%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56318 %T A Smartphone App Self-Management Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial of Clinical Outcomes %A Glynn,Lisa %A Moloney,Eddie %A Lane,Stephen %A McNally,Emma %A Buckley,Carol %A McCann,Margaret %A McCabe,Catherine %+ School of Nursing and Midwifery, University of Galway, University Road, Galway, H91 TK33, Ireland, 353 91 492345, lisa.l.glynn@universityofgalway.ie %K COPD %K self-management %K smartphone application %K clinical health outcomes %K chronic obstructive pulmonary disease %K clinical health %K patient %K patients %K randomised controlled trial %K RCT %K smartphone %K app %K apps %K application %K applications %K mhealth %K mobile health %K effectiveness %K intervention %K interventions %K hospital setting %K quality of life %K self-efficacy %K hospital %K hospitals %K mobile phone %D 2025 %7 23.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %R 10.2196/56318 %U https://mhealth.jmir.org/2025/1/e56318 %U https://doi.org/10.2196/56318 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69113 %T Impact of Acute Respiratory Infections on Medical Absenteeism Among Military Personnel: Retrospective Cohort Study %A M,Premikha %A Goh,Jit Khong %A Ng,Jing Qiang %A Mutalib,Adeliza %A Lim,Huai Yang %K respiratory infections %K military %K epidemiology %K public health %K surveillance %D 2025 %7 18.4.2025 %9 %J JMIR Form Res %G English %X Background: Acute respiratory infections (ARI) are a significant challenge in military settings due to close communal living, which facilitates the rapid transmission of pathogens. A variety of respiratory pathogens contribute to ARI, each varying in prevalence, severity, and impact on organizational productivity. Understanding and mitigating the impact of ARI is critical for optimizing the health of military personnel and maintaining organizational productivity. Objective: This retrospective study of surveillance data aims to identify pathogens causing ARI among servicemen and determine which pathogens contribute most to medical absenteeism, defined as the combined duration of the issued medical certificate and light duty. Methods: From September 2023 to August 2024, anonymous nasopharyngeal swabs (BioFire FilmArray Respiratory Panel) were collected from Singapore Armed Forces servicemen presenting with ARI symptoms after a doctor’s consultation at a local military camp’s medical centre. The presence of fever and duration of medical certificate and light duty were self-reported by Singapore Armed Forces servicemen. Results: A total of 1095 nasopharyngeal swabs were collected, of which 608 (55.5%) tested positive. The most common respiratory pathogen was human rhinovirus/enterovirus (HRV/HEV) in 303 (27.7%) individuals. The highest proportions of fever were observed in servicemen with influenza (62.8%, 27/43), SARS-CoV-2 (34.3%, 12/35), and parainfluenza (31.6%, 12/38). The odds of patients with influenza that have fever was 5.8 times higher than those of patients infected with HRV/HEV (95% CI 2.95‐11.40, P<.001). The median duration of medical certificate, light duty, and medical absenteeism were 0 (IQR 0), 2 (IQR 2) and 2 (IQR 0) days, respectively. The odds of patients with influenza having a medical certificate with duration ≥1 day was 5.34 times higher than those in patients with HRV/HEV (95% CI 2.63‐10.88, P<.001). No significant differences in the duration of medical absenteeism were found between HRV/HEV and other pathogens. Conclusions: Compared to HRV/HEV, influenza infections were significantly associated with longer medical certificate duration. Nonetheless, there were no significant differences in the overall duration of medical absenteeism across pathogens, as servicemen infected with other pathogens were given light duty instead. These findings emphasize the need for pathogen-agnostic ARI measures. While influenza vaccinations are already mandatory for servicemen in local military camps, encouraging additional public health measures (eg, mask-wearing among symptomatic servicemen, COVID-19 vaccinations, therapeutics) can further reduce ARI incidence, minimize the duration of medical absenteeism, and mitigate the impact on organizational productivity. %R 10.2196/69113 %U https://formative.jmir.org/2025/1/e69113 %U https://doi.org/10.2196/69113 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66491 %T Artificial Intelligence Models for Pediatric Lung Sound Analysis: Systematic Review and Meta-Analysis %A Park,Ji Soo %A Park,Sa-Yoon %A Moon,Jae Won %A Kim,Kwangsoo %A Suh,Dong In %+ Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea, 82 2 2072 362, dongins0@snu.ac.kr %K machine learning %K respiratory disease classification %K wheeze detection %K auscultation %K mel-spectrogram %K abnormal lung sound detection %K artificial intelligence %K pediatric %K lung sound analysis %K systematic review %K asthma %K pneumonia %K children %K morbidity %K mortality %K diagnostic %K respiratory pathology %D 2025 %7 18.4.2025 %9 Review %J J Med Internet Res %G English %X 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. %M 40249944 %R 10.2196/66491 %U https://www.jmir.org/2025/1/e66491 %U https://doi.org/10.2196/66491 %U http://www.ncbi.nlm.nih.gov/pubmed/40249944 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e56877 %T Assessing COVID-19 Mortality in Serbia’s Capital: Model-Based Analysis of Excess Deaths %A Cvijanovic,Dane %A Grubor,Nikola %A Rajovic,Nina %A Vucevic,Mira %A Miltenovic,Svetlana %A Laban,Marija %A Mostic,Tatjana %A Tasic,Radica %A Matejic,Bojana %A Milic,Natasa %K COVID-19 %K COVID-19 impact %K SARS-Cov-2 %K coronavirus %K respiratory %K infectious disease %K pulmonary %K pandemic %K excess mortality %K death rate %K death toll %K centralized health care %K urban %K Serbia %K dense population %K public health %K surveillance %D 2025 %7 17.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics. Objective: This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital’s population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets. Methods: Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates. Results: The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0‐19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20‐39 years had an estimated increase in mortality of 32.95%. For people aged 60‐79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged >80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade. Conclusions: The finalized mortality dataset for Belgrade can be safely used in COVID-19 impact analysis. Belgrade experienced a significant increase in mortality during 2020 and 2021, with most of the excess mortality attributable to SARS-CoV-2. Concerns about increased mortality from causes other than COVID-19 in Belgrade seem misplaced as their impact appears negligible. %R 10.2196/56877 %U https://publichealth.jmir.org/2025/1/e56877 %U https://doi.org/10.2196/56877 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66509 %T Oxidative Stress Markers and Prediction of Severity With a Machine Learning Approach in Hospitalized Patients With COVID-19 and Severe Lung Disease: Observational, Retrospective, Single-Center Feasibility Study %A Raspado,Olivier %A Brack,Michel %A Brack,Olivier %A Vivancos,Mélanie %A Esparcieux,Aurélie %A Cart-Tanneur,Emmanuelle %A Aouifi,Abdellah %K oxidative stress %K COVID-19 %K SARS-CoV-2 %K coronavirus %K respiratory %K infectious %K pulmonary %K respiration disorders %K hospitalization %K machine learning %K ML %K biomarker %K lung %K severity %K prediction %D 2025 %7 11.4.2025 %9 %J JMIR Form Res %G English %X Background: Serious pulmonary pathologies of infectious, viral, or bacterial origin are accompanied by inflammation and an increase in oxidative stress (OS). In these situations, biological measurements of OS are technically difficult to obtain, and their results are difficult to interpret. OS assays that do not require complex preanalytical methods, as well as machine learning methods for improving interpretation of the results, would be very useful tools for medical and care teams. Objective: We aimed to identify relevant OS biomarkers associated with the severity of hospitalized patients’ condition and identify possible correlations between OS biomarkers and the clinical status of hospitalized patients with COVID-19 and severe lung disease at the time of hospital admission. Methods: All adult patients hospitalized with COVID-19 at the Infirmerie Protestante (Lyon, France) from February 9, 2022, to May 18, 2022, were included, regardless of the care service they used, during the respiratory infectious COVID-19 epidemic. We collected serous biomarkers from the patients (zinc [Zn], copper [Cu], Cu/Zn ratio, selenium, uric acid, high-sensitivity C-reactive protein [hs-CRP], oxidized low-density lipoprotein, glutathione peroxidase, glutathione reductase, and thiols), as well as demographic variables and comorbidities. A support vector machine (SVM) model was used to predict the severity of the patients’ condition based on the collected data as a training set. Results: A total of 28 patients were included: 8 were asymptomatic at admission (grade 0), 14 had mild to moderate symptoms (grade 1) and 6 had severe to critical symptoms (grade 3). As the first outcome, we found that 3 biomarkers of OS were associated with severity (Zn, Cu/Zn ratio, and thiols), especially between grades 0 and 1 and between grades 0 and 2. As a second outcome, we found that the SVM model could predict the level of severity based on a biological analysis of the level of OS, with only 7% misclassification on the training dataset. As an illustrative example, we simulated 3 different biological profiles (named A, B, and C) and submitted them to the SVM model. Profile B had significantly high Zn, low hs-CRP, a low Cu/Zn ratio, and high thiols, corresponding to grade 0. Profile C had low Zn, low selenium, high oxidized low-density lipoprotein, high glutathione peroxidase, a low Cu/Zn ratio, and low glutathione reductase, corresponding to grade 2. Conclusions: The level of severity of pulmonary damage in patients hospitalized with COVID-19 was predicted using an SVM model; moderate to severe symptoms in patients were associated with low Zn, low plasma thiol, increased hs-CRP, and an increased Cu/Zn ratio among a panel of 10 biomarkers of OS. Since this panel does not require a complex preanalytical method, it can be used and studied in other pathologies associated with OS, such as infectious pathologies or chronic diseases. %R 10.2196/66509 %U https://formative.jmir.org/2025/1/e66509 %U https://doi.org/10.2196/66509 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e67706 %T Extracting Pulmonary Embolism Diagnoses From Radiology Impressions Using GPT-4o: Large Language Model Evaluation Study %A Mahyoub,Mohammed %A Dougherty,Kacie %A Shukla,Ajit %+ Virtua Health, 301 Lippincott Drive, 3rd Fl., Marlton, NJ, 08053, United States, 1 8888478823, mmahyoub@virtua.org %K pulmonary embolism %K large language models %K LLMs %K natural language processing %K GPT-4o %K Clinical Longformer %K text classification %K radiology reports %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Pulmonary embolism (PE) is a critical condition requiring rapid diagnosis to reduce mortality. Extracting PE diagnoses from radiology reports manually is time-consuming, highlighting the need for automated solutions. Advances in natural language processing, especially transformer models like GPT-4o, offer promising tools to improve diagnostic accuracy and workflow efficiency in clinical settings. Objective: This study aimed to develop an automatic extraction system using GPT-4o to extract PE diagnoses from radiology report impressions, enhancing clinical decision-making and workflow efficiency. Methods: In total, 2 approaches were developed and evaluated: a fine-tuned Clinical Longformer as a baseline model and a GPT-4o-based extractor. Clinical Longformer, an encoder-only model, was chosen for its robustness in text classification tasks, particularly on smaller scales. GPT-4o, a decoder-only instruction-following LLM, was selected for its advanced language understanding capabilities. The study aimed to evaluate GPT-4o’s ability to perform text classification compared to the baseline Clinical Longformer. The Clinical Longformer was trained on a dataset of 1000 radiology report impressions and validated on a separate set of 200 samples, while the GPT-4o extractor was validated using the same 200-sample set. Postdeployment performance was further assessed on an additional 200 operational records to evaluate model efficacy in a real-world setting. Results: GPT-4o outperformed the Clinical Longformer in 2 of the metrics, achieving a sensitivity of 1.0 (95% CI 1.0-1.0; Wilcoxon test, P<.001) and an F1-score of 0.975 (95% CI 0.9495-0.9947; Wilcoxon test, P<.001) across the validation dataset. Postdeployment evaluations also showed strong performance of the deployed GPT-4o model with a sensitivity of 1.0 (95% CI 1.0-1.0), a specificity of 0.94 (95% CI 0.8913-0.9804), and an F1-score of 0.97 (95% CI 0.9479-0.9908). This high level of accuracy supports a reduction in manual review, streamlining clinical workflows and improving diagnostic precision. Conclusions: The GPT-4o model provides an effective solution for the automatic extraction of PE diagnoses from radiology reports, offering a reliable tool that aids timely and accurate clinical decision-making. This approach has the potential to significantly improve patient outcomes by expediting diagnosis and treatment pathways for critical conditions like PE. %M 40203306 %R 10.2196/67706 %U https://medinform.jmir.org/2025/1/e67706 %U https://doi.org/10.2196/67706 %U http://www.ncbi.nlm.nih.gov/pubmed/40203306 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69743 %T Assessing Pulmonary Function in Children and Adolescents After Cancer Treatment: Protocol for a Multicenter Cohort Study (Swiss Childhood Cancer Survivor Study FollowUp–Pulmo) %A Žarković,Maša %A Schindera,Christina %A Sommer,Grit %A Schneider,Christine %A Usemann,Jakob %A Otth,Maria %A Lüer,Sonja %A Ansari,Marc %A Latzin,Philipp %A Kuehni,Claudia E %+ Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland, 41 31 684 35 07, claudia.kuehni@unibe.ch %K childhood cancer survivors %K respiratory function tests %K late effects %K pulmonary toxicity %K multiple breath washout test %K cohort study %D 2025 %7 8.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood cancer survivors (CCS) are at risk of pulmonary dysfunction due to cancer treatments, but evidence on prevalence and risk factors remains limited. Most previous studies had small sample sizes or retrospective study designs, little information about treatments, or a lack of standardization of pulmonary function tests (PFTs) or limited their investigation to certain PFTs. Since spirometry mainly assesses the large airways but cancer therapy also affects peripheral airways, additional functional tests are needed. The nitrogen multiple breath washout test (N2MBW) is sensitive to peripheral airway damage in other patient populations, but its benefit in CCS is unknown. Therefore, comprehensive and standardized evaluation of pulmonary function after cancer treatment in childhood, using different PFTs that include N2MBW, is needed to address these knowledge gaps and provide insights into possible early stages of pulmonary dysfunction. Objective: In the Swiss Childhood Cancer Survivor Study (SCCSS) FollowUp–Pulmo, we will comprehensively assess lung function in children and adolescents after treatment for cancer to identify risk factors for pulmonary dysfunction, assess the ability of N2MBW to detect pulmonary dysfunction compared to other PFTs, and investigate the association of functional outcomes from PFTs with self-reported respiratory symptoms. Methods: SCCSS FollowUp–Pulmo is a prospective multicenter longitudinal cohort study embedded in routine clinical care that enrolls CCS aged 6-20 years for whom at least 1 year has passed since a childhood cancer diagnosis, who have completed treatment, and who attend regular pediatric oncological follow-up care. Inclusion criteria comprise any of the following: systemic anticancer treatment (chemotherapy, immunotherapy, or targeted agents), thoracic surgery, thoracic radiotherapy, or hematopoietic stem cell transplantation (HSCT). CCS undergo a standardized pulmonary assessment, including spirometry, body plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO), and N2MBW, and complete a questionnaire on respiratory symptoms and lifestyle. Data from previous and subsequent routine care PFTs will be included in this study. Results: Recruitment started in June 2022 at the University Children’s Hospital Bern, Switzerland. Subsequently, patient recruitment expanded to the University Children’s Hospitals in Basel and Geneva, Switzerland. By October 2024, we had invited 220 patients, of which 201 have already participated in this study, resulting in a response rate of 91%. Their median age at the time of the study was 14 years (IQR 10-17), and the median time since diagnosis was 7 years (IQR 4-10). The study will continuously enroll new CCS. Conclusions: This study will contribute to a comprehensive understanding of pulmonary function in CCS and assess related risk factors, as well as the utility of N2MBW compared to other PFTs. The results will assist in the development of more targeted screening and risk-stratified follow-up care. Trial Registration: ClinicalTrials.gov NCT04732273; https://clinicaltrials.gov/study/NCT04732273 International Registered Report Identifier (IRRID): DERR1-10.2196/69743 %M 40198919 %R 10.2196/69743 %U https://www.researchprotocols.org/2025/1/e69743 %U https://doi.org/10.2196/69743 %U http://www.ncbi.nlm.nih.gov/pubmed/40198919 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64742 %T 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 %A Chen,Yuyin %A Zhang,Yuanyuan %A Long,Xiuhong %A Tu,Huiqiong %A Chen,Jibing %+ Department of Nursing, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, No. 10, Huadong Road, Nanning, 530011, China, 86 13788406562, longxh@gxtcmu.edu.cn %K virtual reality %K video games %K exergaming %K pulmonary rehabilitation %K chronic obstructive pulmonary disease %K lung function %K exercise capacity %K dyspnea %K health status %K randomized controlled trial %K systematic review %K meta-analysis %D 2025 %7 7.4.2025 %9 Review %J J Med Internet Res %G English %X 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. %M 40193185 %R 10.2196/64742 %U https://www.jmir.org/2025/1/e64742 %U https://doi.org/10.2196/64742 %U http://www.ncbi.nlm.nih.gov/pubmed/40193185 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e65456 %T Estimation of Static Lung Volumes and Capacities From Spirometry Using Machine Learning: Algorithm Development and Validation %A Helgeson,Scott A %A Quicksall,Zachary S %A Johnson,Patrick W %A Lim,Kaiser G %A Carter,Rickey E %A Lee,Augustine S %K artificial intelligence %K machine learning %K pulmonary function test %K spirometry %K total lung capacity %K AI %K ML %K lung %K lung volume %K lung capacity %K spirometer %K lung disease %K database %K respiratory %K pulmonary %D 2025 %7 24.3.2025 %9 %J JMIR AI %G English %X Background: Spirometry can be performed in an office setting or remotely using portable spirometers. Although basic spirometry is used for diagnosis of obstructive lung disease, clinically relevant information such as restriction, hyperinflation, and air trapping require additional testing, such as body plethysmography, which is not as readily available. We hypothesize that spirometry data contains information that can allow estimation of static lung volumes in certain circumstances by leveraging machine learning techniques. Objective: The aim of the study was to develop artificial intelligence-based algorithms for estimating lung volumes and capacities using spirometry measures. Methods: This study obtained spirometry and lung volume measurements from the Mayo Clinic pulmonary function test database for patient visits between February 19, 2001, and December 16, 2022. Preprocessing was performed, and various machine learning algorithms were applied, including a generalized linear model with regularization, random forests, extremely randomized trees, gradient-boosted trees, and XGBoost for both classification and regression cohorts. Results: A total of 121,498 pulmonary function tests were used in this study, with 85,017 allotted for exploratory data analysis and model development (ie, training dataset) and 36,481 tests reserved for model evaluation (ie, testing dataset). The median age of the cohort was 64.7 years (IQR 18‐119.6), with a balanced distribution between genders, consisting 48.2% (n=58,607) female and 51.8% (n=62,889) male patients. The classification models showed a robust performance overall, with relatively low root mean square error and mean absolute error values observed across all predicted lung volumes. Across all lung volume categories, the models demonstrated strong discriminatory capacity, as indicated by the high area under the receiver operating characteristic curve values ranging from 0.85 to 0.99 in the training set and 0.81 to 0.98 in the testing set. Conclusions: Overall, the models demonstrate robust performance across lung volume measurements, underscoring their potential utility in clinical practice for accurate diagnosis and prognosis of respiratory conditions, particularly in settings where access to body plethysmography or other lung volume measurement modalities is limited. %R 10.2196/65456 %U https://ai.jmir.org/2025/1/e65456 %U https://doi.org/10.2196/65456 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65789 %T Clinical Safety of Pudilan Xiaoyan Oral Liquid for the Treatment of Upper Respiratory Tract Infection in the Real World: Protocol for a Prospective, Observational, Registry Study %A Wang,Mengmeng %A Wang,Lianxin %A Liu,Fumei %A Chen,Renbo %A Wang,Zhifei %A Cui,Xin %A Li,Yuanyuan %A Xie,Yanming %+ Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16, Nanxiao Street, Dongzhimen, Dongcheng District, Beijing, 100700, China, 86 13911112416, ktzu2018@163.com %K Pudilan Xiaoyan oral liquid %K PDL %K upper respiratory tract infection %K URTI %K registry %K adverse drug reaction %D 2025 %7 21.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pudilan Xiaoyan oral liquid (PDL) is a proprietary Chinese medicine preparation widely used for upper respiratory tract infection, known for its significant therapeutic effects. However, the safety profiles reported in several observational studies vary, and these studies primarily focus on efficacy rather than specifically addressing safety concerns, thus representing inadequate safety monitoring. Objective: This study aimed to investigate the incidence of adverse drug reactions (ADRs) associated with PDL and explore the factors contributing to these reactions. Methods: The study is a prospective, observational, multicenter, hospital-based surveillance study. A total of 17 hospitals from China are involved. The study is expected to enroll a large sample of 10,000 patients aged between 18 and 80 years with upper respiratory tract infection who were prescribed PDL. The patients’ data, including demographics, medical history, diagnostic information, medication details, adverse events, and laboratory test results, will be monitored. The occurrence of ADRs will be recorded. The primary outcome is the incidence of ADR. Secondary outcomes are the ratio of patients whose body temperature return to the normal range (cases of body temperature normalization and the duration for achieving normal body temperature within a 3-day period will be documented) and changes in liver and kidney function (occurrence of drug-induced liver injury and acute kidney injury). Descriptive analyses will be performed for the primary and secondary outcomes. A cohort, nested, case-control study design will be used. If one patient has an ADR, then 4 patients without ADRs will be matched as the control group according to gender, age within 5 years, drug batch, and other factors, at a ratio of 1∶4 to compare the symptoms related to ADRs. The differences of ADR incidence among the possible influencing factors will be compared separately to find the factors with large differences. Then, synthetic minority oversampling technique and group least absolute shrinkage and selection operator methods will be used to identify factors influencing the occurrence of ADRs. Finally, propensity scoring methods will be used to control for confounding variables. The progress of each subcenter will be closely monitored, and the incidence of ADR will be systematically calculated. Furthermore, the characteristics and influencing factors of ADR will be analyzed, along with an investigation into its geographical distribution. Results: The study began on July 17, 2019. Due to the limited number of eligible patients, missed follow-ups, and the huge clinical burden caused by public health events in 2019, the final case will be enrolled on August 30, 2025. Conclusions: This study will obtain safety results of PDL in the real world and provide guidance on the clinical safety of traditional Chinese medicine formulations. Trial Registration: ClinicalTrials.gov NCT04031651; https://clinicaltrials.gov/study/NCT04031651 International Registered Report Identifier (IRRID): DERR1-10.2196/65789 %M 40117581 %R 10.2196/65789 %U https://www.researchprotocols.org/2025/1/e65789 %U https://doi.org/10.2196/65789 %U http://www.ncbi.nlm.nih.gov/pubmed/40117581 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e67239 %T Improving the Robustness and Clinical Applicability of Automatic Respiratory Sound Classification Using Deep Learning–Based Audio Enhancement: Algorithm Development and Validation %A Tzeng,Jing-Tong %A Li,Jeng-Lin %A Chen,Huan-Yu %A Huang,Chu-Hsiang %A Chen,Chi-Hsin %A Fan,Cheng-Yi %A Huang,Edward Pei-Chuan %A Lee,Chi-Chun %+ Department of Electrical Engineering, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu, 300, Taiwan, 886 35162439, cclee@ee.nthu.edu.tw %K respiratory sound %K lung sound %K audio enhancement %K noise robustness %K clinical applicability %K artificial intelligence %K AI %D 2025 %7 13.3.2025 %9 Original Paper %J JMIR AI %G English %X Background: Deep learning techniques have shown promising results in the automatic classification of respiratory sounds. However, accurately distinguishing these sounds in real-world noisy conditions poses challenges for clinical deployment. In addition, predicting signals with only background noise could undermine user trust in the system. Objective: This study aimed to investigate the feasibility and effectiveness of incorporating a deep learning–based audio enhancement preprocessing step into automatic respiratory sound classification systems to improve robustness and clinical applicability. Methods: We conducted extensive experiments using various audio enhancement model architectures, including time-domain and time-frequency–domain approaches, in combination with multiple classification models to evaluate the effectiveness of the audio enhancement module in an automatic respiratory sound classification system. The classification performance was compared against the baseline noise injection data augmentation method. These experiments were carried out on 2 datasets: the International Conference in Biomedical and Health Informatics (ICBHI) respiratory sound dataset, which contains 5.5 hours of recordings, and the Formosa Archive of Breath Sound dataset, which comprises 14.6 hours of recordings. Furthermore, a physician validation study involving 7 senior physicians was conducted to assess the clinical utility of the system. Results: The integration of the audio enhancement module resulted in a 21.88% increase with P<.001 in the ICBHI classification score on the ICBHI dataset and a 4.1% improvement with P<.001 on the Formosa Archive of Breath Sound dataset in multi-class noisy scenarios. Quantitative analysis from the physician validation study revealed improvements in efficiency, diagnostic confidence, and trust during model-assisted diagnosis, with workflows that integrated enhanced audio leading to an 11.61% increase in diagnostic sensitivity and facilitating high-confidence diagnoses. Conclusions: Incorporating an audio enhancement algorithm significantly enhances the robustness and clinical utility of automatic respiratory sound classification systems, improving performance in noisy environments and fostering greater trust among medical professionals. %M 40080816 %R 10.2196/67239 %U https://ai.jmir.org/2025/1/e67239 %U https://doi.org/10.2196/67239 %U http://www.ncbi.nlm.nih.gov/pubmed/40080816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60831 %T Prevalence of Antibiotic Prescribing for Acute Respiratory Tract Infection in Telehealth Versus Face-to-Face Consultations: Cross-Sectional Analysis of General Practice Registrars’ Clinical Practice %A Gao,Yu %A Magin,Parker %A Tapley,Amanda %A Holliday,Elizabeth %A Dizon,Jason %A Fisher,Katie %A van Driel,Mieke %A Davis,Joshua S %A Davey,Andrew %A Ralston,Anna %A Fielding,Alison %A Moad,Dominica %A Mulquiney,Katie %A Clarke,Lisa %A Turner,Alexandria %+ General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Herston, 4029, Australia, 61 3 9698 0655, alex.turner@racgp.org.au %K antimicrobial resistance %K antibiotics stewardship %K telehealth %K general practice %K registrars %K acute respiratory tract infection %K antibiotics %K prescription %K respiratory tract infection %K RTIs %K Australia %K consultations %K teleconsultation %K teleconsult %K bronchitis %K sore throat %K acute otitis %K sinusitis %K in-consultation %K upper respiratory tract infection %D 2025 %7 13.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs. Objective: This study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for common cold (upper respiratory tract infection [URTI]), bronchitis, sore throat, acute otitis media, and sinusitis. Methods: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, a multicenter inception cohort study of registrars’ in-consultation clinical and educational experiences. Analysis used univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was “antibiotic prescribed” for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media. The study factor was consultation type (telehealth or F2F). Results: A total of 2392 registrars participated (response rate=93.4%). The proportions of diagnoses that were managed via telehealth were 25% (5283/21384) overall, 19% (641/3327) for acute sore throat, 29% (3733/12773) for URTI, 21% (364/1772), for acute bronchitis, 4.1% (72/1758) for acute otitis media, and 27% (473/1754) for acute sinusitis. Antibiotics were prescribed for 51% (1685/3327) of sore throat diagnoses, 6.9% (880/12773) of URTI diagnoses, 64% (1140/1772) of bronchitis diagnoses, 61% (1067/1754) of sinusitis diagnoses, and 73% (1278/1758) of otitis media diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (adjusted odds ratio [OR] 0.69, 95% CI 0.55-0.86; P=.001), URTI (adjusted OR 0.64, 95% CI 0.51-0.81; P<.001), and otitis media (adjusted OR 0.47, 95% CI 0.26-0.84; P=.01). There were no significant differences for acute bronchitis (adjusted OR 1.07, 95% CI 0.79-1.45; P=.66) or acute sinusitis (adjusted OR 1, 95% CI 0.76-1.32; P=.99). Conclusions: GP registrars are less likely to prescribe antibiotics for sore throat, URTI, and otitis media when seeing patients by telehealth versus F2F. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs. Therefore, there is no deleterious effect on antibiotic stewardship. %M 40080812 %R 10.2196/60831 %U https://www.jmir.org/2025/1/e60831 %U https://doi.org/10.2196/60831 %U http://www.ncbi.nlm.nih.gov/pubmed/40080812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67999 %T Interprofessional Discussion for Knowledge Transfer in a Digital “Community of Practice” for Managing Pneumoconiosis: Mixed Methods Study %A Sood,Varinn Avi %A Rishel Brakey,Heidi %A Myers,Orrin %A Shore,Xin %A Sood,Akshay %K digital community of practice %K knowledge transfer %K pneumoconiosis %K telementoring %K rural health care %K rural professionals %K multidisciplinary management %K interprofessional discussion %K miner health %K health equity %K mixed methods %K digital health %K public health %K digital community %K self-efficacy %K quantitative analyses %K quantitative %K technology %K multidisciplinary care %K patient outcome %D 2025 %7 13.3.2025 %9 %J JMIR Form Res %G English %X Background: Pneumoconiosis prevalence is increasing in the United States, especially among coal miners. Contemporaneously with an increased need for specialized multidisciplinary care for miners, there is a shortage of experts to fulfill this need. Miners’ Wellness ECHO (Extension for Community Health Outcomes) is a digital community of practice based on interprofessional discussion for knowledge transfer. The program has been demonstrated to increase participants’ self-efficacy for clinical, medicolegal, and “soft” skills related to miners’ health. Objective: We aimed to examine characteristics associated with interprofessional discussions and suggest ways to strengthen knowledge transfer. Methods: This mixed methods study used an exploratory sequential design. We video-recorded and transcribed ECHO sessions over 14 months from July 2018 to September 2019 and analyzed content to examine participant discussions. We focused on participants’ statements of expertise followed by other participants’ acceptance or eschewal of these statements (utterances). We conducted quantitative analyses to examine the associations of active participation in discussion (primary outcome variable, defined as any utterance). We analyzed the association of the outcome on the following predictors: (1) participant group status, (2) study time frame, (3) participant ECHO experience status, (4) concordance of participant group identity between presenter and participant, (5) video usage, and (6) attendance frequency. We used the generalized estimating equations approach for longitudinal data, logit link function for binary outcomes, and LSMEANS to examine least squares means of fixed effects. Results: We studied 23 sessions with 158 unique participants and 539 total participants, averaging 23.4 (SD 5.6) participants per session. Clinical providers, the largest participant group, constituting 36.7% (n=58) of unique participants, were the most vocal group (mean 21.74, SD 2.11 average utterances per person-session). Benefits counselors were the least vocal group, with an average utterance rate of 0.57 (SD 0.29) per person-session and constituting 8.2% (n=13) of unique participants. Thus, various participant groups exhibited different utterance rates across sessions (P=.003). Experienced participants may have dominated active participation in discussion compared to those with less or intermediate experience, but this difference was not statistically significant (P=.11). When the didactic presenter and participant were from the same participant group, active participation by the silent group participants was greater than when both were from different groups. This association was not seen in vocal group participants (interaction P=.003). Compared to those participating by audio, those participating on video tended to have higher rates of active participation, but this difference was not statistically significant (P=.11). Conclusions: Our findings provide insight into the mechanics of interprofessional discussion in a digital community of practice managing pneumoconiosis. Our results underscore the capacity of the novel ECHO model to leverage technology and workforce diversity to facilitate interprofessional discussions on the multidisciplinary care of miners. Future research will evaluate whether this translates into improved patient outcomes. %R 10.2196/67999 %U https://formative.jmir.org/2025/1/e67999 %U https://doi.org/10.2196/67999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51804 %T Impact of Demographic and Clinical Subgroups in Google Trends Data: Infodemiology Case Study on Asthma Hospitalizations %A Portela,Diana %A Freitas,Alberto %A Costa,Elísio %A Giovannini,Mattia %A Bousquet,Jean %A Almeida Fonseca,João %A Sousa-Pinto,Bernardo %+ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, R. Dr. Plácido da Costa, Porto, 4200-450, Portugal, 351 22 551 3622, bernardosousapinto@protonmail.com %K infodemiology %K asthma %K administrative databases %K multimorbidity %K co-morbidity %K respiratory %K pulmonary %K Google Trends %K correlation %K hospitalization %K admissions %K autoregressive %K information seeking %K searching %K searches %K forecasting %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Google Trends (GT) data have shown promising results as a complementary tool to classical surveillance approaches. However, GT data are not necessarily provided by a representative sample of patients and may be skewed toward demographic and clinical groups that are more likely to use the internet to search for their health. Objective: In this study, we aimed to assess whether GT-based models perform differently in distinct population subgroups. To assess that, we analyzed a case study on asthma hospitalizations. Methods: We analyzed all hospitalizations with a main diagnosis of asthma occurring in 3 different countries (Portugal, Spain, and Brazil) for a period of approximately 5 years (January 1, 2012-December 17, 2016). Data on web-based searches on common cold for the same countries and time period were retrieved from GT. We estimated the correlation between GT data and the weekly occurrence of asthma hospitalizations (considering separate asthma admissions data according to patients’ age, sex, ethnicity, and presence of comorbidities). In addition, we built autoregressive models to forecast the weekly number of asthma hospitalizations (for the different aforementioned subgroups) for a period of 1 year (June 2015-June 2016) based on admissions and GT data from the 3 previous years. Results: Overall, correlation coefficients between GT on the pseudo-influenza syndrome topic and asthma hospitalizations ranged between 0.33 (in Portugal for admissions with at least one Charlson comorbidity group) and 0.86 (for admissions in women and in White people in Brazil). In the 3 assessed countries, forecasted hospitalizations for 2015-2016 correlated more strongly with observed admissions of older versus younger individuals (Portugal: Spearman ρ=0.70 vs ρ=0.56; Spain: ρ=0.88 vs ρ=0.76; Brazil: ρ=0.83 vs ρ=0.82). In Portugal and Spain, forecasted hospitalizations had a stronger correlation with admissions occurring for women than men (Portugal: ρ=0.75 vs ρ=0.52; Spain: ρ=0.83 vs ρ=0.51). In Brazil, stronger correlations were observed for admissions of White than of Black or Brown individuals (ρ=0.92 vs ρ=0.87). In Portugal, stronger correlations were observed for admissions of individuals without any comorbidity compared with admissions of individuals with comorbidities (ρ=0.68 vs ρ=0.66). Conclusions: We observed that the models based on GT data may perform differently in demographic and clinical subgroups of participants, possibly reflecting differences in the composition of internet users’ health-seeking behaviors. %M 40063932 %R 10.2196/51804 %U https://www.jmir.org/2025/1/e51804 %U https://doi.org/10.2196/51804 %U http://www.ncbi.nlm.nih.gov/pubmed/40063932 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e63512 %T Development of a Mobile App Game for Practicing Lung Exercises: Feasibility Study %A Pearkao,Chatkhane %A Apiratwarakul,Korakot %A Wicharit,Lerkiat %A Potisopha,Wiphawadee %A Jaitieng,Arunnee %A Homvisetvongsa,Sukuman %A Namwaing,Puthachad %A Pudtuan,Peerapon %K mobile app game %K practice lung exercises %K feasibility study %K mobile phone %K pulmo device %K app %D 2025 %7 4.3.2025 %9 %J JMIR Rehabil Assist Technol %G English %X 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. %R 10.2196/63512 %U https://rehab.jmir.org/2025/1/e63512 %U https://doi.org/10.2196/63512 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e53276 %T Impact of a Point-of-Care Ultrasound Training Program on the Management of Patients With Acute Respiratory or Circulatory Failure by In-Training Emergency Department Residents (IMPULSE): Before-and-After Implementation Study %A Bieler,Sandra %A von Düring,Stephan %A Tagan,Damien %A Grosgurin,Olivier %A Fumeaux,Thierry %K point-of-care ultrasonography %K training program %K emergency department %K acute respiratory failure %K acute circulatory failure %D 2025 %7 3.3.2025 %9 %J JMIRx Med %G English %X Background: Due to its diagnostic accuracy, point-of-care ultrasound (POCUS) is becoming more frequently used in the emergency department (ED), but the feasibility of its use by in-training residents and the potential clinical impact have not been assessed. Objective: This study aimed to assess the feasibility of implementing a structured POCUS training program for in-training ED residents, as well as the clinical impact of their use of POCUS in the management of patients in the ED. Methods: IMPULSE (Impact of a Point-of Care Ultrasound Examination) is a before-and-after implementation study evaluating the impact of a structured POCUS training program for ED residents on the management of patients admitted with acute respiratory failure (ARF) and/or circulatory failure (ACF) in a Swiss regional hospital. The training curriculum was organized into 3 steps and consisted of a web-based training course; an 8-hour, practical, hands-on session; and 10 supervised POCUS examinations. ED residents who successfully completed the curriculum participated in the postimplementation phase of the study. Outcomes were time to ED diagnosis, rate and time to correct diagnosis in the ED, time to prescribe appropriate treatment, and in-hospital mortality. Standard statistical analyses were performed using chi-square and Mann-Whitney U tests as appropriate, supplemented by Bayesian analysis, with a Bayes factor (BF)>3 considered significant. Results: A total of 69 and 54 patients were included before and after implementation of the training program, respectively. The median time to ED diagnosis was 25 (IQR 15‐60) minutes after implementation versus 30 (IQR 10‐66) minutes before implementation, a difference that was significant in the Bayesian analysis (BF=9.6). The rate of correct diagnosis was higher after implementation (51/54, 94% vs 36/69, 52%; P<.001), with a significantly shorter time to correct diagnosis after implementation (25, IQR 15‐60 min vs 43, IQR 11‐70 min; BF=5.0). The median time to prescribe the appropriate therapy was shorter after implementation (47, IQR 25‐101 min vs 70, IQR 20‐120 min; BF=2.0). Finally, there was a significant difference in hospital mortality (9/69, 13% vs 3/54, 6%; BF=15.7). Conclusions: The IMPULSE study shows that the implementation of a short, structured POCUS training program for ED residents is not only feasible but also has a significant impact on their initial evaluation of patients with ARF and/or ACF, improving diagnostic accuracy, time to correct diagnosis, and rate of prescribing the appropriate therapy and possibly decreasing hospital mortality. These results should be replicated in other settings to provide further evidence that implementation of a short, structured POCUS training curriculum could significantly impact ED management of patients with ARF and/or ACF. %R 10.2196/53276 %U https://xmed.jmir.org/2025/1/e53276 %U https://doi.org/10.2196/53276 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64111 %T Screening Workers for Occupational Exposure to Respirable Crystalline Silica: Development and Usability of an Electronic Data Capture Tool %A Hore-Lacy,Fiona %A Dimitriadis,Christina %A Hoy,Ryan F %A Jimenez-Martin,Javier %A Sim,Malcolm R %A Fisher,Jane %A Glass,Deborah C %A Walker-Bone,Karen %K silicosis %K occupational history %K electronic data capture tool (EDCT) %K REDCap %K occupational respiratory screening %K occupational hazard %K exposure %K silica %K fibrotic lung disease %K lung disease %K respirable crystalline silica %K mining %K construction %K workers %K occupational lung disease %K occupational %K Australia %K screening %D 2025 %7 24.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Cases of the occupational lung disease silicosis have been identified in workers processing artificial stone in the stone benchtop industry (SBI). In the Australian state of Victoria, the Regulator commissioned a screening program for all workers in this industry. Objective: To facilitate systematic data collection, including high-quality exposure assessment, an electronic data capture tool (EDCT) was developed. Methods: A multidisciplinary team developed an EDCT using Research Electronic Data Capture (REDCap; Vanderbilt University). The needs of the EDCT were (1) data entry by multiple clinicians and the workers attending for screening and (2) systematic collection of data for clinical and research purposes. The comprehensibility and utility of the tool were investigated with a sample of workers, and the EDCT was subsequently refined. Results: The EDCT was used in clinical practice, with capacity for data extraction for research. Testing of comprehension and utility was undertaken with 15 workers, and the refined version of the Occupational Silica Exposure Assessment Tool (OSEAT) was subsequently developed. Conclusions: The refined OSEAT has been determined to be comprehensible to workers and capable of collecting exposure data suitable for assessment of risk of silicosis. It was developed for workers in the SBI in Australia and is adaptable, including translation into other languages. It can also be modified for SBI workers in other countries and for use by workers from other industries (mining, construction) at risk of silica exposure, including in lower-income settings. %R 10.2196/64111 %U https://humanfactors.jmir.org/2025/1/e64111 %U https://doi.org/10.2196/64111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56038 %T Understanding the Engagement and Interaction of Superusers and Regular Users in UK Respiratory Online Health Communities: Deep Learning–Based Sentiment Analysis %A Li,Xiancheng %A Vaghi,Emanuela %A Pasi,Gabriella %A Coulson,Neil S %A De Simoni,Anna %A Viviani,Marco %A , %+ School of Business and Management, Queen Mary University of London, Mile End Road, Bethnal Green, London, E14NS, United Kingdom, 44 2078825555, x.l.li@qmul.ac.uk %K social media %K online health communities %K social network analysis %K sentiment analysis %K bio-bidirectional encoder representations from transformers %K asthma %K chronic obstructive pulmonary disease %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health communities (OHCs) enable people with long-term conditions (LTCs) to exchange peer self-management experiential information, advice, and support. Engagement of “superusers,” that is, highly active users, plays a key role in holding together the community and ensuring an effective exchange of support and information. Further studies are needed to explore regular users’ interactions with superusers, their sentiments during interactions, and their ultimate impact on the self-management of LTCs. Objective: This study aims to gain a better understanding of sentiment distribution and the dynamic of sentiment of posts from 2 respiratory OHCs, focusing on regular users’ interaction with superusers. Methods: We conducted sentiment analysis on anonymized data from 2 UK respiratory OHCs hosted by Asthma UK (AUK), and the British Lung Foundation (BLF) charities between 2006-2016 and 2012-2016, respectively, using the Bio-Bidirectional Encoder Representation from Transformers (BioBERT), a pretrained language representation model. Given the scarcity of health-related labeled datasets, BioBERT was fine-tuned on the COVID-19 Twitter Dataset. Positive, neutral, and negative sentiments were categorized as 1, 0, and –1, respectively. The average sentiment of aggregated posts by regular users and superusers was then calculated. Superusers were identified based on a definition already used in our previous work (ie, “the 1% users with the largest number of posts over the observation period”) and VoteRank, (ie, users with the best spreading ability). Sentiment analyses of posts by superusers defined with both approaches were conducted for correlation. Results: The fine-tuned BioBERT model achieved an accuracy of 0.96. The sentiment of posts was predominantly positive (60% and 65% of overall posts in AUK and BLF, respectively), remaining stable over the years. Furthermore, there was a tendency for sentiment to become more positive over time. Overall, superusers tended to write shorter posts characterized by positive sentiment (63% and 67% of all posts in AUK and BLF, respectively). Superusers defined by posting activity or VoteRank largely overlapped (61% in AUK and 79% in BLF), showing that users who posted the most were also spreaders. Threads initiated by superusers typically encouraged regular users to reply with positive sentiments. Superusers tended to write positive replies in threads started by regular users whatever the type of sentiment of the starting post (ie, positive, neutral, or negative), compared to the replies by other regular users (62%, 51%, 61% versus 55%, 45%, 50% in AUK; 71%, 62%, 64% versus 65%, 56%, 57% in BLF, respectively; P<.001, except for neutral sentiment in AUK, where P=.36). Conclusions: Network and sentiment analyses provide insight into the key sustaining role of superusers in respiratory OHCs, showing they tend to write and trigger regular users’ posts characterized by positive sentiment. %M 39946690 %R 10.2196/56038 %U https://www.jmir.org/2025/1/e56038 %U https://doi.org/10.2196/56038 %U http://www.ncbi.nlm.nih.gov/pubmed/39946690 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62836 %T Mortality Risk Prediction in Patients With Antimelanoma Differentiation–Associated, Gene 5 Antibody–Positive, Dermatomyositis–Associated Interstitial Lung Disease: Algorithm Development and Validation %A Li,Hui %A Zou,Ruyi %A Xin,Hongxia %A He,Ping %A Xi,Bin %A Tian,Yaqiong %A Zhao,Qi %A Yan,Xin %A Qiu,Xiaohua %A Gao,Yujuan %A Liu,Yin %A Cao,Min %A Chen,Bi %A Han,Qian %A Chen,Juan %A Wang,Guochun %A Cai,Hourong %+ Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Rd., Gulou District, Nanjing, 210008, China, 86 025 83106666, caihourong2013@163.com %K antimelanoma differentiation–associated gene 5 antibody %K dermatomyositis %K interstitial lung disease %K 3-month mortality %K machine learning %K ML %K tool %K web based %K mortality %K idiopathic inflammatory myopathy %K myopathy %K lung disease %K melanoma %K imaging %K clinical outcome %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with antimelanoma differentiation–associated gene 5 antibody–positive dermatomyositis–associated interstitial lung disease (anti-MDA5+DM-ILD) are susceptible to rapidly progressive interstitial lung disease (RP-ILD) and have a high risk of mortality. There is an urgent need for a reliable prediction model, accessible via an easy-to-use web-based tool, to evaluate the risk of death. Objective: This study aimed to develop and validate a risk prediction model of 3-month mortality using machine learning (ML) in a large multicenter cohort of patients with anti-MDA5+DM-ILD in China. Methods: In total, 609 consecutive patients with anti-MDA5+DM-ILD were retrospectively enrolled from 6 hospitals across China. Patient demographics and laboratory and clinical parameters were collected on admission. The primary endpoint was 3-month mortality due to all causes. Six ML algorithms (Extreme Gradient Boosting [XGBoost], logistic regression (LR), Light Gradient Boosting Machine [LightGBM], random forest [RF], support vector machine [SVM], and k-nearest neighbor [KNN]) were applied to construct and evaluate the model. Results: After applying inclusion and exclusion criteria, 509 (83.6%) of the 609 patients were included in our study, divided into a training cohort (n=203, 39.9%), an internal validation cohort (n=51, 10%), and 2 external validation cohorts (n=92, 18.1%, and n=163, 32%). ML identified 8 important variables as critical for model construction: RP-ILD, erythrocyte sedimentation rate (ESR), serum albumin (ALB) level, age, C-reactive protein (CRP) level, aspartate aminotransferase (AST) level, lactate dehydrogenase (LDH) level, and the neutrophil-to-lymphocyte ratio (NLR). LR was chosen as the best algorithm for model construction, and the model demonstrated excellent performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.866, a sensitivity of 84.8%, and a specificity of 84.4% on the validation data set and an AUC of 0.90, a sensitivity of 85.0%, and a specificity of 83.9% on the training data set. Calibration curves and decision curve analysis (DCA) confirmed the model’s accuracy and clinical applicability. Moreover, the model showed strong predictive performance in the external validation cohorts (cohort 1: AUC=0.836, 95% CI 0.754-0.916; cohort 2: AUC=0.915, 95% CI 0.871-0.959), indicating good generalizability. This model was integrated into a web-based tool to predict the 3-month mortality for patients with anti-MDA5+DM-ILD. Conclusions: We successfully developed a robust clinical prediction model and an accompanying web tool to estimate the 3-month mortality risk for patients with anti-MDA5+DM-ILD. %R 10.2196/62836 %U https://www.jmir.org/2025/1/e62836 %U https://doi.org/10.2196/62836 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65840 %T Evaluating the Benefit of Home Support Provider Services for Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea: Protocol for an Ambispective International Real-World Study %A Alami,Sarah %A Schaller,Manuella %A Blais,Sylvie %A Taupin,Henry %A Hernández González,Marta %A Gagnadoux,Frédéric %A Pinto,Paula %A Cano-Pumarega,Irene %A Bedert,Lieven %A Braithwaite,Ben %A Servy,Hervé %A Ouary,Stéphane %A Fabre,Céline %A Bazin,Fabienne %A Texereau,Joëlle %+ Air Liquide Santé International, 10 avenue Aristide Briand, Bagneux, 92220, France, 33 649730596, sarah.alami@airliquide.com %K obstructive sleep apnea %K positive airway pressure %K real-world evidence %K home support provider %K adherence %K electronic patient-reported outcome %K comparative real-world study %D 2025 %7 31.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adherence and persistence to positive airway pressure (PAP) therapy are key factors for positive health outcomes. Home support providers participate in the home implementation and follow-up of PAP therapy for patients with obstructive sleep apnea (OSA). In Europe, home support provider service levels are country (or area) specific, resulting in differences in content and frequency of patient interactions. However, no robust evaluation of the impact of these differences on clinical and patient outcomes has been performed. Objective: The AWAIR study aims to evaluate and compare the impact of different home support provider service levels on PAP adherence and persistence in 4 European countries. Methods: This real-world, ambispective, cohort study—conducted in France, Belgium, Spain, and Portugal—will recruit adults with OSA who started PAP therapy between 2019 and 2023 and were followed by an Air Liquide Healthcare home support provider. Given the large number of eligible participants (around 150,000), the study will use a decentralized and digital approach. A patient video will present the study objectives and the participation process. A secure electronic solution will be used to manage patient information and consent, as well as to administer a web-based questionnaire. Retrospective data, collected during routine patient follow-up by home support providers, include the level of service and device data, notably PAP use. Prospective data collected using an electronic patient-reported outcome tool include health status, OSA-related factors, patient-reported outcomes including quality of life and symptoms, OSA and PAP literacy, patient-reported experience, and satisfaction with PAP therapy and service. Hierarchical models, adjusted for preidentified confounding factors, will be used to assess the net effect of home support provider services on PAP adherence and persistence while minimizing real-world study biases and considering the influence of country-level contextual factors. We hypothesize that higher levels of home support provider services will be positively associated with adherence and persistence to PAP therapy. Results: As of December 2024, the study has received approval in France, Portugal, and 2 regions of Spain. The study began enrollment in France in October 2024. Results are expected in the second quarter of 2025. Conclusions: The AWAIR study has a unique design, leveraging an unprecedented number of eligible participants, decentralized technologies, and a real-world comparative methodology across multiple countries. This approach will highlight intercountry differences in terms of patient characteristics, PAP adherence, and persistence, as well as patient-reported outcomes, patient-reported experiences, and satisfaction with the home service provider. By assessing the added value of home support provider services, the results will support best practices for patient management and for decision-making by payers and authorities. International Registered Report Identifier (IRRID): PRR1-10.2196/65840 %M 39665447 %R 10.2196/65840 %U https://www.researchprotocols.org/2025/1/e65840 %U https://doi.org/10.2196/65840 %U http://www.ncbi.nlm.nih.gov/pubmed/39665447 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e57424 %T Barriers to and Facilitators of Implementing Team-Based Extracorporeal Membrane Oxygenation Simulation Study: Exploratory Analysis %A Brown,Joan %A De-Oliveira,Sophia %A Mitchell,Christopher %A Cesar,Rachel Carmen %A Ding,Li %A Fix,Melissa %A Stemen,Daniel %A Yacharn,Krisda %A Wong,Se Fum %A Dhillon,Anahat %K intensive care unit %K ICU %K teamwork in the ICU %K team dynamics %K collaboration %K interprofessional collaboration %K simulation %K simulation training %K ECMO %K extracorporeal membrane oxygenation %K life support %K cardiorespiratory dysfunction %K cardiorespiratory %K cardiology %K respiratory %K heart %K lungs %D 2025 %7 24.1.2025 %9 %J JMIR Med Educ %G English %X Introduction: Extracorporeal membrane oxygenation (ECMO) is a critical tool in the care of severe cardiorespiratory dysfunction. Simulation training for ECMO has become standard practice. Therefore, Keck Medicine of the University of California (USC) holds simulation-training sessions to reinforce and improve providers knowledge. Objective: This study aimed to understand the impact of simulation training approaches on interprofessional collaboration. We believed simulation-based ECMO training would improve interprofessional collaboration through increased communication and enhance teamwork. Methods: This was a single-center, mixed methods study of the Cardiac and Vascular Institute Intensive Care Unit at Keck Medicine of USC conducted from September 2021 to April 2023. Simulation training was offered for 1 hour monthly to the clinical team focused on the collaboration and decision-making needed to evaluate the initiation of ECMO therapy. Electronic surveys were distributed before, after, and 3 months post training. The survey evaluated teamwork and the effectiveness of training, and focus groups were held to understand social environment factors. Additionally, trainee and peer evaluation focus groups were held to understand socioenvironmental factors. Results: In total, 37 trainees attended the training simulation from August 2021 to August 2022. Using 27 records for exploratory factor analysis, the standardized Cronbach α was 0.717. The survey results descriptively demonstrated a positive shift in teamwork ability. Qualitative themes identified improved confidence and decision-making. Conclusions: The study design was flawed, indicating improvement opportunities for future research on simulation training in the clinical setting. The paper outlines what to avoid when designing and implementing studies that assess an educational intervention in a complex clinical setting. The hypothesis deserves further exploration and is supported by the results of this study. %R 10.2196/57424 %U https://mededu.jmir.org/2025/1/e57424 %U https://doi.org/10.2196/57424 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60669 %T Clinical Characteristics of Virologically Confirmed Respiratory Syncytial Virus in English Primary Care: Protocol for an Observational Study of Acute Respiratory Infection %A Hoang,Uy %A Agrawal,Utkarsh %A Ordóñez-Mena,José Manuel %A Marcum,Zachary %A Radin,Jennifer %A Araujo,Andre %A Panozzo,Catherine A %A Balogh,Orsolya %A Desai,Mihir %A Eltayeb,Ahreej %A Lu,Tianyi %A Nicodemo,Catia %A Gu,Xinchun %A Goudie,Rosalind %A Fan,Xuejuan %A Button,Elizabeth %A Smylie,Jessica %A Joy,Mark %A Jamie,Gavin %A Elson,William %A Byford,Rachel %A Madia,Joan %A Anand,Sneha %A Ferreira,Filipa %A Petrou,Stavros %A Martin,David %A de Lusignan,Simon %+ Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Well Walton Road, Oxford, OX2 6ED, United Kingdom, 44 01865289344, simon.delusignan@phc.ox.ac.uk %K infectious diseases %K primary care %K sentinel surveillance %K point-of-care system %K virologically %K respiratory syncytial virus %K acute respiratory infection %K clinical characteristics %K community dwelling %K adult %K vaccination %K programme %K united kingdom %K incidence %K elderly %D 2025 %7 22.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are gaps in our understanding of the clinical characteristics and disease burden of the respiratory syncytial virus (RSV) among community-dwelling adults. This is in part due to a lack of routine testing at the point of care. More data would enhance our assessment of the need for an RSV vaccination program for adults in the United Kingdom. Objective: This study aimed to implement point-of-care-testing (POCT) in primary care to describe the incidence, clinical presentation, risk factors, and economic burden of RSV among adults presenting with acute respiratory infection. Methods: We are recruiting up to 3600 patients from at least 21 practices across England to participate in the Royal College of General Practitioners Research Surveillance Centre. Practices are selected if they undertake reference virology sampling for the Royal College of General Practitioners Research Surveillance Centre and had previous experience with respiratory illness studies. Any adult, ≥40 years old, presenting with acute respiratory infection with onset ≤10 days, but without RSV within the past 28 days, will be eligible to participate. We will estimate the incidence proportion of RSV, describe the clinical features, and risk factors of patients with RSV infection, and measure the economic burden of RSV infection. Results: A total of 25 practices across different English health administrative regions expressed interest and were recruited to participate. We have created and tested an educational program to deploy POCT for RSV in primary care. In addition to using the POCT device, we provide suggestions about how to integrate POCT into primary care workflow and templates for high-quality data recording of diagnosis, symptoms, and signs. In the 2023-2024 winter RSV detection in the sentinel network grew between October and late November. According to data from the UK Health Security Agency, the peak RSV swab positivity was in International Standards Organization week 48, 2023. Data collection remains ongoing, and results from the subset of practices participating in this study are not yet available. Conclusions: This study will provide data on the RSV incidence in the community as well as rapid information to inform sentinel surveillance and vaccination programs. This information could potentially improve clinical decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/60669 %M 39841515 %R 10.2196/60669 %U https://www.researchprotocols.org/2025/1/e60669 %U https://doi.org/10.2196/60669 %U http://www.ncbi.nlm.nih.gov/pubmed/39841515 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66179 %T Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study %A Cintora-Sanz,Ana María %A Horrillo-García,Cristina %A Quesada-Cubo,Víctor %A Pérez-Alonso,Ana María %A Gutiérrez-Misis,Alicia %K acute respiratory failure %K COVID-19 %K chronic obstructive respiratory insufficiency %K congestive heart failure %K bronchospasm %K emergency medical services costs %K ambulances %K SARS-CoV-2 %K coronavirus %K respiratory %K pulmonary %K pandemic %K economic impact %K observational %K Madrid %K community %K medical records %K health records %K medical advanced life support %K ALS %K acute pulmonary edema %K chronic obstructive pulmonary disease %K COPD %K prevalence %D 2025 %7 16.1.2025 %9 %J JMIR Public Health Surveill %G English %X 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 €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 €58,791,031 (US $61,832,879). %R 10.2196/66179 %U https://publichealth.jmir.org/2025/1/e66179 %U https://doi.org/10.2196/66179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60689 %T The Long-Term Uptake of Home Spirometry in Regular Cystic Fibrosis Care: Retrospective Multicenter Observational Study %A Bertram,Pia %A Oppelaar,Martinus C %A Bannier,Michiel AGE %A Reijers,Monique HE %A van der Vaart,Hester %A van der Meer,Renske %A Altenburg,Josje %A Conemans,Lennart %A Rottier,Bart L %A Nuijsink,Marianne %A van den Wijngaart,Lara S %A Merkus,Peter JFM %A Roukema,Jolt %+ Department of Pediatric Pulmonology, Amalia Children’s Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6526 GA, Netherlands, 31 243614430, marc.oppelaar@radboudumc.nl %K telemonitoring %K eHealth %K spirometry %K adherence %K pulmonary medicine %K home spirometers %K cystic fibrosis %K autosomal disease %K treatment %K remote monitoring %K survival analyses %K frequency %K digital health %K telehealth %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 (ΔMean=0.45, t497.278=–4,197; P<.001) and showed an initial rise followed by a decrease after starting treatment with Elexacaftor/Tezacaftor/Ivacaftor (ΔMean=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. %M 39788554 %R 10.2196/60689 %U https://www.jmir.org/2025/1/e60689 %U https://doi.org/10.2196/60689 %U http://www.ncbi.nlm.nih.gov/pubmed/39788554 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65197 %T Evaluation of a Global Initiative for Asthma Education and Implementation Program to Improve Asthma Care Quality (CARE4ALL): Protocol for a Multicenter, Single-Arm Study %A Huang,Kewu %A Wang,Wenjun %A Wang,Ying %A Li,Yanming %A Feng,Xiaokai %A Shen,Huahao %A Wang,Chen %+ Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China, 86 1085231167, kewuhuang@126.com %K asthma %K management %K quality improvement program %K Global Initiative for Asthma %K GINA %K guidelines %K implementation %K health care %K delivery %D 2025 %7 8.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39778197 %R 10.2196/65197 %U https://www.researchprotocols.org/2025/1/e65197 %U https://doi.org/10.2196/65197 %U http://www.ncbi.nlm.nih.gov/pubmed/39778197 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57271 %T Unveiling the Influence of AI on Advancements in Respiratory Care: Narrative Review %A Alqahtani,Mohammed M %A Alanazi,Abdullah M M %A Algarni,Saleh S %A Aljohani,Hassan %A Alenezi,Faraj K %A F Alotaibi,Tareq %A Alotaibi,Mansour %A K Alqahtani,Mobarak %A Alahmari,Mushabbab %A S Alwadeai,Khalid %A M Alghamdi,Saeed %A Almeshari,Mohammed A %A Alshammari,Turki Faleh %A Mumenah,Noora %A Al Harbi,Ebtihal %A Al Nufaiei,Ziyad F %A Alhuthail,Eyas %A Alzahrani,Esam %A Alahmadi,Husam %A Alarifi,Abdulaziz %A Zaidan,Amal %A T Ismaeil,Taha %+ Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, MC-3129, PO Box 3660, Riyadh, 11481, Saudi Arabia, 966 501407856, Qahtanimoh@ksau-hs.edu.sa %K artificial intelligence %K AI %K respiratory care %K machine learning %K digital health %K narrative review %D 2024 %7 20.12.2024 %9 Review %J Interact J Med Res %G English %X Background: Artificial intelligence is experiencing rapid growth, with continual innovation and advancements in the health care field. Objective: This study aims to evaluate the application of artificial intelligence technologies across various domains of respiratory care. Methods: We conducted a narrative review to examine the latest advancements in the use of artificial intelligence in the field of respiratory care. The search was independently conducted by respiratory care experts, each focusing on their respective scope of practice and area of interest. Results: This review illuminates the diverse applications of artificial intelligence, highlighting its use in areas associated with respiratory care. Artificial intelligence is harnessed across various areas in this field, including pulmonary diagnostics, respiratory care research, critical care or mechanical ventilation, pulmonary rehabilitation, telehealth, public health or health promotion, sleep clinics, home care, smoking or vaping behavior, and neonates and pediatrics. With its multifaceted utility, artificial intelligence can enhance the field of respiratory care, potentially leading to superior health outcomes for individuals under this extensive umbrella. Conclusions: As artificial intelligence advances, elevating academic standards in the respiratory care profession becomes imperative, allowing practitioners to contribute to research and understand artificial intelligence’s impact on respiratory care. The permanent integration of artificial intelligence into respiratory care creates the need for respiratory therapists to positively influence its progression. By participating in artificial intelligence development, respiratory therapists can augment their clinical capabilities, knowledge, and patient outcomes. %M 39705080 %R 10.2196/57271 %U https://www.i-jmr.org/2024/1/e57271 %U https://doi.org/10.2196/57271 %U http://www.ncbi.nlm.nih.gov/pubmed/39705080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51255 %T A Machine Learning–Based Prediction Model for Acute Kidney Injury in Patients With Community-Acquired Pneumonia: Multicenter Validation Study %A Ma,Mengqing %A Chen,Caimei %A Chen,Dawei %A Zhang,Hao %A Du,Xia %A Sun,Qing %A Fan,Li %A Kong,Huiping %A Chen,Xueting %A Cao,Changchun %A Wan,Xin %+ Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing, Nanjing, 210006, China, 86 18951670991, wanxin@njmu.edu.cn %K acute kidney injury %K community-acquired %K pneumonia %K machine learning %K prediction model %D 2024 %7 19.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Acute kidney injury (AKI) is common in patients with community-acquired pneumonia (CAP) and is associated with increased morbidity and mortality. Objective: This study aimed to establish and validate predictive models for AKI in hospitalized patients with CAP based on machine learning algorithms. Methods: We trained and externally validated 5 machine learning algorithms, including logistic regression, support vector machine, random forest, extreme gradient boosting, and deep forest (DF). Feature selection was conducted using the sliding window forward feature selection technique. Shapley additive explanations and local interpretable model-agnostic explanation techniques were applied to the optimal model for visual interpretation. Results: A total of 6371 patients with CAP met the inclusion criteria. The development of CAP-associated AKI (CAP-AKI) was recognized in 1006 (15.8%) patients. The 11 selected indicators were sex, temperature, breathing rate, diastolic blood pressure, C-reactive protein, albumin, white blood cell, hemoglobin, platelet, blood urea nitrogen, and neutrophil count. The DF model achieved the best area under the receiver operating characteristic curve (AUC) and accuracy in the internal (AUC=0.89, accuracy=0.90) and external validation sets (AUC=0.87, accuracy=0.83). Furthermore, the DF model had the best calibration among all models. In addition, a web-based prediction platform was developed to predict CAP-AKI. Conclusions: The model described in this study is the first multicenter-validated AKI prediction model that accurately predicts CAP-AKI during hospitalization. The web-based prediction platform embedded with the DF model serves as a user-friendly tool for early identification of high-risk patients. %M 39699941 %R 10.2196/51255 %U https://www.jmir.org/2024/1/e51255 %U https://doi.org/10.2196/51255 %U http://www.ncbi.nlm.nih.gov/pubmed/39699941 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e56848 %T The Effect of Inhaled Beta-2 Agonists on Heart Rate in Patients With Asthma: Sensor-Based Observational Study %A Khusial,Rishi Jayant %A Sont,Jacob K %A Usmani,Omar S %A Bonini,Matteo %A Chung,Kian Fan %A Fowler,Stephen James %A Honkoop,Persijn J %+ Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 715261319, r.j.khusial@lumc.nl %K asthma %K mHealth %K side effects %K beta-2 agonists %K inhaler medication %K heart rate %K sensor %K observational study %K asthma management %K cardiac cells %K monitoring %K Fitbit %K inhaler %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Beta-2 agonists play an important role in the management of asthma. Inhaled long-acting beta-2 agonists (LABAs) and short-acting beta-2 agonists (SABAs) cause bronchodilation by stimulating adrenoceptors. These receptors are also present in cardiac cells and, as a side effect, could also be stimulated by inhaled beta-2 agonists. Objective: This study aims to assess the effect of beta-2 agonists on heart rate (HR). Methods: The data were retrieved from an observational study, the myAirCoach Quantification Campaign. Beta-2 agonist use was registered by self-reported monthly questionnaires and by smart inhalers. HR was monitored continuously with the Fitbit Charge HR tracker (Fitbit Inc). Patients (aged 18 years and older) were recruited if they had uncontrolled asthma and used inhalation medication. Our primary outcome was the difference in HR between LABA and non-LABA users. Secondary outcomes were the difference in HR on days SABAs were used compared to days SABAs were not used and an assessment of the timing of inhaler use during the day. Results: Patients using LABA did not have a clinically relevant higher HR (average 0.8 beats per minute difference) during the day. Around the moment of SABA inhalation itself, the HR does increase steeply, and it takes 138 minutes before it returns to the normal range. Conclusions: This study indicates that LABAs do not have a clinically relevant effect on HR. SABAs are instead associated with a short-term HR increase. Trial Registration: ClinicalTrials.gov NCT02774772; https://clinicaltrials.gov/study/NCT02774772 %M 39661964 %R 10.2196/56848 %U https://cardio.jmir.org/2024/1/e56848 %U https://doi.org/10.2196/56848 %U http://www.ncbi.nlm.nih.gov/pubmed/39661964 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e58166 %T User Perceptions of Wearability of Knitted Sensor Garments for Long-Term Monitoring of Breathing Health: Thematic Analysis of Focus Groups and a Questionnaire Survey %A Fobelets,Kristel %A Mohanty,Nikita %A Thielemans,Mara %A Thielemans,Lieze %A Lake-Thompson,Gillian %A Liu,Meijing %A Jopling,Kate %A Yang,Kai %+ Department of Electrical and Electronic Engineering, Imperial College London, Exhibition Road, South Kensington, SW7 2BT, United Kingdom, 44 02075946236, k.fobelets@imperial.ac.uk %K health technology %K wearability of knitted sensors %K focus groups %K asthma observation %K medical device %K wearable device %K medical instrument %K medical equipment %K medical tool %K sensor %K physiological sensor %K focus group %K breathing %K respiratory %K respirology %K lung %K monitoring %K monitor %K health monitoring %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Long-term unobtrusive monitoring of breathing patterns can potentially give a more realistic insight into the respiratory health of people with asthma or chronic obstructive pulmonary disease than brief tests performed in medical environments. However, it is uncertain whether users would be willing to wear these sensor garments long term. Objective: Our objective was to explore whether users would wear ordinary looking knitted garments with unobtrusive knitted-in breathing sensors long term to monitor their lung health and under what conditions. Methods: Multiple knitted breathing sensor garments, developed and fabricated by the research team, were presented during a demonstration. Participants were encouraged to touch and feel the garments and ask questions. This was followed by two semistructured, independently led focus groups with a total of 16 adults, of whom 4 had asthma. The focus group conversations were recorded and transcribed. Thematic analysis was carried out by three independent researchers in 3 phases consisting of familiarization with the data, independent coding, and overarching theme definition. Participants also completed a web-based questionnaire to probe opinion about wearability and functionality of the garments. Quantitative analysis of the sensors’ performance was mapped to participants’ garment preference to support the feasibility of the technology for long-term wear. Results: Key points extracted from the qualitative data were (1) garments are more likely to be worn if medically prescribed, (2) a cotton vest worn as underwear was preferred, and (3) a breathing crisis warning system was seen as a promising application. The qualitative analysis showed a preference for a loose-fitting garment style with short sleeves (13/16 participants), 11 out of 16 would also wear snug fitting garments and none of the participants would wear tight-fitting garments over a long period of time. In total, 10 out of 16 participants would wear the snug fitting knitted garment for the whole day and 13 out of 16 would be happy to wear it only during the night if not too hot. The sensitivity demands on the knitted wearable sensors can be aligned with most users’ garment preferences (snug fit). Conclusions: There is an overall positive opinion about wearing a knitted sensor garment over a long period of time for monitoring respiratory health. The knit cannot be tight but a snugly fitted vest as underwear in a breathable material is acceptable for most participants. These requirements can be fulfilled with the proposed garments. Participants with asthma supported using it as a sensor garment connected to an asthma attack alert system. %M 39658003 %R 10.2196/58166 %U https://biomedeng.jmir.org/2024/1/e58166 %U https://doi.org/10.2196/58166 %U http://www.ncbi.nlm.nih.gov/pubmed/39658003 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e54389 %T Pulmonary and Physical Virtual Reality Exercises for Patients With Blunt Chest Trauma: Randomized Clinical Trial %A Groenveld,Tjitske D %A Smits,Indy GM %A Scholten,Naomi %A de Vries,Marjan %A van Goor,Harry %A Stirler,Vincent MA %+ Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, 6525 GA, Netherlands, 31 243667331, tjitske.groenveld@radboudumc.nl %K virtual reality %K pain %K pulmonary %K chest trauma %K blunt thorax trauma %K pain relief %K breathing %K mobilization %K randomized clinical trial %K clinicians %K rehabilitation %K physical activity %K exercise %K interview %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X 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 %M 39652866 %R 10.2196/54389 %U https://games.jmir.org/2024/1/e54389 %U https://doi.org/10.2196/54389 %U http://www.ncbi.nlm.nih.gov/pubmed/39652866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59045 %T Intersection of Performance, Interpretability, and Fairness in Neural Prototype Tree for Chest X-Ray Pathology Detection: Algorithm Development and Validation Study %A Chen,Hongbo %A Alfred,Myrtede %A Brown,Andrew D %A Atinga,Angela %A Cohen,Eldan %+ Department of Mechanical and Industrial Engineering, University of Toronto, 27 King's College Cir, Toronto, ON, Canada, 1 416 978 4184, ecohen@mie.utoronto.ca %K explainable artificial intelligence %K deep learning %K chest x-ray %K thoracic pathology %K fairness %K interpretability %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While deep learning classifiers have shown remarkable results in detecting chest X-ray (CXR) pathologies, their adoption in clinical settings is often hampered by the lack of transparency. To bridge this gap, this study introduces the neural prototype tree (NPT), an interpretable image classifier that combines the diagnostic capability of deep learning models and the interpretability of the decision tree for CXR pathology detection. Objective: This study aimed to investigate the utility of the NPT classifier in 3 dimensions, including performance, interpretability, and fairness, and subsequently examined the complex interaction between these dimensions. We highlight both local and global explanations of the NPT classifier and discuss its potential utility in clinical settings. Methods: This study used CXRs from the publicly available Chest X-ray 14, CheXpert, and MIMIC-CXR datasets. We trained 6 separate classifiers for each CXR pathology in all datasets, 1 baseline residual neural network (ResNet)–152, and 5 NPT classifiers with varying levels of interpretability. Performance, interpretability, and fairness were measured using the area under the receiver operating characteristic curve (ROC AUC), interpretation complexity (IC), and mean true positive rate (TPR) disparity, respectively. Linear regression analyses were performed to investigate the relationship between IC and ROC AUC, as well as between IC and mean TPR disparity. Results: The performance of the NPT classifier improved as the IC level increased, surpassing that of ResNet-152 at IC level 15 for the Chest X-ray 14 dataset and IC level 31 for the CheXpert and MIMIC-CXR datasets. The NPT classifier at IC level 1 exhibited the highest degree of unfairness, as indicated by the mean TPR disparity. The magnitude of unfairness, as measured by the mean TPR disparity, was more pronounced in groups differentiated by age (chest X-ray 14 0.112, SD 0.015; CheXpert 0.097, SD 0.010; MIMIC 0.093, SD 0.017) compared to sex (chest X-ray 14 0.054 SD 0.012; CheXpert 0.062, SD 0.008; MIMIC 0.066, SD 0.013). A significant positive relationship between interpretability (ie, IC level) and performance (ie, ROC AUC) was observed across all CXR pathologies (P<.001). Furthermore, linear regression analysis revealed a significant negative relationship between interpretability and fairness (ie, mean TPR disparity) across age and sex subgroups (P<.001). Conclusions: By illuminating the intricate relationship between performance, interpretability, and fairness of the NPT classifier, this research offers insightful perspectives that could guide future developments in effective, interpretable, and equitable deep learning classifiers for CXR pathology detection. %M 39636692 %R 10.2196/59045 %U https://formative.jmir.org/2024/1/e59045 %U https://doi.org/10.2196/59045 %U http://www.ncbi.nlm.nih.gov/pubmed/39636692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60892 %T Accuracy, Reproducibility, and Responsiveness to Treatment of Home Spirometry in Cystic Fibrosis: Multicenter, Retrospective, Observational Study %A Oppelaar,Martinus C %A van Helvoort,Hanneke AC %A Bannier,Michiel AGE %A Reijers,Monique HE %A van der Vaart,Hester %A van der Meer,Renske %A Altenburg,Josje %A Conemans,Lennart %A Rottier,Bart L %A Nuijsink,Marianne %A van den Wijngaart,Lara S %A Merkus,Peter JFM %A Roukema,Jolt %+ Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, Netherlands, +31 243614430, marc.oppelaar@radboudumc.nl %K telemonitoring %K digital health %K telespirometry %K remote monitoring %K cystic fibrosis %K pediatrics %K reliability %K mobile phone %K hereditary %K chronic pulmonary inflammation %K pulmonary infections %K morbidity %K mortality %K chronic respiratory disease %D 2024 %7 3.12.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 ΔFEV1clinic-home 0.13 L, 95% CI 0.10 to 0.19; mean ΔFVCclinic-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 (Δmean 0.11, 95% CI –0.20 to –0.01) and teenagers (Δmean 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. %M 39626236 %R 10.2196/60892 %U https://www.jmir.org/2024/1/e60892 %U https://doi.org/10.2196/60892 %U http://www.ncbi.nlm.nih.gov/pubmed/39626236 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57708 %T Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review %A Uzzaman,Nazim %A Hammersley,Victoria %A McClatchey,Kirstie %A Sheringham,Jessica %A Singh,Diksha %A Habib,GM Monsur %A Pinnock,Hilary %+ Usher Institute, The University of Edinburgh, 5-7 Little France Road, The Usher Building, Edinburgh, EH16 4UX, United Kingdom, 44 01316517869, hilary.pinnock@ed.ac.uk %K digital health %K asthma %K asynchronous %K asthma care %K effectiveness %K acceptability %K mixed-methods review %K systematic review %K barrier %K remote synchronous %K chronic respiratory disease %K self-management %K digital technology %K asynchronous consultation %K caregiver %K PRISMA %D 2024 %7 3.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Asynchronous digital health (eg, web-based portal, text, and email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (eg, asthma reviews). Objective: We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care. Methods: Following Cochrane methodology, we searched 6 databases (January 2001-July 2022; search update: September 2023) for quantitative, qualitative, or mixed methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively. We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data. Results: We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (standardized mean difference 0.32, 95% CI 0.02-0.63; P=.04) and reduced hospitalizations (risk ratio 0.36; 95% CI 0.14-0.94; P=.04). However, there were no significant differences in quality of life (standardized mean difference 0.16; 95% CI –0.12 to 0.43; P=.26) or emergency department visits (risk ratio 0.83; 95% CI 0.33-2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though health care professionals expressed concerns. Successful implementation necessitated an organizational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities. Conclusions: Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care. This type of consultation, well accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organizational strategies are needed to manage the associated workload. Trial Registration: PROSPERO CRD42022344224; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344224 International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0281538 %M 39626243 %R 10.2196/57708 %U https://www.jmir.org/2024/1/e57708 %U https://doi.org/10.2196/57708 %U http://www.ncbi.nlm.nih.gov/pubmed/39626243 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49123 %T Analysis of Tuberculosis Epidemiological Distribution Characteristics in Fujian Province, China, 2005-2021: Spatial-Temporal Analysis Study %A Yu,Shanshan %A Zhan,Meirong %A Li,Kangguo %A Chen,Qiuping %A Liu,Qiao %A Gavotte,Laurent %A Frutos,Roger %A Chen,Tianmu %K tuberculosis %K TB %K epidemiology %K Fujian Province %K temporal-spatial pattern %K spatial-temporal analysis %K surveillance %K pulmonary tuberculosis %K epidemic status %K detection %D 2024 %7 18.11.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/49123 %U https://publichealth.jmir.org/2024/1/e49123 %U https://doi.org/10.2196/49123 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e56675 %T Association Between X/Twitter and Prescribing Behavior During the COVID-19 Pandemic: Retrospective Ecological Study %A Helgeson,Scott A %A Mudgalkar,Rohan M %A Jacobs,Keith A %A Lee,Augustine S %A Sanghavi,Devang %A Moreno Franco,Pablo %A Brooks,Ian S %A , %+ Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, United States, 1 9049532000, helgeson.scott@mayo.edu %K social media %K infodemic %K COVID-19 %K healthcare utilization %K misinformation %K disinformation %K Twitter %K hydroxychloroquine %K X %K drugs %K pharmacy %K pharmacology %K pharmacotherapy %K pharmaceuticals %K medication %K prescription %K sentiment %K SARS-CoV-2 %K pandemic %K respiratory %K infectious %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media has become a vital tool for health care providers to quickly share information. However, its lack of content curation and expertise poses risks of misinformation and premature dissemination of unvalidated data, potentially leading to widespread harmful effects due to the rapid and large-scale spread of incorrect information. Objective: We aim to determine whether social media had an undue association with the prescribing behavior of hydroxychloroquine, using the COVID-19 pandemic as the setting. Methods: In this retrospective study, we gathered the use of hydroxychloroquine in 48 hospitals in the United States between January and December 2020. Social media data from X/Twitter was collected using Brandwatch, a commercial aggregator with access to X/Twitter’s data, and focused on mentions of “hydroxychloroquine” and “Plaquenil.” Tweets were categorized by sentiment (positive, negative, or neutral) using Brandwatch’s sentiment analysis tool, with results classified by date. Hydroxychloroquine prescription data from the National COVID Cohort Collaborative for 2020 was used. Granger causality and linear regression models were used to examine relationships between X/Twitter mentions and prescription trends, using optimum time lags determined via vector auto-regression. Results: A total of 581,748 patients with confirmed COVID-19 were identified. The median daily number of positive COVID-19 cases was 1318.5 (IQR 1005.75-1940.3). Before the first confirmed COVID-19 case, hydroxychloroquine was prescribed at a median rate of 559 (IQR 339.25-728.25) new prescriptions per day. A day-of-the-week effect was noted in both prescriptions and case counts. During the pandemic in 2020, hydroxychloroquine prescriptions increased significantly, with a median of 685.5 (IQR 459.75-897.25) per day, representing a 22.6% rise from baseline. The peak occurred on April 2, 2020, with 3411 prescriptions, a 397.6% increase. Hydroxychloroquine mentions on X/Twitter peaked at 254,770 per day on April 5, 2020, compared to a baseline of 9124 mentions per day before January 21, 2020. During this study’s period, 3,823,595 total tweets were recorded, with 10.09% (n=386,115) positive, 37.87% (n=1,448,030) negative, and 52.03% (n=1,989,450) neutral sentiments. A 1-day lag was identified as the optimal time for causal association between tweets and hydroxychloroquine prescriptions. Univariate analysis showed significant associations across all sentiment types, with the largest impact from positive tweets. Multivariate analysis revealed only neutral and negative tweets significantly affected next-day prescription rates. Conclusions: During the first year of the COVID-19 pandemic, there was a significant association between X/Twitter mentions and the number of prescriptions of hydroxychloroquine. This study showed that X/Twitter has an association with the prescribing behavior of hydroxychloroquine. Clinicians need to be vigilant about their potential unconscious exposure to social media as a source of medical knowledge, and health systems and organizations need to be more diligent in identifying expertise, source, and quality of evidence when shared on social media platforms. %M 39556417 %R 10.2196/56675 %U https://infodemiology.jmir.org/2024/1/e56675 %U https://doi.org/10.2196/56675 %U http://www.ncbi.nlm.nih.gov/pubmed/39556417 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44845 %T All-Cause and Cause-Specific Burden of Asthma in a Transitioning City in China: Population Study %A Cheng,Xuelin %A Wu,Xiaoling %A Ye,Wenjing %A Chen,Yichen %A Fu,Peihua %A Jia,Wenchang %A Zhang,Wei %A Xu,Xiaoyun %A Gong,Di %A Mou,Changhua %A Gu,Wen %A Luo,Zheng %A Jiang,Sunfang %A Li,Xiaopan %K asthma %K mortality %K years of life lost %K trend analysis %K decomposition method %K Pudong %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/44845 %U https://publichealth.jmir.org/2024/1/e44845 %U https://doi.org/10.2196/44845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58039 %T Pioneering Klebsiella Pneumoniae Antibiotic Resistance Prediction With Artificial Intelligence-Clinical Decision Support System–Enhanced Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry: Retrospective Study %A Jian,Ming-Jr %A Lin,Tai-Han %A Chung,Hsing-Yi %A Chang,Chih-Kai %A Perng,Cherng-Lih %A Chang,Feng-Yee %A Shang,Hung-Sheng %+ Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Division of Clinical Pathology, Taipei City, 11490, Taiwan, 886 920713130, iamkeith001@gmail.com %K Klebsiella pneumoniae %K multidrug resistance %K AI-CDSS %K quinolone %K ciprofloxacin %K levofloxacin %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The rising prevalence and swift spread of multidrug-resistant gram-negative bacteria (MDR-GNB), especially Klebsiella pneumoniae (KP), present a critical global health threat highlighted by the World Health Organization, with mortality rates soaring approximately 50% with inappropriate antimicrobial treatment. Objective: This study aims to advance a novel strategy to develop an artificial intelligence-clinical decision support system (AI-CDSS) that combines machine learning (ML) with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), aiming to significantly improve the accuracy and speed of diagnosing antibiotic resistance, directly addressing the grave health risks posed by the widespread dissemination of pan drug-resistant gram-negative bacteria across numerous countries. Methods: A comprehensive dataset comprising 165,299 bacterial specimens and 11,996 KP isolates was meticulously analyzed using MALDI-TOF MS technology. Advanced ML algorithms were harnessed to sculpt predictive models that ascertain resistance to quintessential antibiotics, particularly levofloxacin and ciprofloxacin, by using the amassed spectral data. Results: Our ML models revealed remarkable proficiency in forecasting antibiotic resistance, with the random forest classifier emerging as particularly effective in predicting resistance to both levofloxacin and ciprofloxacin, achieving the highest area under the curve of 0.95. Performance metrics across different models, including accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1-score, were detailed, underlining the potential of these algorithms in aiding the development of precision treatment strategies. Conclusions: This investigation highlights the synergy between MALDI-TOF MS and ML as a beacon of hope against the escalating threat of antibiotic resistance. The advent of AI-CDSS heralds a new era in clinical diagnostics, promising a future in which rapid and accurate resistance prediction becomes a cornerstone in combating infectious diseases. Through this innovative approach, we answered the challenge posed by KP and other multidrug-resistant pathogens, marking a significant milestone in our journey toward global health security. %M 39509693 %R 10.2196/58039 %U https://www.jmir.org/2024/1/e58039 %U https://doi.org/10.2196/58039 %U http://www.ncbi.nlm.nih.gov/pubmed/39509693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51753 %T Home-Based Connected Devices Combined With Statistical Process Control for the Early Detection of Respiratory Exacerbations by Patients With Cystic Fibrosis: Pilot Interventional Study With a Pre-Post Design %A Le Roux,Enora %A Ursino,Moreno %A Milovanovic,Ivana %A Picq,Paul %A Haignere,Jeremie %A Rault,Gilles %A Pougheon Bertrand,Dominique %A Alberti,Corinne %+ Inserm, Hôpital Universitaire Robert Debré, Assistance publique – Hôpitaux de Paris.Nord - Université Paris Cité, 48 Boulevard Serurier, Paris, 75019, France, 33 679690998, enora.leroux@aphp.fr %K connected devices %K cystic fibrosis %K patient education %K self-management %K medical device %K home monitoring %K remote monitoring %K statistical process control %K connected health %K alerts %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, patients with cystic fibrosis do not routinely monitor their respiratory function at home. Objective: This study aims to assess the clinical validity of using different connected health devices at home to measure 5 physiological parameters to help prevent exacerbations on a personalized basis from the perspective of patient empowerment. Methods: A multicenter interventional pilot study including 36 patients was conducted. Statistical process control—the cumulative sum control chart (CUSUM)—was used with connected health device measures with the objective of sending patients alerts at a relevant time in order to identify their individual risk of exacerbations. Associated patient education was delivered. Quantitative and qualitative data were collected. Results: One-half (18/36) of the patients completed the protocol through the end of the study. During the 12-month intervention, 6162 measures were collected with connected health devices, 387 alerts were sent, and 33 exacerbations were reported. The precision of alerts to detect exacerbations was weak for all parameters, which may be partly related to the low compliance of patients with the measurements. However, a decrease in the median number of exacerbations from 12 months before the study to after the 12-month intervention was observed for patients. Conclusions: The use of connected health devices associated with statistical process control showed that it was not acceptable for all patients, especially because of the burden related to measurements. However, the results suggest that it may be promising, after adaptations, for early identification and better management of exacerbations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/study/NCT03304028 %M 39467550 %R 10.2196/51753 %U https://formative.jmir.org/2024/1/e51753 %U https://doi.org/10.2196/51753 %U http://www.ncbi.nlm.nih.gov/pubmed/39467550 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50846 %T Protective Effect of Allergen Immunotherapy in Patients With Allergic Rhinitis and Asthma Against COVID-19 Infection: Observational, Nationwide, and Multicenter Study %A Qin,Rundong %A Feng,Yan %A Zhang,Huanping %A Zhao,Beibei %A Lei,Wei %A Sun,Hongying %A Zhi,Lili %A Zheng,Zhongsheng %A Wang,Siqin %A Yu,Yafeng %A Jiang,Shengxue %A Liu,Changshan %A Ma,Xingkai %A Ma,Hui %A Wang,Huiying %A Lin,Hang %A He,Qiaojie %A Wu,Lingying %A Zhai,Yingying %A Lu,Honglue %A Chen,Shi %A Ma,Yan %A Jin,Xiaohong %A Deng,Shan %A Zhong,Nanshan %A Chen,Ruchong %A Li,Jing %K allergen immunotherapy %K COVID-19 %K antiviral effect %K allergic rhinitis %K asthma %K viral infection %K allergic disease %K trajectory %K questionnaire-based survey %K clinical evidence %D 2024 %7 16.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Allergic diseases are associated with an increased susceptibility to respiratory tract infections. Although allergen immunotherapy (AIT) alters the course of allergies, there is limited evidence from clinical practice demonstrating its ability to enhance the host defense against pathogens. Objective: The aim of this study was to investigate the protective effect of AIT against viral infection in patients with allergic rhinitis (AR) and allergic asthma (AS) based on clinical evidence. Methods: A multicenter, questionnaire-based survey was conducted during a tremendous surge in COVID-19 cases between February 10, 2023, and March 15, 2023, in 81 centers across China recruiting healthy volunteers and patients with AR and AS to investigate the clinical outcomes of COVID-19 infection. Results: Of 10,151 participants recruited in the survey, 3654 patients and 2192 healthy volunteers who tested positive for COVID-19 were included in this analysis after screening. Overall, no significant differences in COVID-19 outcomes were observed between patients and healthy volunteers. An additional 451 patients were excluded due to their use of biologics as the sole add-on treatment, leaving 3203 patients in the further analysis. Of them, 1752 were undergoing routine medication treatment (RMT; the RMT group), whereas 1057 and 394 were receiving AIT and a combination of AIT and omalizumab (OMA) as adjunct therapies to RMT, respectively (AIT+RMT and AIT+OMA+RMT groups). The AIT group showed milder COVID-19 symptoms, shorter recovery periods, and a lower likelihood of hospitalization or emergency department visits than the RMT group (all P<.05). After adjusting for confounding factors, including demographic characteristics and COVID-19 vaccination, AIT remained a significant protective factor associated with shorter recovery time (adjusted odds ratio [OR] 0.62, 95% CI 0.52‐0.75; adjusted P<.001) and a lower incidence of hospitalization or emergency department visits (adjusted OR 0.73, 95% CI 0.54‐0.98; adjusted P=.03). Furthermore, the AIT+OMA+RMT group showed greater protection with a shorter recovery time (adjusted OR 0.51, 95% CI 0.34‐0.74; adjusted P<.001) than the AIT+RMT group. Conclusions: Our multicenter observational study provides valuable clinical evidence supporting the protective effect of AIT against COVID-19 infection in patients with AR and AS. %R 10.2196/50846 %U https://publichealth.jmir.org/2024/1/e50846 %U https://doi.org/10.2196/50846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44494 %T Reinforcement Learning to Optimize Ventilator Settings for Patients on Invasive Mechanical Ventilation: Retrospective Study %A Liu,Siqi %A Xu,Qianyi %A Xu,Zhuoyang %A Liu,Zhuo %A Sun,Xingzhi %A Xie,Guotong %A Feng,Mengling %A See,Kay Choong %+ Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore, 65 65164984, ephfm@nus.edu.sg %K mechanical ventilation %K reinforcement learning %K artificial intelligence %K validation study %K critical care %K treatment %K intensive care unit %K critically ill %K patient %K monitoring %K database %K mortality rate %K decision support %K support tool %K survival %K prognosis %K respiratory support %D 2024 %7 16.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the significant changes in intensive care medicine over the past 2 decades is the acknowledgment that improper mechanical ventilation settings substantially contribute to pulmonary injury in critically ill patients. Artificial intelligence (AI) solutions can optimize mechanical ventilation settings in intensive care units (ICUs) and improve patient outcomes. Specifically, machine learning algorithms can be trained on large datasets of patient information and mechanical ventilation settings. These algorithms can then predict patient responses to different ventilation strategies and suggest personalized ventilation settings for individual patients. Objective: In this study, we aimed to design and evaluate an AI solution that could tailor an optimal ventilator strategy for each critically ill patient who requires mechanical ventilation. Methods: We proposed a reinforcement learning–based AI solution using observational data from multiple ICUs in the United States. The primary outcome was hospital mortality. Secondary outcomes were the proportion of optimal oxygen saturation and the proportion of optimal mean arterial blood pressure. We trained our AI agent to recommend low, medium, and high levels of 3 ventilator settings—positive end-expiratory pressure, fraction of inspired oxygen, and ideal body weight–adjusted tidal volume—according to patients’ health conditions. We defined a policy as rules guiding ventilator setting changes given specific clinical scenarios. Off-policy evaluation metrics were applied to evaluate the AI policy. Results: We studied 21,595 and 5105 patients’ ICU stays from the e-Intensive Care Unit Collaborative Research (eICU) and Medical Information Mart for Intensive Care IV (MIMIC-IV) databases, respectively. Using the learned AI policy, we estimated the hospital mortality rate (eICU 12.1%, SD 3.1%; MIMIC-IV 29.1%, SD 0.9%), the proportion of optimal oxygen saturation (eICU 58.7%, SD 4.7%; MIMIC-IV 49%, SD 1%), and the proportion of optimal mean arterial blood pressure (eICU 31.1%, SD 4.5%; MIMIC-IV 41.2%, SD 1%). Based on multiple quantitative and qualitative evaluation metrics, our proposed AI solution outperformed observed clinical practice. Conclusions: Our study found that customizing ventilation settings for individual patients led to lower estimated hospital mortality rates compared to actual rates. This highlights the potential effectiveness of using reinforcement learning methodology to develop AI models that analyze complex clinical data for optimizing treatment parameters. Additionally, our findings suggest the integration of this model into a clinical decision support system for refining ventilation settings, supporting the need for prospective validation trials. %M 39219230 %R 10.2196/44494 %U https://www.jmir.org/2024/1/e44494 %U https://doi.org/10.2196/44494 %U http://www.ncbi.nlm.nih.gov/pubmed/39219230 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e44397 %T Predictive Value of Physiological Values and Symptom Scores for Exacerbations in Bronchiectasis and Chronic Obstructive Pulmonary Disease With Frequent Exacerbations: Longitudinal Observational Cohort Study %A Jones,Thomas Llewelyn %A Roberts,Claire %A Elliott,Scott %A Glaysher,Sharon %A Green,Ben %A Shute,Janis K %A Chauhan,Anoop J %+ Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Southwick Hill Rd, Portsmouth, PO6 3LY, United Kingdom, 44 02392286000, thomas.jones@porthosp.nhs.uk %K COPD %K chronic obstructive pulmonary disease %K bronchiectasis %K predictive models %K airway disease %K symptom score %D 2024 %7 8.10.2024 %9 Original Paper %J Interact J Med Res %G English %X 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 %M 39378078 %R 10.2196/44397 %U https://www.i-jmr.org/2024/1/e44397 %U https://doi.org/10.2196/44397 %U http://www.ncbi.nlm.nih.gov/pubmed/39378078 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56059 %T The Effect of Long-Term Particulate Matter Exposure on Respiratory Mortality: Cohort Study in China %A Wang,Ying %A Wang,Zhuohao %A Jiang,Jie %A Guo,Tong %A Chen,Shimin %A Li,Zhiqiang %A Yuan,Zhupei %A Lin,Qiaoxuan %A Du,Zhicheng %A Wei,Jing %A Hao,Yuantao %A Zhang,Wangjian %K respiratory disease %K mortality %K particulate matter %K causal inference %K cohort study %D 2024 %7 24.9.2024 %9 %J JMIR Public Health Surveill %G English %X 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-μg/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. %R 10.2196/56059 %U https://publichealth.jmir.org/2024/1/e56059 %U https://doi.org/10.2196/56059 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e64286 %T Epidemiological Characteristics and Spatiotemporal Clustering of Pulmonary Tuberculosis Among Students in Southwest China From 2016 to 2022: Analysis of Population-Based Surveillance Data %A Kong,Deliang %A Wu,Chengguo %A Cui,Yimin %A Fan,Jun %A Zhang,Ting %A Zhong,Jiyuan %A Pu,Chuan %K student PTB %K Southwest China %K epidemiology %K visualizing incidence map %K spatial autocorrelation analysis %K spatiotemporal clusters %K pulmonary tuberculosis %D 2024 %7 24.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Pulmonary tuberculosis (PTB), as a respiratory infectious disease, poses significant risks of covert transmission and dissemination. The high aggregation and close contact among students in Chinese schools exacerbate the transmission risk of PTB outbreaks. Objective: This study investigated the epidemiological characteristics, geographic distribution, and spatiotemporal evolution of student PTB in Chongqing, Southwest China, aiming to delineate the incidence risks and clustering patterns of PTB among students. Methods: PTB case data from students monitored and reported in the Tuberculosis Information Management System within the China Information System for Disease Control and Prevention were used for this study. Descriptive analyses were conducted to characterize the epidemiological features of student PTB. Spatial trend surface analysis, global and local spatial autocorrelation analyses, and disease rate mapping were performed using ArcGIS 10.3. SaTScan 9.6 software was used to identify spatiotemporal clusters of PTB cases. Results: From 2016 to 2022, a total of 9920 student TB cases were reported in Chongqing, Southwest China, with an average incidence rate of 24.89/100,000. The incidence of student TB showed an initial increase followed by a decline, yet it remained relatively high. High school students (age: 13‐18 years; 6649/9920, 67.03%) and college students (age: ≥19 years; 2921/9920, 29.45%) accounted for the majority of student PTB cases. Patient identification primarily relied on passive detection, with a high proportion of delayed diagnosis and positive etiological results. COVID-19 prevention measures have had some impact on reducing incidence levels, but the primary factor appears to be the implementation of screening measures, which facilitated earlier case detection. Global spatial autocorrelation analysis indicated Moran I values of >0 for all years except 2018, ranging from 0.1908 to 0.4645 (all P values were <.05), suggesting strong positive spatial clustering of student PTB cases across Chongqing. Local spatial autocorrelation identified 7 high-high clusters, 13 low-low clusters, 5 high-low clusters, and 4 low-high clusters. High-high clusters were predominantly located in the southeast and northeast parts of Chongqing, consistent with spatial trend surface analysis and spatiotemporal clustering results. Spatiotemporal scan analysis revealed 4 statistically significant spatiotemporal clusters, with the most likely cluster in the southeast (relative risk [RR]=2.87, log likelihood ratio [LLR]=574.29, P<.001) and a secondary cluster in the northeast (RR=1.99, LLR=234.67, P<.001), indicating higher reported student TB cases and elevated risks of epidemic spread within these regions. Conclusions: Future efforts should comprehensively enhance prevention and control measures in high-risk areas of PTB in Chongqing to mitigate the incidence risk among students. Additionally, implementing proactive screening strategies and enhancing screening measures are crucial for early identification of student patients to prevent PTB outbreaks in schools. %R 10.2196/64286 %U https://publichealth.jmir.org/2024/1/e64286 %U https://doi.org/10.2196/64286 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60769 %T Testing a Consumer Wearables Program to Promote the Use of Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea: Protocol for a Pilot Randomized Controlled Trial %A Mak,Selene %A Ash,Garrett %A Liang,Li-Jung %A Der-McLeod,Erin %A Ghadimi,Sara %A Kewalramani,Anjali %A Naeem,Saadia %A Zeidler,Michelle %A Fung,Constance %+ Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, United States, 1 310 478 3711, selene.mak@va.gov %K sleep apnea %K consumer wearables %K adherence %K self-management %K mobile phone %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although positive airway pressure (PAP) therapy is considered first-line treatment for obstructive sleep apnea (OSA), nonadherence is common. Numerous factors influence PAP use, including a belief that the therapy is important and effective. In theory, providing information to patients about their blood oxygen levels during sleep (which may be low when PAP is not used), juxtaposed to information about their PAP use, may influence a patient’s beliefs about therapy and increase PAP use. With the advent of consumer wearable smartwatches’ blood oxygen saturation monitoring capability (and the existing routine availability of PAP use data transmitted via modem to clinical dashboards), there is an opportunity to provide this combination of information to patients. Objective: This study aims to test the feasibility, acceptability, and preliminary efficacy of the Chronic Care Management With Wearable Devices in Patients Prescribed Positive Airway Pressure Therapy (mPAP), a program that augments current PAP therapy data with consumer-grade wearable device to promote self-management of PAP therapy for OSA in a pilot randomized waitlist-controlled clinical trial. Methods: This is a single-blinded randomized controlled trial. We will randomize 50 individuals with a history of OSA, who receive care from a Department of Veterans Affairs medical center in the Los Angeles area and are nonadherent to prescribed PAP therapy, into either an immediate intervention group or a waitlist control group. During a 28-day intervention, the participants will wear a study-provided consumer wearable device and complete a weekly survey about their OSA symptoms. A report that summarizes consumer wearable–provided oxygen saturation values, PAP use derived from modem data, and patient-reported OSA symptoms will be prepared weekly and shared with the patient. The immediate intervention group will begin intervention immediately after randomization (T1). Assessments will occur at week 5 (T3; 1 week after treatment for the immediate intervention group and repeat baseline for the waitlist control group) and week 11 (T5; follow-up for the immediate intervention group and 1 week after treatment for the waitlist control group). The primary outcome will be the change in 7-day PAP adherence (average minutes per night) from T1 to T3. The primary analysis will be a comparison of the primary outcome between the immediate intervention and the waitlist control groups (intention-to-treat design), using a 2-sample, 2-sided t test on change scores (unadjusted). Results: Recruitment began in October 2023. Data analysis is expected to begin in October 2024 when all follow-ups are complete, and a manuscript summarizing trial results will be submitted following completion of data analysis. Conclusions: Findings from the study may provide additional insights on how patients with OSA might use patient-generated health data collected by consumer wearables to inform self-management of OSA and possibly increase their use of PAP therapy. Trial Registration: ClinicalTrials.gov NCT06039865; https://clinicaltrials.gov/study/NCT06039865 International Registered Report Identifier (IRRID): DERR1-10.2196/60769 %M 39207912 %R 10.2196/60769 %U https://www.researchprotocols.org/2024/1/e60769 %U https://doi.org/10.2196/60769 %U http://www.ncbi.nlm.nih.gov/pubmed/39207912 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57334 %T Metagenomics in the Diagnosis of Pneumonia: Protocol for a Systematic Review %A Quarton,Samuel %A Livesey,Alana %A Jeff,Charlotte %A Hatton,Christopher %A Scott,Aaron %A Parekh,Dhruv %A Thickett,David %A McNally,Alan %A Sapey,Elizabeth %+ National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Translational Medicine, Birmingham, B15 2TH, United Kingdom, 44 01213712000, s.quarton@bham.ac.uk %K pneumonia %K metagenomics %K CAP %K community-acquired pneumonia %K HAP %K hospital-acquired pneumonia %K VAP %K ventilator-associated pneumonia %K diagnosis %K respiratory tract infection %K systematic review %D 2024 %7 18.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39293053 %R 10.2196/57334 %U https://www.researchprotocols.org/2024/1/e57334 %U https://doi.org/10.2196/57334 %U http://www.ncbi.nlm.nih.gov/pubmed/39293053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58187 %T Detection of Sleep Apnea Using Wearable AI: Systematic Review and Meta-Analysis %A Abd-alrazaq,Alaa %A Aslam,Hania %A AlSaad,Rawan %A Alsahli,Mohammed %A Ahmed,Arfan %A Damseh,Rafat %A Aziz,Sarah %A Sheikh,Javaid %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, A31 Luqta street, Education City, Doha, Qatar, 974 55787845654, aaa4027@qatar-med.cornell.edu %K sleep apnea %K hypopnea %K artificial intelligence %K wearable devices %K machine learning %K systematic review %K mobile phone %D 2024 %7 10.9.2024 %9 Review %J J Med Internet Res %G English %X Background: Early detection of sleep apnea, the health condition where airflow either ceases or decreases episodically during sleep, is crucial to initiate timely interventions and avoid complications. Wearable artificial intelligence (AI), the integration of AI algorithms into wearable devices to collect and analyze data to offer various functionalities and insights, can efficiently detect sleep apnea due to its convenience, accessibility, affordability, objectivity, and real-time monitoring capabilities, thereby addressing the limitations of traditional approaches such as polysomnography. Objective: The objective of this systematic review was to examine the effectiveness of wearable AI in detecting sleep apnea, its type, and its severity. Methods: Our search was conducted in 6 electronic databases. This review included English research articles evaluating wearable AI’s performance in identifying sleep apnea, distinguishing its type, and gauging its severity. Two researchers independently conducted study selection, extracted data, and assessed the risk of bias using an adapted Quality Assessment of Studies of Diagnostic Accuracy-Revised tool. We used both narrative and statistical techniques for evidence synthesis. Results: Among 615 studies, 38 (6.2%) met the eligibility criteria for this review. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting apnea events in respiration (apnea and nonapnea events) were 0.893, 0.793, and 0.947, respectively. The pooled mean accuracy of wearable AI in differentiating types of apnea events in respiration (normal, obstructive sleep apnea, central sleep apnea, mixed apnea, and hypopnea) was 0.815. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting sleep apnea were 0.869, 0.938, and 0.752, respectively. The pooled mean accuracy of wearable AI in identifying the severity level of sleep apnea (normal, mild, moderate, and severe) and estimating the severity score (Apnea-Hypopnea Index) was 0.651 and 0.877, respectively. Subgroup analyses found different moderators of wearable AI performance for different outcomes, such as the type of algorithm, type of data, type of sleep apnea, and placement of wearable devices. Conclusions: Wearable AI shows potential in identifying and classifying sleep apnea, but its current performance is suboptimal for routine clinical use. We recommend concurrent use with traditional assessments until improved evidence supports its reliability. Certified commercial wearables are needed for effectively detecting sleep apnea, predicting its occurrence, and delivering proactive interventions. Researchers should conduct further studies on detecting central sleep apnea, prioritize deep learning algorithms, incorporate self-reported and nonwearable data, evaluate performance across different device placements, and provide detailed findings for effective meta-analyses. %M 39255014 %R 10.2196/58187 %U https://www.jmir.org/2024/1/e58187 %U https://doi.org/10.2196/58187 %U http://www.ncbi.nlm.nih.gov/pubmed/39255014 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55207 %T The Impact of Air Pollution Information on Individuals’ Exercise Behavior: Empirical Study Using Wearable and Mobile Devices Data %A Yang,Yang %A Goh,Khim-Yong %A Teo,Hock Hai %A Tan,Sharon Swee-Lin %+ School of Business and Management, Royal Holloway, University of London, Egham Hill, Egham, TW20 0EX, United Kingdom, 44 1784 434 455, y.yang@rhul.ac.uk %K air pollution %K information sources %K exercise activity %K wearable and mobile devices %K econometric analysis %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical exercise and exposure to air pollution have counteracting effects on individuals’ health outcomes. Knowledge on individuals’ real-time exercise behavior response to different pollution information sources remains inadequate. Objective: This study aims to examine the extent to which individuals avoid polluted air during exercise activities in response to different air pollution information sources. Methods: We used data on individuals’ exercise behaviors captured by wearable and mobile devices in 83 Chinese cities over a 2-year time span. In our data set, 35.99% (5896/16,379) of individuals were female and 64% (10,483/16,379) were male, and their ages predominantly ranged from 18 to 50 years. We further augmented the exercise behavior data with air pollution information that included city-hourly level measures of the Air Quality Index and particulate matter 2.5 concentration (in µg/m3), and weather data that include city-hourly level measures of air temperature (ºC), dew point (ºC), wind speed (m/s), and wind direction (degrees). We used a linear panel fixed effect model to estimate individuals’ exercise-aversion behaviors (ie, running exercise distance at individual-hour, city-hour, or city-day levels) and conducted robustness checks using the endogenous treatment effect model and regression discontinuity method. We examined if alternative air pollution information sources could moderate (ie, substitute or complement) the role of mainstream air pollution indicators. Results: Our results show that individuals exhibit a reduction of running exercise behaviors by about 0.50 km (or 7.5%; P<.001) during instances of moderate to severe air pollution, and there is no evidence of reduced distances in instances of light air pollution. Furthermore, individuals’ exercise-aversion behaviors in response to mainstream air pollution information are heightened by different alternative information sources, such as social connections and social media user-generated content about air pollution. Conclusions: Our results highlight the complementary role of different alternative information sources of air pollution in inducing individuals’ aversion behaviors and the importance of using different information channels to increase public awareness beyond official air pollution alerts. %M 39255029 %R 10.2196/55207 %U https://mhealth.jmir.org/2024/1/e55207 %U https://doi.org/10.2196/55207 %U http://www.ncbi.nlm.nih.gov/pubmed/39255029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55641 %T Comparing the Output of an Artificial Intelligence Algorithm in Detecting Radiological Signs of Pulmonary Tuberculosis in Digital Chest X-Rays and Their Smartphone-Captured Photos of X-Ray Films: Retrospective Study %A Ridhi,Smriti %A Robert,Dennis %A Soren,Pitamber %A Kumar,Manish %A Pawar,Saniya %A Reddy,Bhargava %+ Qure.ai, 2nd floor, Prestige Summit, Halasuru, Bangalore, 560042, India, 91 9611981003, dennis.robert.nm@gmail.com %K artificial intelligence %K AI %K deep learning %K early detection %K tuberculosis %K TB %K computer-aided detection %K diagnostic accuracy %K chest x-ray %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) based computer-aided detection devices are recommended for screening and triaging of pulmonary tuberculosis (TB) using digital chest x-ray (CXR) images (soft copies). Most AI algorithms are trained using input data from digital CXR Digital Imaging and Communications in Medicine (DICOM) files. There can be scenarios when only digital CXR films (hard copies) are available for interpretation. A smartphone-captured photo of the digital CXR film may be used for AI to process in such a scenario. There is a gap in the literature investigating if there is a significant difference in the performance of AI algorithms when digital CXR DICOM files are used as input for AI to process as opposed to photos of the digital CXR films being used as input. Objective: The primary objective was to compare the agreement of AI in detecting radiological signs of TB when using DICOM files (denoted as CXRd) as input versus when using smartphone-captured photos of digital CXR films (denoted as CXRp) with human readers. Methods: Pairs of CXRd and CXRp images were obtained retrospectively from patients screened for TB. AI results were obtained using both the CXRd and CXRp files. The majority consensus on the presence or absence of TB in CXR pairs was obtained from a panel of 3 independent radiologists. The positive and negative percent agreement of AI in detecting radiological signs of TB in CXRd and CXRp were estimated by comparing with the majority consensus. The distribution of AI probability scores was also compared. Results: A total of 1278 CXR pairs were analyzed. The positive percent agreement of AI was found to be 92.22% (95% CI 89.94-94.12) and 90.75% (95% CI 88.32-92.82), respectively, for CXRd and CXRp images (P=.09). The negative percent agreement of AI was 82.08% (95% CI 78.76-85.07) and 79.23% (95% CI 75.75-82.42), respectively, for CXRd and CXRp images (P=.06). The median of the AI probability score was 0.72 (IQR 0.11-0.97) in CXRd and 0.72 (IQR 0.14-0.96) in CXRp images (P=.75). Conclusions: We did not observe any statistically significant differences in the output of AI in digital CXRs and photos of digital CXR films. %M 39167435 %R 10.2196/55641 %U https://formative.jmir.org/2024/1/e55641 %U https://doi.org/10.2196/55641 %U http://www.ncbi.nlm.nih.gov/pubmed/39167435 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50244 %T Association of Fine Particulate Matter and Residential Greenness With Risk of Pulmonary Tuberculosis Retreatment: Population-Based Retrospective Study %A Guo,Tonglei %A Shen,Fei %A Xin,Henan %A Du,Jiang %A Cao,Xuefang %A Feng,Boxuan %A He,Yijun %A Shen,Lingyu %A Di,Yuanzhi %A Chen,Yanxiao %A Li,Zihan %A Jin,Qi %A Li,Hongzhi %A Zhang,Chunming %A Gao,Lei %K tuberculosis %K PM2.5 %K particulate matter %K air pollution %K greenness %K retrospective study %K pulmonary %K retreatment %D 2024 %7 12.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The evidence on the association of fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) with pulmonary tuberculosis (PTB) retreatment is limited. There are no data on whether greenness exposure protects air pollution–related PTB retreatment in patients with prior PTB. Objective: In a population-based retrospective study, we aimed to investigate the influence of PM2.5 and residential greenness on the risk of PTB retreatment. Methods: A total of 26,482 patients with incident PTB, registered in a mandatory web-based reporting system between 2012 and 2019 in Zhengzhou, China, were included in the analysis. The exposure to PM2.5 was assessed based on the China High Air Pollutants dataset, and the level of greenness was estimated using the Normalized Difference Vegetation Index (NDVI) values. The associations of PTB retreatment with exposure to PM2.5 and greenness were evaluated, respectively, considering the local socioeconomic level indicated by the nighttime light index. Results: Among the 26,482 patients (mean age 46.86, SD 19.52 years) with a median follow-up time of 1523 days per patient, 1542 (5.82%) PTB retreatments were observed between 2012 and 2019. Exposure to PM2.5 was observed to be significantly associated with the increased risk of PTB retreatment in fully adjusted models with a hazard ratio of 1.97 (95% CI 1.34‐2.83) per 10 μg/m3 increase in PM2.5. Patients living in the regions with relatively high quartiles of NDVI values had a 45% lower risk of PTB retreatment than those living in the regions with the lowest quartile for the 500 m buffers (hazard ratio 0.55, 95% CI 0.40‐0.77). Such a protective effect of residential greenness was more pronounced among patients living in lower nighttime light areas. The strength of the association between PM2.5 exposure and the risk of PTB retreatment was attenuated by greenness. No significant association was observed between NDVI and the incidence of drug resistance. Conclusions: Long-term exposure to PM2.5 might be a risk factor for PTB retreatment, while an increased level of residential greenness was found to be associated with reduced risks of PTB retreatment. Our results suggest strengthening the control of ambient air pollution and improving residential greenness may contribute to the reduction of PTB retreatment. %R 10.2196/50244 %U https://publichealth.jmir.org/2024/1/e50244 %U https://doi.org/10.2196/50244 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54942 %T Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care %A Oppelaar,Martinus C %A Emond,Yvette %A Bannier,Michiel A G E %A Reijers,Monique H E %A van der Vaart,Hester %A van der Meer,Renske %A Altenburg,Josje %A Conemans,Lennart %A Rottier,Bart L %A Nuijsink,Marianne %A van den Wijngaart,Lara S %A Merkus,Peter J F M %A Heinen,Maud %A Roukema,Jolt %+ Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, 6500 HB, Netherlands, 31 24 361 44 30, marc.oppelaar@radboudumc.nl %K telemonitoring %K digital health %K chronic respiratory diseases %K telespirometry %K interviews %K mixed methods %K qualitative study %K remote monitoring %K evaluation %K cystic fibrosis %K pediatrics %K mixed method %K observational study %K health care professionals %K semistructured interview %K psychosocial %K clinicians %K researchers %K policy makers %K telehealth %D 2024 %7 6.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). Objective: This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. Methods: This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. Results: Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. Conclusions: Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs. %M 39106098 %R 10.2196/54942 %U https://www.jmir.org/2024/1/e54942 %U https://doi.org/10.2196/54942 %U http://www.ncbi.nlm.nih.gov/pubmed/39106098 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56594 %T Quality of Chronic Obstructive Pulmonary Disease Information on the Chinese Internet: Website Evaluation Study %A Wang,Qinqin %A Liu,Lingjun %A Li,Hong %A Zhang,Qiao %A Ma,Qianli %+ Chronic Respiratory Disease Management and Rehabilitation Center, SongShan General Hospital, D Building, 1st FIoor, Chongqing, 401120, China, 86 19112955805, cqmql@163.com %K chronic obstructive pulmonary disease %K internet %K information quality %K DISCERN %K websites %K health information %K DISCERN instrument %K pulmonary disease %K chronic pulmonary disease %K cross-sectional study %K website information %K treatment %K COPD %K China %K evaluation %K pulmonary %K chronic %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Form Res %G English %X 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 “慢性阻塞性肺疾病” (“chronic obstructive pulmonary disease” in Chinese) and the commonly used public search terms “慢阻肺” (“COPD”) and “肺气肿” (“emphysema”) combined with the keyword “治疗” (“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. %M 39088820 %R 10.2196/56594 %U https://formative.jmir.org/2024/1/e56594 %U https://doi.org/10.2196/56594 %U http://www.ncbi.nlm.nih.gov/pubmed/39088820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48595 %T 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 %A Ben Yehuda,Ori %A Itelman,Edward %A Vaisman,Adva %A Segal,Gad %A Lerner,Boaz %+ Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, Israel, 972 +972544399763, boaz@bgu.ac.il %K pulmonary embolism %K deep vein thrombosis %K venous thromboembolism %K imbalanced data %K clustering %K risk factors %K Wells score %K revised Genova score %K hospital admission %K machine learning %D 2024 %7 30.7.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39079116 %R 10.2196/48595 %U https://www.jmir.org/2024/1/e48595 %U https://doi.org/10.2196/48595 %U http://www.ncbi.nlm.nih.gov/pubmed/39079116 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54322 %T Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals %A Ladune,Raphaelle %A Hayotte,Meggy %A Vuillemin,Anne %A d'Arripe-Longueville,Fabienne %+ Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, 261 Bd du Mercantour, Nice, 06200, France, 33 618383410, r.ladune@sfr.fr %K cystic fibrosis %K decisional balance %K digital app %K acceptability %K physical activity %K mobile phone %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39078689 %R 10.2196/54322 %U https://formative.jmir.org/2024/1/e54322 %U https://doi.org/10.2196/54322 %U http://www.ncbi.nlm.nih.gov/pubmed/39078689 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49648 %T Kawasaki Disease and Respiratory Viruses: Ecological Spatiotemporal Analysis %A Sawires,Rana %A Clothier,Hazel J %A Burgner,David %A Fahey,Michael Collingwood %A Buttery,Jim %K Kawasaki disease %K pediatric %K infection %K RSV %K human metapneumovirus %K respiratory virus %K virology %K community %K viral infection %K respiratory disease %K respiratory diseases %K children %K epidemiology %K respiratory syncytial virus %D 2024 %7 25.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Kawasaki disease is an uncommon vasculitis affecting young children. Its etiology is not completely understood, although infections have been frequently postulated as the triggers. Respiratory viruses, specifically, have often been implicated as causative agents for Kawasaki disease presentations. Objective: We aimed to conduct an ecological spatiotemporal analysis to determine whether Kawasaki disease incidence was related to community respiratory virus circulation in a shared region and population, and to describe viral associations before and during the COVID-19 pandemic. Methods: We obtained independent statewide data sets of hospital admissions of Kawasaki disease and respiratory multiplex polymerase chain reaction tests performed at two large hospital networks in Victoria, Australia, from July 2011 to November 2021. We studied spatiotemporal relationships by negative binomial regression analysis of the monthly incidence of Kawasaki disease and the rate of positive respiratory polymerase chain reaction tests in different regions of Victoria. Peak viral seasons (95th percentile incidence) were compared to median viral circulation (50th percentile incidence) to calculate peak season increased rate ratios. Results: While no seasonal trend in Kawasaki disease incidence was identified throughout the study period, we found a 1.52 (99% CI 1.27‐1.82) and a 1.43 (99% CI 1.17‐1.73) increased rate ratio of Kawasaki disease presentations in association with human metapneumovirus and respiratory syncytial virus circulation, respectively, before the COVID-19 pandemic. No respiratory viral associations with Kawasaki disease were observed during the COVID-19 pandemic. Conclusions: Our large ecological analysis demonstrates novel spatiotemporal relationships between human metapneumovirus and respiratory syncytial virus circulation with Kawasaki disease. The disappearance of these associations in the COVID-19 pandemic may reflect the reduced circulation of non–SARS-CoV-2 viruses during this period, supporting the prepandemic associations identified in this study. The roles of human metapneumovirus and respiratory syncytial virus in Kawasaki disease etiology warrant further investigation. %R 10.2196/49648 %U https://publichealth.jmir.org/2024/1/e49648 %U https://doi.org/10.2196/49648 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54117 %T Digital Adherence Technologies and Differentiated Care for Tuberculosis Treatment and Their Acceptability Among Persons With Tuberculosis, Health Care Workers, and Key Informants in the Philippines: Qualitative Interview Study %A Leung,Chung Lam %A Alacapa,Jason %A Tasca,Bianca Gonçalves %A Villanueva,Andre Daniel %A Masulit,Saniata %A Ignacio,Marvin Louie %A Uy,Kathleen Nicole %A Pell,Christopher %A van Kalmthout,Kristian %A Powers,Rachel %A Fielding,Katherine %A Jerene,Degu %+ KNCV Tuberculosis Foundation, Maanweg 174, Den Haag, 2516AB, Netherlands, 31 070 416 7222, adrian.leung@kncvtbc.org %K tuberculosis %K digital adherence technologies %K implementation %K acceptability %K qualitative research %K Philippines %K digital health %K tuberculosis treatment %K support strategy %K support %K medication adherence %K health care workers %K interview %K interviews %K user %K user privacy %K privacy %K digital adherence %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital adherence technologies (DATs) are being studied to determine their potential to support tuberculosis (TB) treatment and address the shortcomings of directly observed therapy. Previous research has shown inconclusive results on whether DATs can enhance medication adherence among persons with TB. Objective: This study aims to understand the acceptability of DATs, namely, medication labels and smart pillboxes, among persons with TB, health care workers (HCWs), and key informants (KIs) in the Philippines. The objective is to gain valuable insights that can inform the design and implementation of DATs in the Southeast Asian region, which meet the needs and preferences of end users. Methods: Persons with TB, HCWs, and KIs were recruited from intervention facilities to participate in in-depth interviews conducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematic analysis was carried out using NVivo software (Lumivero) to identify and analyze themes. Themes were then structured within a modified social-ecological model. Results: A total of 25 persons with drug-sensitive TB and 20 HCWs or KIs were interviewed. Both groups emphasized that users’ technology literacy level, financial conditions, and motivation to be cured determined how they interacted with the DAT. They also acknowledged that DATs helped foster their relationship with HCWs and enabled efficient treatment support. Concerning technology, persons with TB found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to their workload but also allowed them to support users who missed doses. However, both groups experienced technical challenges with DATs. Regarding program implementation, users appreciated the clear explanations and demonstrations provided by HCWs. Yet, some users reported inconsistencies between DAT settings and the information provided. HCWs stressed the importance of comprehensive training and sufficient resources for effective program implementation in the future. At the community level, both groups noted that DATs and program design protected users’ privacy and reduced the risk of stigma. Finally, users and HCWs shared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impact of the COVID-19 pandemic. Conclusions: In the Philippines, persons with TB and HCWs showed a high level of acceptance and satisfaction with the impact of DAT and program design. They expressed a desire for the continuation of DATs. The challenges encountered underscore the need for ongoing technological development to minimize malfunctions, enhance the capacity of health facilities, and improve infrastructure. DATs have demonstrated their ability to strengthen user-HCW relationships and protect users from stigmatization. Additional efforts are required to scale up the DAT program in the Philippines. %M 39042889 %R 10.2196/54117 %U https://humanfactors.jmir.org/2024/1/e54117 %U https://doi.org/10.2196/54117 %U http://www.ncbi.nlm.nih.gov/pubmed/39042889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53716 %T Detection of Common Respiratory Infections, Including COVID-19, Using Consumer Wearable Devices in Health Care Workers: Prospective Model Validation Study %A Esmaeilpour,Zeinab %A Natarajan,Aravind %A Su,Hao-Wei %A Faranesh,Anthony %A Friel,Ciaran %A Zanos,Theodoros P %A D’Angelo,Stefani %A Heneghan,Conor %+ Google LLC, 199 Fremont Street, San Francisco, CA, 94105, United States, 1 9293047065, znb.esmailpoor@gmail.com %K COVID detection %K wearable %K respiratory virus detection %K algorithm %K respiratory infection %K respiratory virus %K COVID-19 %K wearable device %K well-being %K health %K physiology %K health care worker %K prediction %K infection %K physical stress %K emotional stress %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The early detection of respiratory infections could improve responses against outbreaks. Wearable devices can provide insights into health and well-being using longitudinal physiological signals. Objective: The purpose of this study was to prospectively evaluate the performance of a consumer wearable physiology-based respiratory infection detection algorithm in health care workers. Methods: In this study, we evaluated the performance of a previously developed system to predict the presence of COVID-19 or other upper respiratory infections. The system generates real-time alerts using physiological signals recorded from a smartwatch. Resting heart rate, respiratory rate, and heart rate variability measured during the sleeping period were used for prediction. After baseline recordings, when participants received a notification from the system, they were required to undergo testing at a Northwell Health System site. Participants were asked to self-report any positive tests during the study. The accuracy of model prediction was evaluated using respiratory infection results (laboratory results or self-reports), and postnotification surveys were used to evaluate potential confounding factors. Results: A total of 577 participants from Northwell Health in New York were enrolled in the study between January 6, 2022, and July 20, 2022. Of these, 470 successfully completed the study, 89 did not provide sufficient physiological data to receive any prediction from the model, and 18 dropped out. Out of the 470 participants who completed the study and wore the smartwatch as required for the 16-week study duration, the algorithm generated 665 positive alerts, of which 153 (23.0%) were not acted upon to undergo testing for respiratory viruses. Across the 512 instances of positive alerts that involved a respiratory viral panel test, 63 had confirmed respiratory infection results (ie, COVID-19 or other respiratory infections detected using a polymerase chain reaction or home test) and the remaining 449 had negative upper respiratory infection test results. Across all cases, the estimated false-positive rate based on predictions per day was 2%, and the positive-predictive value ranged from 4% to 10% in this specific population, with an observed incidence rate of 198 cases per week per 100,000. Detailed examination of questionnaires filled out after receiving a positive alert revealed that physical or emotional stress events, such as intense exercise, poor sleep, stress, and excessive alcohol consumption, could cause a false-positive result. Conclusions: The real-time alerting system provides advance warning on respiratory viral infections as well as other physical or emotional stress events that could lead to physiological signal changes. This study showed the potential of wearables with embedded alerting systems to provide information on wellness measures. %M 39018555 %R 10.2196/53716 %U https://formative.jmir.org/2024/1/e53716 %U https://doi.org/10.2196/53716 %U http://www.ncbi.nlm.nih.gov/pubmed/39018555 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e41749 %T Census-Dependent Mortality of Ventilated Patients With COVID-19 in Israel: Noninterventional Observational Cohort Study %A Mendlovic,Joseph %A Mimouni,Francis B %+ Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, PO Box 12000, Shmuel (Hans) Beyth St 12, Jerusalem, 91120, Israel, 972 6777111 ext 1, sefimen@gmail.com %K COVID-19 %K mortality %K ventilation %K intensive care %K pandemic %K contagious %K disease %K mortality %K database %K data %K patient %K mortality %K medical %K resources %K validation %K public policy %K policy %K pandemic %K health policy %K global health policy %D 2024 %7 9.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic led to several surges in the mass hospitalization rate. Extreme increases in hospital admissions without adequate medical resources may increase mortality. No study has addressed the impact of daily census of ventilated patients on mortality in the context of the pandemic in a nationwide setting. Objective: This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel. Methods: We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients. Results: During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)—backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ≥200 patients ventilated per day, it more than tripled at ≥15% (P<.001). Conclusions: Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy. %M 38981116 %R 10.2196/41749 %U https://www.i-jmr.org/2024/1/e41749 %U https://doi.org/10.2196/41749 %U http://www.ncbi.nlm.nih.gov/pubmed/38981116 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51381 %T Erlotinib or Gefitinib for Treating Advanced Epidermal Growth Factor Receptor Mutation–Positive Lung Cancer in Aotearoa New Zealand: Protocol for a National Whole-of-Patient-Population Retrospective Cohort Study and Results of a Validation Substudy %A Aye,Phyu Sin %A Barnes,Joanne %A Laking,George %A Cameron,Laird %A Anderson,Malcolm %A Luey,Brendan %A Delany,Stephen %A Harris,Dean %A McLaren,Blair %A Brenman,Elliott %A Wong,Jayden %A Lawrenson,Ross %A Arendse,Michael %A Tin Tin,Sandar %A Elwood,Mark %A Hope,Philip %A McKeage,Mark James %+ Department of Pharmacology and Clinical Pharmacology, University of Auckland, 85 Park Road, Auckland, 1025, New Zealand, 64 21 859 588, m.mckeage@auckland.ac.nz %K epidermal growth factor receptor %K erlotinib %K gefitinib %K lung cancer %K retrospective cohort %K study protocol %K validation %D 2024 %7 2.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Starting in 2010, the epidermal growth factor receptor (EGFR) kinase inhibitors erlotinib and gefitinib were introduced into routine use in Aotearoa New Zealand (NZ) for treating advanced lung cancer, but their impact in this setting is unknown. Objective: The study described in this protocol aims to understand the effectiveness and safety of these new personalized lung cancer treatments and the contributions made by concomitant medicines and other factors to adverse outcomes in the general NZ patient population. A substudy aimed to validate national electronic health databases as the data source and the methods for determining patient eligibility and identifying outcomes and variables. Methods: This study will include all NZ patients with advanced EGFR mutation–positive lung cancer who were first dispensed erlotinib or gefitinib before October 1, 2020, and followed until death or for at least 1 year. Routinely collected health administrative and clinical data will be collated from national electronic cancer registration, hospital discharge, mortality registration, and pharmaceutical dispensing databases by deterministic data linkage using National Health Index numbers. The primary effectiveness and safety outcomes will be time to treatment discontinuation and serious adverse events, respectively. The primary variable will be high-risk concomitant medicines use with erlotinib or gefitinib. For the validation substudy (n=100), data from clinical records were compared to those from national electronic health databases and analyzed by agreement analysis for categorical data and by paired 2-tailed t tests for numerical data. Results: In the validation substudy, national electronic health databases and clinical records agreed in determining patient eligibility and for identifying serious adverse events, high-risk concomitant medicines use, and other categorical data with overall agreement and κ statistic of >90% and >0.8000, respectively; for example, for the determination of patient eligibility, the comparison of proxy and standard eligibility criteria applied to national electronic health databases and clinical records, respectively, showed overall agreement and κ statistic of 96% and 0.8936, respectively. Dates for estimating time to treatment discontinuation and other numerical variables and outcomes showed small differences, mostly with nonsignificant P values and 95% CIs overlapping with zero difference; for example, for the dates of the first dispensing of erlotinib or gefitinib, national electronic health databases and clinical records differed on average by approximately 4 days with a nonsignificant P value of .33 and 95% CIs overlapping with zero difference. As of May 2024, the main study is ongoing. Conclusions: A protocol is presented for a national whole-of-patient-population retrospective cohort study designed to describe the safety and effectiveness of erlotinib and gefitinib during their first decade of routine use in NZ for treating EGFR mutation–positive lung cancer. The validation substudy demonstrated the feasibility and validity of using national electronic health databases and the methods for determining patient eligibility and identifying the study outcomes and variables proposed in the study protocol. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000998549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368928 International Registered Report Identifier (IRRID): DERR1-10.2196/51381 %M 38954434 %R 10.2196/51381 %U https://www.researchprotocols.org/2024/1/e51381 %U https://doi.org/10.2196/51381 %U http://www.ncbi.nlm.nih.gov/pubmed/38954434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55361 %T The Accuracy of Pulse Oxygen Saturation, Heart Rate, Blood Pressure, and Respiratory Rate Raised by a Contactless Telehealth Portal: Validation Study %A Gerald Dcruz,Julian %A Yeh,Paichang %+ Docsun Biomedical Holdings, Inc, 6763 32ND Ave N, Saint Petersburg, FL, 33710, United States, 1 (813) 4380045, jan.yeh@docsun.health %K medical devices %K mHealth %K vital signs %K measurements validity %K validation %K validity %K device %K devices %K vital %K vitals %K accuracy %K pulse %K oxygen %K saturation %K heart rate %K blood pressure %K respiration %K respiratory %K telehealth %K telemedicine %K eHealth %K e-health %K self-check %K self-checker %K breathing %K portal %K portals %K self-checking %K self-monitor %K self-monitoring %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The traditional measurement of heart rate (HR), oxygen saturation (SpO2), blood pressure (BP), and respiratory rate (RR) via physical examination can be challenging, and the recent pandemic has accelerated trends toward telehealth and remote monitoring. Instead of going to the physician to check these vital signs, measuring them at home would be more convenient. Vital sign monitors, also known as physiological parameter monitors, are electronic devices that measure and display biological information about patients under constant monitoring. Objective: The purpose of this study was to validate the accuracy of the pulse SpO2, HR, BP, and RR raised by Docsun Telehealth Portal by comparing it with approved medical devices. Methods: This is a noninvasive, self-check, system-based study conducted to validate the detection of vital signs (SpO2, HR, BP, and RR) raised by Docsun Telehealth Portal. The input for software processing involves facial screening without any accessories on the face, scanning directly through the software application portal. The participant’s facial features are detected and screened for the extraction of necessary readings. Results: For the validation of HR, SpO2, BP, and RR measurements, the main outcomes were the mean of the absolute difference between the respective investigational devices and the reference values as well as the absolute percentage difference between the respective investigational devices and the reference values. If the HR was within ±10% of the reference standard or 5 beats per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 1.41 (SD 1.14) beats per minute. The mean absolute percentage difference was 1.69% (SD 1.37). Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for HR measurements. If the RR was within ±10% of the reference standard or 3 breaths per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 0.86 breaths per minute. The mean absolute percentage difference was 4.72%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for RR measurements. SpO2 levels were considered acceptable if the average absolute difference between the Docsun Telehealth Portal and the reference values was ±3%. The mean absolute percentage difference was 0.59%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for SpO2 measurements. The Docsun Telehealth Portal predicted systolic BP with an accuracy of 94.81% and diastolic BP with an accuracy of 95.71%. Conclusions: The results of the study show that the accuracy of the HR, BP, SpO2, and RR values raised by the Docsun Telehealth Portal, compared against the clinically approved medical devices, proved to be accurate by meeting predefined accuracy guidelines. %M 38598698 %R 10.2196/55361 %U https://formative.jmir.org/2024/1/e55361 %U https://doi.org/10.2196/55361 %U http://www.ncbi.nlm.nih.gov/pubmed/38598698 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54497 %T Treating Spontaneous Pneumothorax Using an Innovative Surgical Technique Called Capnodissection Pleurectomy: Case Report %A Qsous,Ghaith %A Ramaraj,Prashanth %A Avtaar Singh,Sanjeet Singh %A Herd,Philip %A Sooraj,Nayandra Runveer %A Will,Malcolm Brodie %+ Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, United Kingdom, 44 01315361000 ext 21076, Prashanth.ramaraj@nhs.net %K capnodissection %K pleurectomy %K VATS %K video-assisted thorascopic surgery %K novel technique %K thoracic surgery %K surgical innovation %K pneumothorax %K spontaneous pneumothorax %K pleurodesis %K management %K bullectomy %K bullae %K young patient %K lung diseases %K chronic obstructive pulmonary disease %K COPD %K surgical treatment %K male %K capnothorax %D 2024 %7 21.6.2024 %9 Case Report %J Interact J Med Res %G English %X Spontaneous pneumothorax is one of the most common conditions encountered in thoracic surgery. This condition can be treated conservatively or surgically based on indications and guidelines. Traditional surgical management includes pleurodesis (mechanical or chemical) in addition to bullectomy if the bullae can be identified. Mechanical pleurodesis is usually performed by surgical pleurectomy or pleural abrasion. In this case report, we present a case of a young patient with spontaneous pneumothorax who needed a surgical intervention. We performed a new, innovative surgical technique for surgical pleurectomy where we used carbon dioxide for dissection of the parietal pleura (capnodissection). This technique may provide similar efficiency to the traditional procedure but with less risk of bleeding and complications. %M 38905630 %R 10.2196/54497 %U https://www.i-jmr.org/2024/1/e54497 %U https://doi.org/10.2196/54497 %U http://www.ncbi.nlm.nih.gov/pubmed/38905630 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53131 %T Preferences, Needs, and Values of Patients With Chronic Obstructive Pulmonary Disease Attending a Telehealth Service: Qualitative Interview Study %A Schmidt,Camilla Wong %A Borgnakke,Karen %A Frølich,Anne %A Kayser,Lars %+ Medical Department, Holbæk Sygehus, Region Zealand, Smedelundsgade 60, Holbæk, 4300, Denmark, 45 59484000, cws@sund.ku.dk %K people with long-term health condition %K patient education %K COPD %K digital health %K ethnography %K inductive %K ethnographic %K chronic %K lung %K lungs %K pulmonary %K respiratory %K self-management %K interview %K interviews %K qualitative %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38905629 %R 10.2196/53131 %U https://humanfactors.jmir.org/2024/1/e53131 %U https://doi.org/10.2196/53131 %U http://www.ncbi.nlm.nih.gov/pubmed/38905629 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57209 %T Pulmonary Tuberculosis Notification Rate Within Shenzhen, China, 2010-2019: Spatial-Temporal Analysis %A Lai,Peixuan %A Cai,Weicong %A Qu,Lin %A Hong,Chuangyue %A Lin,Kaihao %A Tan,Weiguo %A Zhao,Zhiguang %+ Shenzhen Center for Chronic Disease Control, No. 2021 Buxin Road, Shenzhen, 518020, China, 86 0755 2561 8781, 1498384005@qq.com %K tuberculosis %K spatial analysis %K spatial-temporal cluster %K Shenzhen %K China %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pulmonary tuberculosis (PTB) is a chronic communicable disease of major public health and social concern. Although spatial-temporal analysis has been widely used to describe distribution characteristics and transmission patterns, few studies have revealed the changes in the small-scale clustering of PTB at the street level. Objective: The aim of this study was to analyze the temporal and spatial distribution characteristics and clusters of PTB at the street level in the Shenzhen municipality of China to provide a reference for PTB prevention and control. Methods: Data of reported PTB cases in Shenzhen from January 2010 to December 2019 were extracted from the China Information System for Disease Control and Prevention to describe the epidemiological characteristics. Time-series, spatial-autocorrelation, and spatial-temporal scanning analyses were performed to identify the spatial and temporal patterns and high-risk areas at the street level. Results: A total of 58,122 PTB cases from 2010 to 2019 were notified in Shenzhen. The annual notification rate of PTB decreased significantly from 64.97 per 100,000 population in 2010 to 43.43 per 100,000 population in 2019. PTB cases exhibited seasonal variations with peaks in late spring and summer each year. The PTB notification rate was nonrandomly distributed and spatially clustered with a Moran I value of 0.134 (P=.02). One most-likely cluster and 10 secondary clusters were detected, and the most-likely clustering area was centered at Nanshan Street of Nanshan District covering 6 streets, with the clustering time spanning from January 2010 to November 2012. Conclusions: This study identified seasonal patterns and spatial-temporal clusters of PTB cases at the street level in the Shenzhen municipality of China. Resources should be prioritized to the identified high-risk areas for PTB prevention and control. %M 38875687 %R 10.2196/57209 %U https://publichealth.jmir.org/2024/1/e57209 %U https://doi.org/10.2196/57209 %U http://www.ncbi.nlm.nih.gov/pubmed/38875687 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52309 %T Virtual Reality Applications for the Implementation of Domestic Respiratory Rehabilitation Programs for Patients With Long COVID and Post-COVID Condition: Scoping Review %A Dalko,Katharina %A Elsuson,Hlynur Andri %A Kalter,Ivonne %A Zilezinski,Max %A Hofstetter,Sebastian %A Stoevesandt,Dietrich %A Paulicke,Denny %A Jahn,Patrick %+ Dorothea Erxleben Lernzentrum, Medical Faculty Halle, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 12, Halle (Saale), 06112, Germany, 49 345 557 5493, katharina.dalko@medizin.uni-halle.de %K long COVID %K post-COVID %K rehabilitation %K virtual reality %K implementation %K respiratory %K respiratory rehabilitation %K scoping review %K development %K accessibility %K support %K physical %K psychological %K motivation %K compliance %K usability %K COVID-19 %K COVID %D 2024 %7 31.5.2024 %9 Review %J JMIR Serious Games %G English %X Background: Due to a high number of patients affected by long COVID or post-COVID condition, an essential step to address the long-term effects of COVID-19 lies in the development and implementation of flexible and accessible rehabilitation programs. Virtual reality (VR) technologies offer the potential to support traditional therapies with individualized at-home programs. Objective: This study aims to provide an overview of existing scientific evidence on the development and implementation of VR-assisted respiratory rehabilitation programs for patients with long COVID and post-COVID condition and to synthesize the results. Methods: We conducted a scoping review of studies from 6 databases. PubMed, CINAHL, Cochrane, ScienceDirect, Web of Science Social Sciences Citation Index, and PEDro were searched using an exploratory search strategy. The search, which was last updated in February 2024, included peer-reviewed studies on immersive VR applications providing respiratory rehabilitation programs for patients with chronic obstructive pulmonary disease and long COVID or post-COVID condition. Exclusion criteria were studies in clinical or inpatient settings, telemedicine, nonimmersive VR applications, and gray literature. Nine publications were included in this review. Findings were extracted and summarized from the studies according to the JBI (Joanna Briggs Institute) method and thematically categorized. Topics covered were study characteristics, physiotherapeutic concept, clinical parameters, as well as usability and acceptability. Results: The 9 publications included in the qualitative analysis were published in 2019-2023. Eight empirical studies were included: 4 followed a mixed methods design, 3 were qualitative studies, and 1 followed a quantitative method. One scoping review was included in the data analyses. Four of the included studies were on patients with chronic obstructive pulmonary disease. The 9 studies demonstrated that VR-supported respiratory rehabilitation programs result in positive initial outcomes in terms of physical as well as psychological parameters. Particularly noteworthy was the increased motivation and compliance of patients. However, adverse effects and lack of usability are the barriers to the implementation of this innovative approach. Conclusions: Overall, VR is a promising technology for the implementation of individualized and flexible respiratory rehabilitation programs for patients with long COVID and post-COVID condition. Nevertheless, corresponding approaches are still under development and need to be more closely adapted to the needs of users. Further, the evidence was limited to pilot studies or a small number of patients, and no randomized controlled trials or long-term studies were part of the study selection. The included studies were performed by 4 groups of researchers: 3 from Europe and 1 from the United States. %M 38819890 %R 10.2196/52309 %U https://games.jmir.org/2024/1/e52309 %U https://doi.org/10.2196/52309 %U http://www.ncbi.nlm.nih.gov/pubmed/38819890 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53703 %T The Effects of a Dietary Supplement (PediaFlù) Plus Standard of Care in Children With Acute Tonsillopharyngitis/Rhinopharyngitis: Protocol for a Randomized Controlled Trial %A Cardinale,Fabio %A Barattini,Dionisio Franco %A Sbrocca,Federica %A Centi,Alessandro %A Giuntini,Greta %A Morariu Bordea,Maria %A Herteg,Dorina %A Rosu,Serban %A Matei,Cristian Radu %+ Complex Operating Unit Paediatrics, Giovanni XXIII Paediatric Hospital, University of Bari, Via Amendola, 207, Bari, 70123, Italy, 39 080 5596732, fabiocardinale1961@gmail.com %K dietary supplements %K tonsillitis %K pharyngitis %K nasopharyngitis %K Pelargonium %K propolis %K zinc %K severity score %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: A dietary supplement containing Pelargonium sidoides extract, propolis, zinc, and honey has been recently developed and proven to be an effective adjuvant in clinical practice for seasonal diseases and the treatment of respiratory tract disorders. Objective: This trial aims to verify the efficacy of the tested dietary supplement in a pediatric population with acute tonsillopharyngitis/rhinopharyngitis (ATR). Methods: The trial includes children aged between 3 and 10 years with ATR ≤48 h, a negative rapid test for beta-hemolytic streptococcus or culture identification of nasal and/or pharyngeal exudates, and SARS-CoV-2 infection. The dietary supplement tested is an oral solution already on the market based on Pelagon P-70 (equivalent to Pelargonium sidoides d.e. 133.3 mg/100 ml), propolis, zinc, and honey. The product is administered at 5 ml 3 times a day for 6 days for children younger than 6 years and 10 ml 3 times a day for 6 days for children older than 6 years. The study design is open label, randomized, and controlled, with the tested dietary supplement plus standard of care (SoC) versus SoC alone. Patients are enrolled from 3 sites in Romania. The change in Tonsillitis Severity Score and number of treatment failures (using ibuprofen or high-dose paracetamol as rescue medication) are the primary end points. Based on the Tonsillitis Severity Score and the 2-sample comparison of the means formula with a 5% significance level, 80% power, and a minimally clinically important difference of 2 (SD 3.85) points, 120 patients are required. To account for potential screening failures and dropouts, we need to screen a population of approximately 150 children. Results: Patient enrollment began on June 3, 2021 (first patient’s first visit), and ended on August 12, 2021 (last patient’s last visit). The data collection period was from June 3, 2021, to September 16, 2021. The study was funded in February 2023. Data analysis is currently ongoing (April 2024). We expect the results to be published in a peer-reviewed clinical journal in the third quarter of 2024 and presented at scientific meetings in the last quarter of 2024. Conclusions: The data from this trial may help identify new adjuvant treatments for children with ATR when streptococcal infection is excluded by a negative rapid test, thereby avoiding unnecessary antibiotic administration. Trial Registration: ClinicalTrials.gov NCT04899401 https://clinicaltrials.gov/study/NCT04899401 International Registered Report Identifier (IRRID): DERR1-10.2196/53703 %M 38819917 %R 10.2196/53703 %U https://www.researchprotocols.org/2024/1/e53703 %U https://doi.org/10.2196/53703 %U http://www.ncbi.nlm.nih.gov/pubmed/38819917 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e56572 %T A Roadmap for Using Causal Inference and Machine Learning to Personalize Asthma Medication Selection %A Nkoy,Flory L %A Stone,Bryan L %A Zhang,Yue %A Luo,Gang %+ Department of Biomedical Informatics and Medical Education, University of Washington, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 2062214596, gangluo@cs.wisc.edu %K asthma %K causal inference %K forecasting %K machine learning %K decision support %K drug %K drugs %K pharmacy %K pharmacies %K pharmacology %K pharmacotherapy %K pharmaceutic %K pharmaceutics %K pharmaceuticals %K pharmaceutical %K medication %K medications %K medication selection %K respiratory %K pulmonary %K forecast %K ICS %K inhaled corticosteroid %K inhaler %K inhaled %K corticosteroid %K corticosteroids %K artificial intelligence %K personalized %K customized %D 2024 %7 17.4.2024 %9 Viewpoint %J JMIR Med Inform %G English %X Inhaled corticosteroid (ICS) is a mainstay treatment for controlling asthma and preventing exacerbations in patients with persistent asthma. Many types of ICS drugs are used, either alone or in combination with other controller medications. Despite the widespread use of ICSs, asthma control remains suboptimal in many people with asthma. Suboptimal control leads to recurrent exacerbations, causes frequent ER visits and inpatient stays, and is due to multiple factors. One such factor is the inappropriate ICS choice for the patient. While many interventions targeting other factors exist, less attention is given to inappropriate ICS choice. Asthma is a heterogeneous disease with variable underlying inflammations and biomarkers. Up to 50% of people with asthma exhibit some degree of resistance or insensitivity to certain ICSs due to genetic variations in ICS metabolizing enzymes, leading to variable responses to ICSs. Yet, ICS choice, especially in the primary care setting, is often not tailored to the patient’s characteristics. Instead, ICS choice is largely by trial and error and often dictated by insurance reimbursement, organizational prescribing policies, or cost, leading to a one-size-fits-all approach with many patients not achieving optimal control. There is a pressing need for a decision support tool that can predict an effective ICS at the point of care and guide providers to select the ICS that will most likely and quickly ease patient symptoms and improve asthma control. To date, no such tool exists. Predicting which patient will respond well to which ICS is the first step toward developing such a tool. However, no study has predicted ICS response, forming a gap. While the biologic heterogeneity of asthma is vast, few, if any, biomarkers and genotypes can be used to systematically profile all patients with asthma and predict ICS response. As endotyping or genotyping all patients is infeasible, readily available electronic health record data collected during clinical care offer a low-cost, reliable, and more holistic way to profile all patients. In this paper, we point out the need for developing a decision support tool to guide ICS selection and the gap in fulfilling the need. Then we outline an approach to close this gap via creating a machine learning model and applying causal inference to predict a patient’s ICS response in the next year based on the patient’s characteristics. The model uses electronic health record data to characterize all patients and extract patterns that could mirror endotype or genotype. This paper supplies a roadmap for future research, with the eventual goal of shifting asthma care from one-size-fits-all to personalized care, improve outcomes, and save health care resources. %M 38630536 %R 10.2196/56572 %U https://medinform.jmir.org/2024/1/e56572 %U https://doi.org/10.2196/56572 %U http://www.ncbi.nlm.nih.gov/pubmed/38630536 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e51901 %T Preliminary Assessment of an Ambulatory Device Dedicated to Upper Airway Muscle Training in Patients With Sleep Apnea: Proof-of-Concept Study %A Roberge,Patrice %A Ruel,Jean %A Bégin-Drolet,André %A Lemay,Jean %A Gakwaya,Simon %A Masse,Jean-François %A Sériès,Frédéric %+ Mechanical Engineering Department, Université Laval, 1065 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada, 1 418 656 2131 ext 412245, Jean.Ruel@gmc.ulaval.ca %K obstructive sleep apnea/hypopnea syndrome %K OSAHS %K myofunctional therapy %K myotherapy %K oral %K orofacial %K myology %K musculature %K labial %K buccal %K lingual %K speech therapy %K physiotherapy %K physical therapy %K oropharyngeal exercises %K oropharyngeal %K pharyngeal %K pharynx %K hypopnea %K lip %K home-based %K portable device %K devices %K ambulatory %K portable %K monitoring %K apnea %K mouth %K lips %K tongue %K facial %K exercise %K exercises %K myofunctional %K continuous monitoring %K sleep-disordered breathing %K sleep %K breathing %K tongue exercise %K lip exercise %K mHealth %K muscle %K muscles %K muscular %K airway %K sleep apnea %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability. Objective: Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips, tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session. Methods: This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes. Results: Ten participants were enrolled in the study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91% (175/192 sessions). For the tongue exercise, the success rate increased from 66% (211/320 exercises; SD 18%) on the first day to 85% (272/320 exercises; SD 17%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=–0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants’ performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program. Conclusions: The study’s portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation. %M 38875673 %R 10.2196/51901 %U https://biomedeng.jmir.org/2024/1/e51901 %U https://doi.org/10.2196/51901 %U http://www.ncbi.nlm.nih.gov/pubmed/38875673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54236 %T A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study %A Zamora Goicoechea,Jeffrey %A Boughner,Allison %A Cirion Lee,Juan José %A Mahajan,Aman %A Yeo,Kurt %A Sproga,Maris %A Patel,Tasmin %A Saitta,Claudio %A Russell,Christopher %A Coughlan,Michael %A Caponnetto,Pasquale %A Polosa,Riccardo %+ Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia 89, Catana, 95123, Italy, 39 0954781124, polosa@unict.it %K electronic cigarette %K health effects %K respiratory symptoms %K survey %K real-world use study %K e-cigarette %K e-cigarettes %K smoke %K smoker %K smokers %K smoking %K vape %K vaping %K respiratory %K pulmonary %K cross-sectional %K questionnaire %K questionnaires %K survey %K surveys %D 2024 %7 28.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. Objective: We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire—the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. Methods: This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products (“vapers cohort”; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products (“controls cohort”; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the “vapers cohort” will be compared with those of people in the “controls cohort.” Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. Results: Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. Conclusions: This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. International Registered Report Identifier (IRRID): DERR1-10.2196/54236 %M 38546715 %R 10.2196/54236 %U https://www.researchprotocols.org/2024/1/e54236 %U https://doi.org/10.2196/54236 %U http://www.ncbi.nlm.nih.gov/pubmed/38546715 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54081 %T High-Flow Humidified Oxygen as an Early Intervention in Children With Acute Severe Asthma: Protocol for a Feasibility Randomized Controlled Trial %A Rojas-Anaya,Hector %A Kapur,Akshat %A Roberts,Graham %A Roland,Damian %A Gupta,Atul %A Lazner,Michaela %A Bayreuther,Jane %A Pappachan,John %A Jones,Christina %A Bremner,Stephen %A Cantle,Fleur %A Seddon,Paul %+ Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex National Health Service Foundation Trust, Eastern Road, Brighton, BN2 5BE, United Kingdom, 44 7714777361, seddop@gmail.com %K asthma %K child %K wheezing %K oxygen therapy %K high-flow humidified oxygen therapy %D 2024 %7 28.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Acute severe asthma (ASA) is a leading cause of hospital attendance in children. Standard first-line therapy consists of high-dose inhaled bronchodilators plus oral corticosteroids. Treatment for children who fail to respond to first-line therapy is problematic: the use of intravenous agents is inconsistent, and side effects are frequent. High-flow humidified oxygen (HiFlo) is widely used in respiratory conditions and is increasingly being used in ASA, but with little evidence for its effectiveness. A well-designed, adequately powered randomized controlled trial (RCT) of HiFlo therapy in ASA is urgently needed, and feasibility data are required to plan such an RCT. In this study, we describe the protocol for a feasibility study designed to fill this knowledge gap. Objective: This study aims to establish whether a full RCT of early HiFlo therapy in children with ASA can be conducted successfully and safely, to establish whether recruitment using deferred consent is practicable, and to define appropriate outcome measures and sample sizes for a definitive RCT. The underlying hypothesis is that early HiFlo therapy in ASA will reduce the need for more invasive treatments, allow faster recovery and discharge from hospital, and in both these ways reduce distress to children and their families. Methods: We conducted a feasibility RCT with deferred consent to assess the use of early HiFlo therapy in children aged 2 to 11 years with acute severe wheeze not responding to burst therapy (ie, high-dose inhaled salbutamol with or without ipratropium). Children with a Preschool Respiratory Assessment Measure score ≥5 after burst therapy were randomized to commence HiFlo therapy or follow standard care. The candidate primary outcomes assessed were treatment failure requiring escalation and time to meet hospital discharge criteria. Patient and parent experiences were also assessed using questionnaires and telephone interviews. Results: The trial was opened to recruitment in February 2020 but was paused for 15 months owing to the COVID-19 pandemic. The trial was reopened at the lead site in July 2021 and opened at the other 3 sites from August to December 2022. Recruitment was completed in June 2023. Conclusions: This feasibility RCT of early HiFlo therapy in children with ASA recruited to the target despite major disturbances owing to the COVID-19 pandemic. The data are currently being analyzed and will be published separately. Trial Registration: International Standard Randomised Controlled Trial Number Registry ISRCTN78297040; https://www.isrctn.com/ISRCTN78297040 International Registered Report Identifier (IRRID): DERR1-10.2196/54081 %M 38546733 %R 10.2196/54081 %U https://www.researchprotocols.org/2024/1/e54081 %U https://doi.org/10.2196/54081 %U http://www.ncbi.nlm.nih.gov/pubmed/38546733 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52590 %T The Effect of Body Temperature Changes on the Course of Treatment in Patients With Pneumonia and Sepsis: Results of an Observational Study %A Guzelj,Domen %A Grubelnik,Anže %A Greif,Nina %A Povalej Bržan,Petra %A Fluher,Jure %A Kalamar,Žiga %A Markota,Andrej %+ Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska ulica 5, Maribor, 2000, Slovenia, 386 23212008, andrej.markota@ukc-mb.si %K fever %K targeted temperature management %K pneumonia %K sepsis %K intensive care unit %D 2024 %7 1.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Traditionally, patients who are critically ill with infection and fever have been treated with antipyretics or even physically cooled. Presumed benefits of the reduction of body temperature are mostly based on decreased metabolic demands. However, it has been shown that decreasing body temperature in patients who are critically ill is not associated with improvement in treatment outcomes. Additionally, there is some data to support the use of temperature modulation (therapeutic hyperthermia) as an adjuvant treatment strategy in patients with infection. Objective: This study aims to determine the effect of body temperature on the course of intensive care unit (ICU) treatment of patients who are mechanically ventilated with pneumonia, sepsis, and positive tracheal aspirates on admission. Methods: We performed a single-center retrospective study. Core body temperature was measured in all patients. We analyzed associations between average temperatures in the first 48 hours after admission to ICU and ICU treatment parameters. Additionally, patients were divided into three groups: patients with negative tracheal aspirates 1 week after ICU admission (P-N group), patients with a different pathogen in tracheal aspirates 1 week after ICU admission (P-HAP group), and patients with a persisting pathogen in tracheal aspirates 1 week after ICU admission (P-P group). Differences in body temperature and interventions aimed at temperature modulation were determined. Results: We observed a significantly higher average temperature in the first 48 hours after admission to ICU in patients who survived to hospital discharge compared to nonsurvivors (mean 37.2 °C, SD 1 °C vs mean 36.9 °C, SD 1.6 °C; P=.04). We observed no associations between average temperatures in the first 48 hours after ICU admission and days of mechanical ventilation in the first 7 days of treatment (ρ=–0.090; P=.30), the average maximum daily requirement for noradrenaline in the first 7 days of treatment (ρ=–0.029; P=.80), average maximum FiO2 in the first 7 days of ICU treatment (ρ=0.040; P=.70), and requirement for renal replacement therapy in the first 7 days of ICU treatment (mean 37.3 °C, SD 1.4 °C vs mean 37.0 °C, SD 1.3 °C; P=.23). In an additional analysis, we observed a significantly greater use of paracetamol in the P-N group (mean 1.0, SD 1.1 g vs mean 0.4, SD 0.7 g vs mean 0.4, SD 0.8 g; P=.009), a trend toward greater use of active cooling in the first 24 hours after ICU admission in the P-N group (n=11, 44% vs n=14, 33.3% vs n=16, 32%; P=.57), and no other significant differences in parameters of ICU treatment between patient groups. Conclusions: We observed better survival in patients who developed higher body temperatures in the first 48 hours after admission to the ICU; however, we observed no changes in other treatment parameters. Similarly, we observed greater use of paracetamol in patients with negative tracheal aspirates 1 week after ICU admission. Our results support the strategy of temperature tolerance in patients who are intubated with pneumonia and sepsis. %M 38427413 %R 10.2196/52590 %U https://www.i-jmr.org/2024/1/e52590 %U https://doi.org/10.2196/52590 %U http://www.ncbi.nlm.nih.gov/pubmed/38427413 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44717 %T Contactless Monitoring System Versus Gold Standard for Respiratory Rate Monitoring in Emergency Department Patients: Pilot Comparison Study %A Goldfine,Charlotte E %A Oshim,Md Farhan Tasnim %A Chapman,Brittany P %A Ganesan,Deepak %A Rahman,Tauhidur %A Carreiro,Stephanie P %+ Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 617 732 5640, cgoldfine@bwh.harvard.edu %K cardiopulmonary monitoring %K contactless monitor %K radar %K respiratory rate %K vital signs %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Respiratory rate is a crucial indicator of disease severity yet is the most neglected vital sign. Subtle changes in respiratory rate may be the first sign of clinical deterioration in a variety of disease states. Current methods of respiratory rate monitoring are labor-intensive and sensitive to motion artifacts, which often leads to inaccurate readings or underreporting; therefore, new methods of respiratory monitoring are needed. The PulsON 440 (P440; TSDR Ultra Wideband Radios and Radars) radar module is a contactless sensor that uses an ultrawideband impulse radar to detect respiratory rate. It has previously demonstrated accuracy in a laboratory setting and may be a useful alternative for contactless respiratory monitoring in clinical settings; however, it has not yet been validated in a clinical setting. Objective: The goal of this study was to (1) compare the P440 radar module to gold standard manual respiratory rate monitoring and standard of care telemetry respiratory monitoring through transthoracic impedance plethysmography and (2) compare the P440 radar to gold standard measurements of respiratory rate in subgroups based on sex and disease state. Methods: This was a pilot study of adults aged 18 years or older being monitored in the emergency department. Participants were monitored with the P440 radar module for 2 hours and had gold standard (manual respiratory counting) and standard of care (telemetry) respiratory rates recorded at 15-minute intervals during that time. Respiratory rates between the P440, gold standard, and standard telemetry were compared using Bland-Altman plots and intraclass correlation coefficients. Results: A total of 14 participants were enrolled in the study. The P440 and gold standard Bland-Altman analysis showed a bias of –0.76 (–11.16 to 9.65) and an intraclass correlation coefficient of 0.38 (95% CI 0.06-0.60). The P440 and gold standard had the best agreement at normal physiologic respiratory rates. There was no change in agreement between the P440 and the gold standard when grouped by admitting diagnosis or sex. Conclusions: Although the P440 did not have statistically significant agreement with gold standard respiratory rate monitoring, it did show a trend of increased agreement in the normal physiologic range, overestimating at low respiratory rates, and underestimating at high respiratory rates. This trend is important for adjusting future models to be able to accurately detect respiratory rates. Once validated, the contactless respiratory monitor provides a unique solution for monitoring patients in a variety of settings. %M 38363588 %R 10.2196/44717 %U https://formative.jmir.org/2024/1/e44717 %U https://doi.org/10.2196/44717 %U http://www.ncbi.nlm.nih.gov/pubmed/38363588 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47295 %T Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation %A Robinson,Billy %A Proimos,Eleni %A Zou,Daniel %A Gong,Enying %A Oldenburg,Brian %A See,Katharine %+ Department of Respiratory Medicine, Northern Health, 185 Cooper St, Epping, 3076, Australia, 61 38405 8000, billymed1994@gmail.com %K asthma %K mobile health %K mHealth %K app %K mobile %K chronic disease %K systematic review %K smartphone %K review methodology %K respiratory %K compliance %K guideline %K guidelines %K review of apps %K evaluation %K quality %K best practices %K apps %K mobile phone %D 2024 %7 10.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. Objective: This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. Methods: The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Results: Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51%) achieved a total MARS score of ≥3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17%), 12 (25%), 11 (28%), and 14 (31%) apps, respectively; 19 (37%) apps could track or record “asthma symptoms,” which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20%) apps. Five (10%) apps provided an area for patients to store or enter their asthma action plan. Conclusions: This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. Trial Registration: PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894 International Registered Report Identifier (IRRID): RR2-10.2196/33103 %M 38198204 %R 10.2196/47295 %U https://mhealth.jmir.org/2024/1/e47295 %U https://doi.org/10.2196/47295 %U http://www.ncbi.nlm.nih.gov/pubmed/38198204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51065 %T Impact of Remote Patient Monitoring Platform on Patients With Moderate to Severe Persistent Asthma: Observational Study %A Reid,Denzil %A Mehta,Jyotsna %A Anis,Karim %A Mehta,Shail %+ Keva Health, 12 Bedford Street, Lexington, MA, 02420, United States, 1 8007275382, jyotsna@kevahealth.com %K asthma %K remote patient monitoring %K virtual care solution %K respiratory care %K chronic disease management %K spirometry %K telehealth %K management %K chronic disease %K virtual care %K patient monitoring %K respiratory %K respiratory care %K respiratory illness %K patient monitoring tool %K tool %K decision-making %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38153783 %R 10.2196/51065 %U https://formative.jmir.org/2023/1/e51065 %U https://doi.org/10.2196/51065 %U http://www.ncbi.nlm.nih.gov/pubmed/38153783 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52553 %T Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial %A Lindstedt,Sandra %A Silverborn,Martin %A Lannemyr,Lukas %A Pierre,Leif %A Larsson,Hillevi %A Grins,Edgars %A Hyllen,Snejana %A Dellgren,Goran %A Magnusson,Jesper %+ Skane University Hospital, Entregatan 1, Lund, 22460, Sweden, 46 46737220580, sandra.lindstedt@med.lu.se %K lung transplantation %K cytokine filtration %K primary graft dysfunction %K chronic lung allograft dysfunction %K randomized controlled clinical trial %D 2023 %7 13.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37855706 %R 10.2196/52553 %U https://www.researchprotocols.org/2023/1/e52553 %U https://doi.org/10.2196/52553 %U http://www.ncbi.nlm.nih.gov/pubmed/37855706 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41811 %T Airway Sequelae After Mechanical Ventilation for COVID-19: Protocol for a Scoping Review %A Candelo,Estephania %A Arias-Valderrama,Oriana %A Triviño-Arias,Jacobo %A Quiroz,Felipe %A Isaza-Pierotti,Daniel Francisco %A Victoria,William %A Tintinago,Luis F %+ Head and Neck Department, Fundacion Valle del Lili, Carrera 98 # 18-49, Cali, 760003, Colombia, 57 2870327, luis.tintinago@fvl.org.co %K airway %K sequelae %K COVID-19 %K mechanical ventilation %K SARS-CoV-2 %K scoping review %K pulmonary %K mortality %K voice production %K health care cost %K health intervention %D 2023 %7 29.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37191952 %R 10.2196/41811 %U https://www.researchprotocols.org/2023/1/e41811 %U https://doi.org/10.2196/41811 %U http://www.ncbi.nlm.nih.gov/pubmed/37191952 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e47146 %T Continuous Critical Respiratory Parameter Measurements Using a Single Low-Cost Relative Humidity Sensor: Evaluation Study %A Vaussenat,Fabrice %A Bhattacharya,Abhiroop %A Payette,Julie %A Benavides-Guerrero,Jaime A %A Perrotton,Alexandre %A Gerlein,Luis Felipe %A Cloutier,Sylvain G %+ Department of Electrical Engineering, École de Technologie Supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada, 1 514 451 1970, fabrice.vaussenat@lacime.etsmtl.ca %K relative humidity sensor %K design %K develop %K development %K tidal volume %K pulmonary volume %K COPD %K pulmonary %K respiratory %K sensor %K sensors %K wearables %K humidity %K medical device %K development %K breathing %K wearable %K ventilation %K air %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X 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. %M 38875670 %R 10.2196/47146 %U https://biomedeng.jmir.org/2023/1/e47146 %U https://doi.org/10.2196/47146 %U http://www.ncbi.nlm.nih.gov/pubmed/38875670 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51020 %T Repeated Human Exposure to Semivolatile Organic Compounds by Inhalation: Novel Protocol for a Nonrandomized Study %A Reale,Elena %A Hopf,Nancy B %A Breider,Florian %A Grandjean,Dominique %A Pirard,Catherine %A Charlier,Corinne %A Koch,Holger M %A Berthet,Aurélie %A Suarez,Guillaume %A Borgatta,Myriam %+ Department of Occupational Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, Epalinges, Lausanne, 1066, Switzerland, 41 213147435, myriam.borgatta@unisante.ch %K DEHP %K diethylhexyl phthalate %K healthy participants %K inhalation exposure %K phthalates %K portable aerosol-generating device %K protocol %K semi-volatile organic compounds %K SVOCs %K toxicokinetics study %K toxicology %D 2023 %7 13.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Semivolatile organic compounds (SVOCs) comprise several different chemical families used mainly as additives in many everyday products. SVOCs can be released into the air as aerosols and deposit on particulate matter during use by dispersion, evaporation, or abrasion. Phthalates are SVOCs of growing concern due to their endocrine-disrupting effects. Human data on the absorption, distribution, metabolism, and excretion (ADME) of these compounds upon inhalation are almost nonexistent. Objective: The goal of this study is to develop a method for repeated inhalation exposures to SVOCs to characterize their ADME in humans. Methods: We will use diethylhexyl phthalate (DEHP), a major indoor air pollutant, as a model SVOC in this novel protocol. The Swiss official Commission on Ethics in Human Research, Canton de Vaud, approved the study on October 14, 2020 (project-ID 2020-01095). Participants (n=10) will be repeatedly exposed (2 short daily exposures over 4 days) to isotope-labeled DEHP (DEHP-d4) to distinguish administered exposures from background exposures. DEHP-d4 aerosols will be generated with a small, portable, aerosol-generating device. Participants will inhale DEHP-d4-containing aerosols themselves with this device at home. Air concentrations of the airborne phthalates will be less than or equal to their occupational exposure limit (OEL). DEHP-d4 and its metabolites will be quantified in urine and blood before, during, and after exposure. Results: Our developed device can generate DEHP-d4 aerosols with diameters of 2.5 μm or smaller and a mean DEHP-d4 mass of 1.4 (SD 0.2) μg per puff (n=6). As of May 2023, we have enrolled 5 participants. Conclusions: The portable device can be used to generate phthalate aerosols for repeated exposure in human studies. International Registered Report Identifier (IRRID): DERR1-10.2196/51020 %M 37831504 %R 10.2196/51020 %U https://www.researchprotocols.org/2023/1/e51020 %U https://doi.org/10.2196/51020 %U http://www.ncbi.nlm.nih.gov/pubmed/37831504 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41862 %T Mortality Risk and Burden From a Spectrum of Causes in Relation to Size-Fractionated Particulate Matters: Time Series Analysis %A Yang,Jun %A Dong,Hang %A Yu,Chao %A Li,Bixia %A Lin,Guozhen %A Chen,Sujuan %A Cai,Dongjie %A Huang,Lin %A Wang,Boguang %A Li,Mengmeng %+ State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, No 651 Dongfeng East Road, Guangzhou 510060, Guangzhou, 510060, China, 86 020 87345679, limm@sysucc.org.cn %K size-fractionated particulate matter %K cause-specific mortality %K cardiovascular disease %K respiratory disease %K neoplasm %K attributable burden %D 2023 %7 9.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There is limited evidence regarding the adverse impact of particulate matters (PMs) on multiple body systems from both epidemiological and mechanistic studies. The association between size-fractionated PMs and mortality risk, as well as the burden of a whole spectrum of causes of death, remains poorly characterized. Objective: We aimed to examine the wide range of susceptible diseases affected by different sizes of PMs. We also assessed the association between PMs with an aerodynamic diameter less than 1 µm (PM1), 2.5 µm (PM2.5), and 10 µm (PM10) and deaths from 36 causes in Guangzhou, China. Methods: Daily data were obtained on cause-specific mortality, PMs, and meteorology from 2014 to 2016. A time-stratified case-crossover approach was applied to estimate the risk and burden of cause-specific mortality attributable to PMs after adjusting for potential confounding variables, such as long-term trend and seasonality, relative humidity, temperature, air pressure, and public holidays. Stratification analyses were further conducted to explore the potential modification effects of season and demographic characteristics (eg, gender and age). We also assessed the reduction in mortality achieved by meeting the new air quality guidelines set by the World Health Organization (WHO). Results: Positive and monotonic associations were generally observed between PMs and mortality. For every 10 μg/m3 increase in 4-day moving average concentrations of PM1, PM2.5, and PM10, the risk of all-cause mortality increased by 2.00% (95% CI 1.08%-2.92%), 1.54% (95% CI 0.93%-2.16%), and 1.38% (95% CI 0.95%-1.82%), respectively. Significant effects of size-fractionated PMs were observed for deaths attributed to nonaccidental causes, cardiovascular disease, respiratory disease, neoplasms, chronic rheumatic heart diseases, hypertensive diseases, cerebrovascular diseases, stroke, influenza, and pneumonia. If daily concentrations of PM1, PM2.5, and PM10 reached the WHO target levels of 10, 15, and 45 μg/m3, 7921 (95% empirical CI [eCI] 4454-11,206), 8303 (95% eCI 5063-11,248), and 8326 (95% eCI 5980-10690) deaths could be prevented, respectively. The effect estimates of PMs were relatively higher during hot months, among female individuals, and among those aged 85 years and older, although the differences between subgroups were not statistically significant. Conclusions: We observed positive and monotonical exposure-response curves between PMs and deaths from several diseases. The effect of PM1 was stronger on mortality than that of PM2.5 and PM10. A substantial number of premature deaths could be preventable by adhering to the WHO’s new guidelines for PMs. Our findings highlight the importance of a size-based strategy in controlling PMs and managing their health impact. %M 37812487 %R 10.2196/41862 %U https://publichealth.jmir.org/2023/1/e41862 %U https://doi.org/10.2196/41862 %U http://www.ncbi.nlm.nih.gov/pubmed/37812487 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43737 %T The Impact of Metabolic Syndrome Risk Factors on Lung Function Impairment: Cross-Sectional Study %A Molina-Luque,Rafael %A Molina-Recio,Guillermo %A de-Pedro–Jiménez,Domingo %A Álvarez Fernández,Carlos %A García–Rodríguez,María %A Romero-Saldaña,Manuel %+ Estilos de Vida, Innovación y Salud, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avd Menéndez Pidal N/N, Córdoba, 14004, Spain, 34 957 21 37 00, en1moreg@uco.es %K cardiometabolic risk factor %K lung function %K metabolic syndrome %K restrictive lung disease %K spirometry %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37669095 %R 10.2196/43737 %U https://publichealth.jmir.org/2023/1/e43737 %U https://doi.org/10.2196/43737 %U http://www.ncbi.nlm.nih.gov/pubmed/37669095 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49032 %T 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 %A de Lima,Fabiano Francisco %A Lunardi,Adriana Claudia %A Pinheiro,David Halen Araújo %A Carvalho-Pinto,Regina Maria %A Stelmach,Rafael %A Giavina‑Bianchi,Pedro %A Agondi,Rosana Câmara %A Carvalho,Celso RF %+ Department of Physical Therapy, School of Medicine, University of São Paulo, Av. Dr Arnaldo 455 – Room 1210, São Paulo, 01246-903, Brazil, 55 11 984153234, cscarval@usp.br %K asthma %K behavioral intervention %K physical activity %K responders %D 2023 %7 31.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37651174 %R 10.2196/49032 %U https://www.researchprotocols.org/2023/1/e49032 %U https://doi.org/10.2196/49032 %U http://www.ncbi.nlm.nih.gov/pubmed/37651174 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47403 %T Joint Effects of Long-Term Exposure to Ambient Fine Particulate Matter and Ozone on Asthmatic Symptoms: Prospective Cohort Study %A Xu,Jiahong %A Shi,Yan %A Chen,Gongbo %A Guo,Yanfei %A Tang,Weiling %A Wu,Cuiling %A Liang,Shuru %A Huang,Zhongguo %A He,Guanhao %A Dong,Xiaomei %A Cao,Ganxiang %A Yang,Pan %A Lin,Ziqiang %A Zhu,Sui %A Wu,Fan %A Liu,Tao %A Ma,Wenjun %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 West, Huangpu Road, Tianhe District, Guangzhou, 510632, China, 86 13826026605, gztt_2002@163.com %K asthma %K joint association %K ozone %K PM2.5 %K population attributable fraction %K air pollution %K long-term exposure %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37535415 %R 10.2196/47403 %U https://publichealth.jmir.org/2023/1/e47403 %U https://doi.org/10.2196/47403 %U http://www.ncbi.nlm.nih.gov/pubmed/37535415 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46741 %T Recovery of Breakthrough Asthma Attacks Treated With Oral Steroids While on Monoclonal Antibody Therapy: Protocol for a Prospective Observational Study (BOOST) %A Howell,Imran %A Mahdi,Mahdi %A Bafadhel,Mona %A Hinks,Timothy S C %A Ramakrishnan,Sanjay %A Melhorn,James %A Jabeen,Maisha %A Pavord,Ian D %+ Nuffield Department of Medicine, University of Oxford, Level 7 E/F, Rm 7400, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom, 44 01865 221753, imran.howell@ndm.ox.ac.uk %K asthma %K monoclonal antibodies %K steroids %K monoclonal antibody %K oral steroid %K asthma attack %K quality of life %K adult %K inflammatory response %K prednisolone treatment %K treatment %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37351918 %R 10.2196/46741 %U https://www.researchprotocols.org/2023/1/e46741 %U https://doi.org/10.2196/46741 %U http://www.ncbi.nlm.nih.gov/pubmed/37351918 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40193 %T Effectiveness of an Intervention Providing Digitally Generated Personalized Feedback and Education on Adherence to Continuous Positive Airway Pressure: Randomized Controlled Trial %A Lacroix,Joyca %A Tatousek,Jan %A Den Teuling,Niek %A Visser,Thomas %A Wells,Charles %A Wylie,Paul %A Rosenberg,Russell %A Bogan,Richard %+ Department of Digital Engagement, Cognition & Behavior, Philips Research, Eindhoven, Netherlands, High Tech Campus 34, Eindhoven, 5656 AE, Netherlands, 31 628041122, joyca.lacroix@philips.com %K therapy adherence %K personalized feedback %K personalized education %K tailored communication %K psychological profile %K continuous positive airway pressure therapy %K CPAP therapy %K obstructive sleep apnea %D 2023 %7 22.5.2023 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 37213195 %R 10.2196/40193 %U https://www.jmir.org/2023/1/e40193 %U https://doi.org/10.2196/40193 %U http://www.ncbi.nlm.nih.gov/pubmed/37213195 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42549 %T Closed Endotracheal Suction Systems for COVID-19: Rapid Review %A Ramírez-Torres,Carmen Amaia %A Rivera-Sanz,Félix %A Sufrate-Sorzano,Teresa %A Pedraz-Marcos,Azucena %A Santolalla-Arnedo,Ivan %+ Health and Care Research Group, University of La Rioja, 88, Duquesa de la Victoria, Logroño, 26004, Spain, 34 941299050, caramit@unirioja.es %K endotracheal suctioning %K closed suction system %K rapid review %K suction %K mechanical ventilation %K COVID-19 %K intensive care unit %K health intervention %K endotracheal %K patient care %K healthcare %K ventilator %K health benefit %D 2023 %7 10.1.2023 %9 Review %J Interact J Med Res %G English %X Background: The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. Objective: This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. Methods: A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words “endotracheal,” “suction,” and “closed system.” Results: A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. Conclusions: Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time—though it does produce the greatest number of mucosal occlusions—and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines. %M 36548950 %R 10.2196/42549 %U https://www.i-jmr.org/2023/1/e42549 %U https://doi.org/10.2196/42549 %U http://www.ncbi.nlm.nih.gov/pubmed/36548950 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e40289 %T Association of Continuously Measured Vital Signs With Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort Study %A van Goor,Harriet M R %A Vernooij,Lisette M %A Breteler,Martine J M %A Kalkman,Cor J %A Kaasjager,Karin A H %A van Loon,Kim %+ Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 887567967, h.m.r.vangoor-3@umcutrecht.nl %K continuous monitoring %K vital sign monitoring %K COVID-19 %K general ward %K vital sign %K monitoring %K respiration %K data %K respiratory insufficiency %K cohort study %K respiratory rate %K heart rate %K oxygen %K clinical %D 2022 %7 23.11.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Continuous monitoring of vital signs has the potential to assist in the recognition of deterioration of patients admitted to the general ward. However, methods to efficiently process and use continuously measured vital sign data remain unclear. Objective: The aim of this study was to explore methods to summarize continuously measured vital sign data and evaluate their association with respiratory insufficiency in COVID-19 patients at the general ward. Methods: In this retrospective cohort study, we included patients admitted to a designated COVID-19 cohort ward equipped with continuous vital sign monitoring. We collected continuously measured data of respiratory rate, heart rate, and oxygen saturation. For each patient, 7 metrics to summarize vital sign data were calculated: mean, slope, variance, occurrence of a threshold breach, number of episodes, total duration, and area above/under a threshold. These summary measures were calculated over timeframes of either 4 or 8 hours, with a pause between the last data point and the endpoint (the “lead”) of 4, 2, 1, or 0 hours, and with 3 predefined thresholds per vital sign. The association between each of the summary measures and the occurrence of respiratory insufficiency was calculated using logistic regression analysis. Results: Of the 429 patients that were monitored, 334 were included for analysis. Of these, 66 (19.8%) patients developed respiratory insufficiency. Summarized continuously measured vital sign data in timeframes close to the endpoint showed stronger associations than data measured further in the past (ie, lead 0 vs 1, 2, or 4 hours), and summarized estimates over 4 hours of data had stronger associations than estimates taken over 8 hours of data. The mean was consistently strongly associated with respiratory insufficiency for the three vital signs: in a 4-hour timeframe without a lead, the standardized odds ratio for heart rate, respiratory rate, and oxygen saturation was 2.59 (99% CI 1.74-4.04), 5.05 (99% CI 2.87-10.03), and 3.16 (99% CI 1.78-6.26), respectively. The strength of associations of summary measures varied per vital sign, timeframe, and lead. Conclusions: The mean of a vital sign showed a relatively strong association with respiratory insufficiency for the majority of vital signs and timeframes. The type of vital sign, length of the timeframe, and length of the lead influenced the strength of associations. Highly associated summary measures and their combinations could be used in a clinical prediction score or algorithm for an automatic alarm system. %M 36256803 %R 10.2196/40289 %U https://www.i-jmr.org/2022/2/e40289 %U https://doi.org/10.2196/40289 %U http://www.ncbi.nlm.nih.gov/pubmed/36256803 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33389 %T Acceptability of Serious Games in Pediatric Asthma Education and Self-management: Pilot Study %A Silva-Lavigne,Nicole %A Valderrama,Alena %A Pelaez,Sandra %A Bransi,Myriam %A Balli,Fabio %A Gervais,Yannick %A Gaudy,Thomas %A Tse,Sze Man %+ Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada, 1 514 345 4931 ext 5409, sze.man.tse@umontreal.ca %K asthma %K pediatrics %K video games %K eHealth %K self-management %D 2022 %7 7.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Asthma is the most common chronic pediatric disease. Despite existing tools to manage asthma, 40%-55% of children with asthma experience uncontrolled asthma. Serious games (SGs) represent a novel approach in promoting asthma education and self-management for children. Objective: In this qualitative pilot study with an embedded quantitative design, we aim to use focus groups and questionnaires to describe the perceived role of SGs in different aspects of asthma self-management by children and their parents. These aspects include asthma perception and knowledge, the impact of asthma and barriers to asthma self-management, and the support system for asthma self-management. Methods: A total of 5 children with asthma and their parents were invited to participate in an organized gaming session. Children and their parents completed a pregaming questionnaire on their medical history and asthma knowledge. Then, they were invited to test 4 original SG prototypes, after which the children answered a postgaming questionnaire on their asthma knowledge and perception of the SGs. Children and their parents subsequently participated in parallel focus groups, which were video-recorded or audio-recorded, transcribed verbatim, and analyzed by reaching consensus among members of the research team. Results: The mean age of the children was 10.3 (SD 1.5) years, with 20% (1/5) of the children being male. Qualitative data from the transcripts were coded into three separate domains: asthma self-management perception and knowledge, impact of asthma and barriers to asthma self-management, and support system for asthma self-management. We specifically explored the perceived roles of SGs within each domain. A key takeaway message was identified for each of these three domains: heterogeneity of asthma knowledge and the ability of SGs to encourage knowledge transfer through games, consequences and limitations of asthma and the ability of SGs to allow for identification and management of real-life situations through games, and insufficient support system and the ability of SGs to encourage playing with others for support and shared knowledge. Conclusions: Our pilot study explored the role of SGs in the self-management of asthma, as perceived by children and their parents. Our findings support the acceptability of SGs in asthma education and self-management in pediatrics and the necessity for future development in this field. %M 35389354 %R 10.2196/33389 %U https://pediatrics.jmir.org/2022/2/e33389 %U https://doi.org/10.2196/33389 %U http://www.ncbi.nlm.nih.gov/pubmed/35389354 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e24592 %T Pulmonary Screening Practices of Otolaryngology–Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study %A Alnefaie,Majed %A Alamri,Abdullah %A Saeedi,Asalh %A Althobaiti,Awwadh %A Alosaimi,Shahad %A Alqurashi,Yousuf %A Marzouki,Hani %A Merdad,Mazin %+ King Fahad Armed Forces Hospital, Medical Services of The Armed Forces, Al Kurnaysh Rd, Al Andalus, Jeddah, 23311, Saudi Arabia, 966 500900450, Majed.n.md@gmail.com %K squamous cell carcinoma of head and neck %K lung neoplasms %K radiography %K otolaryngology %K surgeons %K survey %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 35302511 %R 10.2196/24592 %U https://www.i-jmr.org/2022/1/e24592 %U https://doi.org/10.2196/24592 %U http://www.ncbi.nlm.nih.gov/pubmed/35302511 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30091 %T Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study %A Hawthorne,Grace %A Greening,Neil %A Esliger,Dale %A Briggs-Price,Samuel %A Richardson,Matthew %A Chaplin,Emma %A Clinch,Lisa %A Steiner,Michael C %A Singh,Sally J %A Orme,Mark W %+ Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester National Health Service Trust, Groby Road, Leicester, LE3 9QP, United Kingdom, 44 116258 ext 3035, grace.france1@nhs.net %K chronic obstructive pulmonary disease %K digital health %K physical activity %K respiratory rate %K wearable technology %K wearable device %K vital signs monitor %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 35171101 %R 10.2196/30091 %U https://humanfactors.jmir.org/2022/1/e30091 %U https://doi.org/10.2196/30091 %U http://www.ncbi.nlm.nih.gov/pubmed/35171101 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31448 %T Multisensory Home-Monitoring in Individuals With Stable Chronic Obstructive Pulmonary Disease and Asthma: Usability Study of the CAir-Desk %A Kohlbrenner,Dario %A Clarenbach,Christian F %A Ivankay,Adam %A Zimmerli,Lukas %A Gross,Christoph S %A Kuhn,Manuel %A Brunschwiler,Thomas %+ Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 43 253 08 42, dario.kohlbrenner@usz.ch %K home monitoring %K digital health %K respiratory disease %K usability %K feasibility %K adherence %K disease management %K chronic disease %K patient monitoring %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 35171107 %R 10.2196/31448 %U https://humanfactors.jmir.org/2022/1/e31448 %U https://doi.org/10.2196/31448 %U http://www.ncbi.nlm.nih.gov/pubmed/35171107 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e25690 %T Assessment of Personal Exposure to Particulate Air Pollution in Different Microenvironments and Traveling by Several Modes of Transportation in Bogotá, Colombia: Protocol for a Mixed Methods Study (ITHACA) %A Malagon-Rojas,Jeadran N %A Pinzón-Silva,Diana Carolina %A Parra,Eliana L %A Lagos M,Luisa F %A Toloza-Perez,Yesith Guillermo %A Hernández Florez,Luis Jorge %A Morales Betancourt,Ricardo %A Romero,Sol Angie %A Ríos Cabra,Ana Paola %A Sarmiento,Olga L %+ Grupo de Salud Ambiental y Laboral, Instituto Nacional de Salud, Ac. 26 #5120, Bogotá, 111311, Colombia, 57 2207700 ext 1476, jmalagon@ins.gov.co %K air pollution %K particulate matter %K black carbon %K mixed methods %K toxic %K air quality %K respiratory %K pollution %K pollutants %K microenvironments %K Bogota %K respiratory disease %K exposure to air pollutants %K air contamination %D 2022 %7 31.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Air pollution in most countries exceeds the levels recommended by the World Health Organization, causing up to one-third of deaths due to noncommunicable diseases. Fine particulate matter (PM2.5) and black carbon (BC) from mobile sources are the main contaminants. Objective: The aim of this study is to assess the relationship of exposure to air pollutants (PM2.5 and BC) in microenvironments according to respiratory health and physical activity in users traveling by different types of transportation in Bogotá, Colombia. Methods: A mixed methods study based on a convergent parallel design will be performed with workers and students. The sample will include 350 healthy transport users traveling by different urban transportation modes in three main routes in Bogotá. The study is broken down into two components: (1) a descriptive qualitative component focused on assessing the individual perception of air pollution using semistructured interviews; and (2) a cross-sectional study measuring the individual exposure to PM2.5 and BC using portable instruments (DustTrak and microAeth, respectively), pulmonary function by spirometry, and physical activity with accelerometry. The analysis will include concurrent triangulation and logistic regression. Results: The findings will be useful for the conception, design, and decision-making process in the sectors of health and mobility from public, academy, and private perspectives. This study includes personal measurements of PM2.5 and BC during typical trips in the city to assess the exposure to these contaminants in the major roadways in real time. The study further compares the performance of two different lung tests to identify possible short-term respiratory effects. As a limitation, the protocol will include participants from different institutions in the city, which are not necessarily representative of all healthy populations in Bogotá. In this sense, it is not possible to draw causation conclusions. Moreover, a convergent parallel design could be especially problematic concerning integration because such a design often lacks a clear plan for making a connection between the two sets of results, which may not be well connected. Nevertheless, this study adopts a procedure for how to integrate qualitative and quantitative data in the interpretation of the results and a multilevel regression. The time that participants must live in the city will be considered; this will be controlled in the stratified analysis. Another limitation is the wide age range and working status of the participants. Regional pollution levels and episodes (PM2.5) will be handled as confounding variables. The study is currently in the enrollment phase of the participants. Measurements have been made on 300 participants. Pandemic conditions affected the study schedule; however, the results are likely to be obtained by late 2022. Conclusions: This study investigates the exposure to air pollutants in microenvironments in Bogotá, Colombia. To our knowledge, this is the first mixed methods study focusing on PM2.5, BC, and respiratory health effects in a city over 2 meters above sea level. This study will provide an integration of air pollution exposure variables and respiratory health effects in different microenvironments. International Registered Report Identifier (IRRID): PRR1-10.2196/25690 %M 35099404 %R 10.2196/25690 %U https://www.researchprotocols.org/2022/1/e25690 %U https://doi.org/10.2196/25690 %U http://www.ncbi.nlm.nih.gov/pubmed/35099404 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28366 %T Machine Learning Approaches for Predicting Difficult Airway and First-Pass Success in the Emergency Department: Multicenter Prospective Observational Study %A Yamanaka,Syunsuke %A Goto,Tadahiro %A Morikawa,Koji %A Watase,Hiroko %A Okamoto,Hiroshi %A Hagiwara,Yusuke %A Hasegawa,Kohei %+ Department of Clinical Epidemiology & Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5841 1887, tag695@mail.harvard.edu %K intubation %K machine learning %K difficult airway %K first-pass success %D 2022 %7 25.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: There is still room for improvement in the modified LEMON (look, evaluate, Mallampati, obstruction, neck mobility) criteria for difficult airway prediction and no prediction tool for first-pass success in the emergency department (ED). Objective: We applied modern machine learning approaches to predict difficult airways and first-pass success. Methods: In a multicenter prospective study that enrolled consecutive patients who underwent tracheal intubation in 13 EDs, we developed 7 machine learning models (eg, random forest model) using routinely collected data (eg, demographics, initial airway assessment). The outcomes were difficult airway and first-pass success. Model performance was evaluated using c-statistics, calibration slopes, and association measures (eg, sensitivity) in the test set (randomly selected 20% of the data). Their performance was compared with the modified LEMON criteria for difficult airway success and a logistic regression model for first-pass success. Results: Of 10,741 patients who underwent intubation, 543 patients (5.1%) had a difficult airway, and 7690 patients (71.6%) had first-pass success. In predicting a difficult airway, machine learning models—except for k-point nearest neighbor and multilayer perceptron—had higher discrimination ability than the modified LEMON criteria (all, P≤.001). For example, the ensemble method had the highest c-statistic (0.74 vs 0.62 with the modified LEMON criteria; P<.001). Machine learning models—except k-point nearest neighbor and random forest models—had higher discrimination ability for first-pass success. In particular, the ensemble model had the highest c-statistic (0.81 vs 0.76 with the reference regression; P<.001). Conclusions: Machine learning models demonstrated greater ability for predicting difficult airway and first-pass success in the ED. %M 35076398 %R 10.2196/28366 %U https://www.i-jmr.org/2022/1/e28366 %U https://doi.org/10.2196/28366 %U http://www.ncbi.nlm.nih.gov/pubmed/35076398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31224 %T A Wi-Fi–Based Mask-Type Laryngoscope for Telediagnosis During the COVID-19 Pandemic: Instrument Validation Study %A Moon,Youngjin %A Hyun,Jaeho %A Oh,Jeongmin %A Lee,Kwanhee %A Lee,Yoon Se %A Kim,Jun Ki %+ Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, Republic of Korea, 82 230108619, kim@amc.seoul.kr %K smartphone-based endoscope %K mobile health %K telediagnosis %K continuum segment %K articulable endoscope %K COVID-19 %K point-of-care diagnostics %K validation %K medical device %K endoscope %K sensor %K innovation %K video %K transmission %D 2021 %7 18.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Owing to the COVID-19 pandemic, social distancing has become mandatory. Wireless endoscopy in contactless examinations promises to protect health care workers and reduce viral spread. Objective: This study aimed to introduce a contactless endoscopic diagnosis system using a wireless endoscope resembling a mask. Methods: The Wi-Fi–based contactless mask endoscopy system comprises a disposable endoscope and a controller. First, the effective force applied by the tip during insertion was evaluated in a simple transoral model consisting of a force sensor on a simulated oropharynx wall. Second, the delay in video streaming was evaluated by comparing the frame rate and delays between a movement and its image over direct and Wi-Fi connections. Third, the system was applied to a detailed laryngopharyngeal tract phantom. Results: The smartphone-controlled wireless endoscopy system was successfully evaluated. The mean, maximum, and minimum collision forces against the wall of the transoral model were 296 mN (30 gf), 363 mN (37 gf), and 235 mN (24 gf), respectively. The delay resulting from the wireless connection was 0.72 seconds. Using the phantom, an inexperienced user took around 1 minute to orient the endoscope to a desired area via the app. Conclusions: Device articulation does not pose a significant risk of laryngopharyngeal wall penetration, and latency does not significantly impede its use. Contactless wireless video streaming was successful within the access point range regardless of the presence of walls. The mask endoscope can be controlled and articulated wirelessly, minimizing contact between patients and device operators. By minimizing contact, the device can protect health care workers from infectious viruses like the coronavirus. %M 34518154 %R 10.2196/31224 %U https://www.jmir.org/2021/10/e31224 %U https://doi.org/10.2196/31224 %U http://www.ncbi.nlm.nih.gov/pubmed/34518154 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30916 %T The Accuracy of Tidal Volume Measured With a Smart Shirt During Tasks of Daily Living in Healthy Subjects: Cross-sectional Study %A Mannée,Denise %A de Jongh,Frans %A van Helvoort,Hanneke %+ Department of Pulmonary Disease, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 24 361 1111, denise.mannee@radboudumc.nl %K telemonitoring %K Hexoskin smart shirt %K smart textiles %K textile sensors %K accuracy %K healthy subjects %K calibration %K tidal volume %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Hexoskin is a smart shirt that can take continuous and objective measurements and could be part of a potential telemonitoring system. Objective: The aim of this study was to determine the accuracy of the calibrated Hexoskin in measuring tidal volumes (TVs) in comparison to spirometry during various tasks. Methods: In a cross-sectional study, the TV of 15 healthy subjects was measured while performing seven tasks using spirometry and the Hexoskin. These tasks were performed during two sessions; between sessions, all equipment was removed. A one-time spirometer-based calibration per task was determined in session 1 and applied to the corresponding task in both sessions. Bland-Altman analysis was used to determine the agreement between TV that was measured with the Hexoskin and that measured with spirometry. A priori, we determined that the bias had to be less than ±5%, with limits of agreement (LOA) of less than ±15%. Lung volumes were measured and had to have LOA of less than ±0.150 L. Results: In the first session, all tasks had a median bias within the criteria (±0.6%). In the second session, biases were ±8.9%; only two tasks met the criteria. In both sessions, LOA were within the criteria in six out of seven tasks (±14.7%). LOA of lung volumes were greater than 0.150 L. Conclusions: The Hexoskin was able to correctly measure TV in healthy subjects during various tasks. However, after reapplication of the equipment, calibration factors were not able to be reused to obtain results within the determined boundaries. Trial Registration: Netherlands Trial Register NL6934; https://www.trialregister.nl/trial/6934 %M 34661546 %R 10.2196/30916 %U https://formative.jmir.org/2021/10/e30916 %U https://doi.org/10.2196/30916 %U http://www.ncbi.nlm.nih.gov/pubmed/34661546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27298 %T Brain Mechanisms of Virtual Reality Breathing Versus Traditional Mindful Breathing in Pain Modulation: Observational Functional Near-infrared Spectroscopy Study %A Hu,Xiao-Su %A Beard,Katherine %A Sherbel,Mary Catherine %A Nascimento,Thiago D %A Petty,Sean %A Pantzlaff,Eddie %A Schwitzer,David %A Kaciroti,Niko %A Maslowski,Eric %A Ashman,Lawrence M %A Feinberg,Stephen E %A DaSilva,Alexandre F %+ Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, 205 Zina Pitcher Pl, room 1021, Ann Arbor, MI, 48109-5720, United States, 1 734 615 3807, adasilva@umich.edu %K virtual reality breathing %K traditional mindful breathing %K pain %K functional near-infrared spectroscopy %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Pain is a complex experience that involves sensory-discriminative and cognitive-emotional neuronal processes. It has long been known across cultures that pain can be relieved by mindful breathing (MB). There is a common assumption that MB exerts its analgesic effect through interoception. Interoception refers to consciously refocusing the mind’s attention to the physical sensation of internal organ function. Objective: In this study, we dissect the cortical analgesic processes by imaging the brains of healthy subjects exposed to traditional MB (TMB) and compare them with another group for which we augmented MB to an outside sensory experience via virtual reality breathing (VRB). Methods: The VRB protocol involved in-house–developed virtual reality 3D lungs that synchronized with the participants’ breathing cycles in real time, providing them with an immersive visual-auditory exteroception of their breathing. Results: We found that both breathing interventions led to a significant increase in pain thresholds after week-long practices, as measured by a thermal quantitative sensory test. However, the underlying analgesic brain mechanisms were opposite, as revealed by functional near-infrared spectroscopy data. In the TMB practice, the anterior prefrontal cortex uniquely modulated the premotor cortex. This increased its functional connection with the primary somatosensory cortex (S1), thereby facilitating the S1-based sensory-interoceptive processing of breathing but inhibiting its other role in sensory-discriminative pain processing. In contrast, virtual reality induced an immersive 3D exteroception with augmented visual-auditory cortical activations, which diminished the functional connection with the S1 and consequently weakened the pain processing function of the S1. Conclusions: In summary, our study suggested two analgesic neuromechanisms of VRB and TMB practices—exteroception and interoception—that distinctively modulated the S1 processing of the ascending noxious inputs. This is in line with the concept of dualism (Yin and Yang). %M 34636731 %R 10.2196/27298 %U https://www.jmir.org/2021/10/e27298 %U https://doi.org/10.2196/27298 %U http://www.ncbi.nlm.nih.gov/pubmed/34636731 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28873 %T Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study %A Ranjan,Yatharth %A Althobiani,Malik %A Jacob,Joseph %A Orini,Michele %A Dobson,Richard JB %A Porter,Joanna %A Hurst,John %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 02078480924, amos.folarin@kcl.ac.uk %K mHealth %K COVID-19 %K mobile health %K remote monitoring %K wearables %K internet of things %K lung diseases %K respiratory health %K mental health %K cardiopulmonary diseases %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34319235 %R 10.2196/28873 %U https://www.researchprotocols.org/2021/10/e28873 %U https://doi.org/10.2196/28873 %U http://www.ncbi.nlm.nih.gov/pubmed/34319235 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24005 %T Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey Study %A Spitzer,Kerry A %A Heineman,Brent %A Jewell,Marcella %A Moran,Michael %A Lindenauer,Peter K %+ Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, 3rd Fl, 3601 Main St, Springfield, MA, 01199, United States, 1 413 794 7909, kerry.spitzer@baystatehealth.org %K asthma %K social media %K Instagram %K social support %K digital storytelling %K young adult %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. Objective: In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram. Methods: We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States. Results: Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9%) were excluded and 110 (24.1%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56% (46/82) were female, 65% (53/82) were non-Hispanic White, and 72% (59/82) had at least some college education. The majority of respondents (67/82, 82%) indicated that they would be willing to participate in the proposed study. Conclusions: Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection. %M 34591019 %R 10.2196/24005 %U https://formative.jmir.org/2021/9/e24005 %U https://doi.org/10.2196/24005 %U http://www.ncbi.nlm.nih.gov/pubmed/34591019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e20131 %T The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study %A McKinstry,Brian %A Alexander,Helen %A Maxwell,Gabriela %A Blaikie,Lesley %A Patel,Sameer %A Guthrie,Bruce %A , %+ Centre for Informatics, Usher Institute, The University of Edinburgh, 17 Burnside Park, Edinburgh, EH165AG, United Kingdom, 44 07803268660, brian.mckinstry@ed.ac.uk %K telemonitoring %K eHealth %K COVID-19 %K primary care %D 2021 %7 27.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: Most people with COVID-19 self-manage at home. However, the condition can deteriorate quickly, and some people may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this. Objective: The aim of this study was to design, implement, and evaluate a telemonitoring system for people with COVID-19 who are self-managing at home and are considered at significant risk of deterioration. Methods: A multidisciplinary team developed a telemonitoring protocol using a commercial platform to record symptoms, pulse oximetry, and temperature. If symptoms or physiological measures breached targets, patients were alerted and asked to phone for an ambulance (red alert) or for advice (amber alert). Patients attending COVID-19 assessment centers, who were considered fit for discharge but at risk of deterioration, were shown how to use a pulse oximeter and the monitoring system, which they were to use twice daily for 2 weeks. Patients could interact with the system via app, SMS, or touch-tone phone. Written guidance on alerts was also provided. Following consent, patient data on telemonitoring usage and alerts were linked to data on the use of service resources. Subsequently, patients who had either used or not used the telemonitoring service, including those who had not followed advice to seek help, agreed to brief telephone interviews to explore their views on, and how they had interacted with, the telemonitoring system. Interviews were recorded and analyzed thematically. Professionals involved in the implementation were sent an online questionnaire asking them about their perceptions of the service. Results: We investigated the first 116 patients who used the service. Of these patients, 71 (61.2%) submitted data and the remainder (n=45, 38.8%) chose to self-monitor without electronic support. Of the 71 patients who submitted data, 35 (49%) received 152 alerts during their 2-week observation. A total of 67 red alerts were for oxygen saturation (SpO2) levels of ≤93%, and 15 red alerts were because patients recorded severe breathlessness. Out of 71 patients, 14 (20%) were admitted to hospital for an average stay of 3.6 (SD 4.5) days. Of the 45 who used written guidance alone, 7 (16%) were admitted to hospital for an average stay of 4.0 (SD 4.2) days and 1 (2%) died. Some patients who were advised to seek help did not do so, some because parameters improved on retesting and others because they felt no worse than before. All patients found self-monitoring to be reassuring. Of the 11 professionals who used the system, most found it to be useful and easy to use. Of these 11 professionals, 5 (45%) considered the system “very safe,” 3 (27%) thought it “could be safer,” and 3 (27%) wished to have more experience with it before deciding. In total, 2 (18%) felt that SpO2 trigger thresholds were too high. Conclusions: Supported self-monitoring of patients with COVID-19 at home is reassuring to patients, is acceptable to clinicians, and can detect important signs of deterioration. Worryingly, some patients, because they felt well, occasionally ignored important signs of deterioration. It is important, therefore, to emphasize the importance of the early investigation and treatment of asymptomatic hypoxia at the time when patients are initiated and in the warning messages that are sent to patients. %M 34449404 %R 10.2196/20131 %U https://formative.jmir.org/2021/9/e20131 %U https://doi.org/10.2196/20131 %U http://www.ncbi.nlm.nih.gov/pubmed/34449404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27447 %T Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach %A Kim,Sunyoung %A Park,Yunoh %A Ackerman,Matthew K %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, United States, 1 848 932 7585, sunyoung.kim@rutgers.edu %K asthma %K children %K indoor air quality %K mobile app %K smartphone %K user-centered design %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. %M 34550080 %R 10.2196/27447 %U https://formative.jmir.org/2021/9/e27447 %U https://doi.org/10.2196/27447 %U http://www.ncbi.nlm.nih.gov/pubmed/34550080 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28028 %T Semisupervised Deep Learning Techniques for Predicting Acute Respiratory Distress Syndrome From Time-Series Clinical Data: Model Development and Validation Study %A Lam,Carson %A Tso,Chak Foon %A Green-Saxena,Abigail %A Pellegrini,Emily %A Iqbal,Zohora %A Evans,Daniel %A Hoffman,Jana %A Calvert,Jacob %A Mao,Qingqing %A Das,Ritankar %+ Dascena, Inc, Suite B, Private Mailbox 65148, 12333 Sowden Rd, Houston, TX, 77080, United States, 1 7149326188, clam@dascena.com %K acute respiratory distress syndrome %K COVID-19 %K semisupervised learning %K deep learning %K machine learning %K algorithm %K prediction %K decision support %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A high number of patients who are hospitalized with COVID-19 develop acute respiratory distress syndrome (ARDS). Objective: In response to the need for clinical decision support tools to help manage the next pandemic during the early stages (ie, when limited labeled data are present), we developed machine learning algorithms that use semisupervised learning (SSL) techniques to predict ARDS development in general and COVID-19 populations based on limited labeled data. Methods: SSL techniques were applied to 29,127 encounters with patients who were admitted to 7 US hospitals from May 1, 2019, to May 1, 2021. A recurrent neural network that used a time series of electronic health record data was applied to data that were collected when a patient’s peripheral oxygen saturation level fell below the normal range (<97%) to predict the subsequent development of ARDS during the remaining duration of patients’ hospital stay. Model performance was assessed with the area under the receiver operating characteristic curve and area under the precision recall curve of an external hold-out test set. Results: For the whole data set, the median time between the first peripheral oxygen saturation measurement of <97% and subsequent respiratory failure was 21 hours. The area under the receiver operating characteristic curve for predicting subsequent ARDS development was 0.73 when the model was trained on a labeled data set of 6930 patients, 0.78 when the model was trained on the labeled data set that had been augmented with the unlabeled data set of 16,173 patients by using SSL techniques, and 0.84 when the model was trained on the entire training set of 23,103 labeled patients. Conclusions: In the context of using time-series inpatient data and a careful model training design, unlabeled data can be used to improve the performance of machine learning models when labeled data for predicting ARDS development are scarce or expensive. %M 34398784 %R 10.2196/28028 %U https://formative.jmir.org/2021/9/e28028 %U https://doi.org/10.2196/28028 %U http://www.ncbi.nlm.nih.gov/pubmed/34398784 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e26350 %T 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 %A De Vos,Ruth %A Brown,Thomas %A Longstaff,Jayne %A Lomax,Mitch %A Mackenzie,Heather %A Hicks,Alexander %A Rupani,Hitasha %A Gates,Jessica %A Fox,Lauren %A Wiffen,Laura %A Chauhan,Anoop J %+ Portsmouth Hospitals University NHS Trust, Research and Innovation Department, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, United Kingdom, 44 2392286000 ext 3125, ruth.devos@porthosp.nhs.uk %K inhaler %K inhaler technique %K inhaler technique error %K asthma %K COPD %D 2021 %7 27.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34448728 %R 10.2196/26350 %U https://www.researchprotocols.org/2021/8/e26350 %U https://doi.org/10.2196/26350 %U http://www.ncbi.nlm.nih.gov/pubmed/34448728 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 3 %P e22524 %T Infrared Thermal Imaging of Patients With Acute Upper Respiratory Tract Infection: Mixed Methods Analysis %A Zhang,Zuopeng %A Cao,ZanFeng %A Deng,Fangge %A Yang,Zhanzheng %A Ma,Sige %A Guan,Qianting %A Liu,Rong %A He,Zhuosen %+ State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Lu, Guangzhou City, Guangdong Province, China, Guangzhou, 510120, China, 86 13234006746, fangge256@sina.com %K acute upper respiratory tract %K infrared thermography %K qualitative study %K quantitative study %D 2021 %7 19.8.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: Upper respiratory tract infection is a common disease of the respiratory system. Its incidence is very high, and it can even cause pandemics. Infrared thermal imaging (IRTI) can provide an objective and quantifiable reference for the visual diagnosis of people with acute respiratory tract infection, and it can function as an effective indicator of clinical diagnosis. Objective: The aims of this study are to observe and analyze the infrared expression location and characteristics of patients with acute upper respiratory tract infection through IRTI technology and to clearly express the quantification of temperature, analyze the role of IRTI in acute upper respiratory tract diagnostic research, and understand the impact of IRTI in qualitative and quantitative research. Methods: From December 2018 to February 2019, 154 patients with acute upper respiratory tract infection were randomly selected from the emergency department of the First Affiliated Hospital of Guangzhou Medical University. Among these patients, 73 were men and 81 were women. The subjects were divided into two groups according to the presence of fever, namely, fever and nonfever groups. Qualitative and quantitative analyses of the infrared thermal images were performed to compare the results before and after application of the technology. Results: Using the method described in this paper, through the analysis of experimental data, we elucidated the role of IRTI in the diagnosis of acute upper respiratory tract infection, and we found that qualitative and quantitative IRTI analyses play important roles. Through the combination of theory and experimental data, the IRTI analysis showed good results in identifying acute upper respiratory tract infection. Conclusions: IRTI technology plays an important role in identifying the infrared expression location and characteristics of patients with acute upper respiratory tract infection as well as in the quantification of clear expression of body temperature, and it provides an objective and quantifiable reference basis for elucidating the pathogenesis of these patients. %M 34420912 %R 10.2196/22524 %U https://www.i-jmr.org/2021/3/e22524 %U https://doi.org/10.2196/22524 %U http://www.ncbi.nlm.nih.gov/pubmed/34420912 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30500 %T Muscular Assessment in Patients With Severe Obstructive Sleep Apnea Syndrome: Protocol for a Case-Control Study %A Borrmann,Paz Francisca %A O'Connor-Reina,Carlos %A Ignacio,Jose M %A Rodriguez Ruiz,Elisa %A Rodriguez Alcala,Laura %A Dzembrovsky,Florencia %A Baptista,Peter %A Garcia Iriarte,Maria T %A Casado Alba,Carlos %A Plaza,Guillermo %+ Otorhinolaryngology Department, Hospital Quironsalud Marbella, Avda Severo Ochoa 22, Marbella (Malaga), Spain, 34 952774200, coconnor@us.es %K myofunctional therapy %K sleep apnea %K sleep disordered breathing %K speech therapy %K phenotype %K sleep %K therapy %K protocol %K muscle %K assessment %K case study %K exercise %K airway %K respiratory %D 2021 %7 6.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Myofunctional therapy is currently a reasonable therapeutic option to treat obstructive sleep apnea-hypopnea syndrome (OSAHS). This therapy is based on performing regular exercises of the upper airway muscles to increase their tone and prevent their collapse. Over the past decade, there has been an increasing number of publications in this area; however, to our knowledge, there are no studies focused on patients who can most benefit from this therapy. Objective: This protocol describes a case-control clinical trial aimed at determining the muscular features of patients recently diagnosed with severe OSAHS compared with those of healthy controls. Methods: Patients meeting set criteria will be sequentially enrolled up to a sample size of 40. Twenty patients who meet the inclusion criteria for controls will also be evaluated. Patients will be examined by a qualified phonoaudiologist who will take biometric measurements and administer the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES), Friedman Staging System, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index questionnaires. Measures of upper airway muscle tone will also be performed using the Iowa Oral Performance Instrument and tongue digital spoon devices. Evaluation will be recorded and reevaluated by a second specialist to determine concordance between observers. Results: A total of 60 patients will be enrolled. Both the group with severe OSAHS (40 patients) and the control group (20 subjects) will be assessed for differences between upper airway muscle tone and OMES questionnaire responses. Conclusions: This study will help to determine muscle patterns in patients with severe OSAHS and can be used to fill the gap currently present in the assessment of patients suitable to be treated with myofunctional therapy. Trial Registration: ISRCTN Registry ISRCTN12596010; https://www.isrctn.com/ISRCTN12596010 International Registered Report Identifier (IRRID): PRR1-10.2196/30500 %M 34115605 %R 10.2196/30500 %U https://www.researchprotocols.org/2021/8/e30500 %U https://doi.org/10.2196/30500 %U http://www.ncbi.nlm.nih.gov/pubmed/34115605 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28624 %T The Efficacy of the Dyson Air Purifier in Improving Asthma Control: Protocol for a Single-Center, Investigator-Led, Randomized, Double-Blind, Placebo-Controlled Trial %A Fong,Wei Chern Gavin %A Grevatt,Susan %A Potter,Stephen %A Tidbury,Tracey %A Kadalayil,Latha %A Bennett,Kaisha %A Larsson,Maria %A Nicolas,Frédéric %A Kurukulaaratchy,Ramesh %A Arshad,Syed Hasan %+ David Hide Asthma and Allergy Research Centre, Isle Of Wight NHS Trust, Newport, , United Kingdom, 44 (0) 1983 534373, S.H.Arshad@soton.ac.uk %K air purifier %K asthma %K clinical trial %K air pollution %K allergens %K respiratory function tests %K bronchial provocation tests %D 2021 %7 27.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Indoor air quality has been shown to influence asthma control and outcomes. Air purifiers and high-efficiency particulate air filtration devices can improve indoor air quality by reducing the indoor levels of air pollution and allergens. However, the influence of this improved indoor air quality on asthma control remains unclear; hence, randomized controlled trials are needed to further elucidate this phenomenon. Objective: This study aims to investigate the effect of reducing the levels of allergens and pollutants in the bedroom and living room through the use of Dyson air purifiers (Dyson Pure Cool) on asthma control. Methods: This is an 18-month long, investigator-led, randomized, double-blinded, placebo-controlled, single-center trial. Subjects will be randomized in a 1:1 ratio to active or placebo Dyson filters. The primary outcome is the change in the scores of Asthma Control Questionnaire 6 and Asthma-specific Quality of Life Questionnaire from baseline. Secondary outcomes include changes in lung function (forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity ratio, and midexpiratory flows), peak expiratory flow measurements, airway hyperresponsiveness (assessed by methacholine bronchial challenge), fractional exhaled nitric oxide, and indoor air pollutant levels. The sample size will be 50 subjects, and all subjects will have a confirmed diagnosis of mild persistent to moderate persistent asthma along with an Asthma Control Questionnaire 6 score of >1.5. Results: This study was approved by the West Midlands Research Ethics Committee (18/WM/0277). The study results will be published in peer-reviewed scientific journals; presented at relevant scientific conferences; and shared in plain English with participants in our newsletters, in our clinics, and via the David Hide Asthma and Allergy Research Centre website. Our trial began in September 2019 and is expected to end in August 2021. Conclusions: This is a double-blinded, placebo-controlled, randomized, investigator-led study to investigate the efficacy of a novel air purifier in improving asthma control in adults. The trial period of 18 months will facilitate the collection of robust data and will therefore generate clear signals. However, this extended trial duration may lead to patient withdrawal. Furthermore, this trial is conducted at a single center and in a location with a homogenous cohort of people, which may affect translatability. Nonetheless, it is hoped that the findings of this trial may help further inform clinicians regarding the utility of this novel device as an adjunct in asthma care. Trial Registration: ClinicalTrials.gov NCT04729530; https://clinicaltrials.gov/ct2/show/NCT04729530 International Registered Report Identifier (IRRID): DERR1-10.2196/28624 %M 34313599 %R 10.2196/28624 %U https://www.researchprotocols.org/2021/7/e28624 %U https://doi.org/10.2196/28624 %U http://www.ncbi.nlm.nih.gov/pubmed/34313599 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e23831 %T The VICTORY (Investigation of Inflammacheck to Measure Exhaled Breath Condensate Hydrogen Peroxide in Respiratory Conditions) Study: Protocol for a Cross-sectional Observational Study %A Fox,Lauren %A Gates,Jessica %A De Vos,Ruth %A Wiffen,Laura %A Hicks,Alexander %A Rupani,Hitasha %A Williams,Jane %A Brown,Thomas %A Chauhan,Anoop J %+ Portsmouth Hospitals University NHS Trust, 1st floor Lancaster House, Queen Alexandra Hospital, Southwick Hill Road, Portsmouth, PO6 3LY, United Kingdom, 44 2392286000 ext 3773, lauren.fox@porthosp.nhs.uk %K medical device %K diagnosis %K hydrogen peroxide %K lung diseases %K exhalation %K asthma %K COPD %K bronchiectasis %K interstitial lung disease %K lung cancer %K breathing pattern disorder %K pneumonia %D 2021 %7 9.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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. %M 34255725 %R 10.2196/23831 %U https://www.researchprotocols.org/2021/7/e23831 %U https://doi.org/10.2196/23831 %U http://www.ncbi.nlm.nih.gov/pubmed/34255725 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e27823 %T Early Identification of COVID-19 Infection Using Remote Cardiorespiratory Monitoring: Three Case Reports %A Polsky,Michael %A Moraveji,Neema %+ Pulmonary Associates of Richmond, 1000 Boulders Parkway, Suite 101, North Chesterfield, VA, 23225, United States, 1 804 320 4243, mpolsky@paraccess.com %K COVID-19 %K remote patient monitoring %K wearable sensors %K monitoring %K case study %K preidentification %K lung %K data collection %K respiration %K prediction %D 2021 %7 16.6.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: The adoption of remote patient monitoring (RPM) in routine medical care requires increased understanding of the physiologic changes accompanying disease development and the proactive interventions that will improve outcomes. Objective: The aim of this study is to present three case reports that highlight the capability of RPM to enable early identification of viral infection with COVID-19 in patients with chronic respiratory disease. Methods: Patients at a large pulmonary practice who were enrolled in a respiratory RPM program and who had contracted COVID-19 were identified. The RPM system (Spire Health) contains three components: (1) Health Tags (Spire Health), undergarment waistband-adhered physiologic monitors that include a respiratory rate sensor; (2) an app on a smartphone; and (3) a web dashboard for use by respiratory therapists. The physiologic data of 9 patients with COVID out of 1000 patients who were enrolled for monitoring were retrospectively reviewed, and 3 instances were identified where the RPM system had notified clinicians of physiologic deviation due to the viral infection. Results: Physiologic deviations from respective patient baselines occurred during infection onset and, although the infection manifested differently in each case, were identified by the RPM system. In the first case, the patient was symptomatic; in the second case, the patient was presymptomatic; and in the third case, the patient varied from asymptomatic to mildly symptomatic. Conclusions: RPM systems intended for long-term use and that use patient-specific baselines can highlight physiologic changes early in the course of acute disease, such as COVID-19 infection. These cases demonstrate opportunities for earlier diagnosis, treatment, and isolation. This study supports the need for further research into how RPM can be effectively integrated into clinical practice. %M 34086588 %R 10.2196/27823 %U https://www.i-jmr.org/2021/2/e27823 %U https://doi.org/10.2196/27823 %U http://www.ncbi.nlm.nih.gov/pubmed/34086588 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29084 %T Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews %A O'Leary,Renee %A Qureshi,Maria Ahmed %A La Rosa,Giusy Rita Maria %A Vernooij,Robin W M %A Odimegwu,Damian Chukwu %A Bertino,Gaetano %A Polosa,Riccardo %+ Center for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 piano, Catania, 95123, Italy, 39 3383892673, renee.oleary@eclatrbc.it %K cardiovascular %K e-cigarettes %K ENDS %K respiratory %K tobacco harm reduction %D 2021 %7 27.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. Objective: We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. Methods: These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. Results: The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. Conclusions: The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial Registration: PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID): DERR1-10.2196/29084 %M 34042601 %R 10.2196/29084 %U https://www.researchprotocols.org/2021/5/e29084 %U https://doi.org/10.2196/29084 %U http://www.ncbi.nlm.nih.gov/pubmed/34042601 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25556 %T COVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study %A Gao,Yang %A Zhong,Linda L D %A Quach,Binh %A Davies,Bruce %A Ash,Garrett I %A Lin,Zhi-Xiu %A Feng,Yibin %A Lau,Benson W M %A Wagner,Peter D %A Yang,Xian %A Guo,Yike %A Jia,Wei %A Bian,Zhaoxiang %A Baker,Julien S %+ Centre for Health and Exercise Science Research, Hong Kong Baptist University, Room AAB 926, 9/F, Academic and Administration Building, Baptist University Road Campus, Kowloon, Hong Kong, 852 34118032, jsbaker@hkbu.edu.hk %K COVID-19 %K rehabilitation %K cardiorespiratory exercise %K Chinese medicine %D 2021 %7 26.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent studies have revealed that many discharged patients with COVID-19 experience ongoing symptoms months later. Rehabilitation interventions can help address the consequences of COVID-19, including medical, physical, cognitive, and psychological problems. To our knowledge, no studies have investigated the effects of rehabilitation following discharge from hospital for patients with COVID-19. Objective: The specific aims of this project are to investigate the effects of a 12-week exercise program on pulmonary fibrosis in patients recovering from COVID-19. A further aim will be to examine how Chinese herbal medicines as well as the gut microbiome and its metabolites regulate immune function and possibly autoimmune deficiency in the rehabilitation process. Methods: In this triple-blinded, randomized, parallel-group, controlled clinical trial, we will recruit adult patients with COVID-19 who have been discharged from hospital in Hong Kong and are experiencing impaired lung function and pulmonary function. A total of 172 eligible patients will be randomized into four equal groups: (1) cardiorespiratory exercise plus Chinese herbal medicines group, (2) cardiorespiratory exercise only group, (3) Chinese herbal medicines only group, and (4) waiting list group (in which participants will receive Chinese herbal medicines after 24 weeks). These treatments will be administered for 12 weeks, with a 12-week follow-up period. Primary outcomes include dyspnea, fatigue, lung function, pulmonary function, blood oxygen levels, immune function, blood coagulation, and related blood biochemistry. Measurements will be recorded prior to initiating the above treatments and repeated at the 13th and 25th weeks of the study. The primary analysis is aimed at comparing the outcomes between groups throughout the study period with an α level of .05 (two-tailed). Results: The trial has been approved by the university ethics committee following the Declaration of Helsinki (approval number: REC/19-20/0504) in 2020. The trial has been recruiting patients. The data collection will be completed in 24 months, from January 1, 2021, to December 31, 2022. Conclusions: Given that COVID-19 and its sequelae would persist in human populations, important findings from this study would provide valuable insights into the mechanisms and processes of COVID-19 rehabilitation. Trial Registration: ClinicalTrials.gov NCT04572360; https://clinicaltrials.gov/ct2/show/NCT04572360 International Registered Report Identifier (IRRID): PRR1-10.2196/25556 %M 33970864 %R 10.2196/25556 %U https://www.researchprotocols.org/2021/5/e25556 %U https://doi.org/10.2196/25556 %U http://www.ncbi.nlm.nih.gov/pubmed/33970864 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e27065 %T Using Computational Methods to Improve Integrated Disease Management for Asthma and Chronic Obstructive Pulmonary Disease: Protocol for a Secondary Analysis %A Luo,Gang %A Stone,Bryan L %A Sheng,Xiaoming %A He,Shan %A Koebnick,Corinna %A Nkoy,Flory L %+ Department of Biomedical Informatics and Medical Education, University of Washington, UW Medicine South Lake Union, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 206 221 4596, gangluo@cs.wisc.edu %K asthma %K chronic obstructive pulmonary disease %K decision support techniques %K forecasting %K machine learning %D 2021 %7 18.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34003134 %R 10.2196/27065 %U https://www.researchprotocols.org/2021/5/e27065 %U https://doi.org/10.2196/27065 %U http://www.ncbi.nlm.nih.gov/pubmed/34003134 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24726 %T eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study %A van Buul,Amanda R %A Derksen,Caroline %A Hoedemaker,Ouke %A van Dijk,Oscar %A Chavannes,Niels H %A Kasteleyn,Marise J %+ Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands, 31 715297550, a.r.van_buul@lumc.nl %K COPD %K eHealth %K exacerbations %K hospitalizations %K mHealth %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33734091 %R 10.2196/24726 %U https://formative.jmir.org/2021/3/e24726 %U https://doi.org/10.2196/24726 %U http://www.ncbi.nlm.nih.gov/pubmed/33734091 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e22948 %T Extreme Prematurity and Pulmonary Outcomes Program in Saitama: Protocol for a Prospective Multicenter Cohort Study in Japan %A Namba,Fumihiko %A Tanaka,Kosuke %A Omori,Sayu %A Ikeda,Kazushige %A Kawabata,Ken %A Sato,Hiroaki %A Honda,Masakazu %A Ichikawa,Tomonori %A Minosaki,Yoshihiro %A Michikawa,Takehiro %A Oka,Shuntaro %A Kabe,Kazuhiko %+ Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Saitama, 350-8550, Japan, 81 49 228 3727, nambaf@saitama-med.ac.jp %K prematurity %K preterm infant %K bronchopulmonary dysplasia %K respiratory outcome %D 2021 %7 5.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also those of long-term respiratory complications of premature birth are increasing, resulting in financial and health burdens in developed countries. Thus far, the risk factors of respiratory morbidities in extremely preterm infants remain unknown. Furthermore, the definition and the predictive ability of BPD for long-term respiratory outcomes are yet to be determined. Objective: The objective of our study, Extreme Prematurity and Pulmonary Outcomes Program in Saitama, is to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifesting in extremely preterm infants. Methods: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study are infants (from each clinical center) with gestational ages 22 to 27 weeks. The target is 400 subjects. This study aims to determine the definition of BPD and other perinatal factors that accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, the association between BPD and postprematurity respiratory disease will be investigated using generalized linear models. Results: The protocol and consent forms were evaluated and approved on September 5, 2019, by the Ethics Committee of Saitama Medical Center, Saitama Medical University. Enrollment began on April 1, 2020. It is expected to end on March 31, 2023. The follow-up for 1 year corrected age is expected to continue through the middle of 2024. Conclusions: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama incorporates aspects of neonatal care in secondary- and tertiary-level NICUs to develop existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and potential mechanistic and therapeutic targets in at-risk subjects. International Registered Report Identifier (IRRID): DERR1-10.2196/22948 %M 33666556 %R 10.2196/22948 %U https://www.researchprotocols.org/2021/3/e22948 %U https://doi.org/10.2196/22948 %U http://www.ncbi.nlm.nih.gov/pubmed/33666556 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e13737 %T Derivation of Breathing Metrics From a Photoplethysmogram at Rest: Machine Learning Methodology %A Prinable,Joseph %A Jones,Peter %A Boland,David %A Thamrin,Cindy %A McEwan,Alistair %+ School of Electrical and Information Engineering, The University of Sydney, Room 402, Building J03, Maze Crescent, Darlington, 2006, Australia, 61 404035701, joseph.prinable@sydney.edu.au %K photoplethysmogram %K respiration %K asthma monitoring %K LSTM %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a recent increased interest in monitoring health using wearable sensor technologies; however, few have focused on breathing. The ability to monitor breathing metrics may have indications both for general health as well as respiratory conditions such as asthma, where long-term monitoring of lung function has shown promising utility. Objective: In this paper, we explore a long short-term memory (LSTM) architecture and predict measures of interbreath intervals, respiratory rate, and the inspiration-expiration ratio from a photoplethysmogram signal. This serves as a proof-of-concept study of the applicability of a machine learning architecture to the derivation of respiratory metrics. Methods: A pulse oximeter was mounted to the left index finger of 9 healthy subjects who breathed at controlled respiratory rates. A respiratory band was used to collect a reference signal as a comparison. Results: Over a 40-second window, the LSTM model predicted a respiratory waveform through which breathing metrics could be derived with a bias value and 95% CI. Metrics included inspiration time (–0.16 seconds, –1.64 to 1.31 seconds), expiration time (0.09 seconds, –1.35 to 1.53 seconds), respiratory rate (0.12 breaths per minute, –2.13 to 2.37 breaths per minute), interbreath intervals (–0.07 seconds, –1.75 to 1.61 seconds), and the inspiration-expiration ratio (0.09, –0.66 to 0.84). Conclusions: A trained LSTM model shows acceptable accuracy for deriving breathing metrics and could be useful for long-term breathing monitoring in health. Its utility in respiratory disease (eg, asthma) warrants further investigation. %M 32735229 %R 10.2196/13737 %U http://mhealth.jmir.org/2020/7/e13737/ %U https://doi.org/10.2196/13737 %U http://www.ncbi.nlm.nih.gov/pubmed/32735229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13551 %T Self-Management Maintenance Inhalation Therapy With eHealth (SELFIE): Observational Study on the Use of an Electronic Monitoring Device in Respiratory Patient Care and Research %A Kuipers,Esther %A Poot,Charlotte C %A Wensing,Michel %A Chavannes,Niels H %A de Smet,Peter AGM %A Teichert,Martina %+ Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, Nijmegen, 6500HB, Netherlands, 31 243610591, esther.kuipers@radboudumc.nl %K eHealth %K pharmacy %K inhalation therapy %K asthma %K COPD %K pharmacy practice research %D 2019 %7 30.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic inhalation monitoring devices (EIMDs) are available to remind patients with respiratory diseases to take their medication and register inhalations for feedback to patients and health care providers as well as for data collection in research settings. Objective: This study aimed to assess the validity as well as the patient-reported usability and acceptability of an EIMD. Methods: This observational study planned to include 21 community pharmacies in the Netherlands. Patient-reported inhalations were collected and compared to EIMD registrations to evaluate the positive predictive value of these registrations as actual patient inhalations. Patients received questionnaires on their experiences and acceptance. Results: A convenience sample of 32 patients was included from across 18 pharmacies, and 932 medication doses were validated. Of these, 796 registrations matched with patient-reported use (true-positive, 85.4%), and 33 inhalation registrations did not match with patient-reported use (false-positive, 3.5%). The positive predictive value was 96.0%, and 103 patient-reported inhalations were not recorded in the database (false-negative, 11.1%). Overall, patients considered the EIMD to be acceptable and easy to use, but many hesitated to continue its use. Reminders and motivational messages were not appreciated by all users, and more user-tailored features in the app were desired. Conclusions: Patients’ interaction with the device in real-world settings is critical for objective measurement of medication adherence. The positive predictive value of this EIMD was found to be acceptable. However, patients reported false-negative registrations and a desire to include more user-tailored features to increase the usability and acceptability of the EIMD. %M 31148542 %R 10.2196/13551 %U http://www.jmir.org/2019/5/e13551/ %U https://doi.org/10.2196/13551 %U http://www.ncbi.nlm.nih.gov/pubmed/31148542 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e13530 %T Clinical Impact of a Digital Dose Counter Pressurized Metered-Dose Inhaler on Uncontrolled Asthma: Cross-Sectional, Observational, Surveillance Study %A Guleria,Randeep %A Korukonda,Krishnaprasad %A , %+ Chembur Clinic, Chembur Naka, Mumbai, 400071, India, 91 9820806811, krishnaprasad1971@gmail.com %K asthma %K drug utilization surveillance %K pseudoadherence %K xanthines %K anti-asthmatic agents %D 2019 %7 7.5.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: In India, control of asthma with persistent symptoms remains a clinical enigma with likely incriminating factors including non- and pseudoadherence to the inhaled corticosteroids and long-acting beta2-agonists. The United States Food and Drug Administration guidance recommends the use of dose counter pressurized metered-dose inhalers (pMDIs) with further mechanisms to track adherence and pseudoadherence in real-world settings. Objective: Digital dose counter pMDIs (dpMDIs) offer simplified, reliable tracking of individual “actuated” dosages with “END” display at completion of the labelled therapeutic aerosol spray. The translational impact on symptom persistence with likely unwarranted exposure to the “Step up” strategy is often prevented if not treated, as in the cases of “pseudo” severe asthma. To further assess the real-world acceptance and clinical impact of dpMDIs in bronchial asthma including poorly controlled or uncontrolled bronchial asthma cases, a noninterventional observational study was performed. Methods: This cross-sectional, retrospective, case cohort, observational study—the Drug Utilization Surveillance—of dpMDIs in bronchial asthma was conducted in September 2016 in an outpatient setting in India. The retrospective analysis was initiated and conducted as per the International Conference on Harmonization Good Clinical Practice principles and Declaration of Helsinki, following approval from the local ethics committee and registration in the Clinical Trial Registry of India. Results: Consecutive cases of moderate-to-severe asthma with poor control (n=4575), diagnosed as per the Global Initiative for Asthma symptom scale at baseline and follow-up, were included. Patients under treatment using dpMDIs were enrolled from 500 centers across India and assessed by respiratory care specialists. Baseline asthma control was assessed as partly controlled (n=4575) or poorly controlled (n=2942). Per protocol analyses showed that asthma was well controlled with dpMDIs at 8 weeks in 92.7% of the cases (2727/2942, P<.001). Adverse events (n=106, 2%) of mild-to-moderate intensity were reported. Nebulization was required in two patients with episodic breathlessness who were discharged with no consequent sequelae. Post hoc analyses for patients with baseline poorly controlled asthma who “switched” exclusively to dpMDI monotherapy or a combination with xanthines or long-acting beta2-agonists showed a “well controlled” asthma status in 85.9% (500/582, P=.04), 95.4% (395/414, P=.048), and 80.3% (106/132, P=.28) of the cases, respectively. The patient acceptability criteria for an “empty” canister was well correlated with the clinical strategy to identify and avoid pseudoadherence in poorly controlled or difficult-to-treat asthma cases, especially in patients who “switched” exclusively to dpMDIs (n=582) and demonstrated responses of “Use till twenty dose display” (65/156, 41.6%), “Use till END display” (83/156, 53.2%), and “Use till LAST spray” (8/156, 5.1%). Conclusions: dpMDIs offer simple, accurate, and reliable tracking of non- and pseudoadherence while highlighting incremental asthma-control rates in severe and pseudosevere asthma cases before risk assessment for further “add-on” therapy Trial Registration: Clinical Trials Registry - India CTRI/2018/06/014595; http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php? trialid=24583 %R 10.2196/13530 %U http://www.i-jmr.org/2019/2/e13530/ %U https://doi.org/10.2196/13530 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e6 %T Telemedicine-Based Approach for Obstructive Sleep Apnea Management: Building Evidence %A Isetta,Valentina %A León,Carmen %A Torres,Marta %A Embid,Cristina %A Roca,Josep %A Navajas,Daniel %A Farré,Ramon %A Montserrat,Josep M %+ Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Casanova 143, Barcelona, 08036, Spain, 34 934039764, valentina.isetta@ub.edu %K telemedicine %K sleep apnea %K CPAP therapy %K teleconsultation %D 2014 %7 19.02.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Telemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management. Objective: The objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients’ CPAP follow-up and training. Methods: We performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement. Results: More than 95% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66% (33/50) of them answered that the teleconsultation could replace 50%-100% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6% of correct answers vs mean 92.1%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups. Conclusions: OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients’ CPAP training and clinical follow-up. %M 24554392 %R 10.2196/ijmr.3060 %U http://www.i-jmr.org/2014/1/e6/ %U https://doi.org/10.2196/ijmr.3060 %U http://www.ncbi.nlm.nih.gov/pubmed/24554392 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 2 %P e15 %T Website Visitors Asking Questions Online to Lung Cancer Specialists: What Do They Want To Know? %A Schook,Romane M %A Linssen,Cilia %A Festen,Jan %A Schramel,Franz MNH %A Lammers,Ernst %A Zaanen,Peter %A Postmus,Pieter E %+ VU University Medical Center, Department of Pulmonary Diseases, De Boelelaan 1117, Amsterdam, 1081HV, Netherlands, 31 4442193, r.schook@vumc.nl %K Internet %K lung neoplasms %K medical informatics %K information services %K patient education %K information needs %K caregivers %D 2013 %7 06.08.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: In 2003 the Dutch Lung Cancer Information Centre (Longkanker Informatie Centrum) launched a website containing information on lung cancer accessible to anyone. Objective: Our study aim was to inventorize the information needs of the visitors of this website by analyzing the questions they asked the lung cancer specialists in the websites interactive section “Ask the Physician”. Methods: The first 2000 questions posted up until May 2006 have been classified by visitors’ wish, type of required information, identity, gender, and phase during treatment course. Results: Our results show that 1893 (1158/1893, 61%) of the questions were asked by a loved one/caregiver and (239/1893 13%) by patients. 1 out of 3 questions was asked by a daughter/grand-daughter. Most questions concerned specific information on lung cancer and lung cancer course (817/1893, 43%). The most inquired specific information topics were therapy side effects, diagnostics, general information on lung cancer, and regular therapy. Furthermore, questioners wanted to verify their own doctor’s information (122/1893, 6%), a diagnosis (267/1893, 14%), and a prognosis (204/1893, 11%). Conclusions: Lung cancer patients and their caregivers asked the most questions in the interactive website section. The most frequently requested information was more detailed information. These include specific information on lung cancer (regular therapy, diagnostics, and disease symptoms), verification of what the doctor has said, diagnosis, and prognosis. Most of the requested information could have been obtained from treating specialists, indicating that current information supply to lung cancer patients and their caregivers may not be matching their needs sufficiently. The further implementation of an online dialogue with lung cancer specialists might be a solution. %M 23919980 %R 10.2196/ijmr.1749 %U http://www.i-jmr.org/2013/2/e15/ %U https://doi.org/10.2196/ijmr.1749 %U http://www.ncbi.nlm.nih.gov/pubmed/23919980