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Neurorehabilitation (NR), a major component of neurosciences, is the process of restoring a patient’s damaged/disorganized neurological function, through training, therapy, and education, while focusing on patient’s independence and well-being. Since the advent of the COVID-19 pandemic, various applications of telecare and telehealth services surged drastically and became an integral part of current clinical practices. Tele-Neurorehabilitation (TNR) is one of such applications. When rehabilitation services were disrupted globally due to lockdown and travel restrictions, the importance of TNR was recognized, especially in developed, low, and middle-income countries. With exponential deployment of telehealth interventions in neurosciences, TNR has become a distinct stand-alone sub-specialty of neurosciences and telehealth. Digital technologies, such as wearables, robotics, and Virtual Reality (VR) have enabled TNR to improve the quality of patients’ lives. Providing NR remotely using digital technologies and customized digital devices is now a reality, and likely to be the new norm soon. This article provides an overview of the needs, utilization, and deployment of TNR, and focuses on digital technology enablers of TNR in pre- and post- COVID-19 pandemic era.

BackgroundThe completeness of adverse event (AE) reports, crucial for assessing putative causal relationships, is measured using the vigiGrade completeness score in VigiBase, the World Health Organization global database of reported potential AEs. Malaysian reports have surpassed the global average score (approximately 0.44), achieving a 5-year average of 0.79 (SD 0.23) as of 2019 and approaching the benchmark for well-documented reports (0.80). However, the contributing factors to this relatively high report completeness score remain unexplored. ObjectiveThis study aims to explore the main drivers influencing the completeness of Malaysian AE reports in VigiBase over a 15-year period using vigiGrade. A secondary objective was to understand the strategic measures taken by the Malaysian authorities leading to enhanced report completeness across different time frames. MethodsWe analyzed 132,738 Malaysian reports (2005-2019) recorded in VigiBase up to February 2021 split into historical International Drug Information System (INTDIS; n=63,943, 48.17% in 2005-2016) and newer E2B (n=68,795, 51.83% in 2015-2019) format subsets. For machine learning analyses, we performed a 2-stage feature selection followed by a random forest classifier to identify the top features predicting well-documented reports. We subsequently applied tree Shapley additive explanations to examine the magnitude, prevalence, and direction of feature effects. In addition, we conducted time-series analyses to evaluate chronological trends and potential influences of key interventions on reporting quality. ResultsAmong the analyzed reports, 42.84% (56,877/132,738) were well documented, with an increase of 65.37% (53,929/82,497) since 2015. Over two-thirds (46,186/68,795, 67.14%) of the Malaysian E2B reports were well documented compared to INTDIS reports at 16.72% (10,691/63,943). For INTDIS reports, higher pharmacovigilance center staffing was the primary feature positively associated with being well documented. In recent E2B reports, the top positive features included reaction abated upon drug dechallenge, reaction onset or drug use duration of

Objectives: A vast amount of literature has been conducted for investigating the association of different lunar phases with human health; and it has mixed reviews for association and non-association of diseases with lunar phases. This study investigates the existence of any impact of moon phases on humans by exploring the difference in the rate of outpatient visits and type of diseases that prevail in either non-moon or moon phases. Methods: We retrieved dates of non-moon and moon phases for eight years (1st January 2001–31st December 2008) from the timeanddate.com website for Taiwan. The study cohort consisted of 1 million people from Taiwan's National Health Insurance Research Database (NHIRD) followed over eight years (1st January 2001–31st December 2008). We used the two-tailed, paired-t-test to compare the significance of difference among outpatient visits for 1229 moon phase days and 1074 non-moon phase days by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes from NHIRD records. Results: We found 58 diseases that showed statistical differences in number of outpatient visits in the non-moon and moon phases. Conclusions: The results of our study identified diseases that have significant variations during different lunar phases (non-moon and moon phases) for outpatient visits in the hospital. In order to fully understand the reality of the pervasive myth of lunar effects on human health, behaviors and diseases, more in-depth research investigations are required for providing comprehensive evidence covering all the factors, such as biological, psychological and environmental aspects.

Cancer significantly contributes to global mortality, with 9.3 million annual deaths. To alleviate this burden, the utilization of artificial intelligence (AI) applications has been proposed in various domains of oncology. However, the potential applications of AI and the barriers to its widespread adoption remain unclear. This study aimed to address this gap by conducting a cross-sectional, global, web-based survey of over 1000 AI and cancer researchers. The results indicated that most respondents believed AI would positively impact cancer grading and classification, follow-up services, and diagnostic accuracy. Despite these benefits, several limitations were identified, including difficulties incorporating AI into clinical practice and the lack of standardization in cancer health data. These limitations pose significant challenges, particularly regarding testing, validation, certification, and auditing AI algorithms and systems. The results of this study provide valuable insights for informed decision-making for stakeholders involved in AI and cancer research and development, including individual researchers and research funding agencies.

The integration of artificial intelligence (AI) into healthcare is progressively becoming pivotal, especially with its potential to enhance patient care and operational workflows. This paper navigates through the complexities and potentials of AI in healthcare, emphasising the necessity of explainability, trustworthiness, usability, transparency and fairness in developing and implementing AI models. It underscores the ‘black box’ challenge, highlighting the gap between algorithmic outputs and human interpretability, and articulates the pivotal role of explainable AI in enhancing the transparency and accountability of AI applications in healthcare. The discourse extends to ethical considerations, exploring the potential biases and ethical dilemmas that may arise in AI application, with a keen focus on ensuring equitable and ethical AI use across diverse global regions. Furthermore, the paper explores the concept of responsible AI in healthcare, advocating for a balanced approach that leverages AI’s capabilities for enhanced healthcare delivery and ensures ethical, transparent and accountable use of technology, particularly in clinical decision-making and patient care.

BackgroundGrowth hormone deficiency (GHD) is a rare disorder characterized by inadequate secretion of growth hormone (GH) from the anterior pituitary gland. One of the challenges in optimizing GH therapy is improving adherence. Using digital interventions may overcome barriers to optimum treatment delivery. Massive open online courses (MOOCs), first introduced in 2008, are courses made available over the internet without charge to a large number of people. Here, we describe a MOOC aiming to improve digital health literacy among healthcare professionals managing patients with GHD. Based on pre- and post-course assessments, we evaluate the improvement in participants’ knowledge upon completion of the MOOC.MethodsThe MOOC entitled ‘Telemedicine: Tools to Support Growth Disorders in a Post-COVID Era’ was launched in 2021. It was designed to cover 4 weeks of online learning with an expected commitment of 2 h per week, and with two courses running per year. Learners’ knowledge was assessed using pre- and post-course surveys via the FutureLearn platform.ResultsOut of 219 learners enrolled in the MOOC, 31 completed both the pre- and post-course assessments. Of the evaluated learners, 74% showed improved scores in the post-course assessment, resulting in a mean score increase of 21.3%. No learner achieved 100% in the pre-course assessment, compared with 12 learners (40%) who achieved 100% in the post-course assessment. The highest score increase comparing the pre- and the post-course assessments was 40%, observed in 16% of learners. There was a statistically significant improvement in post-course assessment scores from 58.1 ± 18.9% to 72.6 ± 22.4% reflecting an improvement of 14.5% (p

BackgroundAn infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. ObjectiveIn this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. MethodsAn iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health–implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. ResultsThe 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. ConclusionsStandardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

Due to the challenges and restrictions posed by COVID-19 pandemic, technology and digital solutions played an important role in the rendering of necessary healthcare services, notably in medical education and clinical care. The aim of this scoping review was to analyze and sum up the most recent developments in Virtual Reality (VR) use for therapeutic care and medical education, with a focus on training medical students and patients. We identified 3743 studies, of which 28 were ultimately selected for the review. The search strategy followed the most recent Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping review (PRISMA-ScR) guidelines. 11 studies (39.3%) in the field of medical education assessed different domains, such as knowledge, skills, attitudes, confidence, self-efficacy, and empathy. 17 studies (60.7%) focused on clinical care, particularly in the areas of mental health, and rehabilitation. Among these, 13 studies also investigated user experiences and feasibility in addition to clinical outcomes. Overall, the findings of our review reported considerable improvements in terms of medical education and clinical care. VR systems were also found to be safe, engaging, and beneficial by the studies’ participants. There were huge variations in studies with respect to the study designs, VR contents, devices, evaluation methods, and treatment periods. In the future, studies may focus on creating definitive guidelines that can help in improving patient care further. Hence, there is an urgent need for researchers to collaborate with the VR industry and healthcare professionals to foster a better understanding of contents and simulation development.

The COVID-19 pandemic has become a major cause of rapid globalization and digitization of educational institutions, including medical education. The adaptation to digital technologies is the purpose of best education and training practices in the development of the academic medical curriculum. Virtual reality (VR) is embraced by the 3D environment and network resources which allow the expansion of VR from the entertainment industry to the education industry. This brief communication explains our understanding and the challenges in adopting VR technologies for medical training at an academic medical center. Advancement in VR technology assists medical institutes to strategize for the further development of medical training and education. There is a timely need for persistence to make the VR content accessible widely and open source. There is an urgent need for collaboration of medical institutes and technology industries on the development of education-related VR content and simulations.

Taiwan’s unique circumstance as a contested state makes it imperative for the country to increase international support for and awareness of its embattled democracy at the hands of the authoritarian government in Beijing through positive public visibility. #TaiwanCanHelp, while perhaps similar to other forms of hashtag activism, is also very different because it also encompasses digitalization of diplomacy, in which the Taiwanese government seeks to raise international awareness of its struggle and gain goodwill through its medical equipment donations. The social influence of #TaiwanCanHelp has not been measured and examined extensively. Evaluation of hashtag use at a holistic level is imperative to the understanding of the extent of resonance across social media. This study explores the dynamics of the #TaiwanCanHelp hashtag on Twitter by quantifying the public response and uncovering the public opinions around #TaiwanCanHelp. A mixed-methods methodology incorporating time-series analysis, sentiment analysis, spatial analysis, and word clouds has been adopted. Our results reveal that #TaiwanCanHelp has resonated beyond Taiwan and received positive responses from diverse users across the globe. Our findings also suggest that the prominence of #TaiwanCanHelp rides on real-life events and is a successful attempt by the Taiwan government in generating international interest through digitalization of diplomacy to advance Taiwan’s interests.

As the obesity rate continues to increase persistently, there is an urgent need to develop an effective weight loss management strategy. Nowadays, the development of artificial intelligence (AI) and cognitive technologies coupled with the rapid spread of messaging platforms and mobile technology with easier access to internet technology offers professional dietitians an opportunity to provide extensive monitoring support to their clients through a chatbot with artificial empathy. This study aimed to design a chatbot with artificial empathic motivational support for weight loss called “SlimMe” and investigate how people react to a diet bot. The SlimMe infrastructure was built using Dialogflow as the natural language processing (NLP) platform and LINE mobile messenger as the messaging platform. We proposed a text-based emotion analysis to simulate artificial empathy responses to recognize the user's emotion. A preliminary evaluation was performed to investigate the early-stage user experience after a 7-day simulation trial. The result revealed that having an artificially empathic diet bot for weight loss management is a fun and exciting experience. The use of emoticons, stickers, and GIF images makes the chatbot response more interactive. Moreover, the motivational support and persuasive messaging features enable the bot to express more empathic and engaging responses to the user. In total, there were 1,007 bot responses from 892 user input messages. Of these, 67.38% (601/1,007) of the chatbot-generated responses were accurate to a relevant user request, 21.19% (189/1,007) inaccurate responses to a relevant request, and 10.31% (92/1,007) accurate responses to an irrelevant request. Only 1.12% (10/1,007) of the chatbot does not answer. We present the design of an artificially empathic diet bot as a friendly assistant to help users estimate their calorie intake and calories burned in a more interactive and engaging way. To our knowledge, this is the first chatbot designed with artificial empathy features, and it looks very promising in promoting long-term weight management. More user interactions and further data training and validation enhancement will improve the bot's in-built knowledge base and emotional intelligence base.

Background People from lower and middle socioeconomic classes and vulnerable populations are among the worst affected by the COVID-19 pandemic, thus exacerbating disparities and the digital divide. Objective To draw a portrait of e-services as a digital approach to support digital health literacy in vulnerable populations amid the COVID-19 infodemic, and identify the barriers and facilitators for their implementation. Methods A scoping review was performed to gather published literature with a broad range of study designs and grey literature without exclusions based on country of publication. A search was created in Medline (Ovid) in March 2021 and translated to Medline, PsycINFO, Scopus and CINAHL with Full Text (EBSCOhost). The combined literature search generated 819 manuscripts. To be included, manuscripts had to be written in English, and present information on digital intervention(s) (e.g. social media) used to enable or increase digital health literacy among vulnerable populations during the COVID-19 pandemic (e.g. older adults, Indigenous people living on reserve). Results Five articles were included in the study. Various digital health literacy-enabling e-services have been implemented in different vulnerable populations. Identified e-services aimed to increase disease knowledge, digital health literacy and social media usage, help in coping with changes in routines and practices, decrease fear and anxiety, increase digital knowledge and skills, decrease health literacy barriers and increase technology acceptance in specific groups. Many facilitators of digital health literacy-enabling e-services implementation were identified in expectant mothers and their families, older adults and people with low-income. Barriers such as low literacy limited to no knowledge about the viruses, medium of contamination, treatment options played an important role in distracting and believing in misinformation and disinformation. Poor health literacy was the only barrier found, which may hinder the understanding of individual health needs, illness processes and treatments for people with HIV/AIDS. Conclusions The literature on the topic is scarce, sparse and immature. We did not find any literature on digital health literacy in Indigenous people, though we targeted this vulnerable population. Although only a few papers were included, two types of health conditions were covered by the literature on digital health literacy-enabling e-services, namely chronic conditions and conditions that are new to the patients. Digital health literacy can help improve prevention and adherence to a healthy lifestyle, improve capacity building and enable users to take the best advantage of the options available, thus strengthening the patient’s involvement in health decisions and empowerment, and finally improving health outcomes. Therefore, there is an urgent need to pursue research on digital health literacy and develop digital platforms to help solve current and future COVID-19-related health needs.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused widespread fear and stress. The pandemic has affected everyone, everywhere, and created systemic inequities, leaving no one behind. In India alone, more than 34,094,373 confirmed COVID-19 cases and 452,454 related deaths have been reported as of October 19, 2021. Around May 2021, the daily number of new COVID-19 cases crossed the 400,000 mark, seriously hampering the health care system. Despite the devastating situation, the public response was seen through their efforts to come forward with innovative ideas for potential ways to combat the pandemic, for instance, dealing with the shortage of oxygen cylinders and hospital bed availability. With increasing COVID-19 vaccination rates since September 2021, along with the diminishing number of daily new cases, the country is conducting preventive and preparatory measures for the third wave. In this article, we propose the pivotal role of public participation and digital solutions to re-establish our society and describe how Sustainable Development Goals (SDGs) can support eHealth initiatives and mitigate infodemics to tackle a postpandemic situation. This viewpoint reflects that the COVID-19 pandemic has featured a need to bring together research findings across disciplines, build greater coherence within the field, and be a driving force for multi-sectoral, cross-disciplinary collaboration. The article also highlights the various needs to develop digital solutions that can be applied to pandemic situations and be reprocessed to focus on other SDGs. Promoting the use of digital health care solutions to implement preventive measures can be enhanced by public empowerment and engagement. Wearable technologies can be efficiently used for remote monitoring or home-based care for patients with chronic conditions. Furthermore, the development and implementation of informational tools can aid the improvement of well-being and dissolve panic-ridden behaviors contributing toward infodemics. Thus, a call to action for an observatory of digital health initiatives on COVID-19 is required to share the main conclusions and lessons learned in terms of resilience, crisis mitigation, and preparedness.

Survival prediction is highly valued in end-of-life care clinical practice, and patient performance status evaluation stands as a predominant component in survival prognostication. While current performance status evaluation tools are limited to their subjective nature, the advent of wearable technology enables continual recordings of patients' activity and has the potential to measure performance status objectively. We hypothesize that wristband actigraphy monitoring devices can predict in-hospital death of end-stage cancer patients during the time of their hospital admissions. The objective of this study was to train and validate a long short-term memory (LSTM) deep-learning prediction model based on activity data of wearable actigraphy devices. The study recruited 60 end-stage cancer patients in a hospice care unit, with 28 deaths and 32 discharged in stable condition at the end of their hospital stay. The standard Karnofsky Performance Status score had an overall prognostic accuracy of 0.83. The LSTM prediction model based on patients' continual actigraphy monitoring had an overall prognostic accuracy of 0.83. Furthermore, the model performance improved with longer input data length up to 48 h. In conclusion, our research suggests the potential feasibility of wristband actigraphy to predict end-of-life admission outcomes in palliative care for end-stage cancer patients.Clinical Trial Registration: The study protocol was registered on ClinicalTrials.gov (ID: NCT04883879).

Background: Smartphones and wearable devices have become a part and parcel of the healthcare industry. The use of wearable technology has already proved its potentials in improving healthcare research, clinical work, and patient care. The real time data allows the care providers to monitor the patients’ symptoms remotely, prioritize the patients’ visits, assist in decision-making, and carry out advanced care planning. Objectives: The primary objective of our study was to investigate the potential use of wearable devices as a prognosis tool among patients in hospice care and palliative care, and the secondary objective was to examine the association between wearable devices and clinical data in the context of patient outcomes, such as discharge and deceased at various time intervals. Methods: We employed a prospective observational research approach to continuously monitor the hand movements of the selected 68 patients between December 2019 and June 2022 via an actigraphy device at hospice or palliative care ward of Taipei Medical University Hospital (TMUH) in Taiwan. Results: The results revealed that the patients with higher scores in the Karnofsky Performance Status (KPS), and Palliative Performance Scale (PPS) tended to live at discharge, while Palliative Prognostic Score (PaP) and Palliative prognostic Index (PPI) also shared the similar trend. In addition, the results also confirmed that all these evaluating tools only suggested rough rather than accurate and definite prediction. The outcomes (May be Discharge (MBD) or expired) were positively correlated with accumulated angle and spin values, i.e., the patients who survived had higher angle and spin values as compared to those who died/expired. Conclusion: The outcomes had higher correlation with angle value compared to spin and ACT. The correlation value increased within the first 48 h and then began to decline. We recommend rigorous prospective observational studies/randomized control trials with many participants for the investigations in the future.

Most of the communicable diseases have contact, airborne and/or droplet mode of transsmission. Following the outbreak of COVID-19, the Taiwan government implemented the use of masks and sanitizer, as well as other preventive measures like social distancing for prevention. This public response likely contributed significantly to the decline in the outbreak of other infectious diseases.

Abstract Background Virtual reality (VR) has several applications in the medical domain and also generates a secure environment to carry out activities. Evaluation of the effectiveness of VR among older populations revealed positive effects of VR as a tool to reduce risks of falls and also improve the social and emotional well-being of older adults. The decline in physical and mental health, the loss of functional capabilities, and a weakening of social ties represent obstacles towards active aging among older adults and indicate a need for support. Existing research focused on the effects of VR among older populations, and its uses and benefits. Our study investigated the acceptance and use of VR by the elderly. Methods This pilot study was conducted on 30 older adults who voluntarily participated during March to May 2018. Nine VR applications that promote physical activities, motivate users, and provide entertainment were chosen for this study. Participants were asked to use any one of the applications of their choice for 15 min twice a week for 6 weeks. At the end of 6 weeks, participants were asked to fill out a questionnaire based on the Technology Acceptance Model and a literature review, to evaluate their acceptance of VR technology. Cronbach’s alpha reliability analysis was used to test the internal consistency of the questionnaire items. Pearson’s product moment correlation was used to examine the validity of the questionnaire. A linear regression and mediation analysis were utilized to identify relationships among the variables of the questionnaire. Results In total, six male and 24 female participants aged 60~95 years volunteered to participate in the study. Perceived usefulness, perceived ease of use, social norms, and perceived enjoyment were seen to have had significant effects on the intention to use VR. Participants agreed to a large extent regarding the perceived usefulness, perceived enjoyment, and their experience of using VR. Thus, VR was seen to have high acceptance among this elderly population. Conclusions Older people have positive perceptions towards accepting and using VR to support active aging. They perceived VR to be useful, easy to use, and an enjoyable experience, implying positive attitudes toward adopting this new technology.

Background and Objectives: Taiwan is among the nations with the highest rates of Type 2 Diabetes Mellitus (T2DM) and Hypertension (HTN). As more cases are reported each year, there is a rise in hospital admissions for people seeking medical attention. This creates a burden on hospitals and affects the overall management and administration of the hospitals. Hence, this study aimed to develop a machine learning (ML) model to predict the Length of Stay (LoS) and mortality among T2DM and HTN inpatients. Materials and Methods: Using Taiwan’s National Health Insurance Research Database (NHIRD), this cohort study consisted of 58,618 patients, where 25,868 had T2DM, 32,750 had HTN, and 6419 had both T2DM and HTN. We analyzed the data with different machine learning models for the prediction of LoS and mortality. The evaluation was done by plotting descriptive statistical graphs, feature importance, precision-recall curve, accuracy plots, and AUC. The training and testing data were set at a ratio of 8:2 before applying ML algorithms. Results: XGBoost showed the best performance in predicting LoS (R2 0.633; RMSE 0.386; MAE 0.123), and RF resulted in a slightly lower performance (R2 0.591; RMSE 0.401; MAE 0.027). Logistic Regression (LoR) performed the best in predicting mortality (CV Score 0.9779; Test Score 0.9728; Precision 0.9432; Recall 0.9786; AUC 0.97 and AUPR 0.93), closely followed by Ridge Classifier (CV Score 0.9736; Test Score 0.9692; Precision 0.9312; Recall 0.9463; AUC 0.94 and AUPR 0.89). Conclusions: We developed a robust prediction model for LoS and mortality of T2DM and HTN inpatients. Linear Regression showed the best performance for LoS, and Logistic Regression performed the best in predicting mortality. The results showed that ML algorithms can not only help healthcare professionals in data-driven decision-making but can also facilitate early intervention and resource planning.

Recommender systems are gaining traction in healthcare because they can tailor recommendations based on users’ feedback concerning their appreciation of previous health-related messages. However, recommender systems are often not grounded in behavioral change theories, which may further increase the effectiveness of their recommendations. This paper’s objective is to describe principles for designing and developing a health recommender system grounded in the I-Change behavioral change model that shall be implemented through a mobile app for a smoking cessation support clinical trial. We built upon an existing smoking cessation health recommender system that delivered motivational messages through a mobile app. A group of experts assessed how the system may be improved to address the behavioral change determinants of the I-Change behavioral change model. The resulting system features a hybrid recommender algorithm for computer tailoring smoking cessation messages. A total of 331 different motivational messages were designed using 10 health communication methods. The algorithm was designed to match 58 message characteristics to each user profile by following the principles of the I-Change model and maintaining the benefits of the recommender system algorithms. The mobile app resulted in a streamlined version that aimed to improve the user experience, and this system’s design bridges the gap between health recommender systems and the use of behavioral change theories. This article presents a novel approach integrating recommender system technology, health behavior technology, and computer-tailored technology. Future researchers will be able to build upon the principles applied in this case study.

Abstract Background Smoking cessation is the most common preventative for an array of diseases, including lung cancer and chronic obstructive pulmonary disease. Although there are many efforts advocating for smoking cessation, smoking is still highly prevalent. For instance, in the USA in 2015, 50% of all smokers attempted to quit smoking, and only 5–7% of them succeeded – with slight deviation depending on external assistance. Previous studies show that computer-tailored messages which support smoking abstinence are effective. The combination of health recommender systems and behavioral-change theories is becoming increasingly popular in computer-tailoring. The objective of this study is to evaluate patients’s smoking cessation rates by means of two randomized controlled trials using computer-tailored motivational messages. A group of 100 patients will be recruited in medical centers in Taiwan (50 patients in the intervention group, and 50 patients in the control group), and a group of 1000 patients will be recruited on-line (500 patients in the intervention group, and 500 patients in the control group). The collected data will be made available to the public in an open-source data portal. Methods Our study will gather data from two sources. The first source is a clinical pilot in which a group of patients from two Taiwanese medical centers will be randomly assigned to either an intervention or a control group. The intervention group will be provided with a mobile app that sends motivational messages selected by a recommender system that takes the user profile (including gender, age, motivations, and social context) and similar users’ opinions. For 6 months, the patients’ smoking activity will be followed up, and confirmed as “smoke-free” by using a test that measures expired carbon monoxide and urinary cotinine levels. The second source will be a public pilot in which Internet users wanting to quit smoking will be able to download the same mobile app as used in the clinical pilot. They will be randomly assigned to a control group that receives basic motivational messages or to an intervention group, that receives personalized messages by the recommender system. For 6 months, patients in the public pilot will be assessed periodically with self-reported questionnaires. Discussion This study will be the first to use the I-Change behavioral-change model in combination with a health recommender system and will, therefore, provide relevant insights into computer-tailoring for smoking cessation. If our hypothesis is validated, clinical practice for smoking cessation would benefit from the use of our mobile solution. Trial registration ClinicalTrials.gov, ID: NCT03108651. Registered on 11 April 2017.

Starting renal replacement therapy (RRT) for patients with chronic kidney disease (CKD) at an optimal time, either with hemodialysis or kidney transplantation, is crucial for patient's well-being and for successful management of the condition. In this paper, we explore the possibilities of creating forecasting models to predict the onset of RRT 3, 6, and 12 months from the time of the patient's first diagnosis with CKD, using only the comorbidities data from National Health Insurance from Taiwan. The goal of this study was to see whether a limited amount of data (including comorbidities but not considering laboratory values which are expensive to obtain in low- and medium-income countries) can provide a good basis for such predictive models. On the other hand, in developed countries, such models could allow policy-makers better planning and allocation of resources for treatment. Using data from 8,492 patients, we obtained the area under the receiver operating characteristic curve (AUC) of 0.773 for predicting RRT within 12 months from the time of CKD diagnosis. The results also show that there is no additional advantage in focusing only on patients with diabetes in terms of prediction performance. Although these results are not as such suitable for adoption into clinical practice, the study provides a strong basis and a variety of approaches for future studies of forecasting models in healthcare.

Improving health and lives of people is undoubtedly one of the prime goals of healthcare organizations, policy-makers, and leaders around the world [...]

Knee osteoarthritis (OA) is a chronic degenerative disorder which could be distinguished by erosion of articular cartilage, pain, stiffness, and crepitus. Not only aging-associated alterations but also the metabolic factors such as hyperglycemia, dyslipidemia, and obesity affect articular tissues and may initiate or exacerbate the OA. The poor self-healing ability of articular cartilage due to limited regeneration in chondrocytes further adversely affects the osteoarthritic microenvironment. Traditional and current surgical treatment procedures for OA are limited and incapable to reverse the damage of articular cartilage. To overcome these limitations, cell-based therapies are currently being employed to repair and regenerate the structure and function of articular tissues. These therapies not only depend upon source and type of stem cells but also on environmental conditions, growth factors, and chemical and mechanical stimuli. Recently, the pluripotent and various multipotent mesenchymal stem cells have been employed for OA therapy, due to their differentiation potential towards chondrogenic lineage. Additionally, the stem cells have also been supplemented with growth factors to achieve higher healing response in osteoarthritic cartilage. In this review, we summarized the current status of stem cell therapies in OA pathophysiology and also highlighted the potential areas of further research needed in regenerative medicine.

ABSTRACT Objective Rapid change in health information technology system had dramatically increased health data accumulated. We aimed to develop an online informatics tool in order to evaluate the risk of drugs for cancer by utilizing medical big data. Data Source We use the Taiwan’s National Health Insurance Database that has provided a huge data which covered all health information including characteristics and all drug information i.e. prescriptions, etc. of 23 million Taiwanese population. Front-end development: Web-based interface was developed by using PHP package and Javascript. In addition, we included the guidelines of evidence based medicine (EBM) level 3 for observational study such as cohort, case-control, and/or case serial self-control in order to support users interact with system. Back-end development: A package of Apache, MySQL & PHP was used to build the serve-side of the system. We integrated the Elasticsearch API5 to our system in order to search and analyze data immediately. The example of data transform to person-level from Taiwan NHI database is shown in Box 1. After then, we also integrated the analytics package (ie. R package) to perform the statistical analysis to a given study. This online analytical tool has capability to massively explore and visualize big data for long term use drugs and cancers through OMOSC system which will help to do mass online studies for long term use drugs and cancer risk. It would help to direct the health care professionals with lack of datamining skills to lead the study. The constructed online system would generate automatically case and controls by utilizing large databases for long term drug exposures and cancer risk. Results The results are shown in odds ratio (OR) and if selected some confounding factors then could also get adjusted odds ratio (AOR) for risk estimation with 95% Confidence Intervals (CI). We used SAS statistical software on the same dataset to validate the OMOSC system results. It could help to do massive online studies which will saves time and cost effective. Conclusion Since the clinical trials are impossible to conduct due to cultural, cost, ethical, political or social obstacles. Therefore, this kind of research model would play an important role in health care industry by providing an excellent opportunities for solving the technological, informatics, and organizational issues towards other broad domains of drugs evaluation by utilizing large-scale databases.

Non-contact sensors are gaining popularity in clinical settings to monitor the vital parameters of patients. In this study, we used a non-contact sensor device to monitor vital parameters like the heart rate, respiration rate, and heart rate variability of hemodialysis (HD) patients for a period of 23 weeks during their HD sessions. During these 23 weeks, a total number of 3237 HD sessions were observed. Out of 109 patients enrolled in the study, 78 patients reported clinical events such as muscle spasms, inpatient stays, emergency visits or even death during the study period. We analyzed the sensor data of these two groups of patients, namely an event and no-event group. We found a statistically significant difference in the heart rates, respiration rates, and some heart rate variability parameters among the two groups of patients when their means were compared using an independent sample t-test. We further developed a supervised machine-learning-based prediction model to predict event or no-event based on the sensor data and demographic information. A mean area under curve (ROC AUC) of 90.16% with 96.21% mean precision, and 88.47% mean recall was achieved. Our findings point towards the novel use of non-contact sensors in clinical settings to monitor the vital parameters of patients and the further development of early warning solutions using artificial intelligence (AI) for the prediction of clinical events. These models could assist healthcare professionals in taking decisions and designing better care plans for patients by early detecting changes to vital parameters.

BACKGROUND: Medication errors are common, life threatening, costly but preventable. Information technology and automated systems are highly efficient for preventing medication errors and therefore widely employed in hospital settings. The aim of this study was to construct a probabilistic model that can reduce medication errors by identifying uncommon or rare associations between medications and diseases. METHODS AND FINDINGS: Association rules of mining techniques are utilized for 103.5 million prescriptions from Taiwan's National Health Insurance database. The dataset included 204.5 million diagnoses with ICD9-CM codes and 347.7 million medications by using ATC codes. Disease-Medication (DM) and Medication-Medication (MM) associations were computed by their co-occurrence and associations' strength were measured by the interestingness or lift values which were being referred as Q values. The DMQs and MMQs were used to develop the AOP model to predict the appropriateness of a given prescription. Validation of this model was done by comparing the results of evaluation performed by the AOP model and verified by human experts. The results showed 96% accuracy for appropriate and 45% accuracy for inappropriate prescriptions, with a sensitivity and specificity of 75.9% and 89.5%, respectively. CONCLUSIONS: We successfully developed the AOP model as an efficient tool for automatic identification of uncommon or rare associations between disease-medication and medication-medication in prescriptions. The AOP model helps to reduce medication errors by alerting physicians, improving the patients' safety and the overall quality of care.

Social media platforms are emerging digital communication channels that provide an easy way for common people to share their health and medication experiences online. With more people discussing their health information online publicly, social media platforms present a rich source of information for exploring adverse drug reactions (ADRs). ADRs are major public health problems that result in deaths and hospitalizations of millions of people. Unfortunately, not all ADRs are identified before a drug is made available in the market. In this study, an ADR event monitoring system is developed which can recognize ADR mentions from a tweet and classify its assertion. We explored several entity recognition features, feature conjunctions, and feature selection and analyzed their characteristics and impacts on the recognition of ADRs, which have never been studied previously. The results demonstrate that the entity recognition performance for ADR can achieve an F-score of 0.562 on the PSB Social Media Mining shared task dataset, which outperforms the partial-matching-based method by 0.122. After feature selection, the F-score can be further improved by 0.026. This novel technique of text mining utilizing shared online social media data will open an array of opportunities for researchers to explore various health related issues.

BACKGROUND: Turnaround time (TAT) is an important indicator of laboratory performance. It is often difficult to achieve fast TAT for blood tests conducted at clinics in developing countries. This is because clinics where the patient is treated are often far away from the laboratory, and transporting blood samples and test results between the two locations creates significant delay. Recent efforts have sought to mitigate this problem by using Short Message Service (SMS) to reduce TAT. Studies reporting the impact of this technique have not been published in scientific literature however. In this paper we present a study of LabPush, a system developed to test whether SMS delivery of HIV related laboratory results to clinics could shorten TAT time significantly. METHOD: LapPush was implemented in six clinics of the Kingdom of Swaziland. SMS results were sent out from the laboratory as a supplement to normal transport of paper results. Each clinic was equipped with a mobile phone to receive SMS results. The laboratory that processes the blood tests was equipped with a system for digital input of results, and transmission of results via SMS to the clinics. RESULTS: Laboratory results were received for 1041 different clinical cases. The total number of SMS records received (1032) was higher than that of paper records (965), indicating a higher loss rate for paper records. A statistical comparison of TAT for SMS and paper reports indicates a statistically significant improvement for SMS. Results were more positive for more rural clinics, and an urban clinic with high workload. CONCLUSION: SMS can be used to reduce TAT for blood tests taken at clinics in developing countries. Benefits are likely to be greater at clinics that are further away from laboratories, due to the difficulties this imposes on transport of paper records.

Given the challenge that healthcare related data are being obtained from various sources and in divergent formats there is an emerging need for providing improved and automated techniques and technologies that perform qualification and standardization of these data. The approach presented in this paper introduces a novel mechanism for the cleaning, qualification, and standardization of the collected primary and secondary data types. The latter is realized through the design and implementation of three (3) integrated subcomponents, the Data Cleaner, the Data Qualifier, and the Data Harmonizer that are further evaluated by performing data cleaning, qualification, and harmonization on top of data related to Pancreatic Cancer to further develop enhanced personalized risk assessment and recommendations to individuals. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is a progressive disorder of the central nervous system. The prevalence of PD varies considerably by age group; it has a higher prevalence in patients aged 60 years and more. Several studies have shown that statin, a cholesterol-lowering medication, reduces the risk of developing PD, but evidence for this is so far inconclusive. The objective of this study is to evaluate the association between statin use and the risk of developing PD. Methods: PubMed, EMBASE, and the bibliographies of articles were searched for studies published between January 1, 1990, and January 1, 2017, which reported on the association between statin use and PD. Articles were included if they (1) were published in English, (2) reported patients treated with statin, and the outcome of interest was PD, (3) provided OR/HR with 95% CI or sufficient information to calculate the 95% CI. All abstracts, full-text articles, and sources were reviewed, with duplicate data excluded. Summary relative risk (RRs) with 95% CI was pooled using a random-effects model. Subgroup and sensitivity analyses were also conducted. Results: We selected 16 out of 529 unique abstracts for full-text review using our selection criteria, and 13 out of these 16 studies, comprising 4,877,059 persons, met all of our inclusion criteria. The overall pooled RR of PD was 0.70 (95% CI 0.58-0.84) with significant heterogeneity between estimates (I² = 93.41%, p = 0.000) for the random-effects model. In subgroup analysis, the greater decreased risk was found in studies from Asia (RR 0.62 95% CI 0.51-0.76), whereas a moderate reduction was observed in studies from North America (RR 0.69 95% CI 0.47-1.00), but less reduction was observed in studies from Europe (RR 0.86 95% CI 0.80--0.92). Also, longterm statin use, simvastatin, and atorvastatin showed a higher rate of reduction with significance heterogeneity. Conclusion: Our results showed that statin use is significantly associated with a lower risk of developing PD. Physicians should consider statin drug therapy, monitor its outcomes, and empower their patients to improve their knowledge, therapeutic outcomes, and quality of life. However, preventive measures and their associated mechanisms must be further assessed and explored. [ABSTRACT FROM AUTHOR]

Background: Benzodiazepines are a widely used medication in developed countries, particularly among elderly patients. However, benzodiazepines are known to affect memory and cognition and might thus enhance the risk of dementia. The objective of this review is to synthesize evidence from observational studies that evaluated the association between benzodiazepines use and dementia risk. Summary: We performed a systematic review and metaanalysis of controlled observational studies to evaluate the risk of benzodiazepines use on dementia outcome. All control observational studies that compared dementia outcome in patients with benzodiazepine use with a control group were included. We calculated pooled ORs using a random-effects model. Ten studies (of 3,696 studies identified) were included in the systematic review, of which 8 studies were included in random-effects meta-analysis and sensitivity analyses. Odds of dementia were 78% higher in those who used benzodiazepines compared with those who did not use benzodiazepines (OR 1.78; 95% CI 1.33-2.38). In subgroup analysis, the higher association was still found in the studies from Asia (OR 2.40; 95% CI 1.66-3.47) whereas a moderate association was observed in the studies from North America and Europe (OR 1.49; 95% CI 1.34-1.65 and OR 1.43; 95% CI 1.16-1.75). Also, diabetics, hypertension, cardiac disease, and statin drugs were associated with increased risk of dementia but negative association was observed in the case of body mass index. There was significant statistical and clinical heterogeneity among studies for the main analysis and most of the sensitivity analyses. There was significant statistical and clinical heterogeneity among the studies for the main analysis and most of the sensitivity analyses. Key Messages: Our results suggest that benzodiazepine use is significantly associated with dementia risk. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variable. Therefore, more research is needed. [ABSTRACT FROM AUTHOR]