Interactive Journal of Medical Research最新文献

Background: The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about the sustainability of this intervention at the global level.

Objective: This research examines the patient experience, health inequalities, and clinician-patient relationship in telemedicine during the COVID-19 pandemic's first 2 years, aiming to identify sustainability factors.

Methods: This study was based on a prepublished protocol using the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included academic and gray literature published between March 2020 and March 2022 according to these criteria: (1) population (any group); (2) concepts (patient experience, clinician-patient relationship, health inequalities); (3) context (telemedicine in primary and outpatient care); (4) excluding studies pertaining to surgery, oncology, and (inpatient) psychiatry. We searched Ovid Medline/PubMed (January 1, 2022), Web of Science (March 19, 2022), Google/Google Scholar (February and March 2022), and others. The risk of bias was not assessed as per guidance. We used an analysis table for the studies and color-coded tabular mapping against a health care technology adoption framework to identify sustainability (using double-blind extraction).

Results: Of the 134 studies that met our criteria, 49.3% (66/134) reported no specific population group. Regarding the concepts, 41.8% (56/134) combined 2 of the concepts studied. The context analysis identified that 56.0% (75/134) of the studies referred to, according to the definition in the United Kingdom, an outpatient (ambulatory care) setting, and 34.3% (46/134) referred to primary care. The patient experience analysis reflected positive satisfaction and sustained access during lockdowns. The clinician-patient relationship impacts were nuanced, affecting interaction and encounter quality. When mapping to the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, 81.3% (109/134) of the studies referenced the innovation's sustainability. Although positive overall, there were some concerns about sustainability based on quality, eHealth literacy, and access to health care for vulnerable migrants and the uninsured.

Conclusions: We identified confusion between the concepts of patient experience and patient satisfaction; therefore, future research could focus on established frameworks to qualify the patient experience across the whole pathway and not just the remote encounter. As expected, our research found mainly descriptive analyses, so there is a need for more robust evidence methods identifying impacts of changes in treatment pathways. This study illustrates modern methods to decolonize academic research by using gray literature extracts in other languages. We acknowledge that the use of Google to identify gray literature at the global level

Background: Excessive use of smartphones is recognized as a major problem in our modern society and can have dramatic consequences on the health of adolescents and young adults. Measuring problematic smartphone use in research and clinical practice is generally operationalized with self-reported questionnaires. In order to comprehensively assess the issue of problematic smartphone usage within the French population, it is imperative to employ validated French-language questionnaires. However, at this point, existing questionnaires are primarily available in English. Furthermore, to the best of our knowledge, these English questionnaires have yet to undergo validation processes for French-speaking cohorts.

Objective: The aim of this study was to perform a cross-cultural translation of the Smartphone Addiction Scale, Nomophobia Questionnaire, Problematic Use of Mobile Phones scale, and Smartphone Addiction Proneness Scale to French.

Methods: The translation process was performed using the forward/backward method. The first translation phase involved asking 4 independent French translators to translate the original English version of the questionnaires into French. In the second phase, the French version was backtranslated to English by a native English speaker. In the third phase, 2 concept experts were asked to comment and suggest modifications to the statements if necessary. Finally, the last version of the translated questionnaires was presented to 18 participants to assess the clarity, intelligibility, and acceptability of the translations.

Results: During the forward translation step, the translation differences were minor. During the backward translation, the English native speaker correctly backtranslated 18 of the 33 items of the Smartphone Addiction Scale, 17 of the 20 items of the Problematic Use of Mobile Phones scale, and 13 of the 15 items of the Smartphone Addiction Proneness Scale. Backtranslation for the Nomophobia Questionnaire was less satisfactory, with only 10 out of 20 items that were correctly backtranslated. The linguistic verification step revealed a minimal modification for the 4 questionnaires. The participants also suggested few improvements that we have considered for the final version. We produced the final version directly after this step.

Conclusions: We successfully adapted and effectively translated 4 questionnaires that assess problematic smartphone use to French. This step is a prerequisite for the validation of the French questionnaires. These adapted measures can serve as valuable research instruments for investigating and addressing issues related to problematic smartphone use in French-speaking countries and for making international comparisons.

Background: Ferroptosis, as a novel modality of cell death, holds significant potential in elucidating the pathogenesis and advancing therapeutic strategies for breast cancer.

Objective: This study aims to comprehensively analyze current ferroptosis research and future trends, guiding breast cancer research advancements and innovative treatment strategies.

Methods: This research used the R package Bibliometrix (Department of Economic and Statistical Sciences at the University of Naples Federico II), VOSviewer (Centre for Science and Technology Studies at Leiden University), and CiteSpace (Drexel University's College of Information Science and Technology), to conduct a bibliometric analysis of 387 papers on breast cancer and ferroptosis from the Web of Science Core Collection. The analysis covers authors, institutions, journals, countries or regions, publication volumes, citations, and keywords.

Results: The number of publications related to this field has surged annually, with China and the United States collaborating closely and leading in output. Sun Yat-sen University stands out among the institutions, while the journal Frontiers in Oncology and the author Efferth T contribute significantly to the field. Highly cited papers within the domain primarily focus on the induction of ferroptosis, protein regulation, and comparisons with other modes of cell death, providing a foundation for breast cancer treatment. Keyword analysis highlights the maturity of glutathione peroxidase 4-related research, with breast cancer subtypes emerging as motor themes and the tumor microenvironment, immunotherapy, and prognostic models identified as basic themes. Furthermore, the application of nanoparticles serves as an additional complement to the basic themes.

Conclusions: The current research status in the field of ferroptosis and breast cancer primarily focuses on the exploration of relevant theoretical mechanisms, whereas future trends and mechanisms emphasize the investigation of therapeutic strategies, particularly the clinical application of immunotherapy related to the tumor microenvironment. Nanotherapy has demonstrated significant clinical potential in this domain. Future research directions should deepen the exploration in this field and accelerate the clinical translation of research findings to provide new insights and directions for the innovation and development of breast cancer treatment strategies.

Background: Participation and completion rates in questionnaire-based surveys are often low.

Objective: This study aims to assess participation and completion rates for a survey using paper and mixed mode questionnaires with patients recruited by research assistants in primary care waiting rooms.

Methods: This cluster-randomized study, conducted in 2023 in France, involved 974 patients from 39 practices randomized into 4 groups: "paper with incentive" (n=251), "paper without incentive" (n=368), "mixed mode with tablet" (n=187), and "mixed mode with QR code" (n=168). Analyses compared the combined paper group with the 2 mixed mode groups and the "paper with incentive" and "paper without incentive" groups. Logistic regressions were used to analyze participation and completion rates.

Results: Of the 974 patients recruited, 822 (women: 536/821, 65.3%; median age 52, IQR 37-68 years) agreed to participate (participation rate=84.4%), with no significant differences between groups. Overall, 806 patients (98.1%) answered all 48 questions. Completion rates were highest in the combined paper group (99.8%) compared to mixed mode groups (96.8% for paper or tablet, 93.3% for paper or QR code; P<.001). There was no significant difference in completion rates between the "paper with incentive" and "paper without incentive" groups (100% vs 99.7%).

Conclusions: Recruiting patients in waiting rooms with research assistants resulted in high participation and completion rates across all groups. Mixed mode options did not enhance participation or completion rates but may offer logistical advantages. Future research should explore incentives and mixed-mode strategies in diverse settings.

Background: As digital mental health delivery becomes increasingly prominent, a solid evidence base regarding its efficacy is needed.

Objective: This study aims to synthesize evidence on the comparative efficacy of systemic psychotherapy interventions provided via digital versus face-to-face delivery modalities.

Methods: We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for searching PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and PSYNDEX and conducting a systematic review and meta-analysis. We included randomized controlled trials comparing mental, behavioral, and somatic outcomes of systemic psychotherapy interventions using self- and therapist-guided digital versus face-to-face delivery modalities. The risk of bias was assessed with the revised Cochrane Risk of Bias tool for randomized trials. Where appropriate, we calculated standardized mean differences and risk ratios. We calculated separate mean differences for nonaggregated analysis.

Results: We screened 3633 references and included 12 articles reporting on 4 trials (N=754). Participants were youths with poor diabetic control, traumatic brain injuries, increased risk behavior likelihood, and parents of youths with anorexia nervosa. A total of 56 outcomes were identified. Two trials provided digital intervention delivery via videoconferencing: one via an interactive graphic interface and one via a web-based program. In total, 23% (14/60) of risk of bias judgments were high risk, 42% (25/60) were some concerns, and 35% (21/60) were low risk. Due to heterogeneity in the data, meta-analysis was deemed inappropriate for 96% (54/56) of outcomes, which were interpreted qualitatively instead. Nonaggregated analyses of mean differences and CIs between delivery modalities yielded mixed results, with superiority of the digital delivery modality for 18% (10/56) of outcomes, superiority of the face-to-face delivery modality for 5% (3/56) of outcomes, equivalence between delivery modalities for 2% (1/56) of outcomes, and neither superiority of one modality nor equivalence between modalities for 75% (42/56) of outcomes. Consequently, for most outcome measures, no indication of superiority or equivalence regarding the relative efficacy of either delivery modality can be made at this stage. We further meta-analytically compared digital versus face-to-face delivery modalities for attrition (risk ratio 1.03, 95% CI 0.52-2.03; P=.93) and number of sessions attended (standardized mean difference -0.11; 95% CI -1.13 to -0.91; P=.83), finding no significant differences between modalities, while CIs falling outside the range of the minimal important difference indicate that equivalence cannot be determined at this stage.

Conclusions: Evidence on digital and face-to-face modalities for systemic psychotherapy interventions is largely heterogeneous,

Background: Cardiovascular diseases are one of the leading causes of mortality globally. Cardiac rehabilitation (CR) programs are crucial for patients recovering from cardiac events, as they help reduce the risk of recurrent events and support patient recovery. The patient's journey in CR spans the stages before, during, and after the program. Patients have to progress through each stage of CR programs successfully to complete the entire CR journey and get the full benefits of CR programs, but numerous barriers within this journey can hinder patient progression.

Objective: This study aims to explore the barriers to progression at all stages of the CR patient journey from the perspectives of health care providers involved in CR care.

Methods: This qualitative study involved semistructured interviews with health care providers involved in CR care from July 2023 to January 2024. A purposive maximal variation sampling method was used to target providers with diverse demographics and specialties. Snowball sampling was used to recruit participants, leveraging the existing networks of participants. Each interview lasted between 30 and 45 minutes. Interviews were recorded, transcribed verbatim, and analyzed using an inductive thematic analysis approach. Data analysis was conducted from August 2023 to February 2024.

Results: Ten health care providers, comprising 7 females and 3 males, were interviewed. Their roles included physician, program director, nurse manager, clinical manager, nurse coordinator, nurse, physiotherapist, and kinesiologist. The analysis identified four overarching themes related to barriers to progression in the CR journey: (1) patients not being referred to CR programs, (2) patients not enrolling in CR programs, (3) patients dropping out of CR programs, and (4) patients' lack of adherence to lifestyle changes post-CR programs.

Conclusions: In light of the growing interest in technological interventions in CR programs, we proposed 4 potential technological solutions to address the barriers to progression identified in our analysis. These solutions aim to provide a foundation for future research to guide the development of effective technologies and enhance patient progression within the CR journey.

In this viewpoint, we argue that recent studies using clinical public databases have revolutionized our understanding of hidradenitis suppurativa (HS), a chronic inflammatory skin condition with significant impacts on patients' quality of life. Our key messages are as follows: (1) these databases enable large-scale studies integrating genetic, epidemiological, and clinical data, providing crucial insights into HS's genetic predispositions, comorbidities, and treatment outcomes; (2) findings highlight a strong genetic component, with mutations in the γ-secretase complex playing a key role in HS pathogenesis and shaping targeted therapies; (3) studies also reveal elevated risks for comorbidities like obesity, diabetes, cardiovascular disease, and systemic inflammation in patients with HS, with diet-driven inflammatory pathways potentially exacerbating disease severity; (4) while these databases offer unprecedented research opportunities, limitations such as data representativeness and quality must be considered; (5) nonetheless, their benefits outweigh potential drawbacks, allowing the identification of rare comorbidities, disease progression patterns, and personalized treatment strategies; and (6) increased funding for HS research is crucial to harness these databases' full potential, develop targeted therapies, and ultimately improve patient outcomes. As HS's impact is disproportionate to current research investments, we believe advocating for more resources and addressing database limitations will be key to advancing HS understanding and care.

Physicians could improve the efficiency of the health care system if a reliable resource were available to aid them in better understanding, selecting, and interpreting the diagnostic laboratory tests. It has been well established and widely recognized that (1) laboratory testing provides 70%-85% of the objective data that physicians use in the diagnosis and treatment of their patients; (2) orders for laboratory tests in the United States have increased, with an estimated volume of 4-5 billion tests per year; (3) there is a lack of user-friendly tools to guide physicians in their test selection and ordering; and (4) laboratory test overutilization and underutilization continue to represent a pervasive source of inefficiency in the health care system. These inappropriate test orders not only lead to slower or incorrect diagnoses for patients but also add a significant financial burden. In addition, many ordered tests are not reimbursed by Medicare because they are inappropriate for the medical condition or were ordered with the incorrect International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic code, not meeting the medical necessity. Therefore, current clinical laboratory test ordering procedures experience a quality gap. Often, providers do not have access to an appropriate tool that uses evidence-based guidelines or algorithms to ensure that tests are not duplicated, overused, or underused. This viewpoint lays out the potential use of an automated laboratory clinical decision support system that helps providers order the right test for the right disease and documents the right reason or medical necessity to pay for the testing.

Background: Caregiver-employees (CEs) for older adults experience a high burden to fulfill their dual roles. Caregiver-friendly workplace policy (CFWP) has been used in many countries to balance employment and caregiving duties, but it is a relatively new concept in Hong Kong.

Objective: This study explored the views and experiences of CEs, employers, and health care professionals regarding CFWP (specifically for older adult caregivers) in Hong Kong.

Methods: This study explored the CFWP-related views and experiences in Hong Kong using 15 in-depth interviews with purposively sampled CEs for older adults, employers, and health care professionals.

Results: Two context-related themes ("lacking leadership" and "unfavorable culture") were identified with thematic analysis. They explain the absence of CFWP in Hong Kong due to the lack of governmental and organizational leadership, and the additional burden experienced by CEs because of the working culture that underpins work-life separation, overprizing business interest, and unsympathetic corporate attitude. Implicit voice theory was applicable in explaining CEs' nondisclosure about their status at work due to potential risks. In addition, the two facilitation-related themes ("role struggle" and "inadequate support") identified in this study exhibit how the dual role had positive and negative spillover effects on each other and the inadequacy of social welfare and health care support systems.

Conclusions: We strongly recommend exploring and adopting potential CFWP in Hong Kong, considering the complexity of factors identified in this study.

Background: Gestational diabetes mellitus (GDM) is characterized by hyperglycemia in pregnancy and typically resolves after birth. Women with GDM have an increased risk of developing type 2 diabetes mellitus (T2DM) later in life compared to those with normoglycemic pregnancy. While diabetes prevention interventions (DPIs) have been developed to delay or prevent the onset of T2DM, few studies have provided process evaluation (PE) data to assess the mechanisms of impact, quality of implementation, or contextual factors that may influence the effectiveness of the intervention.

Objective: This study aims to identify and evaluate PE data and how these link to outcomes of randomized controlled trials (RCTs) of T2DM prevention interventions for women with GDM.

Methods: A systematic review was conducted to identify studies published from 2005 to 2020 aiming to capture the most recent DPIs. Five electronic bibliographic databases (Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, Embase, PubMed, and MEDLINE) were searched to identify relevant studies. Inclusion criteria were published (peer-reviewed) RCTs of DPIs in women with a current diagnosis or history of GDM. Exclusion criteria were studies not published in English; studies where the target population was women who had a family history of T2D or women who were menopausal or postmenopausal; and gray literature, including abstracts in conference proceedings. The Medical Research Council's PE framework of complex interventions was used to identify key PE components. The Mixed Method Appraisal Tool was used to assess the quality of included studies.

Results: A total of 24 studies were included; however, only 5 studies explicitly reported a PE theoretical framework. The studies involved 3 methods of intervention delivery, including in person (n=7), digital (n=7), and hybrid (n=9). Two of the studies conducted pilot RCTs assessing the feasibility and acceptability of their interventions, including recruitment, participation, retention, program implementation, adherence, and satisfaction, and 1 study assessed the efficacy of a questionnaire to promote food and vegetable intake. While most studies linked PE data with study outcomes, it was unclear which of the reported PE components were specifically linked to the positive outcomes.

Conclusions: While the Medical Research Council's framework is a valuable source for conducting systematic reviews on PEs, it has been criticized for lacking practical advice on how to conduct them. The lack of information on PE frameworks in our review also made it difficult to categorize individual PE components against the framework. We need clearer guidance and robust frameworks for conducting PEs for the development and reporting of DPIs for women with GDM.

Trial registration: PROSPERO International Prospective Register