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Interactive Journal of Medical Research
A new general medical journal for the 21st century, focusing on innovation in health and medical research.
Background: Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as Staged or Same-Day procedures. However, evidence guiding the choice between these approaches is lacking. Objective: This systematic review and meta-analysis aimed to evaluate patient outcomes following Staged and Same-Day CF for ASD. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in major databases. Eligible studies comparing Staged and Same-Day CF in adults with ASD were included. Data were extracted, and meta-analysis was performed for peri-operative outcomes and adverse events. Results: Following exclusion criteria, seven studies were included for review. A total of 741 patients undergoing CF for ASD were included in the review (Staged: 331; Same-Day: 410). Four studies that had comparable outcomes were merged for the quantitative meta-analysis and split based on observed measures. Meta-analysis revealed significantly shorter operative time and hospital length of stay for Same-Day CF. Estimated blood loss and peri-operative adverse events trended towards significance favoring Same-Day CF. However, intra-operative and post-operative adverse event, reoperation, and readmission rates showed inconsistent findings between studies. Data quality assessment revealed a moderate degree of bias for all included studies. Conclusions: Same-Day CF may offer advantages in terms of shorter operative time and hospital stay compared to Staged CF for ASD. However, there was marked heterogeneity in peri-operative outcomes reporting, and continuous variables were inconsistently presented. This underscored the need for standardized reporting of clinical variables and patient reported outcomes and higher evidence randomized controlled trials to elucidate the clinical superiority of either approach. Clinical Trial: In accordance with PRISMA-P guidelines, the protocol of the systematic review was registered on the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) (CRD42022339764) and disseminated through the Journal of Medical Internet Research (JMIR) Research Protocols (International Registered Report Identifier (IRRID): PRR1-10.2196/4233)
(Toronto, June 27, 2024) JMIR Publications announced today that the Interactive Journal of Medical Research has received a Journal Impact Factor (JIF) of 1.9 as published in the 2024 Journal Citation Report (JCR) from Clarivate.
Here’s a selection of some of the highly cited articles from the Interactive Journal of Medical Research:
Overall, 8 JMIR Publications journals (more than half of our portfolio of journals with a JIF) secured positions in the top quartile of their respective categories.
A Complete List of JMIR Publications Titles With a JIF in 2024:
For 25 years, JMIR Publications has been advocating for open access in digital health. Discover our complete open access journal portfolio and explore the communities progressing digital health and health research in the internet age.
We are grateful to the scholars, researchers, institutions, funders, peer reviewers, editors, and editorial board members who have contributed to our mission of advancing scientific knowledge.
The Interactive Journal of Medical Research (i-JMR, ISSN: 1929-073X, Journal Impact Factor™ of 1.9 (Clarivate, 2024), 5-Year Journal Impact Factor™: 2.2) is an interdisciplinary medical journal focusing on innovation in health, health care, and medicine. Interactive refers to the relationship between people, disciplines, organizations, systems, and/or technology (e.g. human-to-human, human-to-computer/systems, organization-to-organization, system-to-system, etc). The publications cover multiple areas of health sciences, including - but not limited to - cardiology, dermatology, dental sciences, kinesiology, neurology, nursing, nutrition, ophthalmology, and psychiatry. Innovation is evidenced through studies that: (1) present clinically relevant findings, (2) describe new medical techniques, (3) report unique medical cases, and (4) identify emerging trends in the current literature. All article types are considered for publication in i-JMR, including case reports, observational studies, interventional studies, viewpoints, bibliometric studies and literature reviews, as long as they present innovation. i-JMR is published by JMIR Publications (What is JMIR Publications?), the publisher of JMIR, the leading eHealth/mHealth journal.
i-JMR is indexed in PubMed, PubMed Central, DOAJ, Sherpa/Romeo, EBSCO, and Clarivate's Emerging Sources Citation Index (ESCI).
Background: There is a lack of investigation into the dynamics of blood lipids before, during, and after diurnal fasting, especially in inactive men. Objective: This study determined dynamic changes in blood lipids in inactive men before, during, and after they underwent diurnal fasting. Methods: A total of 44 young men aged a mean 27.6 (SD 5.8) years were recruited to evaluate their habitual physical activity and diet using a questionnaire developed for this study. Body composition was evaluated using a bioelectrical impedance analysis machine (Tanita BC-980). An 8-ml blood sample was collected to evaluate blood lipids and glucose. All measurements were taken 2-3 days before Ramadan, during Ramadan (at week 2 and week 3), and 1 month after Ramadan. A 1-way repeated measures ANOVA was used to compare the measured variables before, during, and after the month of Ramadan. When a significant difference was found, post hoc testing was used. Differences were considered significant at P<.05. Results: There was a significant reduction in low-density lipoprotein during Ramadan compared to before and after Ramadan (83.49 mg/dl at week 3 vs 93.11 mg/dl before Ramadan [P=.02] and 101.59 mg/dl after Ramadan [P=.007]). There were significant elevations in fasting blood glucose (74.60 mmol/L before Ramadan vs 81.52 mmol/L at week 3 [P=.03] and 86.51 mmol/L after Ramadan [P=.01]) and blood pressure (109 mm Hg before Ramadan vs 114 mm Hg after Ramadan; P=.02) reported during and even after the month of Ramadan, although both fasting blood glucose and blood pressure were within normal levels. Conclusions: Ramadan fasting could be an independent factor in reducing low-density lipoprotein. Further investigations are encouraged to clarify the impact of diurnal fasting on blood lipids in people with special conditions.
Background: Health locus of control (HLOC) is a theory that describes how individuals perceive different forces that influence their lives. The concept of a locus of control can affect an individual’s likelihood to commit to behaviors related to their health. This study explores the literature on the relationships between HLOC and medical behavioral interventions.
Objective: This study aims to better understand how HLOC constructs can potentially affect patient responses to health behavioral interventions and to propose a series of guidelines for individuals interested in designing medical behavioral interventions related to HLOC.
Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and performed an analysis of 50 papers related to the topic of HLOC and medical behavioral interventions. Inclusion criteria were studies that had a behavioral intervention involving patients and contained a metric of at least 1 of the constructs related to HLOC. The initial screening and search were conducted by 2 researchers (AY and SM) separately. The results were then combined and compared.
Results: Our findings explore the influence of different levels of HLOC along with the importance of both patient- and health-related context when assessing the relationships between HLOC constructs and the likelihood of health behavior change. The findings show that different constructs related to HLOC can act as reliable predictors for patient responses to medical behavioral interventions. Patients who score higher on internal HLOC measures are more likely to exhibit behaviors that are consistent with positive health outcomes. Patients who score higher on chance HLOC are more likely to exhibit behaviors that may lead to adverse health outcomes. These conclusions are supported by most of the 50 studies surveyed.
Conclusions: We propose guidelines for individuals designing medical behavioral interventions so that they can make use of these relationships linked to HLOC. The three guidelines suggested are as follows: (1) in most situations, improving internal HLOC will improve health outcomes for patients; (2) patients with high external HLOC should be further studied to determine the source of the external HLOC; and (3) patients with a high chance HLOC are less likely to follow preventative behaviors or be responsive to interventions. Limitations of the study are that the primary search and analysis were conducted by 2 principal researchers (AY and SM). Interpretation and development of the guidelines are subject to individual interpretation of results and may not be applicable to all contexts.
Background: Postoperative fever frequently indicates surgical complications and is commonly used to evaluate the efficacy of interventions against surgical stress. However, the presence of circadian rhythms in body temperature may compromise the accurate detection of fever. Objective: This study aimed to investigate the detection rate of fever under intermittent measurement. Methods: We retrospectively reviewed the clinical records of patients who underwent nonemergency gastrointestinal surgery between November 2020 and April 2021. Patients’ temperature data were continuously collected every 4 seconds using a wireless axillary thermometer, and fever was defined as a temperature exceeding 38 °C within a day. To simulate intermittent measurement in clinical practice, the body temperature at each hour was selected from the continuously collected temperature dataset. Considering that temperatures are measured multiple times per day, all possible measurement plans using intermittent measurement were composed by combining 1-24 time points from the 24-hour daily cycle. Fever was clinically diagnosed based on the temperature readings at the selected time points per day. The fever detection rates for each plan, with varying measurement times, were listed and ranked. Results: Based on the temperature data continuously collected by the thermometer, fever occurred in 60 (40.8%) of the 147 included patients within 3 days after surgery. Of the measurement plans that included 1-24 measurements daily, the fever detection rates ranged from 3.3% (2/60) to 85% (51/60). The highest detection rates and corresponding timings for measurement plans with 1, 2, 3, and 4 measurements daily were 38.3% (23/60; at 8 PM), 56.7% (34/60; at 3 AM and 7 or 8 PM), 65% (39/60; at 3 AM, 8 PM, and 10 or 11 PM), and 70% (42/60; at 12 AM, 3 AM, 8 PM, and 11 PM), respectively; and the lowest detection rates were 3.3% (2/60), 6.7% (4/60), 6.7% (4/60), and 8.3% (5/60), respectively. Although fever within 3 days after surgery was not correlated with an increased incidence of postoperative complications (5/60, 8.3% vs 6/87, 6.9%; P=.76), it was correlated with a longer hospital stay (median 7, IQR 6-9 days vs median 6, IQR 5-7 days; P<.001). Conclusions: The fever detection rate of the intermittent approach is determined by the timing and frequency of measurement. Measuring at randomly selected time points can miss many fever events after gastrointestinal surgery. However, we can improve the fever detection rate by optimizing the timing and frequency of measurement.
The psychological well-being of astronauts is becoming just as vital as their physical and technical readiness as space missions extend into deep space. Long-duration missions pose unique challenges, such as isolation, confinement, communication delays, and microgravity, which can significantly affect mental health and cognitive performance. This commentary discusses the need for innovative mental health support systems, including automated psychotherapy, as well as Earth-based training methods like mindfulness and relaxation techniques, to address the psychological demands of space travel. By integrating these approaches into pre-mission preparation and in-flight routines, astronauts can develop self-regulation strategies to manage stress, improve focus, and enhance emotional resilience. Automated psychotherapy available 24-7 provides real-time confidential support when communication with Earth is delayed. As space exploration moves forward, the success of missions will depend not only on technological advancements but also on the development of psychological countermeasures that prioritize mental health alongside physical well-being. This paper emphasizes the importance of continued research and collaboration to refine and test these tools in analog environments, ensuring astronauts are mentally and emotionally prepared for the challenges of space.
Various behavioral and mental health issues have been reported by space crews for decades, with the overall number of mental health complications expected to be higher than is publicly known. The broad range of mental health complications encountered in space is expected to grow as people venture deeper into space. Issues with privacy, dual relationships, and delayed communications make rendering effective psychological therapy difficult in a spaceflight environment and nearly impossible in deep space. Automated psychotherapy offers a way to provide psychotherapy to astronauts both in deep space and low Earth orbit. Although automated psychotherapy is growing in popularity on Earth, little is known about its efficacy in space. This viewpoint serves to highlight the knowns and unknowns regarding this treatment modality for future deep space missions, and places an emphasis on the need for further research into the applicability and practicality of automated psychotherapy for the spaceflight environment, especially as it relates to long-duration, deep space missions.
Background: There has been a global decrease in seasonal influenza activity since the onset of the COVID-19 pandemic.
Objective: We aimed to describe influenza activity during the 2021/2022 season and compare it to the trends from 2012 to 2023. We also explored the influence of social and public health prevention measures during the COVID-19 pandemic on influenza activity.
Methods: We obtained influenza data from January 1, 2012, to February 5, 2023, from publicly available platforms for China, the United States, and Australia. Mitigation measures were evaluated per the stringency index, a composite index with 9 measures. A general additive model was used to assess the stringency index and the influenza positivity rate correlation, and the deviance explained was calculated.
Results: We used over 200,000 influenza surveillance data. Influenza activity remained low in the United States and Australia during the 2021/2022 season. However, it increased in the United States with a positive rate of 26.2% in the 49th week of 2022. During the 2021/2022 season, influenza activity significantly increased compared with the previous year in southern and northern China, with peak positivity rates of 28.1% and 35.1% in the second week of 2022, respectively. After the COVID-19 pandemic, the dominant influenza virus genotype in China was type B/Victoria, during the 2021/2022 season, and accounted for >98% (24,541/24,908 in the South and 20,543/20,634 in the North) of all cases. Influenza virus type B/Yamagata was not detected in all these areas after the COVID-19 pandemic. Several measures individually significantly influence local influenza activity, except for influenza type B in Australia. When combined with all the measures, the deviance explained values for influenza A and B were 87.4% (P<.05 for measures of close public transport and restrictions on international travel) and 77.6% in southern China and 83.4% (P<.05 for measures of school closing and close public transport) and 81.4% in northern China, respectively. In the United States, the association was relatively stronger, with deviance-explained values of 98.6% for influenza A and 99.1% (P<.05 for measures of restrictions on international travel and public information campaign) for influenza B. There were no discernible effects on influenza B activity in Australia between 2020 and 2022 due to the incredibly low positive rate of influenza B. Additionally, the deviance explained values were 95.8% (P<.05 for measures of restrictions on gathering size and restrictions on international travel) for influenza A and 72.7% for influenza B.
Conclusions: Influenza activity has increased gradually since 2021. Mitigation measures for COVID-19 showed correlations with influenza activity, mainly driven by the early stage of the pandemic. During late 2021 and 2022, the influence of mitigation management for COVID-19 seemingly decreased gradually, as the activity of influenza increased compared to the 2020/2021 season.
Trial Registration:
Background: The Delta variant (B.1.617.2) was considered the most dangerous SARS-CoV-2 strain; however, in-depth studies on its impact based on demographic and clinical characteristics of COVID-19 are scarce. Objective: We aimed to investigate the shift in demographic and clinical characteristics of the COVID-19 pandemic with the emergence of the SARS-CoV-2 Delta variant compared with the wild-type (WT) strain (B.1). Methods: A cross-sectional study of COVID-19 cases in the Indian population caused by the WT strain (B.1) and Delta variant of SARS-CoV-2 was performed. The viral genomic sequence metadata containing demographic, vaccination, and patient status details (N=9500, NDelta=6238, NWT=3262) were statistically analyzed. Results: With the Delta variant, in comparison with the WT strain, a higher proportion of young individuals (<20 years) were infected (0-9 years: Delta: 281/6238, 4.5% vs B.1: 75/3262, 2.3%; 10-19 years: Delta: 562/6238, 9% vs B.1: 229/3262, 7%; P<.001). The proportion of women contracting infection increased (Delta: 2557/6238, 41% vs B.1: 1174/3262, 36%; P<.001). However, it decreased for men (Delta: 3681/6238, 59% vs B.1: 2088/3262, 64%; P<.001). An increased proportion of the young population developed symptomatic illness and were hospitalized (Delta: 27/262, 10.3% vs B.1: 5/130, 3.8%; P=.02). Moreover, an increased proportion of the women (albeit not men) from the young (Delta: 37/262, 14.1% vs B.1: 4/130, 3.1%; P<.001) and adult (Delta: 197/262, 75.2% vs B.1: 72/130, 55.4%; P<.001) groups developed symptomatic illness and were hospitalized. The mean age of men and women who contracted infection (Delta: men=37.9, SD 17.2 years; women=36.6, SD 17.6 years; P<.001; B.1: men=39.6, SD 16.9 years; women=40.1, SD 17.4 years; P<.001) as well as developing symptoms or being hospitalized (Delta: men=39.6, SD 17.4 years; women=35.6, SD 16.9 years, P<.001; B.1: men=47, SD 18 years; women=49.5, SD 20.9 years, P<.001) were considerably lower with the Delta variant than the B.1 strain. The total mortality was about 1.8 times higher with the Delta variant than with the WT strain. With the Delta variant, compared with B.1, mortality decreased for men (Delta: 58/85, 68% vs B.1: 15/20, 75%; P<.001); in contrast, it increased for women (Delta: 27/85, 32% vs B.1: 5/20, 25%; P<.001). The odds of death increased with age, irrespective of sex (odds ratio 3.034, 95% CI 1.7-5.2, P<.001). Frequent postvaccination infections (24/6238) occurred with the Delta variant following complete doses. Conclusions: The increased involvement of young people and women, the lower mean age for illness, higher mortality, and frequent postvaccination infections were significant epidemiological concerns with the Delta variant.
Background: COPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity. Objective: This study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event. Methods: We performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated. Results: A total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P<.001), but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in the overall or individually adjusted model. Symptom scores tended to worsen for 10 days on either side of an exacerbation but were of insufficient magnitude for prediction, with area under the receiver operating characteristic curve values of ranging from 0.4 to 0.6. Conclusions: Within this small cohort with bronchiectasis, COPD, or both and airway colonization, physiological and symptom variables did not show sufficient predictive value for exacerbations to be of clinical utility. The self-management education provided as standard of care may be superior to either of these approaches, but benefit in another or larger cohort cannot be excluded.
Background: Thyroid disease (TD) is a prominent endocrine disorder that raises global health concerns; however, its comorbidity patterns remain unclear.
Objective: This study aims to apply a network-based method to comprehensively analyze the comorbidity patterns of TD using large-scale real-world health data.
Methods: In this retrospective observational study, we extracted the comorbidities of adult patients with TD from both private and public data sets. All comorbidities were identified using ICD-10 (International Classification of Diseases, 10th Revision) codes at the 3-digit level, and those with a prevalence greater than 2% were analyzed. Patients were categorized into several subgroups based on sex, age, and disease type. A phenotypic comorbidity network (PCN) was constructed, where comorbidities served as nodes and their significant correlations were represented as edges, encompassing all patients with TD and various subgroups. The associations and differences in comorbidities within the PCN of each subgroup were analyzed and compared. The PageRank algorithm was used to identify key comorbidities.
Results: The final cohorts included 18,311 and 50,242 patients with TD in the private and public data sets, respectively. Patients with TD demonstrated complex comorbidity patterns, with coexistence relationships differing by sex, age, and type of TD. The number of comorbidities increased with age. The most prevalent TDs were nontoxic goiter, hypothyroidism, hyperthyroidism, and thyroid cancer, while hypertension, diabetes, and lipoprotein metabolism disorders had the highest prevalence and PageRank values among comorbidities. Males and patients with benign TD exhibited a greater number of comorbidities, increased disease diversity, and stronger comorbidity associations compared with females and patients with thyroid cancer.
Conclusions: Patients with TD exhibited complex comorbidity patterns, particularly with cardiocerebrovascular diseases and diabetes. The associations among comorbidities varied across different TD subgroups. This study aims to enhance the understanding of comorbidity patterns in patients with TD and improve the integrated management of these individuals.
Background: Clinical routine data derived from university hospitals hold immense value for health-related research on large cohorts. However, using secondary data for hypothesis testing necessitates adherence to scientific, legal (such as the General Data Protection Regulation, federal and state protection legislations), technical, and administrative requirements. This process is intricate, time-consuming, and susceptible to errors. Objective: This study aims to develop a platform that enables clinicians to use current real-world data for testing research and evaluate advantages and limitations at a large university medical center (542,944 patients in 2022). Methods: We identified requirements from clinical practitioners, conceptualized and implemented a platform based on the existing components, and assessed its applicability in clinical reality quantitatively and qualitatively. Results: The proposed platform was established at the University Medical Center Hamburg-Eppendorf and made 639 forms encompassing 10,629 data elements accessible to all resident scientists and clinicians. Every day, the number of patients rises, and parts of their electronic health records are made accessible through the platform. Qualitatively, we were able to conduct a retrospective analysis of Parkinson disease over 777 patients, where we provide additional evidence for a significantly higher proportion of action tremors in patients with rest tremors (340/777, 43.8%) compared with those without rest tremors (255/777, 32.8%), as determined by a chi-square test (P<.001). Quantitatively, our findings demonstrate increased user engagement within the last 90 days, underscoring clinicians’ increasing adoption of the platform in their regular research activities. Notably, the platform facilitated the retrieval of clinical data from 600,000 patients, emphasizing its substantial added value. Conclusions: This study demonstrates the feasibility of simplifying the use of clinical data to enhance exploration and sustainability in scientific research. The proposed platform emerges as a potential technological and legal framework for other medical centers, providing them with the means to unlock untapped potential within their routine data.
Background: Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry.
Objective: The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP.
Methods: The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots.
Results: A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP. Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected.
Conclusions: This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed.
Trial Registration: PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979
Background: Prehospital telemedicine triage systems combined with machine learning (ML) methods have the potential to improve triage accuracy and safely redirect low-acuity patients from attending the emergency department. However, research in prehospital settings is limited but needed; emergency department overcrowding and adverse patient outcomes are increasingly common.
Objective: In this scoping review, we sought to characterize the existing methods for ML-enhanced telemedicine emergency triage. In order to support future research, we aimed to delineate what data sources, predictors, labels, ML models, and performance metrics were used, and in which telemedicine triage systems these methods were applied.
Methods: A scoping review was conducted, querying multiple databases (MEDLINE, PubMed, Scopus, and IEEE Xplore) through February 24, 2023, to identify potential ML-enhanced methods, and for those eligible, relevant study characteristics were extracted, including prehospital triage setting, types of predictors, ground truth labeling method, ML models used, and performance metrics. Inclusion criteria were restricted to the triage of emergency telemedicine services using ML methods on an undifferentiated (disease nonspecific) population. Only primary research studies in English were considered. Furthermore, only those studies using data collected remotely (as opposed to derived from physical assessments) were included. In order to limit bias, we exclusively included articles identified through our predefined search criteria and had 3 researchers (DR, JS, and KS) independently screen the resulting studies. We conducted a narrative synthesis of findings to establish a knowledge base in this domain and identify potential gaps to be addressed in forthcoming ML-enhanced methods.
Results: A total of 165 unique records were screened for eligibility and 15 were included in the review. Most studies applied ML methods during emergency medical dispatch (7/15, 47%) or used chatbot applications (5/15, 33%). Patient demographics and health status variables were the most common predictors, with a notable absence of social variables. Frequently used ML models included support vector machines and tree-based methods. ML-enhanced models typically outperformed conventional triage algorithms, and we found a wide range of methods used to establish ground truth labels.
Conclusions: This scoping review observed heterogeneity in dataset size, predictors, clinical setting (triage process), and reported performance metrics. Standard structured predictors, including age, sex, and comorbidities, across articles suggest the importance of these inputs; however, there was a notable absence of other potentially useful data, including medications, social variables, and health system exposure. Ground truth labeling practices should be reported in a standard fashion as the true model performance hinges on these labels. This review calls for future work to form a standardized framework, thereby supporting consistent reporting and performance comparisons across ML-enhanced prehospital triage systems.
Background: Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as Staged or Same-Day procedures. However, evidence guid...
Background: Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as Staged or Same-Day procedures. However, evidence guiding the choice between these approaches is lacking. Objective: This systematic review and meta-analysis aimed to evaluate patient outcomes following Staged and Same-Day CF for ASD. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in major databases. Eligible studies comparing Staged and Same-Day CF in adults with ASD were included. Data were extracted, and meta-analysis was performed for peri-operative outcomes and adverse events. Results: Following exclusion criteria, seven studies were included for review. A total of 741 patients undergoing CF for ASD were included in the review (Staged: 331; Same-Day: 410). Four studies that had comparable outcomes were merged for the quantitative meta-analysis and split based on observed measures. Meta-analysis revealed significantly shorter operative time and hospital length of stay for Same-Day CF. Estimated blood loss and peri-operative adverse events trended towards significance favoring Same-Day CF. However, intra-operative and post-operative adverse event, reoperation, and readmission rates showed inconsistent findings between studies. Data quality assessment revealed a moderate degree of bias for all included studies. Conclusions: Same-Day CF may offer advantages in terms of shorter operative time and hospital stay compared to Staged CF for ASD. However, there was marked heterogeneity in peri-operative outcomes reporting, and continuous variables were inconsistently presented. This underscored the need for standardized reporting of clinical variables and patient reported outcomes and higher evidence randomized controlled trials to elucidate the clinical superiority of either approach. Clinical Trial: In accordance with PRISMA-P guidelines, the protocol of the systematic review was registered on the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) (CRD42022339764) and disseminated through the Journal of Medical Internet Research (JMIR) Research Protocols (International Registered Report Identifier (IRRID): PRR1-10.2196/4233)
Background: Dementia, especially Alzheimer's disease (AD), increases significantly with age. Type 2 diabetes mellitus (DM) is associated with a higher risk of cognitive decline and dementia. Emerging...
Background: Dementia, especially Alzheimer's disease (AD), increases significantly with age. Type 2 diabetes mellitus (DM) is associated with a higher risk of cognitive decline and dementia. Emerging evidence suggests that certain antidiabetic medications may affect neurodegenerative outcomes. Objective: This study aimed to compare the risk of stroke, dementia, and AD between patients treated with sodium-glucose co-transporter 2 (SGLT2) inhibitors and those treated with thiazolidinediones (TZDs). Methods: This multicenter retrospective observational cohort study utilized electronic health records from 12 secondary and tertiary hospitals in South Korea from October 1, 2009, to April 30, 2023. Patients aged 55 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure were included. Incidence rates of stroke, dementia, and AD were evaluated using propensity score matching and Cox regression analysis to calculate hazard ratios (HRs). Results: The study included 31,998 cases of stroke, 33,942 cases of dementia, and 34,500 cases of AD. Compared to TZDs, the use of SGLT2 inhibitors significantly reduced the risk of stroke (HR 0.6248, 95% CI 0.4154–0.9398, P= .0024), dementia (HR 0.5622, 95% CI 0.4077–0.7751, P=.0004), and AD (HR 0.5556, 95% CI 0.3831–0.8056, P=.0019). Conclusions: SGLT2 inhibitors are associated with a reduced risk of stroke, dementia, and Alzheimer's disease compared to TZDs in patients aged 55 years and older with type 2 diabetes. These findings suggest a potential neuroprotective effect of SGLT2 inhibitors, which may inform therapeutic decision-making for type 2 DM patients at risk for neurodegenerative diseases. Further prospective studies are needed to validate these associations and elucidate the underlying mechanisms. Clinical Trial: Not applicable
Background: Prone positioning has emerged as a crucial intervention in managing acute respiratory failure (ARF), especially in ARDS and COVID-19 patients. Given the increasing interest in this field,...
Background: Prone positioning has emerged as a crucial intervention in managing acute respiratory failure (ARF), especially in ARDS and COVID-19 patients. Given the increasing interest in this field, it is important to characterize global research trends and key contributors to identify future research directions. Objective: The aim of this study was to analyze global research trends, collaboration networks, and research hotspots related to prone positioning in respiratory failure through a comprehensive bibliometric analysis. Methods: Bibliometric analyses were conducted using CiteSpace and Biblioshiny software on publications up to December 12, 2023, from the Web of Science Core Collection, focusing on prone positioning in respiratory failure. Results: A total of 1,263 research articles were identified, published in 50 countries by numerous institutions. The United States, France, and Germany contributed the most publications, with the United States producing 21.9% of the total. Key authors such as Claude Guerin and Luciano Gattinoni were identified as major contributors to the field. Keyword co-occurrence analysis revealed the dynamic nature of research on prone positioning in respiratory failure which highlighted protective ventilation and COVID-19-related ARDS as emerging research hotspots, indicating a shift in research focus during the pandemic. Conclusions: This study revealed a rapidly growing body of literature on prone positioning in respiratory failure, especially in the context of COVID-19. The findings underscore the importance of further multicenter clinical trials to validate current practices and refine treatment protocols. Additionally, the application of prone positioning in non-intubated patients represents a potential future research direction.
Background: : Social accountability in medical education refers to the obligation of medical schools to direct their education, research, and service activities toward addressing the health needs of t...
Background: : Social accountability in medical education refers to the obligation of medical schools to direct their education, research, and service activities toward addressing the health needs of the communities they serve. In Iran, the significance of social accountability has gained recognition, especially in light of reforms aimed at enhancing the quality and relevance of medical education. However, there is limited empirical data regarding the current status of social accountability practices in Iranian medical schools. Objective: Objective: The aim of current study is to define a set of indicators for assessing the social accountability of the medical education and to determine the current situation of accountability of medical education in medical schools in Iran. Methods: Methods: We conducted the study in three phases using a mixed method. The first phase included a comprehensive literature review, including texts, articles, and documents to determine the indicators of medical schools' social accountability assessment. In the second phase, we developed a checklist to assess the social accountability. Finally, in the third phase, we used the checklist and conducted the assessment of medical schools. The checklist with three domains consisting of structure, process, and outcome with10,12 and 8 items in order was sent out to 67 medical schools nationwide. The total score for the survey ranged from 0 to 30 points. The Statistical Package for Social Sciences (SPSS) version 24 was used for data analysis. Results: Results: As findings of the first phase after screening the 1021 documents found through the use of the appropriate search strategy, 10 studies were identified as relevant to our study. The assessment checklist with 30 items was the second phase product. For the third phase, the mean and standard deviation (SD) for the three domains of structure, process, and outcome were 6.94 (2.48), 8.39 (2.70), and 5.26 (2.54) respectively. The total score for social accountability of all medical schools was 20.59 (6.85). Conclusions: Conclusion: Using the self-administered checklist in this study, the status of medical schools according to social accountability indicators was acceptable. In recent years, the importance of social accountability and considering the Social Determinant of Health (SDH) by medical schools was mentioned by the Secretariat of the Council for Undergraduate Medical Education (SCUME). Also, the accreditation of medical education programs has been started in recent years. It seems these policies could promote some activities in line with medical schools' social accountability. However, reaching optimum needs a long way.
Background: Intensive Care Unit (ICU) is the department with the highest incidence of hospital infection, and it is also one of the departments that the hospital infection management department focuse...
Background: Intensive Care Unit (ICU) is the department with the highest incidence of hospital infection, and it is also one of the departments that the hospital infection management department focuses on [1,2]. In recent years, the detection rate of multidrug-resistant bacteria (resistant to ≥3 kinds of antimicrobial agents) has been increasing, and they are increasingly dominating the microbial community in hospital environment. Determining effective infection control measures to prevent cross-transmission of MDRO between patients and the environment can minimize potential infection outbreaks. Zhao Lihua et al [3] found that improving the cleaning and disinfection methods in ICU plays an important role in improving the quality of cleaning and disinfection and reducing the proportion of strains causing hospital infection in MDRO. Cotton swab sampling is the gold standard for testing whether there is pathogenic microorganism pollution on the surface of high-frequency contact [4], and it has always been an important tool to judge the cleanliness of the environment. The guidelines for environmental infection control of the Centers for Disease Control and Prevention in the United States point out that medical institutions do not need routine monitoring of air, water and environmental surfaces, and the cost of routine monitoring is high and the income is insufficient. The correlation between positive results of environmental hygiene monitoring and the incidence of nosocomial infection needs to be studied [3]. In recent years, adenosine triphosphate (ATP) fluorescence monitoring method provides direct and real-time feedback. ATP fluorescence detection method is used to evaluate the cleaning and disinfection effect of environmental objects in ICU, which can provide a favorable reference for the management of environmental cleaning and disinfection in ICU. This study objectively evaluates the effect of ATP fluorescence detection method through a meta-analysis of the cleaning and disinfection effect of environmental objects in ICU, providing a basis for improving the surface cleaning of environmental objects in ICU and reducing the incidence of hospital infection. Objective: Meta-analysis method was used to evaluate the cleaning and disinfection effect of ATP bioluminescence detection on the surface of environmental objects in ICU. Methods: Search China Biomedical Literature Database, CNKI China Knowledge Resource Database, Wanfang Medical Academic Journals, VIP Chinese Journals Database, and all related literatures of PubMed, Cochrane, Embase, Web of Science, MEDLINE and CINAHL from the establishment of the database to June 18th, 2024, collect the intervention research on improving the surface cleaning and disinfection effect of environmental objects in ICU by ATP bioluminescence detection, and use RevMan 5.3 and Stata16.0 software for Meta-analysis. Results: A total of 11 articles were included, including 9 before-and-after controlled studies and 2 prospective studies. The final indicators were the qualified rate of environmental surface cleaning and disinfection. The results of meta-analysis showed that the qualified rate increased by at least 29% and at most 41% after the feedback and supervision of environmental cleaning and disinfection in ICU based on ATP fluorescence detection results, which was statistically significant (Z=11.65, P < 0.05). After the intervention measures such as guidance intervention, education and training, and optimization of environmental disinfection and cleaning process were superimposed, the qualified rate increased by at least 34% and at most 42%, with statistical significance (Z=17.41, P < 0.05). After the implementation of the cluster intervention measures, the qualified rate increased by at least 18% and at most 34%, with statistical significance (Z=4.84, P<0.05). Conclusions: The ATP fluorescence detection method is simple to operate, and the data can be directly read on site, so that potential problems can be found in time and corrective measures can be put forward, which can significantly enhance the awareness of medical staff to strengthen cleaning and disinfection and improve the qualified rate of cleaning and disinfection effects on the surface of environmental objects. Clinical Trial: NA
Background: The internet has become a significant educational resource for health-related information, but there is a lack of quality control. This can lead to misconceptions and wrong adoption of hea...
Background: The internet has become a significant educational resource for health-related information, but there is a lack of quality control. This can lead to misconceptions and wrong adoption of health interventions. Cancer patients might rely on this information regarding treatment options, side effects, and precautions. Objective: This study aims to evaluate online Arabic content related to cancer medications, including chemotherapy, targeted therapy, and biological therapy. Methods: The search in Google engines with the translated Arabic keywords of “Cancer Medications”, “Cancer Treatment”, “Targeted Therapy for the Treatment of Cancer”, “Targeted Therapy”, “Biologic Therapy for Cancer” and “Chemotherapy Medications”. and the first four pages were screened with a total of 69 websites that met the inclusion criteria. The assessment of quality was completed by two independent investigators with DISCERN instrument. Results: The results of the average scores of the DISCERN tool for each website ranged from 22 to 66.5. The websites were categorised into four distinct levels: fair, good, poor, and very poor. Notably, 37% of the websites were rated as fair, 27.5% of the websites received a good rating, 24.6% of the websites scored poorly and 10.1% of the websites were classified as very poor. Conclusions: In this evaluation study, we found that two-thirds of all included websites ranked either fair or good, and the remaining third were ranked as poor or very poor with no site falling under excellent score. In light of these findings, we recommend that website owners and health experts, especially pharmacists, cooperate to deliver health-related information appropriately.
(Toronto, June 27, 2024) JMIR Publications announced today that the Interactive Journal of Medical Research has received a Journal Impact Factor (JIF) of 1.9 as published in the 2024 Journal Citation Report (JCR) from Clarivate. 
