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Quiroz JC, Brieger D, Jorm LR, Sy RW, Hsu B, Gallego B. Predicting Adverse Outcomes Following Catheter Ablation Treatment for Atrial Flutter/Fibrillation. Heart Lung Circ 2024:S1443-9506(24)00003-9. [PMID: 38365498 DOI: 10.1016/j.hlc.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/06/2023] [Accepted: 12/19/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND AND AIM To develop prognostic survival models for predicting adverse outcomes after catheter ablation treatment for non-valvular atrial fibrillation (AF) and/or atrial flutter (AFL). METHODS We used a linked dataset including hospital administrative data, prescription medicine claims, emergency department presentations, and death registrations of patients in New South Wales, Australia. The cohort included patients who received catheter ablation for AF and/or AFL. Traditional and deep survival models were trained to predict major bleeding events and a composite of heart failure, stroke, cardiac arrest, and death. RESULTS Out of a total of 3,285 patients in the cohort, 177 (5.3%) experienced the composite outcome-heart failure, stroke, cardiac arrest, death-and 167 (5.1%) experienced major bleeding events after catheter ablation treatment. Models predicting the composite outcome had high-risk discrimination accuracy, with the best model having a concordance index >0.79 at the evaluated time horizons. Models for predicting major bleeding events had poor risk discrimination performance, with all models having a concordance index <0.66. The most impactful features for the models predicting higher risk were comorbidities indicative of poor health, older age, and therapies commonly used in sicker patients to treat heart failure and AF and AFL. DISCUSSION Diagnosis and medication history did not contain sufficient information for precise risk prediction of experiencing major bleeding events. Predicting the composite outcome yielded promising results, but future research is needed to validate the usefulness of these models in clinical practice. CONCLUSIONS Machine learning models for predicting the composite outcome have the potential to enable clinicians to identify and manage high-risk patients following catheter ablation for AF and AFL proactively.
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Affiliation(s)
- Juan C Quiroz
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
| | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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Liu W, Laranjo L, Klimis H, Chiang J, Yue J, Marschner S, Quiroz JC, Jorm L, Chow CK. Machine-learning versus traditional approaches for atherosclerotic cardiovascular risk prognostication in primary prevention cohorts: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2023:7069320. [PMID: 36869800 DOI: 10.1093/ehjqcco/qcad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) risk prediction is important in guiding the intensity of therapy in CVD prevention. Whilst current risk prediction algorithms use traditional statistical approaches, machine learning (ML) presents an alternative method that may improve risk prediction accuracy. This systematic review and meta-analysis aimed to investigate whether ML algorithms demonstrate greater performance compared to traditional risk scores in CVD risk prognostication. METHODS MEDLINE, EMBASE, CENTRAL and SCOPUS Web of Science Core collection were searched for studies comparing ML models to traditional risk scores for CV risk prediction between the years 2000 and 2021. We included studies which assessed both ML and traditional risk scores in adult (>18 years old) primary prevention populations. We assessed risk of bias using the Prediction model Risk of Bias Assessment Tool (PROBAST) tool. Only studies which provided a measure of discrimination (i.e. C-statistics with 95% confidence intervals) were included in the meta-analysis. RESULTS Sixteen studies were included in the review and meta-analysis (3 302 515 individuals). All study designs were retrospective cohort studies. Three of 16 studies externally validated their models, and 11 reported calibration metrics. Eleven studies demonstrated a high risk of bias. The summary c-statistics (95% CI) of the top performing ML models and traditional risk scores were 0.773 (95%CI: 0.740-0.806) and 0.759 (95%CI: 0.726-0.792) respectively. The difference in c-statistic was 0.0139 (95%CI 0.0139-0.140), P < 0.0001. CONCLUSION ML models outperformed traditional risk scores in discrimination of CVD risk prognostication. Integration of ML algorithms into electronic healthcare systems in primary care could improve identification of patients at high risk of subsequent CV events and hence increase opportunities for CVD prevention. It is uncertain whether they can be implemented in clinical settings. Future implementation research is needed to examine how ML models may be utilised for primary prevention.This review was registered with PROSPERO (CRD42020220811).
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Affiliation(s)
- Weber Liu
- University of Sydney, Faculty of Medicine and Health, Westmead Applied Research Centre (WARC)
| | - Liliana Laranjo
- University of Sydney, Westmead Applied Research Centre (WARC)
| | - Harry Klimis
- University of Sydney, Westmead Applied Research Centre (WARC)
| | - Jason Chiang
- University of Sydney, Westmead Applied Research Centre (WARC)
| | - Jason Yue
- University of Sydney, Faculty of Medicine and Health
| | | | - Juan C Quiroz
- University of New South Wales, Centre for Big Data Research in Health (CBDRH)
| | - Louisa Jorm
- University of NSW, Centre for Big Data Research in Health
| | - Clara K Chow
- University of Sydney, Westmead Applied Research Centre (WARC)
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Tong HL, Maher C, Parker K, Pham TD, Neves AL, Riordan B, Chow CK, Laranjo L, Quiroz JC. The use of mobile apps and fitness trackers to promote healthy behaviors during COVID-19: A cross-sectional survey. PLOS Digit Health 2022; 1:e0000087. [PMID: 36812578 PMCID: PMC9931267 DOI: 10.1371/journal.pdig.0000087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 07/14/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To examine i) the use of mobile apps and fitness trackers in adults during the COVID-19 pandemic to support health behaviors; ii) the use of COVID-19 apps; iii) associations between using mobile apps and fitness trackers, and health behaviors; iv) differences in usage amongst population subgroups. METHODS An online cross-sectional survey was conducted during June-September 2020. The survey was developed and reviewed independently by co-authors to establish face validity. Associations between using mobile apps and fitness trackers and health behaviors were examined using multivariate logistic regression models. Subgroup analyses were conducted using Chi-square and Fisher's exact tests. Three open-ended questions were included to elicit participants' views; thematic analysis was conducted. RESULTS Participants included 552 adults (76.7% women; mean age: 38±13.6 years); 59.9% used mobile apps for health, 38.2% used fitness trackers, and 46.3% used COVID-19 apps. Users of mobile apps or fitness trackers had almost two times the odds of meeting aerobic physical activity guidelines compared to non-users (odds ratio = 1.91, 95% confidence interval 1.07 to 3.46, P = .03). More women used health apps than men (64.0% vs 46.8%, P = .004). Compared to people aged 18-44 (46.1%), more people aged 60+ (74.5%) and more people aged 45-60 (57.6%) used a COVID-19 related app (P < .001). Qualitative data suggest people viewed technologies (especially social media) as a 'double-edged sword': helping with maintaining a sense of normalcy and staying active and socially connected, but also having a negative emotional effect stemming from seeing COVID-related news. People also found that mobile apps did not adapt quickly enough to the circumstances caused by COVID-19. CONCLUSIONS Use of mobile apps and fitness trackers during the pandemic was associated with higher levels of physical activity, in a sample of educated and likely health-conscious individuals. Future research is needed to understand whether the association between using mobile devices and physical activity is maintained in the long-term.
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Affiliation(s)
- Huong Ly Tong
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kate Parker
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences
| | - Tien Dung Pham
- Royal Melbourne Hospital, School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Ana Luisa Neves
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College of London, London, United Kingdom
- Centre for Health Technology and Services Research, Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Benjamin Riordan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Clara K. Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Western Sydney Primary Health Network, Sydney, Australia
| | - Juan C. Quiroz
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Hwang H, Quiroz JC, Gallego B. Assessing the effectiveness of empirical calibration under different bias scenarios. BMC Med Res Methodol 2022; 22:208. [PMID: 35896966 PMCID: PMC9327283 DOI: 10.1186/s12874-022-01687-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Estimations of causal effects from observational data are subject to various sources of bias. One method for adjusting for the residual biases in the estimation of treatment effects is through the use of negative control outcomes, which are outcomes not believed to be affected by the treatment of interest. The empirical calibration procedure is a technique that uses negative control outcomes to calibrate p-values. An extension of this technique calibrates the coverage of the 95% confidence interval of a treatment effect estimate by using negative control outcomes as well as positive control outcomes, which are outcomes for which the treatment of interest has known effects. Although empirical calibration has been used in several large observational studies, there is no systematic examination of its effect under different bias scenarios. Methods The effect of empirical calibration of confidence intervals was analyzed using simulated datasets with known treatment effects. The simulations consisted of binary treatment and binary outcome, with biases resulting from unmeasured confounder, model misspecification, measurement error, and lack of positivity. The performance of the empirical calibration was evaluated by determining the change in the coverage of the confidence interval and the bias in the treatment effect estimate. Results Empirical calibration increased coverage of the 95% confidence interval of the treatment effect estimate under most bias scenarios but was inconsistent in adjusting the bias in the treatment effect estimate. Empirical calibration of confidence intervals was most effective when adjusting for the unmeasured confounding bias. Suitable negative controls had a large impact on the adjustment made by empirical calibration, but small improvements in the coverage of the outcome of interest were also observable when using unsuitable negative controls. Conclusions This work adds evidence to the efficacy of empirical calibration of the confidence intervals in observational studies. Calibration of confidence intervals is most effective where there are biases due to unmeasured confounding. Further research is needed on the selection of suitable negative controls. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01687-6.
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Affiliation(s)
- Hon Hwang
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Level 2, AGSM Building, G27, Botany St, Kensington NSW, Sydney, 2052, Australia
| | - Juan C Quiroz
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Level 2, AGSM Building, G27, Botany St, Kensington NSW, Sydney, 2052, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Level 2, AGSM Building, G27, Botany St, Kensington NSW, Sydney, 2052, Australia.
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Quiroz JC, Brieger D, Jorm LR, Sy RW, Falster MO, Gallego B. An Observational Study of Clinical and Health System Factors Associated With Catheter Ablation and Early Ablation Treatment for Atrial Fibrillation in Australia. Heart Lung Circ 2022; 31:1269-1276. [PMID: 35623999 DOI: 10.1016/j.hlc.2022.04.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/20/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate clinical and health system factors associated with receiving catheter ablation (CA) and earlier ablation for non-valvular atrial fibrillation (AF). METHODS We used hospital administrative data linked with death registrations in New South Wales, Australia for patients with a primary diagnosis of AF between 2009 and 2017. Outcome measures included receipt of CA versus not receiving CA during follow-up (using Cox regression) and receipt of early ablation (using logistic regression). RESULTS Cardioversion during index admission (hazard ratio [HR] 1.96; 95% CI 1.75-2.19), year of index admission (HR 1.07; 1.07; 95% CI 1.05-1.10), private patient status (HR 2.65; 95% CI 2.35-2.97), and living in more advantaged areas (HR 1.18; 95% CI 1.13-1.22) were associated with a higher likelihood of receiving CA. A history of congestive heart failure, hypertension, diabetes, and myocardial infarction were associated with a lower likelihood of receiving CA. Private patient status (odds ratio [OR] 2.04; 95% CI 1.59-2.61), cardioversion during index admission (OR 1.25; 95% CI 1.0-1.57), and history of diabetes (OR 1.6; 95% CI 1.06-2.41) were associated with receiving early ablation. CONCLUSIONS Beyond clinical factors, private patients are more likely to receive CA and earlier ablation than their public counterparts. Whether the earlier access to ablation procedures in private patients is leading to differences in outcomes among patients with atrial fibrillation remains to be explored.
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Affiliation(s)
- Juan C Quiroz
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
| | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael O Falster
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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Quiroz JC, Chard T, Sa Z, Ritchie A, Jorm L, Gallego B. Extract, transform, load framework for the conversion of health databases to OMOP. PLoS One 2022; 17:e0266911. [PMID: 35404974 PMCID: PMC9000122 DOI: 10.1371/journal.pone.0266911] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/29/2022] [Indexed: 11/22/2022] Open
Abstract
Common data models standardize the structures and semantics of health datasets, enabling reproducibility and large-scale studies that leverage the data from multiple locations and settings. The Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) is one of the leading common data models. While there is a strong incentive to convert datasets to OMOP, the conversion is time and resource-intensive, leaving the research community in need of tools for mapping data to OMOP. We propose an extract, transform, load (ETL) framework that is metadata-driven and generic across source datasets. The ETL framework uses a new data manipulation language (DML) that organizes SQL snippets in YAML. Our framework includes a compiler that converts YAML files with mapping logic into an ETL script. Access to the ETL framework is available via a web application, allowing users to upload and edit YAML files via web editor and obtain an ETL SQL script for use in development environments. The structure of the DML maximizes readability, refactoring, and maintainability, while minimizing technical debt and standardizing the writing of ETL operations for mapping to OMOP. Our framework also supports transparency of the mapping process and reuse by different institutions.
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Affiliation(s)
- Juan C. Quiroz
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
- * E-mail:
| | - Tim Chard
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Zhisheng Sa
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Angus Ritchie
- Concord Clinical School, University of Sydney, Sydney, Australia
- Health Informatics Unit, Sydney Local Health District, Camperdown, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
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Tong HL, Quiroz JC, Kocaballi AB, Ijaz K, Coiera E, Chow CK, Laranjo L. A personalized mobile app for physical activity: An experimental mixed-methods study. Digit Health 2022; 8:20552076221115017. [PMID: 35898287 PMCID: PMC9309778 DOI: 10.1177/20552076221115017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To investigate the feasibility of the be.well app and its personalization
approach which regularly considers users’ preferences, amongst university
students. Methods We conducted a mixed-methods, pre-post experiment, where participants used
the app for 2 months. Eligibility criteria included: age 18–34 years; owning
an iPhone with Internet access; and fluency in English. Usability was
assessed by a validated questionnaire; engagement metrics were reported.
Changes in physical activity were assessed by comparing the difference in
daily step count between baseline and 2 months. Interviews were conducted to
assess acceptability; thematic analysis was conducted. Results Twenty-three participants were enrolled in the study (mean age = 21.9 years,
71.4% women). The mean usability score was 5.6 ± 0.8 out of 7. The median
daily engagement time was 2 minutes. Eighteen out of 23 participants used
the app in the last month of the study. Qualitative data revealed that
people liked the personalized activity suggestion feature as it was
actionable and promoted user autonomy. Some users also expressed privacy
concerns if they had to provide a lot of personal data to receive highly
personalized features. Daily step count increased after 2 months of the
intervention (median difference = 1953 steps/day, p-value
<.001, 95% CI 782 to 3112). Conclusions Incorporating users’ preferences in personalized advice provided by a
physical activity app was considered feasible and acceptable, with
preliminary support for its positive effects on daily step count. Future
randomized studies with longer follow up are warranted to determine the
effectiveness of personalized mobile apps in promoting physical
activity.
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Affiliation(s)
- Huong Ly Tong
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Juan C Quiroz
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Tong HL, Quiroz JC, Kocaballi AB, Fat SCM, Dao KP, Gehringer H, Chow CK, Laranjo L. Personalized mobile technologies for lifestyle behavior change: A systematic review, meta-analysis, and meta-regression. Prev Med 2021; 148:106532. [PMID: 33774008 DOI: 10.1016/j.ypmed.2021.106532] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/07/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022]
Abstract
Given that the one-size-fits-all approach to mobile health interventions have limited effects, a personalized approach might be necessary to promote healthy behaviors and prevent chronic conditions. Our systematic review aims to evaluate the effectiveness of personalized mobile interventions on lifestyle behaviors (i.e., physical activity, diet, smoking and alcohol consumption), and identify the effective key features of such interventions. We included any experimental trials that tested a personalized mobile app or fitness tracker and reported any lifestyle behavior measures. We conducted a narrative synthesis for all studies, and a meta-analysis of randomized controlled trials. Thirty-nine articles describing 31 interventions were included (n = 77,243, 64% women). All interventions personalized content and rarely personalized other features. Source of data included system-captured (12 interventions), user-reported (11 interventions) or both (8 interventions). The meta-analysis showed a moderate positive effect on lifestyle behavior outcomes (standardized difference in means [SDM] 0.663, 95% CI 0.228 to 1.10). A meta-regression model including source of data found that interventions that used system-captured data for personalization were associated with higher effectiveness than those that used user-reported data (SDM 1.48, 95% CI 0.76 to 2.19). In summary, the field is in its infancy, with preliminary evidence of the potential efficacy of personalization in improving lifestyle behaviors. Source of data for personalization might be important in determining intervention effectiveness. To fully exploit the potential of personalization, future high-quality studies should investigate the integration of multiple data from different sources and include personalized features other than content.
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Affiliation(s)
- Huong Ly Tong
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Juan C Quiroz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - A Baki Kocaballi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; School of Computer Science, University of Technology Sydney, Sydney, Australia
| | | | | | - Holly Gehringer
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Kocaballi AB, Coiera E, Tong HL, White SJ, Quiroz JC, Rezazadegan F, Willcock S, Laranjo L. A network model of activities in primary care consultations. J Am Med Inform Assoc 2021; 26:1074-1082. [PMID: 31329875 PMCID: PMC6748800 DOI: 10.1093/jamia/ocz046] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 11/26/2022] Open
Abstract
Objective The objective of this study is to characterize the dynamic structure of primary care consultations by identifying typical activities and their inter-relationships to inform the design of automated approaches to clinical documentation using natural language processing and summarization methods. Materials and Methods This is an observational study in Australian general practice involving 31 consultations with 4 primary care physicians. Consultations were audio-recorded, and computer interactions were recorded using screen capture. Physical interactions in consultation rooms were noted by observers. Brief interviews were conducted after consultations. Conversational transcripts were analyzed to identify different activities and their speech content as well as verbal cues signaling activity transitions. An activity transition analysis was then undertaken to generate a network of activities and transitions. Results Observed activity classes followed those described in well-known primary care consultation models. Activities were often fragmented across consultations, did not flow necessarily in a defined order, and the flow between activities was nonlinear. Modeling activities as a network revealed that discussing a patient’s present complaint was the most central activity and was highly connected to medical history taking, physical examination, and assessment, forming a highly interrelated bundle. Family history, allergy, and investigation discussions were less connected suggesting less dependency on other activities. Clear verbal signs were often identifiable at transitions between activities. Discussion Primary care consultations do not appear to follow a classic linear model of defined information seeking activities; rather, they are fragmented, highly interdependent, and can be reactively triggered. Conclusion The nonlinearity of activities has significant implications for the design of automated information capture. Whereas dictation systems generate literal translation of speech into text, speech-based clinical summary systems will need to link disparate information fragments, merge their content, and abstract coherent information summaries.
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Affiliation(s)
- Ahmet Baki Kocaballi
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Huong Ly Tong
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarah J White
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Juan C Quiroz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Fahimeh Rezazadegan
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Simon Willcock
- Health Sciences Centre, Macquarie University, Sydney, Australia
| | - Liliana Laranjo
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Laranjo L, Ding D, Heleno B, Kocaballi B, Quiroz JC, Tong HL, Chahwan B, Neves AL, Gabarron E, Dao KP, Rodrigues D, Neves GC, Antunes ML, Coiera E, Bates DW. Do smartphone applications and activity trackers increase physical activity in adults? Systematic review, meta-analysis and metaregression. Br J Sports Med 2020; 55:422-432. [PMID: 33355160 DOI: 10.1136/bjsports-2020-102892] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the effectiveness of physical activity interventions involving mobile applications (apps) or trackers with automated and continuous self-monitoring and feedback. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed and seven additional databases, from 2007 to 2020. STUDY SELECTION Randomised controlled trials in adults (18-65 years old) without chronic illness, testing a mobile app or an activity tracker, with any comparison, where the main outcome was a physical activity measure. Independent screening was conducted. DATA EXTRACTION AND SYNTHESIS We conducted random effects meta-analysis and all effect sizes were transformed into standardised difference in means (SDM). We conducted exploratory metaregression with continuous and discrete moderators identified as statistically significant in subgroup analyses. MAIN OUTCOME MEASURES Physical activity: daily step counts, min/week of moderate-to-vigorous physical activity, weekly days exercised, min/week of total physical activity, metabolic equivalents. RESULTS Thirty-five studies met inclusion criteria and 28 were included in the meta-analysis (n=7454 participants, 28% women). The meta-analysis showed a small-to-moderate positive effect on physical activity measures (SDM 0.350, 95% CI 0.236 to 0.465, I2=69%, T 2=0.051) corresponding to 1850 steps per day (95% CI 1247 to 2457). Interventions including text-messaging and personalisation features were significantly more effective in subgroup analyses and metaregression. CONCLUSION Interventions using apps or trackers seem to be effective in promoting physical activity. Longer studies are needed to assess the impact of different intervention components on long-term engagement and effectiveness.
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Affiliation(s)
- Liliana Laranjo
- Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia .,Centre for Health Informatics - Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ding Ding
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bruno Heleno
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Baki Kocaballi
- Centre for Health Informatics - Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Juan C Quiroz
- Centre for Health Informatics - Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Huong Ly Tong
- Centre for Health Informatics - Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bahia Chahwan
- Centre for Health Informatics - Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Elia Gabarron
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromso, Norway
| | - Kim Phuong Dao
- Centre for Health Informatics - Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David Rodrigues
- Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Maria L Antunes
- Escola Superior Tecnologias da Saude, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Enrico Coiera
- Centre for Health Informatics - Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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11
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Laranjo L, Quiroz JC, Tong HL, Arevalo Bazalar M, Coiera E. A Mobile Social Networking App for Weight Management and Physical Activity Promotion: Results From an Experimental Mixed Methods Study. J Med Internet Res 2020; 22:e19991. [PMID: 33289670 PMCID: PMC7755540 DOI: 10.2196/19991] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/06/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Smartphone apps, fitness trackers, and online social networks have shown promise in weight management and physical activity interventions. However, there are knowledge gaps in identifying the most effective and engaging interventions and intervention features preferred by their users. OBJECTIVE This 6-month pilot study on a social networking mobile app connected to wireless weight and activity tracking devices has 2 main aims: to evaluate changes in BMI, weight, and physical activity levels in users from different BMI categories and to assess user perspectives on the intervention, particularly on social comparison and automated self-monitoring and feedback features. METHODS This was a mixed methods study involving a one-arm, pre-post quasi-experimental pilot with postintervention interviews and focus groups. Healthy young adults used a social networking mobile app intervention integrated with wireless tracking devices (a weight scale and a physical activity tracker) for 6 months. Quantitative results were analyzed separately for 2 groups-underweight-normal and overweight-obese BMI-using t tests and Wilcoxon sum rank, Wilcoxon signed rank, and chi-square tests. Weekly BMI change in participants was explored using linear mixed effects analysis. Interviews and focus groups were analyzed inductively using thematic analysis. RESULTS In total, 55 participants were recruited (mean age of 23.6, SD 4.6 years; 28 women) and 45 returned for the final session (n=45, 82% retention rate). There were no differences in BMI from baseline to postintervention (6 months) and between the 2 BMI groups. However, at 4 weeks, participants' BMI decreased by 0.34 kg/m2 (P<.001), with a loss of 0.86 kg/m2 in the overweight-obese group (P=.01). Participants in the overweight-obese group used the app significantly less compared with individuals in the underweight-normal BMI group, as they mentioned negative feelings and demotivation from social comparison, particularly from upward comparison with fitter people. Participants in the underweight-normal BMI group were avid users of the app's self-monitoring and feedback (P=.02) and social (P=.04) features compared with those in the overweight-obese group, and they significantly increased their daily step count over the 6-month study duration by an average of 2292 steps (95% CI 898-3370; P<.001). Most participants mentioned a desire for a more personalized intervention. CONCLUSIONS This study shows the effects of different interventions on participants from higher and lower BMI groups and different perspectives regarding the intervention, particularly with respect to its social features. Participants in the overweight-obese group did not sustain a short-term decrease in their BMI and mentioned negative emotions from app use, while participants in the underweight-normal BMI group used the app more frequently and significantly increased their daily step count. These differences highlight the importance of intervention personalization. Future research should explore the role of personalized features to help overcome personal barriers and better match individual preferences and needs.
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Affiliation(s)
- Liliana Laranjo
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Juan C Quiroz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Huong Ly Tong
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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12
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Quiroz JC, Laranjo L, Tufanaru C, Kocaballi AB, Rezazadegan D, Berkovsky S, Coiera E. Empirical analysis of Zipf's law, power law, and lognormal distributions in medical discharge reports. Int J Med Inform 2020; 145:104324. [PMID: 33181446 DOI: 10.1016/j.ijmedinf.2020.104324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/04/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bayesian modelling and statistical text analysis rely on informed probability priors to encourage good solutions. OBJECTIVE This paper empirically analyses whether text in medical discharge reports follow Zipf's law, a commonly assumed statistical property of language where word frequency follows a discrete power-law distribution. METHOD We examined 20,000 medical discharge reports from the MIMIC-III dataset. Methods included splitting the discharge reports into tokens, counting token frequency, fitting power-law distributions to the data, and testing whether alternative distributions-lognormal, exponential, stretched exponential, and truncated power-law-provided superior fits to the data. RESULT Discharge reports are best fit by the truncated power-law and lognormal distributions. Discharge reports appear to be near-Zipfian by having the truncated power-law provide superior fits over a pure power-law. CONCLUSION Our findings suggest that Bayesian modelling and statistical text analysis of discharge report text would benefit from using truncated power-law and lognormal probability priors and non-parametric models that capture power-law behavior.
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Affiliation(s)
- Juan C Quiroz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Centre for Big Data Research in Health, UNSW, Sydney, Australia.
| | - Liliana Laranjo
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catalin Tufanaru
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Ahmet Baki Kocaballi
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Faculty of Engineering and IT, University of Technology Sydney, Australia
| | - Dana Rezazadegan
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Swinburne University of Technology, Department of Computer Science and Software Engineering, Melbourne, Australia
| | - Shlomo Berkovsky
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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13
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Kocaballi AB, Ijaz K, Laranjo L, Quiroz JC, Rezazadegan D, Tong HL, Willcock S, Berkovsky S, Coiera E. Envisioning an artificial intelligence documentation assistant for future primary care consultations: A co-design study with general practitioners. J Am Med Inform Assoc 2020; 27:1695-1704. [PMID: 32845984 PMCID: PMC7671614 DOI: 10.1093/jamia/ocaa131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The study sought to understand the potential roles of a future artificial intelligence (AI) documentation assistant in primary care consultations and to identify implications for doctors, patients, healthcare system, and technology design from the perspective of general practitioners. MATERIALS AND METHODS Co-design workshops with general practitioners were conducted. The workshops focused on (1) understanding the current consultation context and identifying existing problems, (2) ideating future solutions to these problems, and (3) discussing future roles for AI in primary care. The workshop activities included affinity diagramming, brainwriting, and video prototyping methods. The workshops were audio-recorded and transcribed verbatim. Inductive thematic analysis of the transcripts of conversations was performed. RESULTS Two researchers facilitated 3 co-design workshops with 16 general practitioners. Three main themes emerged: professional autonomy, human-AI collaboration, and new models of care. Major implications identified within these themes included (1) concerns with medico-legal aspects arising from constant recording and accessibility of full consultation records, (2) future consultations taking place out of the exam rooms in a distributed system involving empowered patients, (3) human conversation and empathy remaining the core tasks of doctors in any future AI-enabled consultations, and (4) questioning the current focus of AI initiatives on improved efficiency as opposed to patient care. CONCLUSIONS AI documentation assistants will likely to be integral to the future primary care consultations. However, these technologies will still need to be supervised by a human until strong evidence for reliable autonomous performance is available. Therefore, different human-AI collaboration models will need to be designed and evaluated to ensure patient safety, quality of care, doctor safety, and doctor autonomy.
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Affiliation(s)
- A Baki Kocaballi
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Faculty of Engineering & IT, University of Technology Sydney, Sydney, Australia
| | - Kiran Ijaz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Liliana Laranjo
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Juan C Quiroz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Dana Rezazadegan
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Victoria, Australia
| | - Huong Ly Tong
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Simon Willcock
- Health Sciences Centre, Macquarie University, Sydney, Australia
| | - Shlomo Berkovsky
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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14
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Quiroz JC, Laranjo L, Kocaballi AB, Briatore A, Berkovsky S, Rezazadegan D, Coiera E. Identifying relevant information in medical conversations to summarize a clinician-patient encounter. Health Informatics J 2020; 26:2906-2914. [PMID: 32865113 DOI: 10.1177/1460458220951719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To inform the development of automated summarization of clinical conversations, this study sought to estimate the proportion of doctor-patient communication in general practice (GP) consultations used for generating a consultation summary. Two researchers with a medical degree read the transcripts of 44 GP consultations and highlighted the phrases to be used for generating a summary of the consultation. For all consultations, less than 20% of all words in the transcripts were needed for inclusion in the summary. On average, 9.1% of all words in the transcripts, 26.6% of all medical terms, and 27.3% of all speaker turns were highlighted. The results indicate that communication content used for generating a consultation summary makes up a small portion of GP consultations, and automated summarization solutions-such as digital scribes-must focus on identifying the 20% relevant information for automatically generating consultation summaries.
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Affiliation(s)
| | | | | | | | | | | | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Australia
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15
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Kocaballi AB, Quiroz JC, Rezazadegan D, Berkovsky S, Magrabi F, Coiera E, Laranjo L. Responses of Conversational Agents to Health and Lifestyle Prompts: Investigation of Appropriateness and Presentation Structures. J Med Internet Res 2020; 22:e15823. [PMID: 32039810 PMCID: PMC7055771 DOI: 10.2196/15823] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Conversational agents (CAs) are systems that mimic human conversations using text or spoken language. Their widely used examples include voice-activated systems such as Apple Siri, Google Assistant, Amazon Alexa, and Microsoft Cortana. The use of CAs in health care has been on the rise, but concerns about their potential safety risks often remain understudied. OBJECTIVE This study aimed to analyze how commonly available, general-purpose CAs on smartphones and smart speakers respond to health and lifestyle prompts (questions and open-ended statements) by examining their responses in terms of content and structure alike. METHODS We followed a piloted script to present health- and lifestyle-related prompts to 8 CAs. The CAs' responses were assessed for their appropriateness on the basis of the prompt type: responses to safety-critical prompts were deemed appropriate if they included a referral to a health professional or service, whereas responses to lifestyle prompts were deemed appropriate if they provided relevant information to address the problem prompted. The response structure was also examined according to information sources (Web search-based or precoded), response content style (informative and/or directive), confirmation of prompt recognition, and empathy. RESULTS The 8 studied CAs provided in total 240 responses to 30 prompts. They collectively responded appropriately to 41% (46/112) of the safety-critical and 39% (37/96) of the lifestyle prompts. The ratio of appropriate responses deteriorated when safety-critical prompts were rephrased or when the agent used a voice-only interface. The appropriate responses included mostly directive content and empathy statements for the safety-critical prompts and a mix of informative and directive content for the lifestyle prompts. CONCLUSIONS Our results suggest that the commonly available, general-purpose CAs on smartphones and smart speakers with unconstrained natural language interfaces are limited in their ability to advise on both the safety-critical health prompts and lifestyle prompts. Our study also identified some response structures the CAs employed to present their appropriate responses. Further investigation is needed to establish guidelines for designing suitable response structures for different prompt types.
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Affiliation(s)
- Ahmet Baki Kocaballi
- Australian Institute of Health Innovation
, Macquarie University, Sydney, Australia
| | - Juan C Quiroz
- Australian Institute of Health Innovation
, Macquarie University, Sydney, Australia
| | - Dana Rezazadegan
- Australian Institute of Health Innovation
, Macquarie University, Sydney, Australia
| | - Shlomo Berkovsky
- Australian Institute of Health Innovation
, Macquarie University, Sydney, Australia
| | - Farah Magrabi
- Australian Institute of Health Innovation
, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation
, Macquarie University, Sydney, Australia
| | - Liliana Laranjo
- Australian Institute of Health Innovation
, Macquarie University, Sydney, Australia
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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16
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Kocaballi AB, Berkovsky S, Quiroz JC, Laranjo L, Tong HL, Rezazadegan D, Briatore A, Coiera E. The Personalization of Conversational Agents in Health Care: Systematic Review. J Med Internet Res 2019; 21:e15360. [PMID: 31697237 PMCID: PMC6873147 DOI: 10.2196/15360] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The personalization of conversational agents with natural language user interfaces is seeing increasing use in health care applications, shaping the content, structure, or purpose of the dialogue between humans and conversational agents. OBJECTIVE The goal of this systematic review was to understand the ways in which personalization has been used with conversational agents in health care and characterize the methods of its implementation. METHODS We searched on PubMed, Embase, CINAHL, PsycInfo, and ACM Digital Library using a predefined search strategy. The studies were included if they: (1) were primary research studies that focused on consumers, caregivers, or health care professionals; (2) involved a conversational agent with an unconstrained natural language interface; (3) tested the system with human subjects; and (4) implemented personalization features. RESULTS The search found 1958 publications. After abstract and full-text screening, 13 studies were included in the review. Common examples of personalized content included feedback, daily health reports, alerts, warnings, and recommendations. The personalization features were implemented without a theoretical framework of customization and with limited evaluation of its impact. While conversational agents with personalization features were reported to improve user satisfaction, user engagement and dialogue quality, the role of personalization in improving health outcomes was not assessed directly. CONCLUSIONS Most of the studies in our review implemented the personalization features without theoretical or evidence-based support for them and did not leverage the recent developments in other domains of personalization. Future research could incorporate personalization as a distinct design factor with a more careful consideration of its impact on health outcomes and its implications on patient safety, privacy, and decision-making.
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Affiliation(s)
- Ahmet Baki Kocaballi
- Australian Institute of Health Innovation
, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Shlomo Berkovsky
- Australian Institute of Health Innovation
, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Juan C Quiroz
- Australian Institute of Health Innovation
, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Liliana Laranjo
- Australian Institute of Health Innovation
, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Huong Ly Tong
- Australian Institute of Health Innovation
, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Dana Rezazadegan
- Australian Institute of Health Innovation
, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Agustina Briatore
- Health Information Systems Office, Ministry of Health, Buenos Aires, Argentina
| | - Enrico Coiera
- Australian Institute of Health Innovation
, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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17
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Tong HL, Coiera E, Tong W, Wang Y, Quiroz JC, Martin P, Laranjo L. Efficacy of a Mobile Social Networking Intervention in Promoting Physical Activity: Quasi-Experimental Study. JMIR Mhealth Uhealth 2019; 7:e12181. [PMID: 30920379 PMCID: PMC6458538 DOI: 10.2196/12181] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/13/2018] [Accepted: 01/30/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Technological interventions such as mobile apps, Web-based social networks, and wearable trackers have the potential to influence physical activity; yet, only a few studies have examined the efficacy of an intervention bundle combining these different technologies. OBJECTIVE This study aimed to pilot test an intervention composed of a social networking mobile app, connected with a wearable tracker, and investigate its efficacy in improving physical activity, as well as explore participant engagement and the usability of the app. METHODS This was a pre-post quasi-experimental study with 1 arm, where participants were subjected to the intervention for a 6-month period. The primary outcome measure was the difference in daily step count between baseline and 6 months. Secondary outcome measures included engagement with the intervention and system usability. Descriptive and inferential statistical tests were conducted; posthoc subgroup analyses were carried out for participants with different levels of steps at baseline, app usage, and social features usage. RESULTS A total of 55 participants were enrolled in the study; the mean age was 23.6 years and 28 (51%) were female. There was a nonstatistically significant increase in the average daily step count between baseline and 6 months (mean change=14.5 steps/day, P=.98, 95% CI -1136.5 to 1107.5). Subgroup analysis comparing the higher and lower physical activity groups at baseline showed that the latter had a statistically significantly higher increase in their daily step count (group difference in mean change from baseline to 6 months=3025 steps per day, P=.008, 95% CI 837.9-5211.8). At 6 months, the retention rate was 82% (45/55); app usage decreased over time. The mean system usability score was 60.1 (SD 19.2). CONCLUSIONS This study showed the preliminary efficacy of a mobile social networking intervention, integrated with a wearable tracker to promote physical activity, particularly for less physically active subgroups of the population. Future research should explore how to address challenges faced by physically inactive people to provide tailored advices. In addition, users' perspectives should be explored to shed light on factors that might influence their engagement with the intervention.
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Affiliation(s)
- Huong Ly Tong
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - William Tong
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Ying Wang
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Juan C Quiroz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Paige Martin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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18
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Wiff R, Barrientos MA, Milessi AC, Quiroz JC, Harwood J. Modelling production per unit of food consumed in fish populations. J Theor Biol 2015; 365:67-75. [PMID: 25445187 DOI: 10.1016/j.jtbi.2014.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 11/17/2022]
Abstract
The ratio of production-to-consumption (ρ) reflects how efficiently a population can transform ingested food into biomass. Usually this ratio is estimated by separately integrating cohort per-recruit production and consumption per unit of biomass. Estimates of ρ from cohort analysis differ from those that consider the whole population, because fish populations are usually composed of cohorts that differ in their relative abundance. Cohort models for ρ also assume a stable age-structure and a constant population size (stationary condition). This may preclude their application to harvested populations, in which variations in fishing mortality and recruitment will affect age-structure. In this paper, we propose a different framework for estimating (ρ) in which production and consumption are modelled simultaneously to produce a population estimator of ρ. Food consumption is inferred from the physiological concepts underpinning the generalised von Bertalanffy growth function (VBGF). This general framework allows the effects of different age-structures to be explored, with a stationary population as a special case. Three models with different complexities, depending mostly on what assumptions are made about age-structure, are explored. The full data model requires knowledge about food assimilation efficiency, parameters of the VBGF and the relative proportion of individuals at age a at time y (Py(a)). A simpler model, which requires less data, is based on the stationary assumption. Model results are compared with estimates from cohort models for ρ using simulated fish populations of different lifespans. The models proposed here were also applied to three fish populations that are targets of commercial fisheries in the south-east Pacific. Uncertainty in the estimation of ρ was evaluated using a resampling approach. Simulation showed that cohort and population models produce different estimates for ρ and those differences depend on lifespan, fishing mortality and recruitment variations. Results from the three case studies show that the population model gives similar estimates to those reported by empirical models in other fish species. This modelling framework allows ρ to be related directly to population length- or age-structure and thus has the potential to improve the biological realism of both population and ecosystem models.
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Affiliation(s)
- Rodrigo Wiff
- Centre for Research into Ecological and Environmental Modelling, School of Mathematics and Statistics. University of St. Andrews, The Observatory, Buchanan Gardens, St. Andrews KY16 9LZ, Scotland, UK.
| | - Mauricio A Barrientos
- Instituto de Matemáticas, Pontificia Universidad Católica de Valparaíso, Blanco Viel 596, Cerro Barón, Valparaíso, Chile
| | - Andrés C Milessi
- Instituto Nacional de Investigación y Desarrollo Pesquero (INIDEP), Paseo Victoria Ocampo No. 1, 7600 Mar del Plata, Argentina; Comisión de Investigaciones Científicas de la Provincia de Bs.As (CIC). Calle 526, 1900, La Plata, Buenos Aires, Argentina
| | - J C Quiroz
- Institute for Marine and Antarctic Studies, University of Tasmania, Private Bag 49, Hobart, Tasmania 7001, Australia; División de Investigación Pesquera, Instituto de Fomento Pesquero (IFOP), Blanco 839, Valparaíso, Chile
| | - John Harwood
- Centre for Research into Ecological and Environmental Modelling, School of Mathematics and Statistics. University of St. Andrews, The Observatory, Buchanan Gardens, St. Andrews KY16 9LZ, Scotland, UK
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