for the Management of Chronic Obstructive Pulmonary Disease: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="23",
volume="8",
number="7",
pages="e17409",
keywords="mhealth",
keywords="COPD",
keywords="health technology",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Using a mobile health (mHealth) intervention consisting of a smartphone and compatible medical device has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective: This study aims to describe the demographics, use, and access to smartphones of patients with COPD. It also aims to explore and develop an understanding of potential facilitators and barriers that might influence patients using mHealth interventions for COPD management. Methods: This was an explanatory, sequential mixed methods study. Patients who attended respirology clinics completed a questionnaire on technology access and use. We conducted semistructured individual interviews with the patients. Interview topics included the following: demographics, mHealth use, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of mHealth interventions for COPD management. Results: A total of 100 adults completed the survey but 22 participants were excluded because they were not diagnosed with COPD. Of these, 10 patients with COPD participated in the interview. The quantitative component revealed that many patients with COPD owned a mobile phone, but only about one-fourth of the participants (18/77, 23\%) owned a smartphone. The likelihood of owning a smartphone was not associated with age, sex, marital status, or geographical location, but patients with high educational status were more likely to own a smartphone. The qualitative component found that patients with COPD, in general, had a positive attitude toward mHealth adoption for COPD management, but several facilitators and barriers were identified. The main facilitators of mHealth adoption are possible health benefits for patients, ease of use, educating patients, and credibility. Alternatively, the barriers to adoption are technical issues, lack of awareness, potential limited uptake from older adults, privacy and confidentiality issues, finances, and lack of interest in mHealth Conclusions: It is important to understand the perceptions of patients with COPD regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management. ",
doi="10.2196/17409",
url="http://mhealth.jmir.org/2020/7/e17409/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706697"
}


@Article{info:doi/10.2196/14178,
author="Jung, Timothy
and Moorhouse, Natasha
and Shi, Xin
and Amin, Farhan Muhammad",
title="A Virtual Reality--Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="7",
volume="22",
number="7",
pages="e14178",
keywords="virtual reality",
keywords="COPD",
keywords="rehabilitation",
abstract="Background: The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely. Objective: This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs. Methods: This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale. Results: In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures. Conclusions: Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale. ",
doi="10.2196/14178",
url="https://www.jmir.org/2020/7/e14178",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673224"
}


@Article{info:doi/10.2196/15449,
author="Korpershoek, G. Yvonne J.
and Hermsen, Sander
and Schoonhoven, Lisette
and Schuurmans, J. Marieke
and Trappenburg, A. Jaap C.",
title="User-Centered Design of a Mobile Health Intervention to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease (Copilot): Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="15",
volume="22",
number="6",
pages="e15449",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="behavior change",
keywords="COPD",
keywords="exacerbation",
keywords="self-management",
keywords="self-care",
keywords="mobile phone",
abstract="Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention---Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions. ",
doi="10.2196/15449",
url="https://www.jmir.org/2020/6/e15449",
url="http://www.ncbi.nlm.nih.gov/pubmed/32538793"
}


@Article{info:doi/10.2196/16203,
author="Bentley, L. Claire
and Powell, Lauren
and Potter, Stephen
and Parker, Jack
and Mountain, A. Gail
and Bartlett, Kiera Yvonne
and Farwer, Jochen
and O'Connor, Cath
and Burns, Jennifer
and Cresswell, L. Rachel
and Dunn, D. Heather
and Hawley, S. Mark",
title="The Use of a Smartphone App and an Activity Tracker to Promote Physical Activity in the Management of Chronic Obstructive Pulmonary Disease: Randomized Controlled Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="3",
volume="8",
number="6",
pages="e16203",
keywords="mobile health",
keywords="mHealth",
keywords="chronic obstructive pulmonary disease",
keywords="feasibility",
keywords="physical activity",
keywords="activity tracker",
keywords="Fitbit",
keywords="self-management",
keywords="health behavior change",
keywords="pulmonary rehabilitation",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR). Objective: This study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness. Methods: We conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity--based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology. Results: Overall, 47\% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation. Conclusions: mHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates. ",
doi="10.2196/16203",
url="https://mhealth.jmir.org/2020/6/e16203",
url="http://www.ncbi.nlm.nih.gov/pubmed/32490838"
}


@Article{info:doi/10.2196/16147,
author="Fan, G. Kathleen
and Mandel, Jess
and Agnihotri, Parag
and Tai-Seale, Ming",
title="Remote Patient Monitoring Technologies for Predicting Chronic Obstructive Pulmonary Disease Exacerbations: Review and Comparison",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="21",
volume="8",
number="5",
pages="e16147",
keywords="COPD",
keywords="disease exacerbation",
keywords="remote patient monitoring",
keywords="mobile health",
keywords="telehealth",
keywords="at-home monitoring",
keywords="remote monitoring system",
keywords="wearable",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death by disease worldwide and has a 30-day readmission rate of 22.6\%. In 2015, COPD was added to the Medicare Hospital Readmission Reductions Program. Objective: The objective of this paper was to survey the current medical technologies for remote patient monitoring (RPM) tools that forecast COPD exacerbations in order to reduce COPD readmissions. Methods: We searched literature and digital health news to find commercially available RPM devices focused on predicting COPD exacerbations. These technologies were reviewed and compared according to four criteria: forecasting ability, cost, ease of use, and appearance. A rating system was developed to facilitate the evaluation process. Results: As of June 2019, a list of handheld and hands-free devices was compiled. We compared features and found substantial variations. Devices that ranked higher on all criteria tended to have a high or unlisted price. Commonly mass-marketed devices like the pulse oximeter and spirometer surprisingly fulfilled the least criteria. Conclusions: The COPD RPM technologies with most technological promise and compatibility with daily living appear to have high or unlisted prices. Consumers and providers need better access to product information to make informed decisions. ",
doi="10.2196/16147",
url="http://mhealth.jmir.org/2020/5/e16147/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348262"
}


@Article{info:doi/10.2196/16289,
author="Davies, Alan
and Mueller, Julia
and Hennings, Jean
and Caress, Ann-Louise
and Jay, Caroline",
title="Recommendations for Developing Support Tools With People Suffering From Chronic Obstructive Pulmonary Disease: Co-Design and Pilot Testing of a Mobile Health Prototype",
journal="JMIR Hum Factors",
year="2020",
month="May",
day="15",
volume="7",
number="2",
pages="e16289",
keywords="chronic obstructive pulmonary disease",
keywords="app design",
keywords="mHealth",
keywords="ecological momentary assessment",
keywords="mobile phone",
abstract="Background: Gaps exist between developers, commissioners, and end users in terms of the perceived desirability of different features and functionalities of mobile apps. Objective: The objective of this study was to co-design a prototype mobile app for people with chronic obstructive pulmonary disease (COPD). We present lessons learned and recommendations from working on a large project with various stakeholders to develop a mobile app for patients with COPD. Methods: We adopted a user-centered, participatory approach to app development. Following a series of focus groups and interviews to capture requirements, we developed a prototype app designed to enable daily symptom recording (experience sampling). The prototype was tested in a usability study applying the think aloud protocol with people with COPD. It was then released via the Android app store, and experience sampling data and event data were captured to gather further usability data. Results: A total of 5 people with COPD participated in the pilot study. Identified themes include familiarity with technology, appropriate levels for feeding back information, and usability issues such as manual dexterity. Moreover, 37 participants used the app over a 4-month period (median age 47 years). The symptoms most correlated to perceived well-being were tiredness (r=0.61; P<.001) and breathlessness (r=0.59; P<.001). Conclusions: Design implications for COPD apps include the need for clearly labeled features (rather than relying on colors or symbols that require experience using smartphones), providing weather information, and using the same terminology as health care professionals (rather than simply lay terms). Target users, researchers, and developers should be involved at every stage of app development, using an iterative approach to build a prototype app, which should then be tested in controlled settings as well as in the wild (ie, when deployed and used in real-world settings) over longer periods. ",
doi="10.2196/16289",
url="http://humanfactors.jmir.org/2020/2/e16289/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32410730"
}


@Article{info:doi/10.2196/17089,
author="Jiang, Yuyu
and Liu, Fenglan
and Guo, Jianlan
and Sun, Pingping
and Chen, Zhongyi
and Li, Jinping
and Cai, Liming
and Zhao, Hongqing
and Gao, Ping
and Ding, Zhaosheng
and Wu, Xiaoliang",
title="Evaluating an Intervention Program Using WeChat for Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="21",
volume="22",
number="4",
pages="e17089",
keywords="chronic obstructive pulmonary disease",
keywords="randomized controlled trial",
keywords="self-efficacy",
keywords="telemedicine",
keywords="the eHealth enhanced chronic care model",
keywords="WeChat",
abstract="Background: The application of telemedicine in home pulmonary rehabilitation interventions for the management of patients with chronic obstructive pulmonary disease (COPD) has achieved promising results. Objective: This study aimed to develop a WeChat official account (Pulmonary Internet Explorer Rehabilitation [PeR]) based on social media. It further evaluated the effect of PeR on the quality of life, symptoms, and exercise self-efficacy of patients with COPD. Methods: The functional modules of PeR were developed by a multidisciplinary team according to the electronic health--enhanced chronic care model (eCCM) components. A total of 106 patients were randomly selected (53 in the PeR group and 53 in the outpatient face-to-face group [FtF]). Pulmonary rehabilitation intervention was conducted for 3 months, and the outcome was observed for 3 months. The primary outcome was patient quality of life measured with the COPD assessment test (CAT). The secondary outcomes were evaluated using the modified Medical Research Council scale (mMRC), exercise self-regulatory efficacy scale (Ex-SRES), and St George's Respiratory Questionnaire (SGRQ). Results: The intention-to-treat analysis was used in the study. A total of 94 participants completed the 6-month pulmonary rehabilitation program. No statistically significant differences were observed in CAT (F1,3=7.78, P=.001), Ex-SRES (F1,3=21.91, P<.001), and mMRC scores (F1,3=29.64, P<.001) between the two groups with the variation in time tendency. The Ex-SRES score had a significant effect on the CAT score (P=.03). The partial regression coefficient of Ex-SRES to CAT was 0.81, and Exp (B) was 2.24. Conclusions: The telemedicine technology was effective using the eCCM combined with a behavioral intervention strategy centering on self-efficacy. Pulmonary rehabilitation at home through PeR and FtF could improve the sense of self-efficacy and quality of life and alleviate symptoms in patients with COPD. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900022770; https://tinyurl.com/tmmvpq3 ",
doi="10.2196/17089",
url="http://www.jmir.org/2020/4/e17089/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32314971"
}


@Article{info:doi/10.2196/16461,
author="Sharman, Almaz
and Zhussupov, Baurzhan
and Sharman, Dana
and Kim, Irina",
title="Evaluating Mobile Apps and Biosensing Devices to Monitor Physical Activity and Respiratory Function in Smokers With and Without Respiratory Symptoms or Chronic Obstructive Pulmonary Disease: Protocol for a Proof-of-Concept, Open-Label, Feasibility Study",
journal="JMIR Res Protoc",
year="2020",
month="Mar",
day="26",
volume="9",
number="3",
pages="e16461",
keywords="COPD",
keywords="mobile health apps",
keywords="mHealth",
keywords="smokers",
keywords="feasibility study",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a global public health problem, and continuous monitoring is essential for both its management as well as the management of other chronic diseases. Telemonitoring using mobile health (mHealth) devices has the potential to promote self-management, improve control, increase quality of life, and prevent hospital admissions. Objective: This study aims to demonstrate whether a large-scale study assessing the use of mHealth devices to improve the treatment, assessment, compliance, and outcomes of chronic diseases, particularly COPD and cardio-metabolic syndrome, is feasible. This will allow our team to select the appropriate design and characteristics for our large-scale study. Methods: A total of 3 cohorts, with 9 participants in each, will use mHealth devices for 90 days while undergoing the current standard of care. These groups are: 9 ``non-COPD,'' otherwise healthy, smokers; 9 ``grey zone'' smokers (forced expiratory volume in 1 second/ forced vital capacity ?0.70 after bronchodilator treatment; COPD Assessment Test ?10); and 9 smokers diagnosed with Stage 1-3 COPD. Rates of recruitment, retention, and adherence will be measured. Overall, two mHealth devices will be utilized in the study: the AnaMed Original Equipment Manufacturer device (measures distance, energy expenditure, heart rate, and heart rate variability) and the Air Next mobile spirometry device. The mHealth devices will be compared against industry standards. Additionally, a questionnaire will be administered to assess the participants' perceptions of the mHealth technologies used. Results: The inclusion of participants started in June 2019. Study results will be published in peer-reviewed scientific journals. Conclusions: This study will demonstrate whether a large-scale study to assess the use of mHealth devices to improve the treatment, assessment, compliance, and outcomes of chronic diseases, particularly COPD and cardio-metabolic syndrome, is feasible. It will also allow the research team to select the appropriate design and characteristics for the large-scale study. Trial Registration: ClinicalTrials.gov NCT04081961; https://clinicaltrials.gov/ct2/show/NCT04081961 International Registered Report Identifier (IRRID): DERR1-10.2196/16461 ",
doi="10.2196/16461",
url="http://www.researchprotocols.org/2020/3/e16461/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32213479"
}


@Article{info:doi/10.2196/15699,
author="Rodriguez  Hermosa, Luis Juan
and Fuster Gomila, Antonia
and Puente Maestu, Luis
and Amado Diago, Antonio Carlos
and Callejas Gonz{\'a}lez, Javier Francisco
and Malo De Molina Ruiz, Rosa
and Fuentes Ferrer, E. Manuel
and {\'A}lvarez Sala-Walther, Luis Jose
and Calle Rubio, Myriam",
title="Compliance and Utility of a Smartphone App for the Detection of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="19",
volume="8",
number="3",
pages="e15699",
keywords="chronic obstructive pulmonary disease",
keywords="mHealth",
keywords="compliance",
keywords="mobile phone",
abstract="Background: In recent years, mobile health (mHealth)--related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring. Objective: This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair. Methods: This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional. Results: Overall, compliance with daily records in the app was 66.6\% (120/180), with a duration compliance of 78.8\%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P<.05). During the study, the patients experienced a total of 262 exacerbations according to daily records in the app, 99 (37.8\%) of which were reported exacerbations and 163 (62.2\%) were unreported exacerbations. None of the subject-related variables were found to be significantly associated with reporting. The duration of the event and number of symptoms present during the first day were strongly associated with reporting. Despite substantial variations in the COPD Assessment Test (CAT), there was improvement only among patients with no exacerbation and those with reported exacerbations. Nevertheless, CAT scores deteriorated among patients with unreported exacerbations. Conclusions: The daily use of the Prevexair app is feasible and acceptable for patients with COPD who are motivated in their self-care because of frequent exacerbations of their disease. Monitoring through the Prevexair app showed great potential for the implementation of self-care plans and offered a better diagnosis of their chronic condition. ",
doi="10.2196/15699",
url="http://mhealth.jmir.org/2020/3/e15699/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32191213"
}


@Article{info:doi/10.2196/17161,
author="De Ram{\'o}n Fern{\'a}ndez, Alberto
and Ruiz Fern{\'a}ndez, Daniel
and Marcos-Jorquera, Diego
and Gilart Iglesias, Virgilio",
title="Support System for Early Diagnosis of Chronic Obstructive Pulmonary Disease Based on the Service-Oriented Architecture Paradigm and Business Process Management Strategy: Development and Usability Survey Among Patients and Health Care Providers",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="17",
volume="22",
number="3",
pages="e17161",
keywords="COPD",
keywords="misdiagnosis",
keywords="business process management strategy, support system",
keywords="service-oriented architecture",
keywords="hospital information system",
keywords="early diagnosis",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with a high global prevalence. The main scientific societies dedicated to the management of this disease have published clinical practice guidelines for quality practice. However, at present, there are important weaknesses in COPD diagnosis criteria that often lead to underdiagnosis or misdiagnosis. Objective: We sought to develop a new support system for COPD diagnosis. The system was designed to overcome the weaknesses detected in current guidelines with the goals of enabling early diagnosis, and improving the diagnostic accuracy and quality of care provided. Methods: We first analyzed the main clinical guidelines for COPD to detect weaknesses that exist in the current diagnostic process, and then proposed a redesign based on a business process management (BPM) strategy for its optimization. The BPM system acts as a backbone throughout the process of COPD diagnosis in this proposed approach. The newly developed support system was integrated into a health information system for validation of its use in a hospital environment. The system was qualitatively evaluated by experts (n=12) and patients (n=36). Results: Among the 12 experts, 10 (83\%) positively evaluated our system with respect to increasing the speed for making the diagnosis, helping in interpreting results, and encouraging opportunistic diagnosis. With an overall rating of 4.29 on a 5-point scale, 27/36 (75\%) of patients considered that the system was very useful in providing a warning about possible cases of COPD. The overall assessment of the system was 4.53 on a 5-point Likert scale with agreement to extend its use to all primary care centers. Conclusions: The proposed system provides a functional method to overcome the weaknesses detected in the current diagnostic process for COPD, which can help foster early diagnosis, while improving the diagnostic accuracy and quality of care provided. ",
doi="10.2196/17161",
url="https://www.jmir.org/2020/3/e17161",
url="http://www.ncbi.nlm.nih.gov/pubmed/32181744"
}


@Article{info:doi/10.2196/13197,
author="Pekmezaris, Renee
and Kozikowski, Andrzej
and Pascarelli, Briana
and Wolf-Klein, Gisele
and Boye-Codjoe, Eugenia
and Jacome, Sonia
and Madera, Danielle
and Tsang, Donna
and Guerrero, Brenda
and Medina, Richard
and Polo, Jennifer
and Williams, Myia
and Hajizadeh, Negin",
title="A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="31",
volume="4",
number="1",
pages="e13197",
keywords="COPD",
keywords="pulmonary rehabilitation",
keywords="telehealth",
keywords="CPBR",
keywords="disparities",
keywords="telemonitoring",
abstract="Background: Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. Objective: This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. Methods: We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. Results: We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. Conclusions: These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. Trial Registration: ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485 ",
doi="10.2196/13197",
url="https://formative.jmir.org/2020/1/e13197",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012039"
}


@Article{info:doi/10.2196/15466,
author="Dobson, Rosie
and Herbst, Pauline
and Candy, Sarah
and Brott, Tamzin
and Garrett, Jeffrey
and Humphrey, Gayl
and Reeve, Julie
and Tawhai, Merryn
and Taylor, Denise
and Warren, Jim
and Whittaker, Robyn",
title="Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews",
journal="JMIR Form Res",
year="2019",
month="Dec",
day="20",
volume="3",
number="4",
pages="e15466",
keywords="mHealth",
keywords="rehabilitation",
keywords="COPD",
abstract="Background: Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. Objective: The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. Methods: A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. Results: Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. Conclusions: These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population. ",
doi="10.2196/15466",
url="http://formative.jmir.org/2019/4/e15466/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31859681"
}


@Article{info:doi/10.2196/14946,
author="Whelan, E. Maxine
and Velardo, Carmelo
and Rutter, Heather
and Tarassenko, Lionel
and Farmer, J. Andrew",
title="Mood Monitoring Over One Year for People With Chronic Obstructive Pulmonary Disease Using a Mobile Health System: Retrospective Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="22",
volume="7",
number="11",
pages="e14946",
keywords="pulmonary disease, chronic obstructive",
keywords="self-management",
keywords="telemedicine",
keywords="computers",
keywords="handheld",
keywords="anxiety",
keywords="depression",
abstract="Background: Comorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment. Objective: We used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring. Methods: A total of 107 men and women with a clinical diagnosis of COPD, aged ?40 years old, were recruited to the intervention arm of the EDGE trial. Participants were invited to complete the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 test every four weeks using a tablet computer. Mood disturbance based on these measures was defined as a score ?5 on either scale. Participants reporting a mood disturbance were automatically directed (signposted) to a stress or mood management video. Study outcomes included measures of health status, respiratory quality of life, and symptoms of anxiety and depression. Results: Overall, 94 (87.9\%) participants completed the 12-month study. A total of 80 participants entered at least one response each month for at least ten months. On average, 16 participants (range 8-38 participants) entered ?2 responses each month. Of all the participants, 47 (50\%) gave responses indicating a mood disturbance. Participants with a mood disturbance score for both scales (n=47) compared with those without (n=20) had lower health status (P=.008), lower quality of life (P=.009), and greater anxiety (P<.001) and increased depression symptoms (P<.001). Videos were viewed by 64 (68\%) people over 12 months. Of the 220 viewing visualizations, 70 (34.7\%) began after being signposted. Participants signposted to the stress management video (100\%; IQR 23.3-100\%) watched a greater proportion of it compared to those not signposted (38.4\%; IQR 16.0-68.1\%; P=.03), whereas duration of viewing was not significantly different for the mood management video. Conclusions: Monitoring of anxiety and depression symptoms for people with COPD is feasible. More than half of trial participants reported scores indicating a mood disturbance during the study. Signposting participants to an advisory video when reporting increased symptoms of a mood disturbance resulted in a longer view-time for the stress management video. The opportunity to elicit measures of mood regularly as part of a health monitoring system could contribute to better care for people with COPD. ",
doi="10.2196/14946",
url="http://mhealth.jmir.org/2019/11/e14946/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31755872"
}


@Article{info:doi/10.2196/13286,
author="Chen, Jessica
and Kaye, Leanne
and Tuffli, Michael
and Barrett, A. Meredith
and Jones-Ford, Shelanda
and Shenouda, Tina
and Gondalia, Rahul
and Henderson, Kelly
and Combs, Veronica
and Van Sickle, David
and Stempel, A. David",
title="Passive Monitoring of Short-Acting Beta-Agonist Use via Digital Platform in Patients With Chronic Obstructive Pulmonary Disease: Quality Improvement Retrospective Analysis",
journal="JMIR Form Res",
year="2019",
month="Oct",
day="23",
volume="3",
number="4",
pages="e13286",
keywords="chronic obstructive pulmonary disease",
keywords="telemedicine",
keywords="quality improvement, feasibility",
keywords="nebulizers and vaporizers",
keywords="health services",
abstract="Background: Digital health programs assist patients with chronic obstructive pulmonary disease (COPD) to better manage their disease. Technological and adoption barriers have been perceived as a limitation. Objective: The aim of the research was to evaluate a digital quality improvement pilot in Medicare-eligible patients with COPD. Methods: COPD patients were enrolled in a digital platform to help manage their medications and symptoms as part of their routine clinical care. Patients were provided with electronic medication monitors (EMMs) to monitor short-acting beta-agonist (SABA) use passively and a smartphone app to track use trends and receive feedback. Providers also had access to data collected via a secure website and were sent email notifications if a patient had a significant change in their prescribed inhaler use. Providers then determined if follow-up was needed. Change in SABA use and feasibility outcomes were evaluated at 3, 6, and 12 months. Results: A total of 190 patients enrolled in the pilot. At 3, 6, and 12 months, patients recorded significant reductions in daily and nighttime SABA use and increases in SABA-free days (all P<.001). Patient engagement, as measured by the ratio of daily active use to monthly active use, was >90\% at both 6 and 12 months. Retention at 6 months was 81\% (154/190). Providers were sent on average two email notifications per patient during the 12-month program. Conclusions: A digital health program integrated as part of standard clinical practice was feasible and had low provider burden. The pilot demonstrated significant reduction in SABA use and increased SABA-free days among Medicare-eligible COPD patients. Further, patients readily adopted the digital platform and demonstrated strong engagement and retention rates at 6 and 12 months. ",
doi="10.2196/13286",
url="http://formative.jmir.org/2019/4/e13286/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31647471"
}


@Article{info:doi/10.2196/14408,
author="Boer, Lonneke
and Bischoff, Erik
and van der Heijden, Maarten
and Lucas, Peter
and Akkermans, Reinier
and Vercoulen, Jan
and Heijdra, Yvonne
and Assendelft, Willem
and Schermer, Tjard",
title="A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="9",
volume="7",
number="10",
pages="e14408",
keywords="COPD",
keywords="symptom flare up",
keywords="mHealth",
keywords="self-management",
abstract="Background: Many patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs. Objective: This study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals. Methods: In a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models. Results: Of the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95\% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good. Conclusions: This study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan. Trial Registration: ClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096. ",
doi="10.2196/14408",
url="https://mhealth.jmir.org/2019/10/e14408",
url="http://www.ncbi.nlm.nih.gov/pubmed/31599729"
}


@Article{info:doi/10.2196/ijmr.9637,
author="Lanning, Eleanor
and Longstaff, Jayne
and Jones, Thomas
and Roberts, Claire
and Neville, Daniel
and DeVos, Ruth
and Storrar, Will
and Green, Ben
and Brown, Thomas
and Leung, Anthony
and Fogg, Carole
and Dominey, Rachel
and Bassett, Paul
and Meredith, Paul
and Chauhan, J. Anoop",
title="Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD): Mixed Methods Evaluation of a Novel Integrated Care Clinic",
journal="Interact J Med Res",
year="2019",
month="Oct",
day="1",
volume="8",
number="4",
pages="e9637",
keywords="chronic obstructive pulmonary disease",
keywords="comorbidity",
keywords="multidisciplinary",
keywords="delivery of health care",
keywords="diagnosis",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is the second-leading cause of death in the United Kingdom and accounts for 1.7\% of bed days in acute hospitals. An estimated two-third of patients with COPD remain undiagnosed. Objective: Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD) aimed to proactively identify patients from primary care who were undiagnosed or had uncontrolled COPD and to provide a comprehensive integrated multidisciplinary clinic to address the needs of this complex group for improving diagnosis, personalizing therapy, and empowering patients to self-manage their condition. Methods: This clinic was led by a respiratory specialist team from Portsmouth Hospitals NHS Trust working with five primary care surgeries in Wessex. A total of 108 patients were reviewed, with 98 patients consenting to provide additional data for research. Diagnoses were changed in 14 patients, and 32 new diagnoses were made. Results: Reductions were seen across all aspects of unscheduled care as compared to the prior 12 months, including in emergency general practitioner visits (3.37-0.79 visits per patient, P<.001), exacerbations (2.64-0.56 per patient, P=.01), out-of-hours calls (0.16-0.05 per patient, P=.42), and hospital admissions (0.49-0.12 per patient, P=.48). Improvements were observed in the quality of life and symptom scores in addition to patient activation and patient-reported confidence levels. Conclusions: This pilot demonstrates that the MISSION model may be an effective way to provide comprehensive gold-standard care that is valued by patients and to promote integration across sectors. ",
doi="10.2196/ijmr.9637",
url="https://www.i-jmr.org/2019/4/e9637",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573894"
}


@Article{info:doi/10.5210/ojphi.v5i1.4408,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4408",
doi="10.5210/ojphi.v5i1.4408",
url=""
}