Journal of Medical Internet Research最新文献

Background: Patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) experience significant psychological distress, impacting outcomes. While mindfulness-based interventions (MBIs) are beneficial, access is limited. Internet-delivered MBIs (iMBIs) offer an accessible alternative; yet, qualitative understanding of patient experiences with tailored iMBIs for this specific population is lacking.

Objective: This study aimed to explore the facilitators and barriers of patients with HCC post TACE and participated in tailored iMBIs.

Methods: From November 2020 to December 2022, 11 patients with HCC post TACE who had taken part in tailored iMBIs were purposively recruited from a tertiary hospital in Jilin Province. Data were collected through semistructured interviews lasting 30-60 minutes. The interviews were analyzed using conventional content analysis.

Results: Five main categories emerged from the analysis: (1) mindfulness mindset, including acceptance, calmness, and mood improvement; (2) improvement of physical discomfort, such as better sleep, pain relief, reduced gastrointestinal symptoms, and increased activity levels; (3) resistance to mindfulness practice, including perceived lack of effectiveness, unsuitable conditions, equipment limitations, and difficulty concentrating; (4) support and encouragement, involving social support, supervision, and professional guidance; and (5) accessibility and convenience characterized by restoration of life balance and user-friendly features of the practice. Each category encompassed several subcategories reflecting the diverse experiences of participants.

Conclusions: While iMBIs were generally perceived as convenient and accessible, challenges such as equipment limitations were noted. Future implementation should focus on enhancing supportive factors to improve adherence, minimizing barriers, and refining the design and delivery of iMBI programs.

Trial registration: Chinese Clinical Trial Registry ChiCTR1900027976; https://www.chictr.org.cn/showproj.html?proj=46657.

Background: Assistive robotics for helping older people live well and stay independent has, to date, failed to fulfill its promise: there are few assistive robots in everyday use. In part, this failing can be attributed to inadequate or missing co-design activities that would ensure that these technologies and any services that incorporate them are developed with prospective end users, addressing their actual needs and wants, and not merely for them, and based on lazy assumptions about heterogeneous user groups.

Objective: This exercise aimed to address some of these limitations by taking a "phenomenological snapshot" of what it means to be an older person in the current sociotechnological context, and making this snapshot, along with the co-design materials developed, available to the wider assistive robotics community to provide solid foundational evidence for steering the development of assistive robotics in more productive directions.

Methods: Two rounds of co-design workshops have been conducted with older people and their caregivers, based on an innovative methodology that used personas and speculative designs to explore sensitive everyday difficulties faced by participants and highlight some of their general wishes for and concerns about assistive robotics. The data collected during the workshops were analyzed, and key themes were extracted.

Results: Analysis of the workshop data gives access to the lived experience of older people and their caregivers, and their opinions about domestic robotics and assistive technologies more generally. The findings are organized thematically as everyday difficulties, the daily problems faced by older people; ideas for aging better, older people's own suggestions for how their lives could be improved; and living with technology, their preferences and requirements for assistive robots, along with their concerns about what the introduction of robots might mean, both for themselves and for society more widely.

Conclusions: We believe that our findings provide solid foundational evidence for the development of assistive robotics for older people. We are in the process of disseminating these results through various channels to the wider assistive robotics community; ultimately, the success of our activities will be demonstrated only through the development of acceptable, useful, and viable assistive robotics for older people.

Background: Interoperability has been a challenge for half a century. Led by an informatics view of the world, the quest for interoperability has evolved from typing and categorizing data to building increasingly complex models. In parallel with the development of these models, the field of terminologies and ontologies emerged to refine granularity and introduce notions of hierarchy. Clinical data models and terminology systems vary in purpose, and their fixed categories shape and constrain representation, which inevitably leads to information loss.

Objective: Despite these efforts, semantic interoperability remains imperfect. Achieving it is essential for effective data reuse but requires more than rich terminologies and standardized models. This methodological study explores the extent to which the SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) compositional grammar can be leveraged and extended to approximate a formal descriptive grammar, allowing clinical reality to be expressed in coherent, meaningful sentences rather than preconstrained categories.

Methods: Building on a decade of semantic representation efforts at the Geneva University Hospitals, we developed a framework to identify recurring semantic gaps in clinical data. We addressed these gaps by systematically modifying the SNOMED CT Machine Read` Concept Model and extending its Augmented Backus-Naur Form syntax to support necessary grammatical structures and external vocabularies.

Results: This approach enabled the semantic representation of over 119,000 distinct data elements covering 13 billion instances. By extending the grammar, we successfully addressed critical limitations such as negation, scalar values, uncertainty, temporality, and the integration of external terminologies like Pango. The extensions proved essential for capturing complex clinical nuances that standard precoordinated concepts could not represent.

Conclusions: Rather than creating a new standard from scratch, extending the grammatical capabilities of SNOMED CT offers a viable pathway toward high-fidelity semantic representation. This work serves as a proof-of-concept that separating the rules of composition from vocabulary allows for a more flexible and robust description of clinical reality, provided that challenges regarding governance and machine readability are addressed.