Interactive Journal of Medical Research最新文献

Background: Medication adherence, or how patients take their medication as prescribed, is suboptimal worldwide. Improving medication-taking habit might be an effective way to improve medication adherence. However, habit is difficult to quantify, and conventional habit metrics are self-reported, with recognized limitations. Recently, several objective habit metrics have been proposed, based on objective medication-taking data.

Objective: We aim to explore the correlation between objective habit metrics and objective medication adherence on a large dataset.

Methods: The Medication Event Monitoring System Adherence Knowledge Center, a database of anonymized electronic medication intake data from ambulant participants enrolled in past clinical studies, was used as the data source. Electronic medication intake data from participants following a once-daily regimen and monitored for 14 days or more were used. Further, two objective habit metrics were computed from each participant's medication intake history: (1) SD of the hour of intake, representing daily variability in the timing of medication intakes, and (2) weekly cross-correlation, representing weekly consistency in the timing of medication intakes. The implementation component of medication adherence was quantified using (1) the proportion of doses taken and (2) the proportion of correct days.

Results: A total of 15,818 participants met the criteria. These participants took part in 108 clinical studies mainly focused on treatments for hypertension (n=4737, 30%) and osteoporosis (n=3353, 21%). The SD of the hour of intake was significantly negatively correlated with the 2 objective adherence metrics: proportion of correct days (Spearman correlation coefficient, ρ_S=-0.62, P<.001) and proportion of doses taken (ρ_S=-0.09, P<.001). The weekly cross-correlation was significantly positively correlated with the 2 objective adherence metrics: proportion of correct days (ρ_S=0.55, P<.001) and proportion of doses taken (ρ_S=0.32, P<.001). A lower daily or weekly variability in the timing of medication intakes is thus associated with better medication adherence. However, no variability is not the norm, as only 3.6% of participants have 95% of their intakes in a 1-hour window. Among the numerous factors influencing medication adherence, habit strength is an important one as it explains over 30% of the variance in medication adherence.

Conclusions: Objective habit metrics are correlated to objective medication adherence. Such objective habit metrics can be used to monitor patients and identify those who may benefit from habit-building support.

Background: Incorporating artificial intelligence (AI) into medical education has gained significant attention for its potential to enhance teaching and learning outcomes. However, it lacks a comprehensive study depicting the academic performance and status of AI in the medical education domain.

Objective: This study aims to analyze the social patterns, productive contributors, knowledge structure, and clusters since the 21st century.

Methods: Documents were retrieved from the Web of Science Core Collection database from 2000 to 2024. VOSviewer, Incites, and Citespace were used to analyze the bibliometric metrics, which were categorized by country, institution, authors, journals, and keywords. The variables analyzed encompassed counts, citations, H-index, impact factor, and collaboration metrics.

Results: Altogether, 7534 publications were initially retrieved and 2775 were included for analysis. The annual count and citation of papers exhibited exponential trends since 2018. The United States emerged as the lead contributor due to its high productivity and recognition levels. Stanford University, Johns Hopkins University, National University of Singapore, Mayo Clinic, University of Arizona, and University of Toronto were representative institutions in their respective fields. Cureus, JMIR Medical Education, Medical Teacher, and BMC Medical Education ranked as the top four most productive journals. The resulting heat map highlighted several high-frequency keywords, including performance, education, AI, and model. The citation burst time of terms revealed that AI technologies shifted from imaging processing (2000), augmented reality (2013), and virtual reality (2016) to decision-making (2020) and model (2021). Keywords such as mortality and robotic surgery persisted into 2023, suggesting the ongoing recognition and interest in these areas.

Conclusions: This study provides valuable insights and guidance for researchers who are interested in educational technology, as well as recommendations for pioneering institutions and journal submissions. Along with the rapid growth of AI, medical education is expected to gain much more benefits.

Large language models (LLMs) are artificial intelligence tools that have the prospect of profoundly changing how we practice all aspects of medicine. Considering the incredible potential of LLMs in medicine and the interest of many health care stakeholders for implementation into routine practice, it is therefore essential that clinicians be aware of the basic risks associated with the use of these models. Namely, a significant risk associated with the use of LLMs is their potential to create hallucinations. Hallucinations (false information) generated by LLMs arise from a multitude of causes, including both factors related to the training dataset as well as their auto-regressive nature. The implications for clinical practice range from the generation of inaccurate diagnostic and therapeutic information to the reinforcement of flawed diagnostic reasoning pathways, as well as a lack of reliability if not used properly. To reduce this risk, we developed a general technical framework for approaching LLMs in general clinical practice, as well as for implementation on a larger institutional scale.

Although uroflowmetry and bladder diaries are widely used for noninvasive evaluation of lower urinary tract symptoms, they still have limitations in diagnostic capability and users' convenience. The aim of this paper is to discuss potential solutions by reviewing (1) the evolution and current clinical use of uroflowmetry and bladder diary, including clinical guidelines, daily practice applications, and their historical development; (2) a growing trend toward using home devices with various technologies; and (3) a comprehensive comparison of the strengths and weaknesses of these home devices. In our opinion, the following points can be highlighted: (1) the emerging trend of using home devices can enhance diagnostic capabilities through repeated measurements and the convenience of at-home testing and (2) home devices, which provide both frequency-volume and uroflowmetry information, have the potential to transform the management of lower urinary tract symptoms.

Background: Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one's own body sensory perception and can combine conventional and VR approaches.

Objective: The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP.

Methods: A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories.

Results: We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended.

Conclusions: For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed.

Background: By allowing for abortion bans and restrictions to take effect in the majority of US states, the 2022 Dobbs v Jackson Women's Health Organization decision portends to have lasting impacts on patient care and the physician workforce. Notably, it is already beginning to impact practice location preferences of US health care workers, evidenced by declining application rates to residency programs in abortion-restrictive states since 2022. Yet, there remains a gap in the literature regarding why this trend exists.

Objective: This study aims to describe what factors are driving the practice location preferences of medical students and physicians after the Dobbs decision.

Methods: This study analyzes qualitative data from a web-based, cross-sectional study. In August 2022, a nonprobabilistic sample of physicians and medical students were surveyed on social media about the impact of overturning Roe v Wade on practice location preferences, which included the free-text question "Please share your thoughts about the overturning of Roe v Wade and how it will affect your decision about your (residency/job or fellowship) programs." A total of 3 independent team members completed an inductive thematic analysis of 524 free responses, resolving differences by discussion.

Results: Approximately 1 in 4 survey respondents also completed the free-response item (524/2063, 25.4%); a total of 219 were medical students, 129 were residents and fellows, and 176 were practicing physicians. Of them, approximately half (261/524, 50.5%) resided in states where abortion bans were in place or anticipated. Those who answered the free-response item were relatively more likely to hail from states with restrictive abortion bans (P<.001) compared to those who did not, with other demographic characteristics being largely similar between the groups. Inductive thematic analysis yielded 2 broad thematic categories: patient-related and workforce-related factors influencing practice decision preferences. The 3 most common themes overall were respondent concerns regarding their patient's access to care (249/524, 47.5%), their desire not to practice or train in a state with abortion restrictions regardless of current residence (249/524, 47.5%), and their personal belief that abortion bans are human rights and/or body autonomy violation (197/524, 37.6%). Some respondents stated that the Dobbs decision would not impact their choice of practice location (41/524, 7.8%), and some supported it (35/594, 6.7%).

Conclusions: This study shows that abortion restrictions are having an impact on the practice location preferences of the physician workforce due to both patient care and personal factors. It is important that state policy makers and others who are considering abortion restrictions also consider how to address these concerns of physicians and medical students, to avoid wo

Background: Adherence to antiretroviral therapy is a critical component in achieving viral suppression in people living with HIV in addition to increasing overall quality of life. Several indirect methods have been used to measure adherence including the Simplified Medication Adherence Questionnaire (SMAQ).

Objective: The objective of this study is to evaluate the reliability and validity of the SMAQ in men living with HIV/AIDS attending a Mexican national hospital.

Methods: A cross-sectional analytical design study was carried out in a Mexican National Hospital in Jalisco, including men aged >18 years with at least 3 months of antiretroviral treatment, excluding those with cognitive difficulties in answering the survey. A minimum sample size was calculated to detect the contribution of the variables within the model. The analysis included descriptive tests, confirmatory factor analysis, reliability and validity assessment, correlation between adherence and viral load, and association between viral load and adherence.

Results: The final analysis included a total of 260 patients with a mean age of 43 (SD 12) years and an average of 8.97 (SD 6.33) years on antiretroviral treatment. The SMAQ showed sufficient structural validity (comparative fit index=1, root-mean-square error of approximation=0, 90% CI 0-0.085) with satisfactory factor loadings on most questions except item 2 (Do you always take your medication at the prescribed time?). The reliability of the scale is acceptable (Cronbach α=0.702, ω=0.718). Adherence correlated with viral load significantly but not with recent TCD4 lymphocyte levels. Patients classified as adherent were three times more likely to be undetectable than nonadherent patients (odds ratio 3.31, 95% CI 1.13-9.64, P=.04).

Conclusions: The SMAQ represents an adequate tool to assess adherence in men living with HIV in the Mexican context, this will contribute to this study and compression of adherence to establish future intervention programs.

Background: Good communication between health authorities and citizens is crucial for adherence to preventive measures during a pandemic. Crisis communication often appeals to worries about negative consequences for oneself or others. While worry can motivate protective behavior, it can also be overwhelming and lead to irrational choices or become a mental health problem. Also, the levels and consequences of worry can differ between different groups of citizens. Little is known about the evolution of worries during the pandemic and adherence to measures in distinct groups.

Objective: This study aimed to evaluate worries in the Swiss population as well as associations between worry levels and citizens' adherence to government restrictions during different phases of the COVID-19 pandemic.

Methods: We carried out an observational study with 4 cross-sectional online surveys of adults in the Canton of Vaud, Switzerland. Questionnaires were distributed through social media and websites during 4 periods: survey 1: April 17 to May 14, 2020; survey 2: May 15 to June 22, 2020; survey 3: October 30 to December 12, 2020; and survey 4: June 18 to December 30, 2021. On visual analog scales from 0 to 100, participants reported worry, self-adherence to pandemic restrictions, and their perceived adherence to others. We used multivariable linear regression, adjusting for age, gender, health literacy, and education to assess associations between self-reported worry, adherence, and study periods.

Results: We collected 7106 responses. After excluding 2377 questionnaires (incomplete, age <18 years, residence outside Vaud), 4729 (66.55%) were analyzed (mean age 47, SD 15.6 years, 63.96% women). Mean worry across the 4 periods was 42/100, significantly higher in women (44.25/100, vs 37.98/100; P<.001) and young people (43.77/100 in those aged 18-39 years, vs 41.69/100; P=.005; in those aged 40-64 years and 39.16/100; P=.002; in those aged >64 years). Worries were higher during survey 1 and survey 3 (52.41/100 and 56.32/100 vs 38.93/100, P<.001; and 35.71/100, P<.001) than during survey 2 and survey 4, respectively. This corresponds to pandemic peaks during which federal restrictions were better followed with self-reported adherence of 84.80/100 and 89.59/100 in survey 1 and survey 3 versus 78.69/100 (P<.001) and 78.64/100 (P<.001) in survey 2 and survey 4. A 2.9-point increase in worry score, adjusted for the pandemic period, gender, age, education, and health literacy, was associated with a 10-point increase in personal adherence score (95% CI 2.5-3.2; P<.001).

Conclusions: Worries were higher in women, young people, and during the peak of the COVID-19 pandemic. Higher worry levels were associated with increased self-reported adherence to federal restrictions. Authorities should consider population worry levels and population subgroups in the planning and des