%0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e66336 %T Innovative, Technology-Driven, Digital Tools for Managing Pediatric Urinary Incontinence: Scoping Review %A Bladt,Lola %A Vermeulen,Jiri %A Vermandel,Alexandra %A De Win,Gunter %A Van Campenhout,Lukas %+ Department of Product Development, Faculty of Design Sciences, University of Antwerp, Paardenmarkt 90/94, Antwerp, 2000, Belgium, 32 497848014, lola.bladt@uantwerpen.be %K pediatric urinary incontinence %K nocturnal enuresis %K behavioral therapy %K urotherapy %K patient compliance %K digital health %K serious games %K telehealth %K health technology %K enuresis alarm %K artificial intelligence %K AI %D 2025 %7 5.5.2025 %9 Review %J Interact J Med Res %G English %X Background: Urinary incontinence affects approximately 7% to 10% of children during the day and 9% to 12% of children during the night. Treatment mainly involves lifestyle advice and behavioral methods, but motivation and adherence are low. Traditional tools such as pen-and-paper solutions may feel outdated and no longer meet the needs of today’s “digital native” children. Meanwhile, digital interventions have already shown effectiveness in other pediatric health care areas. Objective: This scoping review aimed to identify and map innovative, technology-driven, digital tools for managing pediatric urinary incontinence. Methods: PubMed, Web of Science, and the Cochrane Library were searched in March 2022 without date restrictions, complemented by cross-referencing. Studies were eligible if they focused on pediatric patients (aged ≤18 years) with bladder and bowel dysfunctions and explored noninvasive, technology-based interventions such as digital health, remote monitoring, and gamification. Studies on adults, invasive treatments, and conventional methods without tangible tools were excluded. Gray literature was considered, but non–English-language, inaccessible, or result-lacking articles were excluded. A formal critical appraisal was not conducted as the focus was on mapping existing tools rather than evaluating effectiveness. Data analysis combined descriptive statistics and qualitative content analysis, categorizing tools through iterative coding and team discussions. Results: In total, 66 articles were included, with nearly one-third (21/66, 32%) focusing on nocturnal enuresis. Our analysis led to the identification of six main categories of tools: (1) digital self-management (7/66, 11%); (2) serious games (7/66, 11%); (3) reminder technology (6/66, 9%); (4) educational media (12/66, 18%), further divided into video (5/12, 42%) and other media (7/12, 58%); (5) telehealth and remote patient monitoring (13/66, 20%), with subcategories of communication (5/13, 38%) and technological advances (8/13, 62%); and (6) enuresis alarm innovations (21/66, 32%), further divided into novel configurations (8/21, 38%) and prevoid alarms (13/21, 62%). Conclusions: The field of pediatric urinary incontinence demonstrates a considerable level of innovation, as evidenced by the inclusion of 66 studies. Many tools identified in this review were described as promising and feasible alternatives to traditional methods. These tools were reported to enhance engagement, improve compliance, and increase patient satisfaction and preference while also having the potential to save time for health care providers. However, this review also identified gaps in research, highlighting the need for more rigorous research to better assess the tools’ effectiveness and address the complex, multifaceted challenges of pediatric urinary incontinence management. Limitations of this review include restricting the search to 3 databases, excluding non–English-language articles, the broad scope, and single-reviewer screening, although frequent team discussions ensured rigor. We propose that future tools should integrate connected, adaptive, and personalized approaches that align with stakeholder needs, guided by a multidisciplinary, human-centered framework combining both qualitative and quantitative insights. %M 40324170 %R 10.2196/66336 %U https://www.i-jmr.org/2025/1/e66336 %U https://doi.org/10.2196/66336 %U http://www.ncbi.nlm.nih.gov/pubmed/40324170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56533 %T Assessment of Environmental, Sociocultural, and Physiological Influences on Women’s Toileting Decisions and Behaviors Using “Where I Go”: Pilot Study of a Mobile App %A Smith,Abigail R %A Mueller,Elizabeth R %A Lewis,Cora E %A Markland,Alayne %A Smerdon,Caroline %A Smith,Ariana L %A Sutcliffe,Siobhan %A Wyman,Jean F %A Low,Lisa Kane %A Miller,Janis M %A , %K ecological momentary assessment %K time location factors %K voiding diary %K voiding behaviors %K population studies %K mobile application %K app %K bladder health %K data collection tool %K decision support %D 2025 %7 12.2.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Little is known about women’s decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app “Where I Go” captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with “Where I Go”, variation in novel parameters collected, and readiness for the data collection tool’s use in population-based studies. Methods: “Where I Go” has three components: (1) real-time data, (2) short look-back periods (3‐4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant’s self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86%, on day 1 and 40/44, 91%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61%, on day 1 and 129/171, 75%, on day 2) due to a need to go (114/140, 66%, on day 1 and 153/171, 74%, on day 2). The most common reasons for delaying toileting were “work duties” (33/140, 21%, on day 1 and 21/171, 11%, on day 2) and “errands or traveling” (19/140, 12%, on day 1 and 19/171, 10%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93%, on day 1 and 42/44, 95%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95% CI 3.0-3.5; mean on day 2=4.3, 95% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in “Where I Go” showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: “Where I Go” has potential to increase the understanding of factors that affect women’s toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies. International Registered Report Identifier (IRRID): RR2-10.2196/54046 %R 10.2196/56533 %U https://mhealth.jmir.org/2025/1/e56533 %U https://doi.org/10.2196/56533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56039 %T Satisfactory Evaluation of Call Service Using AI After Ureteral Stent Insertion: Randomized Controlled Trial %A Cho,Ukrae %A Gwon,Yong Nam %A Chong,Seung Ryong %A Han,Ji Yeon %A Kim,Do Kyung %A Doo,Seung Whan %A Yang,Won Jae %A Kim,Kyeongmin %A Shim,Sung Ryul %A Jung,Jaehun %A Kim,Jae Heon %+ Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea, 82 2 709 9378, piacekjh@hanmail.net %K artificial intelligence %K AI %K ureteral stent %K complications %K randomized controlled trial %K urologic procedures %K urology %K patients %K information resources %D 2025 %7 21.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Ureteral stents, such as double-J stents, have become indispensable in urologic procedures but are associated with complications like hematuria and pain. While the advancement of artificial intelligence (AI) technology has led to its increasing application in the health sector, AI has not been used to provide information on potential complications and to facilitate subsequent measures in the event of such complications. Objective: This study aimed to assess the effectiveness of an AI-based prediction tool in providing patients with information about potential complications from ureteroscopy and ureteric stent placement and indicating the need for early additional therapy. Methods: Overall, 28 patients (aged 20-70 years) who underwent ureteral stent insertion for the first time without a history of psychological illness were consecutively included. A “reassurance-call” service was set up to equip patients with details about the procedure and postprocedure care, to monitor for complications and their severity. Patients were randomly allocated into 2 groups, reassurance-call by AI (group 1) and reassurance-call by humans (group 2). The primary outcome was the level of satisfaction with the reassurance-call service itself, measured using a Likert scale. Secondary outcomes included satisfaction with the AI-assisted reassurance-call service, also measured using a Likert scale, and the level of satisfaction (Likert scale and Visual Analogue Scale [VAS]) and anxiety (State-Trait Anxiety Inventory and VAS) related to managing complications for both groups. Results: Of the 28 recruited patients (14 in each group), 1 patient in group 2 dropped out. Baseline characteristics of patients showed no significant differences (all P>.05). Satisfaction with reassurance-call averaged 4.14 (SD 0.66; group 1) and 4.54 (SD 0.52; group 2), with no significant difference between AI and humans (P=.11). AI-assisted reassurance-call satisfaction averaged 3.43 (SD 0.94). Satisfaction about the management of complications using the Likert scale averaged 3.79 (SD 0.70) and 4.23 (SD 0.83), respectively, showing no significant difference (P=.14), but a significant difference was observed when using the VAS (P=.01), with 6.64 (SD 2.13) in group 1 and 8.69 (SD 1.80) in group 2. Anxiety about complications using the State-Trait Anxiety Inventory averaged 36.43 (SD 9.17) and 39.23 (SD 8.51; P=.33), while anxiety assessed with VAS averaged 4.86 (SD 2.28) and 3.46 (SD 3.38; P=.18), respectively, showing no significant differences. Multiple regression analysis was performed on all outcomes, and humans showed superior satisfaction than AI in the management of complications. Otherwise, most of the other variables showed no significant differences (P.>05). Conclusions: This is the first study to use AI for patient reassurance regarding complications after ureteric stent placement. The study found that patients were similarly satisfied for reassurance calls conducted by AI or humans. Further research in larger populations is warranted to confirm these findings. Trial Registration: Clinical Research Information System KCT0008062; https://tinyurl.com/4s8725w2 %M 39836955 %R 10.2196/56039 %U https://www.jmir.org/2025/1/e56039 %U https://doi.org/10.2196/56039 %U http://www.ncbi.nlm.nih.gov/pubmed/39836955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54209 %T Sentiments of Individuals with Interstitial Cystitis/Bladder Pain Syndrome Toward Pentosan Polysulfate Sodium: Infodemiology Study %A Hswen,Yulin %A Qin,Qiuyuan %A Smith,Pressley %A Swierczynski,Alison %A Bauer,Stuart %A Ladson,Erika %A Garrett,Amanda Leigh %A Brownstein,Catherine A %K interstitial cystitis %K IC %K painful bladder syndrome %K bladder pain syndrome %K BPS %K social media %K social network %K pain %K treatment %K chronic condition %K chronic disease %K chronic illness %K Elmiron %K pentosan polysulfate sodium %K PPS %K internet forum %D 2025 %7 17.1.2025 %9 %J JMIR Form Res %G English %X Background: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a multifactorial, chronic syndrome involving urinary frequency, urgency, and bladder discomfort. These IC/BPS symptoms can significantly impact individuals’ quality of life, affecting their mental, physical, sexual, and financial well-being. Individuals sometimes rely on peer-to-peer support to understand the disease and find methods of alleviating symptoms. The only US Food and Drug Administration–approved medication to treat IC/BPS is pentosan polysulfate sodium (PPS). However, ocular pigmentary maculopathy has been described in some individuals, with greater severity associated with prolonged PPS exposure. Objective: While prior research has separately assessed the benefits and side effects of PPS, this study sought to identify (1) sentiments of individuals with IC/BPS toward PPS and (2) topics discussed by individuals with IC/BPS in conjunction with PPS through use of an internet peer-to-peer forum. Methods: Data were collected from Inspire—an anonymous web-based health community where individuals gather by condition to find support and information. Sentiment analysis and percentages of negative, positive, and neutral sentiment for PPS discussions encompassing each topic was conducted using VADER (Valence Aware Dictionary for Sentiment Reasoning). Topic modeling was conducted using latent Dirichlet allocation. Words with the highest probability were ranked to categorize each topic, and authors manually investigated and labeled discussions. Results: There were 354 forum posts related to PPS. Topic modeling with latent Dirichlet allocation revealed 5 topic categories: “ineffectiveness or discontinued use,” “alternative treatments,” “personal treatment suggestions based on experience,” “severe side effects,” and “risk of long-term use.” Topics related to “severe side effects” and “risk of long-term use” garnered less discussion, with the former also having the lowest positive sentiment (4.28, 14.29%). The topic “ineffectiveness or discontinued use” was most frequently discussed. This topic also had the highest percentage of negative posts (52/152, 34.21%). However, the average compound score was within the neutral compound score range (−0.094, SD 0.625). In addition, forum data highlighted individuals’ acknowledgment of the efficacy of PPS in improving their quality of life, with statements such as “saved my sanity” being representative. The overall compound individuals’ sentiment toward PPS was −0.083, split across 32.49% (115/354) negative, 22.03% (78/354) positive, and 45.48% (161/354) neutral sentiment categories. Conclusions: The overall authentic sentiment toward PPS is broad but balances to neutral. This neutral sentiment suggests that while some individuals express concerns about the side effects and long-term risks associated with PPS, others appreciate its positive impact on their quality of life. This research confirms that individuals with IC/BPS actively engage with health forums like Inspire to seek information, share their experiences, and explore different treatment options. As IC/BPS remains a complex syndrome, this study highlights the value of patient-led discussions in informing treatment decisions. Furthermore, these findings suggest that health care providers might benefit from considering the insights shared on peer-to-peer forums to better understand individual preferences, concerns, and expectations. %R 10.2196/54209 %U https://formative.jmir.org/2025/1/e54209 %U https://doi.org/10.2196/54209 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60136 %T Disparities in the Prevalence of Urinary Diseases Among Prisoners in Taiwan: Population-Based Cross-Sectional Study %A Wang,Yen-Chun %A Jiesisibieke,Zhu Liduzi %A Yang,Yu-Pei %A Wang,Bing-Long %A Hsiung,Ming-Chon %A Tung,Tao-Hsin %K prisoners %K Taiwan %K health care %K urinary disease %K urinary tract infection %K prison health %D 2024 %7 24.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Prisoner health is a major global concern, with prisoners often facing limited access to health care and enduring chronic diseases, infectious diseases, and poor mental health due to unsafe prison environments, unhygienic living conditions, and inadequate medical resources. In Taiwan, prison health is increasingly an issue, particularly concerning urinary diseases such as urinary tract infections. Limited access to health care and unsanitary conditions exacerbate these problems. Urinary disease epidemiology varies by sex and age, yet studies in Asia are scarce, and comprehensive data on urinary diseases in Taiwanese prisons remain limited. Objective: This study aimed to investigate the prevalence of urinary diseases among Taiwanese prisoners and explore the differences in disease prevalence between men and women, as well as across different age groups. Methods: This study used data on prisoners from the National Health Insurance Research Database covering the period from January 1 to December 31, 2013. Prisoners covered by National Health Insurance who were diagnosed with urinary diseases, identified by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes 580‐599 based on their medical records, and had more than one medical visit to ambulatory care or inpatient services were included. Sex- and age-stratified analyses were conducted to determine the differences in the prevalence of urinary diseases. Results: We examined 83,048 prisoners, including 2998 with urinary diseases. The overall prevalence of urinary system diseases among prisoners was 3.61% (n=2998; n=574, 6.64% in men and n=2424, 3.26% in women). The prevalence rate in men was significantly lower than that in women (prevalence ratio: 0.46, P<.001). In age-stratified analysis, the prevalence rate among prisoners aged >40 years was 4.5% (n=1815), compared to 2.77% (n=1183) in prisoners aged ≤40 years. Prisoners aged >40 years had a higher prevalence (prevalence ratio: 1.69, P<.001). Other disorders of the urethra and urinary tract (ICD-9-CM: 599), including urinary tract infection, urinary obstruction, and hematuria, were the most prevalent diseases of the urethra and urinary tract across age and sex groups. Women and older prisoners had a higher prevalence of most urinary tract diseases. There were no significant sex-specific differences in adjusted prevalence ratios for acute glomerulonephritis, nephrotic syndrome, kidney infections, urethritis (nonsexually transmitted), or urethral syndrome. However, based on the age-specific adjusted prevalence ratio analysis, cystitis was more prevalent among younger prisoners (prevalence ratio: 0.69, P=.004). Conclusions: Urinary system infections and inflammation are common in prisons. Our findings advocate for policy reforms aimed at improving health care accessibility in prisons, with a particular focus on the needs of high-risk groups such as women and older prisoners. Further research linking claims data with prisoner information is crucial to providing more comprehensive medical services and achieving health equity. %R 10.2196/60136 %U https://publichealth.jmir.org/2024/1/e60136 %U https://doi.org/10.2196/60136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58510 %T Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: Survey Study %A Alfozan,Mohammed %A Alshahrani,Saad %A Alasmi,Raed %K delivery of health care %K social media %K urologists %K urology %K Saudi Arabia %K professional communication %K physician behavior %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: Social media (So-Me) platforms are valuable resources for health care professionals and academics to discover, discuss, and distribute current advances in research and clinical practices, including technology trends. Objective: This study aims to assess the role of So-Me in urological practice in Saudi Arabia. It explores the influence of digital platforms on patient interaction, professional communication, decision-making, and education. Methods: The survey was conducted among 145 urologists from July 2021 to July 2022 following institutional review board approval. A questionnaire designed using the SurveyMonkey platform examined urologists’ knowledge of So-Me. The survey was conducted using the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines and was open for 17 weeks. Data analysis was performed using SPSS 21.0. Results: Of the 145 participants, 70% (n=102) were Saudi Arabians. The most common age groups were 30‐40 (n=68, 46.8%) and 41‐50 (n=61, 42.2%) years, with a gender distribution of 44.8% (n=65) women and 55.2% (n=80) men. A total of 61.5% (n=89) of urologists reported using So-Me accounts for professional purposes, with 54.9% (n=80) sharing health-related information. Social media enhanced patient connections beyond clinic visits for 55.8% (n=81) of respondents, while 57.2% (n=83) used it to provide educational resources. Additionally, 56.5% (n=82) believed So-Me facilitated patient feedback and improved their practice. In terms of professional communication, 60.6% (n=88) of urologists agreed that So-Me facilitated collaboration with colleagues, while 63.3% (n=92) used it to stay updated on the latest advances in urology. Furthermore, 62% (n=90) followed professional societies or journals on So-Me, and 63.3% (n=92) used it for continuing medical education. A majority (n=94, 64.7%) reported that So-Me influenced treatment decisions based on new research findings, and 85.3% (n=124) learned about novel technologies and treatment options through these platforms. Regression analysis showed a significant positive correlation between gender and social media usage patterns (R=0.653, R2=0.426), indicating that approximately 42.6% of the differences in usage patterns can be attributed to gender. However, the Pearson χ2 analysis showed that gender did not significantly affect most aspects of social media use, except information sharing and participating in online discussions (both P<.05). Conclusions: This study highlights the widespread use of So-Me among urologists in Saudi Arabia, underscoring its role in enhancing patient interaction, professional development, and clinical decision-making. Strategically designed health care programs using social media could improve and modernize professional and patient-centered care in Saudi Arabia through legislative assistance and guidelines. %R 10.2196/58510 %U https://formative.jmir.org/2024/1/e58510 %U https://doi.org/10.2196/58510 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e63289 %T Survival After Radical Cystectomy for Bladder Cancer: Development of a Fair Machine Learning Model %A Carbunaru,Samuel %A Neshatvar,Yassamin %A Do,Hyungrok %A Murray,Katie %A Ranganath,Rajesh %A Nayan,Madhur %+ Department of Urology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, United States, 1 (646) 825 6300, samuel.carbunaru@nyulangone.org %K machine learning %K bladder cancer %K survival %K prediction %K model %K bias %K fairness %K radical cystectomy %K mortality rate %K algorithmic fairness %K health equity %K healthcare disparities %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Prediction models based on machine learning (ML) methods are being increasingly developed and adopted in health care. However, these models may be prone to bias and considered unfair if they demonstrate variable performance in population subgroups. An unfair model is of particular concern in bladder cancer, where disparities have been identified in sex and racial subgroups. Objective: This study aims (1) to develop a ML model to predict survival after radical cystectomy for bladder cancer and evaluate for potential model bias in sex and racial subgroups; and (2) to compare algorithm unfairness mitigation techniques to improve model fairness. Methods: We trained and compared various ML classification algorithms to predict 5-year survival after radical cystectomy using the National Cancer Database. The primary model performance metric was the F1-score. The primary metric for model fairness was the equalized odds ratio (eOR). We compared 3 algorithm unfairness mitigation techniques to improve eOR. Results: We identified 16,481 patients; 23.1% (n=3800) were female, and 91.5% (n=15,080) were “White,” 5% (n=832) were “Black,” 2.3% (n=373) were “Hispanic,” and 1.2% (n=196) were “Asian.” The 5-year mortality rate was 75% (n=12,290). The best naive model was extreme gradient boosting (XGBoost), which had an F1-score of 0.860 and eOR of 0.619. All unfairness mitigation techniques increased the eOR, with correlation remover showing the highest increase and resulting in a final eOR of 0.750. This mitigated model had F1-scores of 0.86, 0.904, and 0.824 in the full, Black male, and Asian female test sets, respectively. Conclusions: The ML model predicting survival after radical cystectomy exhibited bias across sex and racial subgroups. By using algorithm unfairness mitigation techniques, we improved algorithmic fairness as measured by the eOR. Our study highlights the role of not only evaluating for model bias but also actively mitigating such disparities to ensure equitable health care delivery. We also deployed the first web-based fair ML model for predicting survival after radical cystectomy. %R 10.2196/63289 %U https://medinform.jmir.org/2024/1/e63289 %U https://doi.org/10.2196/63289 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48225 %T Correlation Between Electronic Patient-Reported Outcomes and Biological Markers of Key Parameters in Acute Radiation Cystitis Among Patients With Prostate Cancer (RABBIO): Prospective Observational Study %A Helissey,Carole %A Cavallero,Sophie %A Guitard,Nathalie %A Thery,Hélène %A Parnot,Charles %A Schernberg,Antoine %A Aissa,Imen %A Raffin,Florent %A Le Coz,Christine %A Mondot,Stanislas %A Christopoulos,Christos %A Malek,Karim %A Malaurie,Emmanuelle %A Blanchard,Pierre %A Chargari,Cyrus %A Francois,Sabine %K prostate cancer %K acute radiation cystitis %K e-PRO %K quality of life %K biomarkers %K electronic patient-reported outcome %D 2024 %7 12.12.2024 %9 %J JMIR Cancer %G English %X Background: Despite advances in radiation techniques, radiation cystitis (RC) remains a significant cause of morbidity from pelvic radiotherapy, which may affect patients’ quality of life (QoL). The pathophysiology of RC is not well understood, which limits the development of effective treatments. Objective: The Radiotoxicity Bladder Biomarkers study aims to investigate the correlation between blood and urinary biomarkers and the intensity of acute RC symptoms and QoL in patients undergoing localized prostate cancer radiotherapy. Methods: This study included patients with low- or intermediate-risk localized prostate cancer who were eligible for localized radiotherapy. Blood and urinary biomarkers were analyzed before radiotherapy was initiated and at weeks 4 and 12 of radiation therapy. Patients completed questionnaires related to RC symptoms and QoL (International Prostate Symptom Score and Functional Assessment of Cancer Therapy-Prostate [FACT-P]) using a digital remote monitoring platform. The information was processed by means of an algorithm, which classified patients according to the severity of symptoms and adverse events reported. Levels of blood and urinary biomarkers were tested with the severity of acute RC symptoms and patient-reported QoL. Results: A total of 401 adverse events questionnaires were collected over the duration of this study from 20 patients. The most frequently reported adverse events at week 4 were pollakiuria, constipation, and diarrhea. In comparison with baseline, the mean FACT-P score decreased at week 4. A significant increase in the proportion of M2 phenotype cells (CD206+, CD163+, CD204+) at W12 compared to W0 was observed. An increase in serum and urine levels of macrophage colony-stimulating factor (M-CSF), hepatocyte growth factor, and macrophagic inflammatory protein was observed at week 12 compared to baseline levels. Baseline serum and urine M-CSF concentrations showed a significant negative correlation with FACT-P scores at weeks 4 and 12 (r=−0.65, P=.04, and r=−0.76, P=.02, respectively). Conclusions: The Radiotoxicity Bladder Biomarkers study is the first to explore the overexpression of inflammatory proteins in blood and urine of patients with symptoms of acute RC. These preliminary findings suggest that serum and urine levels of hepatocyte growth factor, M-CSF, and macrophagic inflammatory protein, as well as macrophage polarization, are mobilized after prostate radiotherapy. The elevated M-CSF levels in serum and urine at baseline were associated with the deterioration of QoL during radiotherapy. The results of this study may help to develop mitigation strategies to limit radiation damage to the bladder. Trial Registration: ClinicalTrials.gov NCT05246774; https://clinicaltrials.gov/study/NCT05246774 %R 10.2196/48225 %U https://cancer.jmir.org/2024/1/e48225 %U https://doi.org/10.2196/48225 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55870 %T Efficacy of Electroacupuncture in the Treatment of Mild to Moderate Female Stress Urinary Incontinence: Protocol for a Systematic Review and Network Meta-Analysis %A Shi,JiaNi %A Li,Peiqi %A Wu,Yifan %A Li,Jiawei %A Zhang,Yuchen %A Xiao,Bin %+ School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China, 86 17321311968, xiaobin@shutcm.edu.cn %K stress urinary incontinence %K electroacupuncture %K drugs %K pelvic floor muscle training %K systematic review %K network meta-analysis %D 2024 %7 4.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress urinary incontinence (SUI), the most common form of urinary incontinence, is a condition that affects many women. It is characterized by involuntary urine leakage during activities that increase abdominal pressure, such as sneezing, coughing, or physical exertion, according to the International Continence Society. SUI affects patients’ quality of life and causes depression and emotional disorders, which negatively influences physical and mental health. The participants in the studies in this review comprised women with mild to moderate SUI, because there are more female patients than male patients, and most patients with severe SUI are treated surgically. Moreover, after retrieval, there were no systematic reviews or network meta-analyses (NMAs) of conservative treatments, such as electroacupuncture (EA), in women with mild to moderate SUI. Objective: This study aims to investigate the efficacy of electroacupuncture among women with mild to moderate SUI using an NMA. Methods: Randomized clinical trials related to conservative treatments for SUI will be searched in 5 English and 3 Chinese literature databases: EMBASE, PubMed, Cochrane, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), WanFang, and the Chinese BioMedical Literature Database. The search period for these 8 electronic databases will be from 2002 to 2022. The PROSPERO database and the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) database will also be searched. Two reviewers will independently complete the research selection. After screening the studies, 2 other researchers will extract the data, and the quality of the included studies will be evaluated according to the quality standards specified in the Cochrane Collaboration Tool (version 2). The primary outcomes will be the change in urine leakage determined by a 1-hour pad test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores at baseline and at the conclusion of the follow-up. The secondary outcomes will be 72-hour incontinence episodes, residual bladder volume, effective rate, urodynamic indexes, and other reported measurements. Stata (version 14.0; StataCorp) and Review Manager (RevMan version 5.3; Cochrane) will be implemented for data synthesis and meta-analysis. Results: The results are not yet accessible because this is a protocol for a systematic review and meta-analysis. The protocol was registered on INPLASY on February 22, 2023. By April 6, 2023, we had completed the literature search of the 8 databases and completed the selection and data extraction of the articles. Conclusions: The results of this systematic review will demonstrate the efficacy of EA among women with mild to moderate SUI. The results will provide evidence for clinicians and guideline makers to choose suitable treatments for SUI. Trial Registration: International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) 202320098; https://inplasy.com/inplasy-2023-2-0098/ International Registered Report Identifier (IRRID): DERR1-10.2196/55870 %M 39496309 %R 10.2196/55870 %U https://www.researchprotocols.org/2024/1/e55870 %U https://doi.org/10.2196/55870 %U http://www.ncbi.nlm.nih.gov/pubmed/39496309 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53673 %T The Association Between Solid Fuel Use and Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia in Sichuan, China: Cross-Sectional Study %A Yuan,Qiming %A Zhou,Xianghong %A Ma,Li %A Cai,Boyu %A Zhang,Zilong %A Deng,Linghui %A Hu,Dan %A Jiang,Zhongyuan %A Wang,Mingda %A Wei,Qiang %A Qiu,Shi %K benign prostatic hyperplasia %K lower urinary tract symptoms %K solid fuel %K household air pollution %K China %K male %K cohort study %K prostate %K aging %K smoking %K alcohol %D 2024 %7 31.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Benign prostatic hyperplasia (BPH) is a global age-related disease. It has been reported that over half of the Chinese male population aged 70 years or older are experiencing BPH. Solid fuel, which is the major source of household air pollution, has been reportedly associated with several adverse events, including sex hormone disorders. Due to the certain relationship between sex hormone levels and prostate disease, the relationship between solid fuel use and lower urinary tract symptoms (LUTSs) suggestive of BPH (LUTS/BPH) deserves further exploration. Objective: This study mainly aimed to investigate the association between solid fuel use and LUTS/BPH. Methods: The data used in this study were obtained from the West China Natural Population Cohort Study. Household energy sources were assessed using questionnaires. LUTS/BPH was evaluated based on participant self-reports. We performed propensity score matching (PSM) to reduce the influence of bias and unmeasured confounders. The odds ratio (OR) and 95% CI of LUTS/BPH for the solid fuel group compared with the clean fuel group were calculated. We also conducted stratified analyses based on BMI, metabolic syndrome, waist to hip ratio, drinking status, smoking status, and age. Results: A total of 5463 participants were included in this study, including 399 solid fuel users and 5064 clean fuel users. After PSM, the solid fuel group included 354 participants, while the clean fuel group included 701 participants. Solid fuel use was positively correlated with LUTS/BPH before and after PSM (OR 1.68, 95% CI 1.31‐2.15 and OR 1.81, 95% CI 1.35‐2.44, respectively). In stratified analyses, the OR of the nonsmoking group was higher than that of the smoking group (OR 2.56, 95% CI 1.56‐4.20 and OR 1.47, 95% CI 0.99‐2.18, respectively). Similarly, the OR of the nondrinking group was higher than that of the drinking group (OR 2.70, 95% CI 1.46‐4.99 and OR 1.48, 95% CI 1.01‐2.17, respectively). Conclusions: A positive correlation between solid fuel use and LUTS/BPH was observed. The results suggest that improving fuel structure for household cooking and other household needs can possibly help reduce the risk of LUTS/BPH. Trial Registration: China Clinical Trial Registration Center ChiCTR1900024623; https://www.chictr.org.cn/showproj.html?proj=40590 %R 10.2196/53673 %U https://publichealth.jmir.org/2024/1/e53673 %U https://doi.org/10.2196/53673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52282 %T Differences in Messenger RNA Expression of Fibulin-1, Elastin, Matrix Metalloproteinase-1, Basic Fibroblast Growth Factor, and α-Smooth Muscle Actin Between the Ventral and Dorsal Tunica Dartos in Patients With Hypospadias and Chordee: Protocol for a Prospective Cohort Study %A Pitoyo,Joko %A Alvarino, %A Darwin,Eryati %A Yanwirasti, %+ Faculty of Medicine, Universitas Andalas, Perintis Kemerdekaan No. 94, Fakultas Kedokteran Kampus Jati, Padang, 25127, Indonesia, 62 62 751 31746, jokopitoyodr@lecturer.unri.ac.id %K chordee %K gene expression %K hypospadias %K polymerase chain reaction %K mRNA %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hypospadias is a common congenital anomaly characterized by the displacement of the urethral opening to the ventral side of the penis. Surgical correction is often necessary for functional and psychological reasons. The etiology involves genetic and environmental factors, and chordee, a downward curvature of the penis, is a common complication. Proteins such as fibulin-1, elastin, matrix metalloproteinase-1, basic fibroblast growth factor, and α-smooth muscle actin play roles in hypospadias development. Objective: The study’s aim is to investigate the differences in messenger RNA (mRNA) expression of fibulin-1, elastin, matrix metalloproteinase-1, basic fibroblast growth factor, and α-smooth muscle actin between the ventral and dorsal tunica dartos in patients with hypospadias and chordee. Methods: This prospective cohort study aims to investigate differences in mRNA expression of the abovementioned proteins between the ventral and dorsal tunica dartos in patients with hypospadias and chordee. Ethics approval has been obtained, and consent from parents will be obtained before data collection. Eligible participants are aged 6-18 months, diagnosed with hypospadias and chordee, and planned for urethroplasty. Tissue samples will be collected from both aspects of the tunica dartos and analyzed using real-time quantitative reverse transcription–polymerase chain reaction. Data analysis will involve statistical tests and normalization of housekeeping genes. Results: This study is at the protocol development stage. A pilot study regarding its feasibility has been ongoing as of August 2023. The study results are expected to be available by the end of 2024. Conclusions: The study of mRNA expressions of various proteins in the tunica dartos of patients with hypospadias and chordee is expected to improve the understanding and expand the knowledge of the pathophysiology of hypospadias and chordee. International Registered Report Identifier (IRRID): DERR1-10.2196/52282 %M 39476852 %R 10.2196/52282 %U https://www.researchprotocols.org/2024/1/e52282 %U https://doi.org/10.2196/52282 %U http://www.ncbi.nlm.nih.gov/pubmed/39476852 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62762 %T WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice %A Fabens,Isabella %A Makhele,Calsile %A Igaba,Nelson Kibiribiri %A Hlongwane,Sizwe %A Phohole,Motshana %A Waweru,Evelyn %A Oni,Femi %A Khwepeya,Madalitso %A Sardini,Maria %A Moyo,Khumbulani %A Tweya,Hannock %A Wafula,Mourice Barasa %A Pienaar,Jacqueline %A Ndebele,Felex %A Setswe,Geoffrey %A Dong,Tracy Qi %A Feldacker,Caryl %+ International Training and Education Center for Health (I-TECH), Departments of Global Health and Medicine, University of Washington, 13th Floor, 908 Jefferson Street, Seattle, WA, 98104, United States, 1 206 221 4970, cfeld@uw.edu %K 2-way texting %K text messages %K WhatsApp %K digital health innovations %K male circumcision %K South Africa %K quality improvement %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. Objective: The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Methods: Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Results: Over a 2-month period—from August to October, 2023—337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33%) WhatsApp clients and 44 (28%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. Conclusions: When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting. %M 39412842 %R 10.2196/62762 %U https://formative.jmir.org/2024/1/e62762 %U https://doi.org/10.2196/62762 %U http://www.ncbi.nlm.nih.gov/pubmed/39412842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54046 %T Design of a Tool Capable of Assessing Environmental Sociocultural Physical Factors Influencing Women’s Decisions on When and Where to Toilet Within Real-World Settings: Protocol for the Build and Usability Testing of a Mobile App for Use by Community-Dwelling Women %A Miller,Janis M %A Wyman,Jean F %A An,Lawrence %A Chu,Haitao %A Fok,Cynthia S %A Lavender,Missy %A Lewis,Cora Elizabeth %A Markland,Alayne D %A Rickey,Leslie M %A Sheng,Ying %A Sutcliffe,Siobhan %A Low,Lisa Kane %A Mueller,Elizabeth R %A , %+ Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor, MI, 48109, United States, 1 7347644545, janismm@umich.edu %K mobile app %K urinary bladder %K woman’s health %K toileting %K ecological momentary assessment %K time factors %K population studies %K real-world environment %K mobile phone %D 2024 %7 18.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women’s decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when “thinking about my bladder” and shortly before “I just peed,” (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study. Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. International Registered Report Identifier (IRRID): RR1-10.2196/54046 %M 39293052 %R 10.2196/54046 %U https://www.researchprotocols.org/2024/1/e54046 %U https://doi.org/10.2196/54046 %U http://www.ncbi.nlm.nih.gov/pubmed/39293052 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63551 %T Quantification of Urinary Exosomal Prostate-Specific Antigen for the Diagnosis of Prostate Cancer Using Clinical Laboratory–Based Techniques: Protocol for a Case-Control Study %A Li,Guorong %A Tholance,Yannick %A Mallouk,Nora %A Waeckel,Louis %A Flandrin,Pascale %A Bali,Bruno %A Badet,Lionel %A Cornillon,Pierre %+ Department of Urology, North Hospital, CHU Saint-Etienne, Saint-Etienne, 42100, France, 33 0477828814, guorong.li@chu-st-etienne.fr %K liquid biopsy %K urinary exosome %K diagnosis %K PSA %K prostate-specific antigen %K prostate cancer %D 2024 %7 11.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prostate cancer is the most common cancer in men and represents a major public health problem. The current method for the diagnosis or screening of prostate cancer is invasive and costly. There have been renewed and innovative studies searching for urinary biomarkers to aid in the diagnosis of prostate cancer, especially with technologies based on urinary exosomes. However, technologies based on urine exosomes usually need expensive machines such as an ultracentrifuge and they are difficult to standardize, which hinder their application in clinical laboratories. We have optimized and standardized the isolation of urinary exosomes with the precipitation method. We have found that urinary exosomal prostate-specific antigen (PSA) can be quantified by automatic Elecsys total PSA technique. Objective: In this study, our objective is to utilize urinary exosomes from prostate cancer for the development of a test to aid in its diagnosis. Methods: Exosomes from the prostate cancer cell line LNCaP was used to set up the technique. To analyze urine samples from patients, the methods include the collection of first-void urine using the Colli-Pee device, the isolation of urine exosomes using the optimized precipitation method, and the quantification of exosomal PSA by Elecsys total PSA. Results: This will be a 2-year study. We will start including patients and controls in the last quarter of 2024. We expect the results to be published in the second quarter of 2027. Conclusions: This is the first study to quantify urinary exosomal PSA using the Elecsys total PSA technique for the diagnosis of prostate cancer. This study emphasizes techniques that are suitable for implementation in clinical laboratories, which will facilitate the application of urinary exosomes to simplify and improve the diagnosis and screening of prostate cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/63551 %M 39024018 %R 10.2196/63551 %U https://www.researchprotocols.org/2024/1/e63551 %U https://doi.org/10.2196/63551 %U http://www.ncbi.nlm.nih.gov/pubmed/39024018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56500 %T Comparing GPT-4 and Human Researchers in Health Care Data Analysis: Qualitative Description Study %A Li,Kevin Danis %A Fernandez,Adrian M %A Schwartz,Rachel %A Rios,Natalie %A Carlisle,Marvin Nathaniel %A Amend,Gregory M %A Patel,Hiren V %A Breyer,Benjamin N %+ Department of Urology, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, United States, 1 415 353 2200, kevin.d.li@ucsf.edu %K artificial intelligence %K ChatGPT %K large language models %K qualitative analysis %K content analysis %K buried penis %K qualitative interviews %K qualitative description %K urology %D 2024 %7 21.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Large language models including GPT-4 (OpenAI) have opened new avenues in health care and qualitative research. Traditional qualitative methods are time-consuming and require expertise to capture nuance. Although large language models have demonstrated enhanced contextual understanding and inferencing compared with traditional natural language processing, their performance in qualitative analysis versus that of humans remains unexplored. Objective: We evaluated the effectiveness of GPT-4 versus human researchers in qualitative analysis of interviews with patients with adult-acquired buried penis (AABP). Methods: Qualitative data were obtained from semistructured interviews with 20 patients with AABP. Human analysis involved a structured 3-stage process—initial observations, line-by-line coding, and consensus discussions to refine themes. In contrast, artificial intelligence (AI) analysis with GPT-4 underwent two phases: (1) a naïve phase, where GPT-4 outputs were independently evaluated by a blinded reviewer to identify themes and subthemes and (2) a comparison phase, where AI-generated themes were compared with human-identified themes to assess agreement. We used a general qualitative description approach. Results: The study population (N=20) comprised predominantly White (17/20, 85%), married (12/20, 60%), heterosexual (19/20, 95%) men, with a mean age of 58.8 years and BMI of 41.1 kg/m2. Human qualitative analysis identified “urinary issues” in 95% (19/20) and GPT-4 in 75% (15/20) of interviews, with the subtheme “spray or stream” noted in 60% (12/20) and 35% (7/20), respectively. “Sexual issues” were prominent (19/20, 95% humans vs 16/20, 80% GPT-4), although humans identified a wider range of subthemes, including “pain with sex or masturbation” (7/20, 35%) and “difficulty with sex or masturbation” (4/20, 20%). Both analyses similarly highlighted “mental health issues” (11/20, 55%, both), although humans coded “depression” more frequently (10/20, 50% humans vs 4/20, 20% GPT-4). Humans frequently cited “issues using public restrooms” (12/20, 60%) as impacting social life, whereas GPT-4 emphasized “struggles with romantic relationships” (9/20, 45%). “Hygiene issues” were consistently recognized (14/20, 70% humans vs 13/20, 65% GPT-4). Humans uniquely identified “contributing factors” as a theme in all interviews. There was moderate agreement between human and GPT-4 coding (κ=0.401). Reliability assessments of GPT-4’s analyses showed consistent coding for themes including “body image struggles,” “chronic pain” (10/10, 100%), and “depression” (9/10, 90%). Other themes like “motivation for surgery” and “weight challenges” were reliably coded (8/10, 80%), while less frequent themes were variably identified across multiple iterations. Conclusions: Large language models including GPT-4 can effectively identify key themes in analyzing qualitative health care data, showing moderate agreement with human analysis. While human analysis provided a richer diversity of subthemes, the consistency of AI suggests its use as a complementary tool in qualitative research. With AI rapidly advancing, future studies should iterate analyses and circumvent token limitations by segmenting data, furthering the breadth and depth of large language model–driven qualitative analyses. %M 39167785 %R 10.2196/56500 %U https://www.jmir.org/2024/1/e56500 %U https://doi.org/10.2196/56500 %U http://www.ncbi.nlm.nih.gov/pubmed/39167785 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56277 %T Deprescribing as a Way to Reduce Inappropriate Use of Drugs for Overactive Bladder in Primary Care (DROP): Protocol for a Cluster Randomized Controlled Trial With an Embedded Explanatory Sequential Mixed Methods Study %A Soerensen,Ann Lykkegaard %A Haase Juhl,Marie %A Krogh,Marlene Lunddal %A Grønkjær,Mette %A Kristensen,Jette Kolding %A Olesen,Anne Estrup %+ Department of Pharmacology, Aalborg University Hospital, Gartnerboligen, ground floor, Mølleparkvej 8a, Aalborg, 9000, Denmark, 45 72691086, ann.lykkegaard@rn.dk %K deprescribing %K overactive bladder %K general practice %K patient safety %K potentially inappropriate medication %K geriatric %K elderly %K medication safety %K geriatrics %K anticholinergic drugs %K safety %K prescription %K Denmark %K general practitioner %K evidence-based intervention %K evidence-based %K intervention %K health care %K medication %K efficacy %K DROP study %K DROP %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel. Objective: This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients. Methods: The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement. Results: The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions. Conclusions: The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study’s contribution lies in generating evidence for deprescribing practices and influencing best practices in health care. Trial Registration: ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975 International Registered Report Identifier (IRRID): DERR1-10.2196/56277 %M 39042875 %R 10.2196/56277 %U https://www.researchprotocols.org/2024/1/e56277 %U https://doi.org/10.2196/56277 %U http://www.ncbi.nlm.nih.gov/pubmed/39042875 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58599 %T Building Dual AI Models and Nomograms Using Noninvasive Parameters for Aiding Male Bladder Outlet Obstruction Diagnosis and Minimizing the Need for Invasive Video-Urodynamic Studies: Development and Validation Study %A Tsai,Chung-You %A Tian,Jing-Hui %A Lee,Chien-Cheng %A Kuo,Hann-Chorng %+ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, 970, Taiwan, 886 3 856 1825, hck@tzuchi.com.tw %K bladder outlet obstruction %K lower urinary tract symptoms %K machine learning %K nomogram %K artificial intelligence %K video urodynamic study %D 2024 %7 23.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Diagnosing underlying causes of nonneurogenic male lower urinary tract symptoms associated with bladder outlet obstruction (BOO) is challenging. Video-urodynamic studies (VUDS) and pressure-flow studies (PFS) are both invasive diagnostic methods for BOO. VUDS can more precisely differentiate etiologies of male BOO, such as benign prostatic obstruction, primary bladder neck obstruction, and dysfunctional voiding, potentially outperforming PFS. Objective: These examinations’ invasive nature highlights the need for developing noninvasive predictive models to facilitate BOO diagnosis and reduce the necessity for invasive procedures. Methods: We conducted a retrospective study with a cohort of men with medication-refractory, nonneurogenic lower urinary tract symptoms suspected of BOO who underwent VUDS from 2001 to 2022. In total, 2 BOO predictive models were developed—1 based on the International Continence Society’s definition (International Continence Society–defined bladder outlet obstruction; ICS-BOO) and the other on video-urodynamic studies–diagnosed bladder outlet obstruction (VBOO). The patient cohort was randomly split into training and test sets for analysis. A total of 6 machine learning algorithms, including logistic regression, were used for model development. During model development, we first performed development validation using repeated 5-fold cross-validation on the training set and then test validation to assess the model’s performance on an independent test set. Both models were implemented as paper-based nomograms and integrated into a web-based artificial intelligence prediction tool to aid clinical decision-making. Results: Among 307 patients, 26.7% (n=82) met the ICS-BOO criteria, while 82.1% (n=252) were diagnosed with VBOO. The ICS-BOO prediction model had a mean area under the receiver operating characteristic curve (AUC) of 0.74 (SD 0.09) and mean accuracy of 0.76 (SD 0.04) in development validation and AUC and accuracy of 0.86 and 0.77, respectively, in test validation. The VBOO prediction model yielded a mean AUC of 0.71 (SD 0.06) and mean accuracy of 0.77 (SD 0.06) internally, with AUC and accuracy of 0.72 and 0.76, respectively, externally. When both models’ predictions are applied to the same patient, their combined insights can significantly enhance clinical decision-making and simplify the diagnostic pathway. By the dual-model prediction approach, if both models positively predict BOO, suggesting all cases actually resulted from medication-refractory primary bladder neck obstruction or benign prostatic obstruction, surgical intervention may be considered. Thus, VUDS might be unnecessary for 100 (32.6%) patients. Conversely, when ICS-BOO predictions are negative but VBOO predictions are positive, indicating varied etiology, VUDS rather than PFS is advised for precise diagnosis and guiding subsequent therapy, accurately identifying 51.1% (47/92) of patients for VUDS. Conclusions: The 2 machine learning models predicting ICS-BOO and VBOO, based on 6 noninvasive clinical parameters, demonstrate commendable discrimination performance. Using the dual-model prediction approach, when both models predict positively, VUDS may be avoided, assisting in male BOO diagnosis and reducing the need for such invasive procedures. %M 39042442 %R 10.2196/58599 %U https://www.jmir.org/2024/1/e58599 %U https://doi.org/10.2196/58599 %U http://www.ncbi.nlm.nih.gov/pubmed/39042442 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56333 %T Finite Element Analysis of Pelvic Floor Biomechanical Models to Elucidate the Mechanism for Improving Urination and Defecation Dysfunction in Older Adults: Protocol for a Model Development and Validation Study %A Wang,Rui %A Liu,Guangtian %A Jing,Liwei %A Zhang,Jing %A Li,Chenyang %A Gong,Lichao %+ School of Nursing, Capital Medical University, 10 Xitoutiao, You'anmenwai, Fengtai District, Beijing, 100069, China, 86 13021000866, lwjing2004@ccmu.edu.cn %K elderly %K older adults %K pelvic cavity %K finite element analysis %K biomechanical model %K protocol %K urination %K incontinence %K aging %K bowel dysfunction %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The population is constantly aging, and most older adults will experience many potential physiological changes as they age, leading to functional decline. Urinary and bowel dysfunction is the most common obstacle in older people. At present, the analysis of pelvic floor histological changes related to aging has not been fully elucidated, and the mechanism of improving intestinal control ability in older people is still unclear. Objective: The purpose of this study is to describe how the finite element method will be used to understand the mechanical characteristics of and physiological changes in the pelvic cavity during the rehabilitation process, providing theoretical support for the mechanism for improving urination and defecation dysfunction in older individuals. Methods: We will collect magnetic resonance imaging (MRI) and computed tomography (CT) data of the pelvic cavity of one male and one female volunteer older than 60 years and use the finite element method to construct a 3D computer simulation model of the pelvic cavity. By simulating different physiological states, such as the Valsalva maneuver and bowel movement, we will verify the accuracy of the constructed model, investigate the effects of different neuromuscular functional changes, and quantify the impact proportions of the pelvic floor muscle group, core muscle group, and sacral nerve. Results: At present, we have registered the study in the Chinese Clinical Trial Registry and collected MRI and CT data for an older male and an older female patient. Next, the construction and analysis of the finite element model will be accomplished according to the study plan. We expect to complete the construction and analysis of the finite element model by July 2024 and publish the research results by October 2025. Conclusions: Our study will build finite element models of the pelvic floor of older men and older women, and we shall elucidate the relationship between the muscles of the pelvic floor, back, abdomen, and hips and the ability of older adults to control bowel movements. The results of this study will provide theoretical support for elucidating the mechanism for improving urination and defecation dysfunction through rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400080749; https://www.chictr.org.cn/showproj.html?proj=193428 International Registered Report Identifier (IRRID): DERR1-10.2196/56333 %M 38820582 %R 10.2196/56333 %U https://www.researchprotocols.org/2024/1/e56333 %U https://doi.org/10.2196/56333 %U http://www.ncbi.nlm.nih.gov/pubmed/38820582 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49903 %T Content Validity and Psychometric Properties of the German Version of the Holm and Cordoba Urinary Tract Infection Score for Uncomplicated Urinary Tract Infections in Women: Protocol for a Validation Study %A Piontek,Katharina %A Nestler,Sophie %A Holm,Anne %A Brodersen,John Brandt %A Apfelbacher,Christian %+ Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany, 49 391 67 24307, katharina.piontek@med.ovgu.de %K uncomplicated urinary tract infections %K patient-reported outcome measures %K PROM %K PROMs %K content validity %K psychometric properties %K patient reported %K validity %K validation %K urology %K urinary %K urinary tract infection %K UTI %K psychometric %K scale %K score %K scoring %K assessment %K women’s health %K internal medicine %K women %K urinary tract infections %K bacterial infection %K primary care %K infection %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Uncomplicated urinary tract infections (UTIs) in women are among the most common bacterial infections in primary care. Given the health threats related to the overuse of antibiotics, alternative options are of increasing importance. Patient-reported outcome measures are valuable tools for including the patients’ perspective when evaluating the efficacy of these strategies. Aiming to identify a suitable instrument to measure the severity and bothersomeness of UTI symptoms in women, we performed a systematic review of the literature and identified the Holm and Cordoba Urinary Tract Infection Score (HCUTI), which measures the severity, bothersomeness, and impact of uncomplicated UTIs on daily activities. This instrument showed sufficient content validity but needs translation and further validation before it can be used in German research. Objective: For use in the German setting, we aim (1) to perform translation and linguistic validation of the HCUTI and (2) to evaluate content validity and psychometric properties of the German version of the HCUTI in a population of women with uncomplicated UTIs. Methods: The HCUTI will be translated and linguistically validated using the dual-panel method. This process involves a bilingual translation panel and a lay panel to check the comprehensibility of the translation. Content validity of the translated questionnaire will be assessed using cognitive interviews according to the criteria for good content validity as recommended by the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) group involving women with uncomplicated UTIs and health care professionals. Subsequent psychometric validation of the German version of the HCUTI in a population of women with uncomplicated UTIs will include the assessment of structural validity, internal consistency, test-retest reliability, construct validity, responsiveness, and interpretability. Results: Results of the translation and linguistic validation process and the results of the content validity study were obtained in September 2023 and will be published separately. Data on the psychometric properties of the German version of the HCUTI are anticipated in mid-2024. Conclusions: We expect that data from the content validity study will provide important suggestions for potential modifications of the HCUTI for use in the German setting. The final version of the questionnaire will be used for the assessment of its psychometric properties in a large population of women with uncomplicated UTIs. International Registered Report Identifier (IRRID): PRR1-10.2196/49903 %M 38713509 %R 10.2196/49903 %U https://www.researchprotocols.org/2024/1/e49903 %U https://doi.org/10.2196/49903 %U http://www.ncbi.nlm.nih.gov/pubmed/38713509 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e51326 %T Prediction of Antibiotic Resistance in Patients With a Urinary Tract Infection: Algorithm Development and Validation %A İlhanlı,Nevruz %A Park,Se Yoon %A Kim,Jaewoong %A Ryu,Jee An %A Yardımcı,Ahmet %A Yoon,Dukyong %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Yongin, 16995, Republic of Korea, 82 3151898450, dukyong.yoon@yonsei.ac.kr %K antibiotic resistance %K machine learning %K urinary tract infections %K UTI %K decision support %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: The early prediction of antibiotic resistance in patients with a urinary tract infection (UTI) is important to guide appropriate antibiotic therapy selection. Objective: In this study, we aimed to predict antibiotic resistance in patients with a UTI. Additionally, we aimed to interpret the machine learning models we developed. Methods: The electronic medical records of patients who were admitted to Yongin Severance Hospital, South Korea were used. A total of 71 features extracted from patients’ admission, diagnosis, prescription, and microbiology records were used for classification. UTI pathogens were classified as either sensitive or resistant to cephalosporin, piperacillin-tazobactam (TZP), carbapenem, trimethoprim-sulfamethoxazole (TMP-SMX), and fluoroquinolone. To analyze how each variable contributed to the machine learning model’s predictions of antibiotic resistance, we used the Shapley Additive Explanations method. Finally, a prototype machine learning–based clinical decision support system was proposed to provide clinicians the resistance probabilities for each antibiotic. Results: The data set included 3535, 737, 708, 1582, and 1365 samples for cephalosporin, TZP, TMP-SMX, fluoroquinolone, and carbapenem resistance prediction models, respectively. The area under the receiver operating characteristic curve values of the random forest models were 0.777 (95% CI 0.775-0.779), 0.864 (95% CI 0.862-0.867), 0.877 (95% CI 0.874-0.880), 0.881 (95% CI 0.879-0.882), and 0.884 (95% CI 0.884-0.885) in the training set and 0.638 (95% CI 0.635-0.642), 0.630 (95% CI 0.626-0.634), 0.665 (95% CI 0.659-0.671), 0.670 (95% CI 0.666-0.673), and 0.721 (95% CI 0.718-0.724) in the test set for predicting resistance to cephalosporin, TZP, carbapenem, TMP-SMX, and fluoroquinolone, respectively. The number of previous visits, first culture after admission, chronic lower respiratory diseases, administration of drugs before infection, and exposure time to these drugs were found to be important variables for predicting antibiotic resistance. Conclusions: The study results demonstrated the potential of machine learning to predict antibiotic resistance in patients with a UTI. Machine learning can assist clinicians in making decisions regarding the selection of appropriate antibiotic therapy in patients with a UTI. %M 38421718 %R 10.2196/51326 %U https://medinform.jmir.org/2024/1/e51326 %U https://doi.org/10.2196/51326 %U http://www.ncbi.nlm.nih.gov/pubmed/38421718 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e51461 %T Potential Implementers’ Perspectives on the Development and Implementation of an e–Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study %A Coumoundouros,Chelsea %A El Arab,Rabie Adel %A Farrand,Paul %A Hamilton,Alexander %A Sanderman,Robbert %A von Essen,Louise %A Woodford,Joanne %+ Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden, 46 729 999 211, joanne.woodford@kbh.uu.se %K health care professional %K implementation %K informal caregiver %K chronic kidney disease %K e–mental health %K Consolidated Framework for Implementation Research %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: e–Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e–mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development. Objective: This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e–mental health intervention for caregivers of people living with CKD. Methods: Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework. Results: A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e–mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption. Conclusions: Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e–mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development. %M 37792676 %R 10.2196/51461 %U https://humanfactors.jmir.org/2023/1/e51461 %U https://doi.org/10.2196/51461 %U http://www.ncbi.nlm.nih.gov/pubmed/37792676 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43194 %T Identifying Targets for Innovation in Amazon Reviews of Bedwetting Alarms: Thematic Analysis %A Sahoo,Astha %A Starr,Savannah Leah %A Osadchiy,Vadim %A Desai,Sophia %A Iyer,Neha %A Luff,Marie %A Sollender,Grace E %A Sturm,Renea %+ University of California, Los Angeles Mattel Children’s Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, United States, 1 (310) 825 9111, rsturm@mednet.ucla.edu %K Amazon %K bedwetting alarms %K nocturnal enuresis %K online reviews %K early customer discovery %K online %K diagnosis %K pediatric %K teen %K adolescent %K sensor %K treatment %K age %K sex %K device %K user %K adaptability %K efficacy %K child health %K bedwet %K enuresis %K Urology %K pediatric urology %K alarm %K alert %K notification %K sleeping practice %K sleep practice %K sleep disorder %K polysomnography %K thematic analysis %K natural language processing %K NLP %D 2023 %7 6.7.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Nocturnal enuresis (NE) is a frequent diagnosis in pediatric and adolescent populations with an estimated prevalence of around 15% at the age of 6 years. NE can have a substantial impact on multiple health domains. Bedwetting alarms, which typically consist of a sensor and moisture-activated alarm, are a common treatment. Objective: This study aimed to determine areas of satisfaction versus dissatisfaction reported by the parents and caregivers of children using current bedwetting alarms. Methods: Using the search term “bedwetting alarms” on the Amazon marketplace, products with >300 reviews were included. For each product, the 5 reviews ranked the “most helpful” for each star category were selected for analysis. Meaning extraction method was applied to identify major themes and subthemes. A percent skew was calculated by summing the total number of mentions of each subtheme,+1 for a positive mention, 0 for a neutral mention, and –1 for a negative mention, and dividing this total by the number of reviews in which that particular subtheme was observed. Subanalyses were performed for age and gender. Results: Of 136 products identified, 10 were evaluated based on the selection criteria. The main themes identified across products were long-term concerns, marketing, alarm systems, and device mechanics and features. The subthemes identified as future targets for innovation included alarm accuracy, volume variability, durability, user-friendliness, and adaptability to girls. In general, durability, alarm accuracy, and comfort were the most negatively skewed subthemes (with a negative skew of –23.6%, –20.0%, and –12.4% respectively), which are indicative of potential areas for improvement. Effectiveness was the only substantially positively skewed subtheme (16.8%). Alarm sound and device features were positively skewed for older children, whereas ease of use had a negative skew for younger children. Girls and their caretakers reported negative experiences with devices that featured cords, arm bands, and sensor pads. Conclusions: This analysis provides an innovation roadmap for future device design to improve patient and caregiver satisfaction and compliance with bedwetting alarms. Our results highlight the need for additional options in alarm sound features, as children of different ages have divergent preferences in this domain. Additionally, girls and their parents and caretakers provided more negative overall reviews regarding the range of current device features compared to boys, indicating a potential focus area for future development. The percent skew showed that subthemes were often more negatively skewed toward girls, with the ease of use being –10.7% skewed for boys versus –20.5% for girls, and comfort being –7.1% skewed for boys versus –29.4% for girls. Put together, this review highlights multiple device features that are targets for innovation to ensure translational efficacy regardless of age, gender, or specific family needs. %M 37410523 %R 10.2196/43194 %U https://www.i-jmr.org/2023/1/e43194 %U https://doi.org/10.2196/43194 %U http://www.ncbi.nlm.nih.gov/pubmed/37410523 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44244 %T Diagnostic and Therapeutic Management of Urinary Tract Infections in Catalonia, Spain: Protocol for an Observational Cohort Study %A Moragas Moreno,Ana %A Fernández-García,Silvia %A Llor,Carl %A Ouchi,Dan %A García-Sangenís,Ana %A Monteagudo,Mònica %A Monfà,Ramon %A Giner-Soriano,Maria %+ Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Gran Via Corts Catalanes, 587, átic, Barcelona, 08007, Spain, 34 93 482 46 51, sfernandezg@idiapjgol.info %K urinary tract infection %K primary health care %K anti-bacterial agents %K diagnosis %K drug resistance %K electronic health records %D 2023 %7 22.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Antibiotic resistance is an individual and public health problem; multidrug-resistant infections could cause an estimated 10 million deaths worldwide by 2050. Unnecessary use of antimicrobials is the most important cause of resistance generation in the community, and an estimated 80% of antimicrobials are prescribed in primary health care, frequently for urinary tract infections (UTIs). Objective: This paper presents the protocol for the first phase of the Urinary Tract Infections in Catalonia (Infeccions del tracte urinari a Catalunya) project. We aim to examine the epidemiology of the different types of UTIs in Catalonia (an autonomous community in Spain) and their diagnostic and therapeutic management by health professionals. Furthermore, we aim to evaluate the correlation between types and total consumption of antibiotics for recurrent UTIs in 2 cohorts of women with the presence and severity of infectious complications of urological origin, especially pyelonephritis and sepsis, and 2 potentially serious infections: pneumonia and COVID-19. Methods: The study is a population-based observational cohort study including adults with a diagnosis of UTI registered in the Information System for the Development of Research in Primary Care (in Catalan: Sistema d’informació per al desenvolupament de la investigació en atenció primària), the Minimum Basic Data Sets of Hospital Discharges and Emergency Departments (in Catalan: Conjunt mínim bàsic de dades a l’hospitalització d'aguts i d’atenció urgent), and data from the Hospital Dispensing Medicines Register (in Catalan: Medicació hospitalària de dispensació ambulatòria) of Catalonia from the period between 2012 and 2021. We will evaluate the variables obtained from the databases to analyze the proportion of different types of UTIs, the percentage of adequate antibiotic treatments prescribed or received for recurrent UTIs according to the national guidelines, and the proportion of UTIs with complications. Results: We expect to describe the epidemiology of UTIs in Catalonia from 2012 to 2021, as well as describe the diagnostic and therapeutic management of UTIs by health professionals. Conclusions: We expect to find a high percentage of UTI cases with inadequate management according to the national guidelines, considering that on many occasions UTIs are treated with second- or third-line antibiotic therapies with a preference for the longest regimens. Furthermore, the use of antibiotic suppressive therapies, or prophylaxis, in recurrent UTIs will likely be highly variable. Moreover, we aim to determine whether women with recurrent UTIs treated with antibiotic suppressive therapies have a higher incidence and severity of potentially serious future infections, with special attention to acute pyelonephritis, urosepsis, COVID-19, and pneumonia, compared to women who receive antibiotic treatment after they present with a UTI. This is an observational study of data from administrative databases that will not allow causality analysis. The limitations of the study will be handled according to the appropriate statistical methods. Trial Registration: European Union Electronic Register of Post-Authorisation Studies EUPAS49724; https://www.encepp.eu/encepp/viewResource.htm?id=49725 International Registered Report Identifier (IRRID): DERR1-10.2196/44244 %M 36811950 %R 10.2196/44244 %U https://www.researchprotocols.org/2023/1/e44244 %U https://doi.org/10.2196/44244 %U http://www.ncbi.nlm.nih.gov/pubmed/36811950 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e33357 %T A Machine Learning Approach to Predict the Outcome of Urinary Calculi Treatment Using Shock Wave Lithotripsy: Model Development and Validation Study %A Moghisi,Reihaneh %A El Morr,Christo %A Pace,Kenneth T %A Hajiha,Mohammad %A Huang,Jimmy %+ School of Information Technology, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, rmoghisi88@gmail.com %K lithotripsy %K urolithiasis %K machine learning %K treatment outcome %K ensemble learning %K AdaBoost %K renal stones %K kidney disease %D 2022 %7 16.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy are established treatments for renal stones. Historically, SWL has been a predominant and commonly used procedure for treating upper tract renal stones smaller than 20 mm in diameter due to its noninvasive nature. However, the reported failure rate of SWL after one treatment session ranges from 30% to 89%. The failure rate can be reduced by identifying candidates likely to benefit from SWL and manage patients who are likely to fail SWL with other treatment modalities. This would enhance and optimize treatment results for SWL candidates. Objective: We proposed to develop a machine learning model that can predict SWL outcomes to assist practitioners in the decision-making process when considering patients for stone treatment. Methods: A data set including 58,349 SWL procedures performed during 31,569 patient visits for SWL to a single hospital between 1990 and 2016 was used to construct and validate the predictive model. The AdaBoost algorithm was applied to a data set with 17 predictive attributes related to patient demographics and stone characteristics, with success or failure as an outcome. The AdaBoost algorithm was also applied to a training data set. The generated model’s performance was compared to that of 5 other machine learning algorithms, namely C4.5 decision tree, naïve Bayes, Bayesian network, K-nearest neighbors, and multilayer perceptron. Results: The developed model was validated with a testing data set and performed significantly better than the models generated by the other 5 predictive algorithms. The sensitivity and specificity of the model were 0.875 and 0.653, respectively, while its positive predictive value was 0.7159 and negative predictive value was 0.839. The C-statistics of the receiver operating characteristic (ROC) analysis was 0.843, which reflects an excellent test. Conclusions:  We have developed a rigorous machine learning model to assist physicians and decision-makers to choose patients with renal stones who are most likely to have successful SWL treatment based on their demographics and stone characteristics. The proposed machine learning model can assist physicians and decision-makers in planning for SWL treatment and allow for more effective use of limited health care resources and improve patient prognoses. %M 35293872 %R 10.2196/33357 %U https://www.i-jmr.org/2022/1/e33357 %U https://doi.org/10.2196/33357 %U http://www.ncbi.nlm.nih.gov/pubmed/35293872 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30989 %T Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study %A Jaffar,Aida %A Mohd-Sidik,Sherina %A Foo,Chai Nien %A Admodisastro,Novia %A Abdul Salam,Sobihatun Nur %A Ismail,Noor Diana %+ Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia, 60 3 9769 2541, sherina@upm.edu.my %K User-centered design %K mHealth app %K Digital intervention %K mHealth Development and Evaluation Framework %K Usability %K Acceptability %K Pelvic Floor Muscle Training %K Urinary incontinence %K Pregnancy %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design–11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. %M 35113025 %R 10.2196/30989 %U https://humanfactors.jmir.org/2022/1/e30989 %U https://doi.org/10.2196/30989 %U http://www.ncbi.nlm.nih.gov/pubmed/35113025 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26781 %T Using Large-scale Social Media Analytics to Understand Patient Perspectives About Urinary Tract Infections: Thematic Analysis %A Gonzalez,Gabriela %A Vaculik,Kristina %A Khalil,Carine %A Zektser,Yuliya %A Arnold,Corey %A Almario,Christopher V %A Spiegel,Brennan %A Anger,Jennifer %+ Department of Urology, Davis School of Medicine, University of California, Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 95817, United States, 1 9167342222, drggonzalez@ucdavis.edu %K female urology %K urinary tract infections %K health services research %K social media %K online community %K online forum %K latent Dirichlet allocation %K data mining %K digital ethnography %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Current qualitative literature about the experiences of women dealing with urinary tract infections (UTIs) is limited to patients recruited from tertiary centers and medical clinics. However, traditional focus groups and interviews may limit what patients share. Using digital ethnography, we analyzed free-range conversations of an online community. Objective: This study aimed to investigate and characterize the patient perspectives of women dealing with UTIs using digital ethnography. Methods: A data-mining service was used to identify online posts. A thematic analysis was conducted on a subset of the identified posts. Additionally, a latent Dirichlet allocation (LDA) probabilistic topic modeling method was applied to review the entire data set using a semiautomatic approach. Each identified topic was generated as a discrete distribution over the words in the collection, which can be thought of as a word cloud. We also performed a thematic analysis of the word cloud topic model results. Results: A total of 83,589 posts by 53,460 users from 859 websites were identified. Our hand-coding inductive analysis yielded the following 7 themes: quality-of-life impact, knowledge acquisition, support of the online community, health care utilization, risk factors and prevention, antibiotic treatment, and alternative therapies. Using the LDA topic model method, 105 themes were identified and consolidated into 9 categories. Of the LDA-derived themes, 25.7% (27/105) were related to online community support, and 22% (23/105) focused on UTI risk factors and prevention strategies. Conclusions: Our large-scale social media analysis supports the importance and reproducibility of using online data to comprehend women’s UTI experience. This inductive thematic analysis highlights patient behavior, self-empowerment, and online media utilization by women to address their health concerns in a safe, anonymous way. %M 35076404 %R 10.2196/26781 %U https://www.jmir.org/2022/1/e26781 %U https://doi.org/10.2196/26781 %U http://www.ncbi.nlm.nih.gov/pubmed/35076404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30762 %T Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study %A Lee,Austin W %A Kenfield,Stacey A %A Wang,Elizabeth Y %A Enriquez,Anthony %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Breyer,Benjamin N %A Bauer,Scott R %+ Department of Urology, University of California, San Francisco, 550 16th Street, Box 1695, San Francisco, CA, 94158, United States, 1 415 221 4810 ext 24322, Scott.Bauer@ucsf.edu %K LUTS %K tamsulosin %K mobile %K app %K mobile phone %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men. Objective: We aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy. Methods: We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility. Results: We enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms. Conclusions: This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men. %M 34889745 %R 10.2196/30762 %U https://formative.jmir.org/2021/12/e30762 %U https://doi.org/10.2196/30762 %U http://www.ncbi.nlm.nih.gov/pubmed/34889745 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e25878 %T Barriers and Facilitators Associated With App-Based Treatment for Female Urinary Incontinence: Mixed Methods Evaluation %A Wessels,Nienke J %A Loohuis,Anne M M %A van der Worp,Henk %A Abbenhuis,Linde %A Dekker,Janny %A Berger,Marjolein Y %A van Gemert-Pijnen,Julia E W C %A Blanker,Marco H %+ Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, FA21, PO Box 196, Groningen, , Netherlands, 31 05 03616746, n.j.wessels@umcg.nl %K mHealth %K female %K mixed methods %K primary health care %K urinary incontinence %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: App-based treatment for urinary incontinence is a proven effective and cost-effective alternative to care as usual, but successful implementation requires that we identify and address the barriers and facilitators associated with app use. Objective: The goal of the research was to explore the factors influencing app-based treatment for urinary incontinence and identify which barriers or facilitators are associated with treatment success or failure. Methods: We used a sequential explanatory mixed methods design to connect the results of a randomized controlled trial with data from semistructured interviews. This previous RCT had shown the noninferiority of app-based treatment compared with care as usual for urinary incontinence over 4 months. Participants who reported success or failure with app-based treatment, as measured by the change in International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form symptom score, were selected for telephone interview by purposive sampling (n=17). This study reports mainly on the qualitative component of our mixed methods study. Qualitative analyses were conducted in two ways. First, we analyzed the qualitative data of all interviewed participants and discussed the relationships between the main themes. Second, the experiences between the success (n=9) and failure group (n=8) were compared and contrasted to explore factors that were positively or negatively associated with the quantitative effect of app-based treatment. These factors were then interpreted as barriers to and facilitators of successful app-based treatment. Results: Four interrelated themes were identified as affecting the app based treatment effect: adherence, personal factors, app factors, and awareness. Qualitative analyses of the relationships between the themes showed that adherence-related factors directly influenced treatment effect in both a positive and negative matter. In turn, adherence was also positively and negatively influenced by the other 3 themes. Additionally, awareness was positively influenced by the treatment effect. Within these themes, several factors were identified that acted as barriers (eg, unrealistic expectation of time investment and interfering personal circumstances), facilitators (eg, strict integration of exercises and prior pelvic floor muscle therapy), or both (eg, personality traits and increased awareness of symptoms). Conclusions: This study shows that the effect of app-based treatment for urinary incontinence is mainly influenced by adherence, which in turn is affected by personal factors, app-based factors, and awareness. The identified factors could function as both facilitators and barriers depending on the user and interaction with other themes. Insight into these facilitators and barriers could lead to improved implementation and increased treatment effectiveness by targeting women most likely to benefit and through further development of the app. International Registered Report Identifier (IRRID): RR2-10.1002/nau.23507 %M 34533466 %R 10.2196/25878 %U https://mhealth.jmir.org/2021/9/e25878 %U https://doi.org/10.2196/25878 %U http://www.ncbi.nlm.nih.gov/pubmed/34533466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e19439 %T A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial %A Wadensten,Towe %A Nyström,Emma %A Franzén,Karin %A Lindam,Anna %A Wasteson,Elisabet %A Samuelsson,Eva %+ Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE-90187, Sweden, 46 907855000, towe.wadensten@umu.se %K eHealth %K mHealth %K urinary incontinence %K urgency urinary incontinence %K mixed urinary incontinence %K self-management %K mobile app %K smartphone app %K women %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care. Treatment access and self-management for these conditions can be supported through eHealth approaches. Objective: This study aimed to investigate the efficacy of the mobile app Tät II for self-management of UUI and MUI in women. Methods: This randomized controlled trial included women ≥18 years old with UUI or MUI and ≥2 leakages per week. Those with red-flag symptoms were excluded. Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire. Data were collected using another questionnaire and a 2-day bladder diary. A telephone interview confirmed the symptom diagnosis. Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided. The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)−Urinary Incontinence Short Form (ICIQ-UI SF). Urgency symptoms were assessed using the ICIQ−Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ−Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol). Incontinence episode frequency (IEF) was calculated per bladder diary entries. Improvement was measured using the Patient’s Global Impression of Improvement. All outcomes were self-reported. Cure was defined as no leakages per the bladder diary. Intention-to-treat analysis was performed. Results: Between April 2017 and March 2018, 123 women (mean age 58.3, SD 9.6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group. Of these, 35 (28%) women had UUI, and 88 (72%) had MUI. Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference −3.1, 95% CI −4.8 to −1.3). The estimated between-group difference was −1.8 (95% CI −2.8 to −0.99) for mean ICIQ-OAB score and −6.3 (95% CI −10.5 to −2.1) for the mean ICIQ-LUTSqol score at follow-up. IEF reduction from baseline to follow-up was greater in the treatment group (−10.5, IQR −17.5 to −3.5) than in the information group (P<.001). Improvement was reported by 87% (52/60) of treatment group participants and by 30% (19/63) of information group participants. The cure rate was 32% in the treatment group, and 6% in the information group (odds ratio 5.4, 95% CI 1.9-15.6; P=.002). About 67% (40/60) of the treatment group participants used the app more than thrice a week. Conclusions: The treatment app was effective for improving urgency and mixed incontinence in women. When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care. Trial Registration: ClinicalTrials.gov NCT03097549; https://clinicaltrials.gov/ct2/show/NCT03097549 %M 33818395 %R 10.2196/19439 %U https://www.jmir.org/2021/4/e19439 %U https://doi.org/10.2196/19439 %U http://www.ncbi.nlm.nih.gov/pubmed/33818395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21875 %T Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study %A Dubin,Justin M %A Wyant,W Austin %A Balaji,Navin C %A Ong,William LK %A Kettache,Reda H %A Haffaf,Malik %A Zouari,Skander %A Santillan,Diego %A Autrán Gómez,Ana Maria %A Sadeghi-Nejad,Hossein %A Loeb,Stacy %A Borin,James F %A Gomez Rivas,Juan %A Grummet,Jeremy %A Ramasamy,Ranjith %A Teoh,Jeremy Y C %+ Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, United States, 1 973 634 8677, jdubin50@gmail.com %K coronavirus %K COVID-19 %K technology %K telemedicine %K telehealth %K urology %K cross-sectional %K perception %K usability %K barrier %K implementation %D 2020 %7 5.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. Objective: The aim of this study was to investigate current telemedicine usage by urologists, urologists’ perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. Methods: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists’ perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. Results: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients’ lack of technological comprehension, patients’ lack of access to the required technology, and reimbursement concerns. Conclusions: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists’ usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest. %M 33031047 %R 10.2196/21875 %U https://www.jmir.org/2020/11/e21875 %U https://doi.org/10.2196/21875 %U http://www.ncbi.nlm.nih.gov/pubmed/33031047 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17114 %T User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study %A Wessels,Nienke J %A Hulshof,Lisa %A Loohuis,Anne M M %A van Gemert-Pijnen,Lisette %A Jellema,Petra %A van der Worp,Henk %A Blanker,Marco H %+ Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Postbus 196, Huispostcode FA21, Groningen, 9700 AD, Netherlands, 31 503616746, n.j.wessels@umcg.nl %K ehealth %K mobile applications %K self-management %K qualitative research %D 2020 %7 12.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although several apps are available to support the treatment of urinary incontinence (UI), little has been reported about the experiences and preferences of their users. Objective: The objective of this study was to explore the experiences and preferences of women using a mobile app for the treatment of UI and to identify potential improvements to the app. We developed this app for three types of UI: stress UI, urgency UI, and mixed UI. Methods: The participants in this qualitative study were women with self-reported stress UI, urgency UI, or mixed UI who used an app-based treatment to manage their condition for at least six weeks. Following the intervention, semistructured interviews were conducted to explore the participants’ experiences and preferences regarding the app. All interviews were audio-recorded, transcribed verbatim, and analyzed separately by two researchers. Results: Data saturation was reached after interviewing 9 women (aged 32-68 years) with stress UI (n=1, 11%), urgency UI (n=3, 33%), or mixed UI (n=5, 56%). Accessibility, awareness, usability, and adherence emerged as the main themes. On the one hand, participants appreciated that the app increased their accessibility to care, preserved their privacy, increased their awareness of therapeutic options, was easy to use and useful, and supported treatment adherence. On the other hand, some participants reported that they wanted more contact with a care provider, and others reported that using the app increased their awareness of symptoms. Conclusions: This qualitative study indicates that women appreciate app-based treatment for UI because it can lower barriers to treatment and increase both awareness and adherence to treatment. However, the app does not offer the ability of face-to-face contact and can lead to a greater focus on symptoms. %M 32530431 %R 10.2196/17114 %U http://mhealth.jmir.org/2020/6/e17114/ %U https://doi.org/10.2196/17114 %U http://www.ncbi.nlm.nih.gov/pubmed/32530431 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e10195 %T Association of Social Media Presence with Online Physician Ratings and Surgical Volume Among California Urologists: Observational Study %A Houman,Justin %A Weinberger,James %A Caron,Ashley %A Hannemann,Alex %A Zaliznyak,Michael %A Patel,Devin %A Moradzadeh,Ariel %A Daskivich,Timothy J %+ Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, United States, 1 7149287950, justin.houman@cshs.org %K social media %K surgical volume %K physician ratings %D 2019 %7 13.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Urologists are increasingly using various forms of social media to promote their professional practice and attract patients. Currently, the association of social media on a urologists’ practice is unknown. Objectives: We aimed to determine whether social media presence is associated with higher online physician ratings and surgical volume among California urologists. Methods: We sampled 195 California urologists who were rated on the ProPublica Surgeon Scorecard website. We obtained information on professional use of online social media (Facebook, Instagram, Twitter, blog, and YouTube) in 2014 and defined social media presence as a binary variable (yes/no) for use of an individual platform or any platform. We collected data on online physician ratings across websites (Yelp, Healthgrades, Vitals, RateMD, and UCompareHealthcare) and calculated the mean physician ratings across all websites as an average weighted by the number of reviews. We then collected data on surgical volume for radical prostatectomy from the ProPublica Surgeon Scorecard website. We used multivariable linear regression to determine the association of social media presence with physician ratings and surgical volume. Results: Among our sample of 195 urologists, 62 (32%) were active on some form of social media. Social media presence on any platform was associated with a slightly higher mean physician rating (β coefficient: .3; 95% CI 0.03-0.5; P=.05). However, only YouTube was associated with higher physician ratings (β coefficient: .3; 95% CI 0.2-0.5; P=.04). Social media presence on YouTube was strongly associated with increased radical prostatectomy volume (β coefficient: 7.4; 95% CI 0.3-14.5; P=.04). Social media presence on any platform was associated with increased radical prostatectomy volume (β coefficient: 7.1; 95% CI –0.7 to 14.2; P=.05). Conclusions: Urologists’ use of social media, especially YouTube, is associated with a modest increase in physician ratings and prostatectomy volume. Although a majority of urologists are not currently active on social media, patients may be more inclined to endorse and choose subspecialist urologists who post videos of their surgical technique. %M 31411141 %R 10.2196/10195 %U https://www.jmir.org/2019/8/e10195/ %U https://doi.org/10.2196/10195 %U http://www.ncbi.nlm.nih.gov/pubmed/31411141