1
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Yang J, Yan JS, Xiong CX, Zhang XM, Shen L, Zhi JL, Ma SY, Dong HX, Yang YS. Development and validation of a scoring system to predict esophagogastroduodenoscopy necessity. J Dig Dis 2023; 24:671-680. [PMID: 37971314 DOI: 10.1111/1751-2980.13241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This study aimed to develop and validate a scoring system for predicting the need for esophagogastroduodenoscopy (EGD) in clinical practice to enhance accuracy and reduce misapplications. METHODS From February 2021 to April 2022, outpatients scheduled for EGD at the Department of Gastroenterology in our hospital were recruited. Patients completed the system evaluation by providing clinical symptoms, relevant medical history, and endoscopic findings. Patients were randomly divided into the training and validation cohorts (at 2:1 ratio). The optimal algorithm was selected from five alternatives including a parallel test. Six physicians participated in a human-computer comparative validation. Sensitivity and negative likelihood ratio (-LR) were used as the primary indicators. RESULTS Altogether 865 patients were enrolled, with 578 in the training cohort and 287 in the validation cohort. The scoring system comprised 21 variables, including age, 13 typical clinical symptoms, and seven medical history variables. The parallel test was selected as the final algorithm. Positive EGD findings were reported in 54.5% of the training cohort and 62.7% of the validation cohort. The scoring system demonstrated a sensitivity of 79.0% in the training cohort and 83.9% in the validation cohort, with -LR being 0.627 and 0.615, respectively. Compared to physicians, the scoring system exhibited higher sensitivity (84.0% vs 68.7%, P = 0.02) and a lower -LR (1.11 vs 2.41, P = 0.439). CONCLUSIONS We developed a scoring system to predict the necessity of EGD using a parallel test algorithm, which was user-friendly and effective, as evidenced by single-center validation.
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Affiliation(s)
- Jing Yang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | | | - Cen Xi Xiong
- School of Medicine, Nankai University, Tianjin, China
| | - Xiao Mei Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lei Shen
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun Li Zhi
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shu Yun Ma
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hong Xia Dong
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yun Sheng Yang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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2
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Edgley K, Horne AW, Saunders PTK, Tsanas A. Symptom tracking in endometriosis using digital technologies: Knowns, unknowns, and future prospects. Cell Rep Med 2023; 4:101192. [PMID: 37729869 PMCID: PMC10518625 DOI: 10.1016/j.xcrm.2023.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
Endometriosis is a common chronic pain condition with no known cure and limited treatment options. Digital technologies, ranging from smartphone apps to wearable sensors, have shown potential toward facilitating chronic pain assessment and management; however, to date, many of these tools have not been specifically deployed or evaluated in patients with endometriosis-associated pain. Informed by previous studies in related chronic pain conditions, we discuss how digital technologies may be used in endometriosis to facilitate objective, continuous, and holistic symptom tracking. We postulate that these pervasive and increasingly affordable technologies present promising opportunities toward developing decision-support tools assisting healthcare professionals and empowering patients with endometriosis to make better-informed choices about symptom management.
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Affiliation(s)
- Katherine Edgley
- EXPPECT and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4UU, Scotland, UK.
| | - Andrew W Horne
- EXPPECT and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4UU, Scotland, UK
| | - Philippa T K Saunders
- Centre for Inflammation Research, University of Edinburgh, Edinburgh EH16 4UU, Scotland, UK
| | - Athanasios Tsanas
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh EH16 4UX, Scotland, UK; Alan Turing Institute, London NW1 2DB, UK
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3
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Alvarez M, Colee J, Langkamp-Henken B, Dahl WJ. Assessing Gastrointestinal Tolerance in Healthy Adults: Reliability and Validity of a Weekly Questionnaire. Curr Dev Nutr 2023; 7:101976. [PMID: 37600933 PMCID: PMC10432906 DOI: 10.1016/j.cdnut.2023.101976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
When examining gastrointestinal tolerance to nondigestible carbohydrates, a weekly vs. daily symptoms questionnaire may lessen participant burden. This secondary analysis examined the reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) in healthy adults. The internal consistency reliability of the GSRS syndromes and a daily questionnaire (DQ) comparator were determined. The GSRS syndromes prediction of slow transit stool form was assessed by ROC analysis. The DQ (α = 0.76) and GSRS syndromes of constipation (α = 0.73; ω = 0.74), and diarrhea (α = 0.76; ω = 0.77) exhibited acceptable reliability, as did the GSRS overall (α = 0.76; ω = 0.87) but not the syndromes of abdominal pain (α = 0.54; ω = 0.54), reflux (α = 0.69; ω = 0.67), or indigestion (α = 0.64; ω = 0.67). The GSRS syndromes predicted slow transit stools (AUC = 0.855), and the GSRS items of stomach pain, nausea, flatus, constipation, and diarrhea were moderately correlated (ρ = 0.55-0.64; P < 0.001) with the corresponding DQ items. The GSRS may be useful to assess gastrointestinal tolerance and efficacy of nondigestible carbohydrates given its performance at predicting slow transit stools, suggestive of constipation.
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Affiliation(s)
- Melissa Alvarez
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
| | - James Colee
- Institute of Food and Agricultural Sciences (IFAS) Statistics, University of Florida, Gainesville, FL, United States
| | - Bobbi Langkamp-Henken
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
| | - Wendy J. Dahl
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
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Pathipati MP, Shah ED, Kuo B, Staller KD. Digital health for functional gastrointestinal disorders. Neurogastroenterol Motil 2023; 35:e14296. [PMID: 34796577 PMCID: PMC9117568 DOI: 10.1111/nmo.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders are a common but challenging set of conditions to treat. Gastroenterology practices often struggle to meet the needs of patients with functional disorders given the need for careful monitoring, frequent communication, and management of stressors that occur outside of the clinical setting. In recent years, applications in digital health have created a new set of tools that can improve the care of these patients, including through improved symptom tracking, physiologic monitoring, direct provision of care, and patient support. PURPOSE The purpose of this review is to evaluate how digital applications are being used to manage functional gastrointestinal disorders today, with several examples of relevant technologies and organizations. It also the shortcomings of current treatment strategies and how they can be overcome.
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Affiliation(s)
- Mythili P. Pathipati
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric D. Shah
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle D. Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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5
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König LM, Van Emmenis M, Nurmi J, Kassavou A, Sutton S. Characteristics of smartphone-based dietary assessment tools: a systematic review. Health Psychol Rev 2022; 16:526-550. [PMID: 34875978 DOI: 10.1080/17437199.2021.2016066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Smartphones have become popular in assessing eating behaviour in real-life and real-time. This systematic review provides a comprehensive overview of smartphone-based dietary assessment tools, focusing on how dietary data is assessed and its completeness ensured. Seven databases from behavioural, social and computer science were searched in March 2020. All observational, experimental or intervention studies and study protocols using a smartphone-based assessment tool for dietary intake were included if they reported data collected by adults and were published in English. Out of 21,722 records initially screened, 117 publications using 129 tools were included. Five core assessment features were identified: photo-based assessment (48.8% of tools), assessed serving/ portion sizes (48.8%), free-text descriptions of food intake (42.6%), food databases (30.2%), and classification systems (27.9%). On average, a tool used two features. The majority of studies did not implement any features to improve completeness of the records. This review provides a comprehensive overview and framework of smartphone-based dietary assessment tools to help researchers identify suitable assessment tools for their studies. Future research needs to address the potential impact of specific dietary assessment methods on data quality and participants' willingness to record their behaviour to ultimately improve the quality of smartphone-based dietary assessment for health research.
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Affiliation(s)
- Laura M König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Kulmbach, Germany.,Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Miranda Van Emmenis
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Johanna Nurmi
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Aikaterini Kassavou
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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6
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A systematic review of engagement reporting in remote measurement studies for health symptom tracking. NPJ Digit Med 2022; 5:82. [PMID: 35768544 PMCID: PMC9242990 DOI: 10.1038/s41746-022-00624-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/01/2022] [Indexed: 01/25/2023] Open
Abstract
Remote Measurement Technologies (RMTs) could revolutionise management of chronic health conditions by providing real-time symptom tracking. However, the promise of RMTs relies on user engagement, which at present is variably reported in the field. This review aimed to synthesise the RMT literature to identify how and to what extent engagement is defined, measured, and reported, and to present recommendations for the standardisation of future work. Seven databases (Embase, MEDLINE and PsycINFO (via Ovid), PubMed, IEEE Xplore, Web of Science, and Cochrane Central Register of Controlled Trials) were searched in July 2020 for papers using RMT apps for symptom monitoring in adults with a health condition, prompting users to track at least three times during the study period. Data were synthesised using critical interpretive synthesis. A total of 76 papers met the inclusion criteria. Sixty five percent of papers did not include a definition of engagement. Thirty five percent included both a definition and measurement of engagement. Four synthetic constructs were developed for measuring engagement: (i) engagement with the research protocol, (ii) objective RMT engagement, (iii) subjective RMT engagement, and (iv) interactions between objective and subjective RMT engagement. The field is currently impeded by incoherent measures and a lack of consideration for engagement definitions. A process for implementing the reporting of engagement in study design is presented, alongside a framework for definition and measurement options available. Future work should consider engagement with RMTs as distinct from the wider eHealth literature, and measure objective versus subjective RMT engagement.Registration: This review has been registered on PROSPERO [CRD42020192652].
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7
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Jakob R, Harperink S, Rudolf AM, Fleisch E, Haug S, Mair JL, Salamanca-Sanabria A, Kowatsch T. Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review. J Med Internet Res 2022; 24:e35371. [PMID: 35612886 PMCID: PMC9178451 DOI: 10.2196/35371] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/31/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background Mobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions. Objective This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks. Methods A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings. Results The literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%). Conclusions This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app’s intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data.
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Affiliation(s)
- Robert Jakob
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Samira Harperink
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Aaron Maria Rudolf
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland
| | - Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
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8
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Ma T, Wang H, Wei M, Lan T, Wang J, Bao S, Ge Q, Fang Y, Sun X. Application of smart-phone use in rapid food detection, food traceability systems, and personalized diet guidance, making our diet more health. Food Res Int 2022; 152:110918. [DOI: 10.1016/j.foodres.2021.110918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022]
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9
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Oka A, Ishimura N, Ishihara S. A New Dawn for the Use of Artificial Intelligence in Gastroenterology, Hepatology and Pancreatology. Diagnostics (Basel) 2021; 11:1719. [PMID: 34574060 PMCID: PMC8468082 DOI: 10.3390/diagnostics11091719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) is rapidly becoming an essential tool in the medical field as well as in daily life. Recent developments in deep learning, a subfield of AI, have brought remarkable advances in image recognition, which facilitates improvement in the early detection of cancer by endoscopy, ultrasonography, and computed tomography. In addition, AI-assisted big data analysis represents a great step forward for precision medicine. This review provides an overview of AI technology, particularly for gastroenterology, hepatology, and pancreatology, to help clinicians utilize AI in the near future.
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan; (N.I.); (S.I.)
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Sharma A, Rao SSC, Kearns K, Orleck KD, Waldman SA. Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders. Aliment Pharmacol Ther 2021; 53:1250-1267. [PMID: 33909919 PMCID: PMC8252518 DOI: 10.1111/apt.16369] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/24/2020] [Accepted: 03/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic constipation is a common, heterogeneous disorder with multiple symptoms and pathophysiological mechanisms. Patients are often referred to a gastroenterology provider after laxatives fail. However, there is limited knowledge of the spectrum and management of constipation disorders. AIM To discuss the latest understanding of the spectrum of constipation disorders, tools for identifying a pathophysiologic-based diagnosis in the specialist setting, treatment options and the patient's perspective of constipation. METHODS Literature searches were conducted using PubMed for constipation diagnostic criteria, diagnostic tools and approved treatments. The authors provided insight from their own practices. RESULTS Clinical assessment, stool diaries and Rome IV diagnostic criteria can facilitate diagnosis, evaluate severity and distinguish between IBS with constipation, chronic idiopathic constipation and dyssynergic defecation. Novel smartphone applications can help track constipation symptoms. Rectal examinations, anorectal manometry and balloon expulsion, assessments of neuromuscular function with colonic transit time and colonic manometry can provide mechanistic understanding of underlying pathophysiology. Treatments include lifestyle and diet changes, biofeedback therapy and pharmacological agents. Several classes of laxatives, as well as prokinetic and prosecretory agents, are available; here we describe their mechanisms of action, efficacy and side effects. CONCLUSIONS Constipation includes multiple overlapping subtypes identifiable using detailed history, current diagnostic tools and smartphone applications. Recognition of individual subtype(s) could pave the way for optimal, evidence-based treatments by a gastroenterology provider.
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Affiliation(s)
- Amol Sharma
- Division of Gastroenterology/HepatologyMedical College of GeorgiaAugusta UniversityAugustaGAUSA
| | - Satish S. C. Rao
- Division of Gastroenterology/HepatologyMedical College of GeorgiaAugusta UniversityAugustaGAUSA
| | | | | | - Scott A. Waldman
- Department of Pharmacology and Experimental TherapeuticsThomas Jefferson UniversityPhiladelphiaPAUSA
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11
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Weerts ZZRM, Heinen KGE, Masclee AAM, Quanjel ABA, Winkens B, Vork L, Rinkens PELM, Jonkers DMAE, Keszthelyi D. Smart Data Collection for the Assessment of Treatment Effects in Irritable Bowel Syndrome: Observational Study. JMIR Mhealth Uhealth 2020; 8:e19696. [PMID: 33030150 PMCID: PMC7669448 DOI: 10.2196/19696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/30/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND End-of-day symptom diaries are recommended by drug regulatory authorities to assess treatment response in patients with irritable bowel syndrome. We developed a smartphone app to measure treatment response. OBJECTIVE Because the employment of an app to measure treatment response in irritable bowel syndrome is relatively new, we aimed to explore patients' adherence to diary use and characteristics associated with adherence. METHODS A smartphone app was developed to serve as a symptom diary. Patients with irritable bowel syndrome (based on Rome IV criteria) were instructed to fill out end-of-day diary questionnaires during an 8-week treatment. Additional online questionnaires assessed demographics, irritable bowel syndrome symptom severity, and psychosocial comorbidities. Adherence rate to the diary was defined as the percentage of days completed out of total days. Adherence to the additional web-based questionnaires was also assessed. RESULTS Overall, 189 patients were included (age: mean 34.0 years, SD 13.3 years; female: 147/189, 77.8%; male: 42/189, 22.2%). The mean adherence rate was 87.9% (SD 9.4%). However, adherence to the diary decreased over time (P<.001). No significant association was found between adherence and gender (P=.84), age (P=.22), or education level (lower education level: P=.58, middle education level: P=.46, versus high education level), while higher anxiety scores were associated with lower adherence (P=.03). Adherence to the online questionnaires was also high (>99%). Missing data due to technical issues were limited. CONCLUSIONS The use of a smartphone app as a symptom diary to assess treatment response resulted in high patient adherence. The data-collection framework described led to standardized data collection with excellent completeness and can be used for future randomized controlled trials. Due to the slight decrease in adherence to diary use throughout the study, this method might be less suitable for longer trials.
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Affiliation(s)
- Zsa Zsa R M Weerts
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Koert G E Heinen
- MEMIC Center for Data and Information Management, Maastricht University, Maastricht, Netherlands
| | - Ad A M Masclee
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Amber B A Quanjel
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University Medical Center+, Maastricht, Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Lisa Vork
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Paula E L M Rinkens
- MEMIC Center for Data and Information Management, Maastricht University, Maastricht, Netherlands
| | - Daisy M A E Jonkers
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Daniel Keszthelyi
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
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12
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Parasa S, Wallace M, Bagci U, Antonino M, Berzin T, Byrne M, Celik H, Farahani K, Golding M, Gross S, Jamali V, Mendonca P, Mori Y, Ninh A, Repici A, Rex D, Skrinak K, Thakkar SJ, van Hooft JE, Vargo J, Yu H, Xu Z, Sharma P. Proceedings from the First Global Artificial Intelligence in Gastroenterology and Endoscopy Summit. Gastrointest Endosc 2020; 92:938-945.e1. [PMID: 32343978 DOI: 10.1016/j.gie.2020.04.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Artificial intelligence (AI), specifically deep learning, offers the potential to enhance the field of GI endoscopy in areas ranging from lesion detection and classification to quality metrics and documentation. Progress in this field will be measured by whether AI implementation can lead to improved patient outcomes and more efficient clinical workflow for GI endoscopists. The aims of this article are to report the findings of a multidisciplinary group of experts focusing on issues in AI research and applications related to gastroenterology and endoscopy, to review the current status of the field, and to produce recommendations for investigators developing and studying new AI technologies for gastroenterology. METHODS A multidisciplinary meeting was held on September 28, 2019, bringing together academic, industry, and regulatory experts in diverse fields including gastroenterology, computer and imaging sciences, machine learning, computer vision, U.S. Food and Drug Administration, and the National Institutes of Health. Recent and ongoing studies in gastroenterology and current technology in AI were presented and discussed, key gaps in knowledge were identified, and recommendations were made for research that would have the highest impact in making advances and implementation in the field of AI to gastroenterology. RESULTS There was a consensus that AI will transform the field of gastroenterology, particularly endoscopy and image interpretation. Powered by advanced machine learning algorithms, the use of computer vision in endoscopy has the potential to result in better prediction and treatment outcomes for patients with gastroenterology disorders and cancer. Large libraries of endoscopic images, "EndoNet," will be important to facilitate development and application of AI systems. The regulatory environment for implementation of AI systems is evolving, but common outcomes such as colon polyp detection have been highlighted as potential clinical trial endpoints. Other threshold outcomes will be important, as well as clarity on iterative improvement of clinical systems. CONCLUSIONS Gastroenterology is a prime candidate for early adoption of AI. AI is rapidly moving from an experimental phase to a clinical implementation phase in gastroenterology. It is anticipated that the implementation of AI in gastroenterology over the next decade will have a significant and positive impact on patient care and clinical workflows. Ongoing collaboration among gastroenterologists, industry experts, and regulatory agencies will be important to ensure that progress is rapid and clinically meaningful. However, several constraints and areas will benefit from further exploration, including potential clinical applications, implementation, structure and governance, role of gastroenterologists, and potential impact of AI in gastroenterology.
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Affiliation(s)
- Sravanthi Parasa
- Department of Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
| | - Michael Wallace
- Department of Medicine, Mayo Clinic, Director, Digestive Diseases Research Program, Editor in Chief Gastrointestinal Endoscopy, President, Florida Gastroenterology Society, Jacksonville, Florida, USA
| | - Ulas Bagci
- Artificial Intelligence in Medicine (AIM), Center for Research in Computer Vision, University of Central Florida, Orlando, Florida, USA
| | - Mark Antonino
- Gastroenterology and Endoscopy Devices Team, Division of Renal, Gastrointestinal, Obesity and Transplant Devices, Office of Gastrorenal, ObGyn, General Hospital and Urology Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Tyler Berzin
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael Byrne
- Division of Gastroenterology, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Haydar Celik
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA; George Washington University, Washington, DC, USA
| | - Keyvan Farahani
- Image-Guided Interventions and Imaging Informatics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Martin Golding
- Gastroenterology and Endoscopy Devices Team, Division of Renal, Gastrointestinal, Obesity and Transplant Devices, Office of Gastrorenal, ObGyn, General Hospital and Urology Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Seth Gross
- Department of Medicine, Division of Gastroenterology, Clinical Care and Quality, NYU Langone Health, New York, New York, USA
| | - Vafa Jamali
- Respiratory, Gastrointestinal & Informatics, Medtronic Inc, Boulder, Colorado, USA
| | - Paulo Mendonca
- Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan
| | | | | | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas, Research Hospital, Milan, Italy
| | - Douglas Rex
- Departments of Medicine, Endoscopy, and Gastroenterology, Indiana University of School of Medicine, Indianapolis, Indiana, USA
| | - Kris Skrinak
- Global Machine Learning Segment Lead, Amazon Web Services, New York, New York, USA
| | - Shyam J Thakkar
- Department of Endoscopy, Allegheny Health Network, Department of Medicine, Temple University, Philadelphia, Pennsylvania, USA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | | | - John Vargo
- Department of Medicine, Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Honggang Yu
- Division of Gastroenterology, Renmin Hospital, Wuhan University, Wuhan, China
| | - Ziyue Xu
- Medical Image Analysis, NVIDIA, Bethesda, Maryland, USA
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
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13
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Therkildsen SB, Hansen LH, Jensen LED, Finderup J. A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study. JMIR Form Res 2019; 3:e13786. [PMID: 31750836 PMCID: PMC6914284 DOI: 10.2196/13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. OBJECTIVE The aim of this study was to uncover the applicability of the DG as a PDA. METHODS The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. RESULTS A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. CONCLUSIONS The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents' average age. Thus, the applicability of the DG cannot be definitively determined.
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Affiliation(s)
| | | | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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14
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May M, Junghaenel DU, Ono M, Stone AA, Schneider S. Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review. THE JOURNAL OF PAIN 2018; 19:699-716. [PMID: 29371113 PMCID: PMC6026050 DOI: 10.1016/j.jpain.2018.01.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 01/11/2023]
Abstract
Self-reported pain intensity assessments are central to chronic pain research. Ecological momentary assessment (EMA) methodologies are uniquely positioned to collect these data, and are indeed being used in the field. However, EMA protocols are complex, and many decisions are necessary in the design of EMA research studies. A systematic literature review identified 105 articles drawing from 62 quantitative EMA research projects examining pain intensity in adult chronic pain patients. Study characteristics were tabulated to summarize and describe the use of EMA, with an emphasis placed on various dimensions of decision-making involved in executing EMA methodologies. Most identified studies considered within-person relationships between pain and other variables, and a few examined interventions on chronic pain. There was a trend toward the use of smartphones as EMA data collection devices more recently, and completion rates were not reported in nearly one third of studies. Pain intensity items varied widely with respect to number of scale points, anchor labels, and length of reporting period; most used numeric rating scales. Recommendations are provided for reporting to improve reproducibility, comparability, and interpretation of results, and for opportunities to clarify the importance of design decisions. PERSPECTIVE Studies that use EMA methodologies to assess pain intensity are heterogeneous. Aspects of protocol design, including data input modality and pain item construction, have the potential to influence the data collected. Thorough reporting on design features and completion rates therefore facilitates reproducibility, comparability, and interpretation of study results.
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Affiliation(s)
- Marcella May
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California.
| | - Doerte U Junghaenel
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Masakatsu Ono
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Arthur A Stone
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Stefan Schneider
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
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15
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Zia J, Chung CF, Xu K, Dong Y, Schenk JM, Cain K, Munson S, Heitkemper MM. Inter-Rater Reliability of Provider Interpretations of Irritable Bowel Syndrome Food and Symptom Journals. J Clin Med 2017; 6:jcm6110105. [PMID: 29113044 PMCID: PMC5704122 DOI: 10.3390/jcm6110105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 12/16/2022] Open
Abstract
There are currently no standardized methods for identifying trigger food(s) from irritable bowel syndrome (IBS) food and symptom journals. The primary aim of this study was to assess the inter-rater reliability of providers’ interpretations of IBS journals. A second aim was to describe whether these interpretations varied for each patient. Eight providers reviewed 17 IBS journals and rated how likely key food groups (fermentable oligo-di-monosaccharides and polyols, high-calorie, gluten, caffeine, high-fiber) were to trigger IBS symptoms for each patient. Agreement of trigger food ratings was calculated using Krippendorff’s α-reliability estimate. Providers were also asked to write down recommendations they would give to each patient. Estimates of agreement of trigger food likelihood ratings were poor (average α = 0.07). Most providers gave similar trigger food likelihood ratings for over half the food groups. Four providers gave the exact same written recommendation(s) (range 3–7) to over half the patients. Inter-rater reliability of provider interpretations of IBS food and symptom journals was poor. Providers favored certain trigger food likelihood ratings and written recommendations. This supports the need for a more standardized method for interpreting these journals and/or more rigorous techniques to accurately identify personalized IBS food triggers.
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Affiliation(s)
- Jasmine Zia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA.
| | - Chia-Fang Chung
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Kaiyuan Xu
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Yi Dong
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | | | - Kevin Cain
- Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle, WA 98195, USA.
| | - Sean Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA 98195, USA.
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16
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Klumpp M. Automation and artificial intelligence in business logistics systems: human reactions and collaboration requirements. INTERNATIONAL JOURNAL OF LOGISTICS-RESEARCH AND APPLICATIONS 2017. [DOI: 10.1080/13675567.2017.1384451] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Matthias Klumpp
- Department of Industrial Engineering and Business Information Systems (IEBIS), University of Twente, Enschede, The Netherlands
- Institute for Logistics and Service Management (ild), FOM University of Applied Sciences, Essen, Germany
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17
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Iacob T, Ţăţulescu DF, Dumitraşcu DL. Therapy of the postinfectious irritable bowel syndrome: an update. ACTA ACUST UNITED AC 2017; 90:133-138. [PMID: 28559695 PMCID: PMC5433563 DOI: 10.15386/cjmed-752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/15/2016] [Indexed: 12/12/2022]
Abstract
After acute infectious gastroenteritis, up to thirty percent of patients present prolonged gastrointestinal symptoms and a part of those affected patients can have the diagnostic criteria for postinfectious irritable bowel syndrome. Treatment is symptom directed rather than curative and includes agents prescribed for the treatment of irritable bowel syndrome in general. Prophylaxis or early treatment of acute bacterial diarrhea may reduce the risk of postinfectious irritable bowel syndrome development by reducing the occurrence, duration, and severity of the chronic inflammation and mucosal alterations (all these believed to play an important role in disease persistence). Probiotic treatment is effective in restoring the intestinal microbiota in patients with irritable bowel syndrome and in animal models there are improvements of postinfectious irritable bowel syndrome. Fecal microbiota transplantation seems to be one of the most effective methods of treating the postinfectious irritable bowel syndrome (with recurrent episodes) caused by Clostridium difficile.
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Affiliation(s)
- Teodora Iacob
- Department of Infectious Diseases, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Doina F Ţăţulescu
- Department of Infectious Diseases, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - D L Dumitraşcu
- 2nd Medical Department, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
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18
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Schroeder J, Hoffswell J, Chung CF, Fogarty J, Munson S, Zia J. Supporting Patient-Provider Collaboration to Identify Individual Triggers using Food and Symptom Journals. CSCW : PROCEEDINGS OF THE CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK. CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK 2017; 2017:1726-1739. [PMID: 28516172 PMCID: PMC5432206 DOI: 10.1145/2998181.2998276] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient-generated data can allow patients and providers to collaboratively develop accurate diagnoses and actionable treatment plans. Unfortunately, patients and providers often lack effective support to make use of such data. We examine patient-provider collaboration to interpret patient-generated data. We focus on irritable bowel syndrome (IBS), a chronic illness in which particular foods can exacerbate symptoms. IBS management often requires patient-provider collaboration using a patient's food and symptom journal to identify the patient's triggers. We contribute interactive visualizations to support exploration of such journals, as well as an examination of patient-provider collaboration in interpreting the journals. Drawing upon individual and collaborative interviews with patients and providers, we find that collaborative review helps improve data comprehension and build mutual trust. We also find a desire to use tools like our interactive visualizations within and beyond clinic appointments. We discuss these findings and present guidance for the design of future tools.
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Affiliation(s)
| | - Jane Hoffswell
- Computer Science & Engineering, DUB Group, University of Washington
| | - Chia-Fang Chung
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - James Fogarty
- Computer Science & Engineering, DUB Group, University of Washington
| | - Sean Munson
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - Jasmine Zia
- Division of Gastroenterology, DUB Group, University of Washington
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19
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Zia JK, Chung CF, Schroeder J, Munson SA, Kientz JA, Fogarty J, Bales E, Schenk JM, Heitkemper MM. The feasibility, usability, and clinical utility of traditional paper food and symptom journals for patients with irritable bowel syndrome. Neurogastroenterol Motil 2017; 29. [PMID: 27619957 DOI: 10.1111/nmo.12935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Paper food and gastrointestinal (GI) symptom journals are used to help irritable bowel syndrome (IBS) patients determine potential trigger foods. The primary aim of this study was to evaluate the feasibility, usability, and clinical utility of such journals as a data collection tool. A secondary aim was to explore a method for analyzing journal data to describe patterns of diet and symptoms. METHODS Participants (N=17) were asked to log three sets of 3-day food and symptom journals over a 15-day period. Feasibility was evaluated by journal completion rates, symptom logging compliance, and logging fatigability. The feasibility, usability, and clinical utility of journaling were also assessed by a customized evaluation and exit interview. For each journal, regression analyses were conducted to examine relationships between key meal nutrients and subsequent symptoms. KEY RESULTS Most participants were young (mean age 35±12) Caucasian (N=13) women (N=14). Journal completion rates were 100% for all participants with no logging fatigability. Over half perceived paper journaling of food and symptoms as feasible, usable, and clinically useful. Thirteen participants demonstrated a strong association with at least one symptom and meal nutrient. Patterns of associations differed among participants. CONCLUSIONS AND INFERENCES Paper journaling of food and GI symptoms for 9 days over a 15-day period appeared to be a feasible and usable data collection tool for IBS patients. Over half perceived journaling as at least somewhat clinically useful. Findings from this study support the anecdote that food trigger(s) and associated symptom(s) vary for each individual.
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Affiliation(s)
- J K Zia
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - C-F Chung
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J Schroeder
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - S A Munson
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J A Kientz
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J Fogarty
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - E Bales
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J M Schenk
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M M Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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20
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Remotely engaged: Lessons from remote monitoring in multiple sclerosis. Int J Med Inform 2017; 100:26-31. [PMID: 28241935 DOI: 10.1016/j.ijmedinf.2017.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Evaluate web-based patient-reported outcome (wbPRO) collection in MS subjects in terms of feasibility, reliability, adherence, and subject-perceived benefits; and quantify the impact of MS-related symptoms on perceived well-being. METHODS Thirty-one subjects with MS completed wbPROs targeting MS-related symptoms over six months using a customized web portal. Demographics and clinical outcomes were collected in person at baseline and six months. RESULTS Approximately 87% of subjects completed wbPROs without assistance, and wbPROs strongly correlated with standard PROs (r>0.91). All wbPROs were completed less frequently in the second three months (p<0.05). Frequent wbPRO completion was significantly correlated with higher step on the Expanded Disability Status Scale (EDSS) (p=0.026). Nearly 52% of subjects reported improved understanding of their disease, and approximately 16% wanted individualized wbPRO content. Over half (63.9%) of perceived well-being variance was explained by MS symptoms, notably depression (rs=-0.459), fatigue (rs=-0.390), and pain (rs=-0.389). CONCLUSIONS wbPRO collection was feasible and reliable. More disabled subjects had higher completion rates, yet most subjects failed requirements in the second three months. Remote monitoring has potential to improve patient-centered care and communication between patient and provider, but tailored PRO content and other innovations are needed to combat declining adherence.
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