JMIR Open Peer Review Submissions

How should debriefing be undertaken in web-based studies? Findings from a Randomised Controlled Trial

Sat, 26 May 2012 12:29:59 EDT

Background: Internet research may raise older ethical issues in new forms or pose new issues. It has been recommended that debriefing information online be kept very short, with further information including study results made available if requested by participants. There are no empirical studies which compare possible alternative methods of debriefing in online studies. Objective: To undertake a randomised controlled trial evaluating how to implement the recommended approach by assessing the effects of two different approaches on accessing of additional information. Methods: All 11,943 participants in the Effects of Study Design and Allocation (ESDA) study, which employed deception, were randomly assigned to one of two methods of debriefing: Group A received the debriefing information in the body of an e-mail with links to protocol and results pages; Group B were presented with these links after clicking on an initial link in the body of the e-mail to view the debriefing information on a website. Outcomes assessed were the proportions clicking on the links to the protocol and results summary and the time spent on these pages by those accessing them. Results: The group who were presented with no debriefing information in the body of the e-mail and went to a website for this information (Group B) were approximately twice as likely to subsequently access the protocol and the results summary. These differences between the two groups were highly statistically significant. Although these differences are clear, the overall proportions accessing such information were low, and there were no differences in mean time spent reading these pages. Only one quarter of Group B actually accessed debriefing information. Conclusions: In circumstances where the uptake of fuller information on study design, methods and findings is deemed important, debriefing information may be better provided via a link and not included in the body of an e-mail. Doing so may, however, reduce the extent of receiving any debriefing information at all. There is a wider need for high quality empirical studies to inform ethical evaluations. Clinical Trial: Australian New Zealand Clinical Trials Registry, ACTRN12610000846022 (http://www.anzctr.org.au/) Date Submitted: May 26, 2012. Open Peer Review Period: May 26, 2012 - Jul 21, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Consistently increasing numbers of online ratings of healthcare in England

Wed, 16 May 2012 10:39:19 EDT

Text of letter: In a recent JMIR article, Gao and colleagues demonstrated the growing number of internet-based ratings of physicians on a commercially-owned website in the USA [1]. In England, in keeping with our National Health Service, we have a government run website that allows patients to rate and comment on their care online in a similar way, but at the level of healthcare provider organisations rather than individuals. The website is called NHS Choices [2]. Gao suggests that their results demonstrate a positive correlation between online ratings and physician quality. We have similarly demonstrated how better online ratings at the organisational level are associated with better clinical outcomes [3], and patient experience measured by surveys [4] in England. In a new analysis to allow comparison with Gao’s results, we looked at the number of ratings of hospitals posted on the NHS Choices website over the period since it started (August 2008) to the end of 2011. There were 20,996 ratings of hospitals over the 40 month period, fewer than in the US. We found a more gradual, linear increase in ratings in England (Figure 1) compared with the accelerating growth in ratings seen on commercial sites in the US [1]. We hope this adds to the work of our American colleagues, and demonstrates that the increasing number of online ratings of healthcare is an international phenomenon, even if England is perhaps at an earlier stage on the curve than the US. Date Submitted: May 4, 2012. Open Peer Review Period: May 16, 2012 - Jul 11, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Design and deployment of a new eService for the assessment of patients with acute stroke: TeleStroke

Fri, 11 May 2012 12:41:32 EDT

Background: Health care service based on telemedicine enables the reduction of physical and time barriers in stroke treatments. Moreover, this service connects centres specialised on stroke treatment with other centres and practitioners. As a result, it is increased accessibility to neurology specialist care and fibrinolytic treatment. Objective: Development and introduction of a new aid for the treatment of patients with acute stroke based on telemedicine (TeleStroke) at Virgen del Rocío University Hospital. Methods: The system is fundamentally based on communication between the requesting hospital where the patient is located and the referral hospital where the specialised group are based. Two different elements can be seen in the architecture of the system to be described: TeleStroke medical station and communication between medical stations. The TeleStroke medical station built into the information systems of the requesting hospital through the monitoring of standards and the medical station of the referral hospital where the neurologist receives the consultation from the requesting hospital. Communication between both stations based on the premises of speed, interoperability, security and mobility. The evaluation phase includes patients who presented acute stroke symptoms and they were examined by TeleStroke in two hospitals, which are in a distance of 16 and 110 kilometers from Virgen del Rocío University Hospital, from October 2008 to January 2011. We analyzed the number of queries telematics, the percentage of patients treated with fibrinolysis and the times. To evaluate the acceptability of the system TeleStroke by medical professionals has developed a web-based questionnaire in technology acceptance model. Results: A total of 28 patients were evaluated through queries telematic. 19 out of 28 patients (68%) received fibrinolysis treatment. The most common reasons for not treating with fibrinolysis included: clinical criteria at six out of nine patients (66%) and beyond the time window at three out of nine patients (33%). The mean “onset-to-hospital” time was 69 minutes, the mean time from admission to CT image was 33 minutes, the mean “door-to-needle” time was 82 minutes and the mean “onset-to-needle” time was 150 minutes. 34 out of 61 medical professionals completed a questionnaire to evaluate the acceptability of the system TeleStroke. The mean values for each item are higher than 6.50 so that respondents positively evaluated each item This survey was assessed by the Cronbach's alpha test to determine the reliability of the questionnaire and the obtained results showed a value of 0.97. Conclusions: The implementation of TeleStroke has made real the possibility of receiving an effective treatment for patients in acute phase of stroke, a treatment they could not access until now because of the necessary time required for transferring patients to referral hospitals. Date Submitted: May 11, 2012. Open Peer Review Period:...

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Recruitment, participation, and satisfaction of youth with type 1 diabetes in e-Health psycho-educational research

Fri, 11 May 2012 12:41:04 EDT

Background: E-health technologies, such as the internet, offer a platform for improving the dissemination and accessibility of psycho-educational programs for youth with chronic illness. Little is known, however, about the recruitment process and yield of diverse samples in internet research with youth who have a chronic illness. Objective: The purpose of this study was to compare the demographic and clinical characteristics of youth with type 1 diabetes (T1D) on recruitment, participation, and satisfaction with two e-Health psycho-educational programs. Methods: Youth with T1D from 4 U.S. sites were invited to participate (n=518) with 320 eligible youth consenting (mean age = 12.3 + 1.1, 55% female, 62.2% white, mean A1C = 8.3 + 1.5). Data for this secondary analysis included demographic information (age, race/ethnicity, income), depressive symptoms, recruitment rates [refusal at point of contact (22%), those who consented but did not participate (i.e., passive refusals) (15%), and enrolled youth (63%)], participation (80% lessons completed), and a satisfaction survey (ie., how helpful, enjoyable). Chi-square or ANOVA analyses were used. Results: There were significant differences in recruitment rates by income and race/ethnicity such that non-white and low-income youth were more likely to refuse passively compared to white and higher income youth who were more likely to enroll (P<.001). Participation in program sessions was high, with 78% of youth completing at least 4 of 5 sessions. There were no significant differences in participation by program, age, gender, or race/ethnicity. Low-income youth were less likely to participate (P=.002). Satisfaction in both programs was also high (3.9 out of 5). There were significant gender, race/ethnicity, and income differences, in that girls (P=.001), non-White youth (P=.02), and low-income youth (P=.02) reported higher satisfaction. There were no differences in satisfaction by program or age. Conclusions: Results indicate that minority and low-income youth with T1D are less likely to enroll in internet-based research than White and higher income youth; thus, creative recruitment approaches are needed. Low-income youth were less likely to participate, possibly due to access. However, once enrolled, diverse and low-income youth with T1D were as highly satisfied with the e-Health programs as White youth and those with higher income. Results suggest that e-Health programs have the potential to reach diverse youth and be appealing to them. Clinical Trial: NCT00684658 Date Submitted: May 10, 2012. Open Peer Review Period: May 11, 2012 - Jul 6, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Influence of delivery strategy on message processing mechanisms and e-loyalty of a Dutch computer tailored smoking cessation intervention

Tue, 08 May 2012 15:22:18 EDT

Background: Smoking tobacco is one of the most preventable causes of illness and death. Internet computer tailored (CT) smoking cessation interventions have shown to be effective. Although these interventions have the potential to reach a large number of smokers, they often face high attrition rates, especially among lower educated smokers. A possible reason for the high attrition rates in the latter group is that the CT smoking cessation interventions may not be attractive enough as they are mainly text-based. Video-based messages might be more effective in attracting attention and stimulating comprehension in people with a lower educational level and therefore reduce attrition rates. Objective: The objective of the present study was to investigate whether differences exist in message processing mechanisms (attention, comprehension, self-reference, appreciation, processing) and e-loyalty (intention to visit the website again, recommend the website to others) according to delivery strategy (video or text based messages) and educational level toward a Dutch CT smoking cessation program. Methods: Smokers who were motivated to quit within the following six months and who were aged over 16 were included in the program. The study was a randomized control trial with two conditions (video/text CT). The sample was stratified into 2 categories, low and high educated participants. In total, 139 participants completed the first session of the web-based CT intervention and were subsequently asked to fill out a questionnaire assessing message processing mechanisms and e-loyalty. ANOVAs and regression analyses were conducted to investigate the differences in message processing mechanisms and e-loyalty with regard to delivery strategy and education. Results: No interaction effects were found between delivery strategy and educational level on message processing mechanisms and e-loyalty. Delivery strategy had no effect on e-loyalty and processing mechanisms. However, results indicated that lower educated participants showed higher attention (F(1,138)=3.97; P=.05) and processing levels (F(1,138)=4.58; P=.04). Results revealed also that lower educated participants were more inclined to visit the CT intervention website again (F(1,138)=4.43; P=.04). Conclusions: CT programs have the potential to positively influence lower educated groups as they might be more involved in the CT intervention than higher educated smokers. Longitudinal studies with a larger sample are needed to gain more insight into the role of delivery strategy in tailored information and to investigate whether the intention to visit the intervention website again results in the ultimate goal of behavior change. Clinical Trial: Nederlands Trial Register (NTR3102) Date Submitted: May 2, 2012. Open Peer Review Period: May 8, 2012 - Jul 3, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Internet Intervention Promotes Physical Activity by Sedentary Older Adults

Tue, 08 May 2012 09:26:00 EDT

Background: Background. Physical activity (PA) for older adults has well documented physical and cognitive benefits, but most seniors do not meet recommended guidelines for PA, and interventions are lacking. Objective: Objectives. This study evaluated the efficacy of a 12-week Internet intervention to help sedentary older adults adopt and maintain an exercise regimen. Methods. A total of 368 men and women over 55 years of age (x = 60.3; SD 4.9) were recruited and screened and assessed online. They were randomized into treatment and control groups and assessed at pre-test, at 12 weeks, and at six months. After treatment group participants rated their fitness level, activity goals, and barriers to exercise, the Internet intervention program helped them select exercise activities in the areas of endurance, flexibility, strengthening, and balance enhancement. They returned to the program weekly for automated video and text support and education, with the option to change or increase their exercise plan. The program also included on-going problem solving to overcome user-identified barriers to exercise. Methods: Methods. A total of 368 men and women over 55 years of age (x = 60.3; SD 4.9) were recruited and screened and assessed online. They were randomized into treatment and control groups and assessed at pre-test, at 12 weeks, and at six months. After treatment group participants rated their fitness level, activity goals, and barriers to exercise, the Internet intervention program helped them select exercise activities in the areas of endurance, flexibility, strengthening, and balance enhancement. They returned to the program weekly for automated video and text support and education, with the option to change or increase their exercise plan. The program also included on-going problem solving to overcome user-identified barriers to exercise. Results: Results. The multivariate model indicated significant treatment effects at posttest (P = .001; large effect size) and at six months (P = .001; medium effect size). At posttest, intervention participation showed significant improvement on 13 of 14 outcome measures compared to the control group. At six months, treatment group participants maintained large gains compared to the control participants on all 14 outcome measures. Conclusions: Conclusions. These results suggest that an online PA program has the potential to positively impact the physical activity of sedentary older adult participants. More research is needed to replicate the study results, which were based on self-report measures. Research is also needed to intervention effects with older populations. Clinical Trial: Clinicaltrials.gov NCT01579240 Date Submitted: May 4, 2012. Open Peer Review Period: May 8, 2012 - Jul 3, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Exploring nurses' intention to use a computerized platform in the resuscitation unit: Development and validation of a questionnaire based on the Theory of Planned Behavior

Tue, 01 May 2012 11:13:32 EDT

Background: In emergency department resuscitation units, writing down information related to interventions, physical examination, vital signs, investigations and treatments ordered is a crucial task carried out by nurses. In order to facilitate this task, a team composed of emergency physicians, nurses, and one computer engineer created a novel electronic platform equipped with a tactile screen which allows systematic collection of critical data. This electronic platform also has medical software (Reascribe+TM) which functions as an electronic medical record (EMR) and a clinical decision support system (CDSS). Objective: The aim of this study was to develop and validate a questionnaire that could help evaluate nurses' intention to use a novel computerized platform in an emergency department resuscitation unit, based on Ajzen’s Theory of Planned Behavior (TPB). Methods: The population for this study was composed of 87 nurses who worked in the resuscitation unit of a tertiary trauma center. Three focus groups were held with nurses working in the resuscitation unit in order to identify the salient modal beliefs of regarding their intended use of a new electronic medical charting system for the care of trauma patients. The system included a clinical decision support tool (ReaScribe+TM, ReaEvolution, Québec, Canada). A questionnaire was developed in which salient modal beliefs were used as items in order to evaluate the TPB constructs. We also added 13 questions to evaluate nurses’ computer literacy. The final questionnaire was composed of 46 questions to be answered on a seven-point Likert scale. All nurses in the resuscitation unit and present during a regular work shift were individually contacted by the principal investigator or a research assistant (phase I). A subsample of the nurses who completed the questionnaire was invited to complete it a second time two weeks later (phase II). Results: In phase I, 62 of the 70 questionnaires administered were received (89% response rate). Of the 27 questionnaires administered in phase II (retest phase), 25 were completed (93% response rate). The questionnaire showed very good internal consistency as Cronbach’s alpha was higher than 0.7 for all constructs. Temporal stability was acceptable with intraclass correlations between 0.41 and 0.68. The intention to use ReaScribe+TM to chart the resuscitation of trauma patients was very high among the respondents. In the logistic regression model, the only construct that predicted nurses’ intention to adopt the computerized platform was the professional norm (OR 3.31; 95% CI 1.41 – 7.78). Conclusions: We developed and validated a questionnaire that can now be used in other emergency departments prior to implementation of the computerized platform. The intention to adopt was very high among the respondents which suggests that the implementation of this innovation could be successful at our institution. Date Submitted: Apr 30, 2012. Open Peer Review...

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Information theoretic approach to reduce both of information loss and sensitive data disclosure in the k-anonymity methods

Tue, 01 May 2012 11:05:58 EDT

Background: Electronic Health Records (EHRs) enable the sharing of patient medical data. Since EHRs include patients’ private data, access to researchers is restricted. Therefore k-anonymity is necessary to keep patients’ private data safe without damaging useful medical information. However, k-anonymity cannot prevent sensitive attribute disclosure. An alternative, l-diversity, has been proposed as a solution to this problem and is defined as: each Q-Block (i.e., each set of rows corresponding to the same value for identifiers) contains at least l well-represented values for each sensitive attribute. While l-diversity protects against sensitive attribute disclosure, it has a limitation in that it only focuses on diversifying sensitive attributes. Objective: The aim of the study is to develop k-anonymity method that not only minimizes information loss but also achieves diversity of the sensitive attribute. Methods: This paper proposes a new privacy protection method that uses conditional entropy and mutual information. This method considers both information loss as well as diversity of sensitive attributes. Conditional entropy can measure the information loss by generalization and mutual information is used to achieve the diversity of sensitive attributes. This method can offer appropriate Q-Blocks for generalization. Results: We used the adult database from UCI Machine Learning Repository and found that the proposed method can greatly reduce information loss compared with a recent l-diversity study. It can also achieve the diversity of sensitive attributes by counting the number of Q-Blocks that have leaks of diversity. Conclusions: This study provides a privacy protection method that can improve data utility and protect against sensitive attribute disclosure. The method is viable and should be of interest for further privacy protection in EHR applications. Date Submitted: Apr 27, 2012. Open Peer Review Period: May 1, 2012 - Jun 26, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Architectures and Processes for Nationwide Patient-Centric Consent Management

Wed, 25 Apr 2012 10:15:14 EDT

Background: Before electronic health information can be shared, the patient’s consent must be obtained. However, the current paper-based process is insufficient at a nationwide scale. Improvements will need to be introduced gradually, in a manner compatible with an exceedingly complex system: multiple professions, islands of partial standardization, radical differences in automation and technical sophistication, autonomous players with differing motivations, refusals to participate, external data sources, an evolving and unpredictable legal landscape, and pressure groups from privacy advocates, researchers, and health providers. Objective: We propose pragmatic requirements and a highly patient-centric, Internet-based consent management architecture, based on our Kairon Consents prototype. Methods: We examine requirements for serving a wide variety of patients and providers, including their diverse incentives. We then describe a modular, incrementally adoptable system design, and illustrate its behavior and advantages via use cases. Results: Our approach lets patients specify their privacy preferences covering a variety of possible uses of their personal health information in one virtual document; emergencies and research can be included, and government defaults and mandates mixed in as additional rules. Then, we describe how a record holder uses the consent service to determine just the privacy constraints that need to be enforced for a particular request. With today’s systems, many of these constraints need to be verified manually; our architecture enables incremental automation. We illustrate our architecture through a variety of use cases that we are able to support, and examine the independent stakeholders’ incentives to participate. The approach was found able to handle an extremely wide range of requirements. Open problems were identified; while new features are needed, the architecture extends naturally. Conclusions: It appears quite feasible to implement patient-centric consent, hosted in the cloud or at an HIE. Clinical Trial: not applicable Date Submitted: Apr 25, 2012. Open Peer Review Period: Apr 25, 2012 - Jun 20, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Factors that Influence the Adoption and Use of Social Media by Physicians to Share Medical Information

Fri, 20 Apr 2012 16:18:54 EDT

Background: Within the medical community there is persistent debate as to whether the information available through social media is trustworthy and valid, whether physicians are ready to adopt these technologies and ultimately, embrace these technologies as a format for professional development and life-long learning. How social media channels are the vehicles through which clinicians are exposed to emerging information that has the potential to inform or change their practice remains an open question. Objective: The purpose of this study was to identify factors that influence physicians’ use of social media to share and exchange medical information with other physicians as a component of their life-long learning and continuing professional development. Methods: A survey instrument was developed based on the Technology Acceptance Model (TAM)., hypothesizing that technology usage is best predicted by a physician’s attitudes toward the technology, perceptions about the technology’s usefulness and ease of use, and individual factors such as personal innovativeness. The survey was distributed via email to a random sample of 1695 practicing oncologists and primary care physicians in the United States in March 2011. Responses from 485 physicians were analyzed (response rate = 29%). Results: Overall, 24% of physicians use social media to scan or explore medical information on a daily basis; while 15% contribute new information via social media on a daily basis. The main factors influencing a physician’s usage of social media to share medical knowledge with other physicians are perceived ease of use and usefulness. Physicians who have positive attitudes towards the use of social media are more likely to use social media, and to share medical information with other physicians through social media. Neither age nor gender had a significant impact on adoption or usage of social media. In general, physicians believe that information available through social media channels is of high quality, is up-to-date, and that the use of social media for continuing professional development improves their on-the-job performance. Conclusions: Based on the results of this study, the use of social media applications may be an efficient and effective method for physicians to keep up-to-date and to share newly acquired medical knowledge with other physicians within the medical community. Date Submitted: Apr 16, 2012. Open Peer Review Period: Apr 20, 2012 - Jun 15, 2012.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.