Date Submitted: Nov 24, 2025. Open Peer Review Period: Nov 25, 2025 - Jan 20, 2026.

Date Submitted: Nov 24, 2025. Open Peer Review Period: Nov 25, 2025 - Jan 20, 2026.

For instance, a 2024 study from the Journal of Medical Internet Research highlighted that AI-driven rehabilitation tools improved recovery rates ...

A 2025 Journal of Medical Internet Research publication revealed that digital pain management platforms integrating tramadol monitoring tools ...

Journal of Medical Internet Research · Journal of Medical Internet Research 10643 articles · JMIR Research Protocols 5160 articles · JMIR Formative ...

Background: The integration of Electronic Health Records (EHRs) with telehealth platforms represents a transformative approach in healthcare, providing critical accessibility and engagement solutions, especially during the #covid19 pandemic. In Riyadh's hospitals, the adoption of EHR-integrated telehealth has significantly increased and offers enhanced patient care options. However, there is a need to examine its continued relevance, effectiveness, and challenges in a post-pandemic context. Objective: This research aims to qualitatively investigate the #usability, perceived benefits, and barriers of patient access to EHR-integrated telehealth from both patients and healthcare providers (HCPs) in a major Riyadh hospital. Methods: A qualitative research design was used, featuring semi-structured interviews with 20 patients and 10 HCPs, selected through purposive sampling for their direct experience with EHR-integrated telehealth services at Sulaiman Al-Habib Hospital in Riyadh. Thematic analysis, supported by NVivo 14 software, was employed to analyze the transcriptions and extract themes related to #usability, perceived benefits, and barriers. Results: Findings indicate that patients generally regard EHR-integrated telehealth positively, appreciating its navigability, convenience, and facilitation of remote healthcare interactions. Reported benefits included reduced physical visits, time savings, and more accessible follow-ups, contributing to greater continuity of care. However, significant barriers were identified, including technical challenges, lack of integration across hospital branches, absence of insurance payment linkages, and limited patient choice among providers. HCPs also expressed concerns over digital literacy gaps, the platform’s limitations for specialized and complex care, and technical disruptions impacting care delivery. Conclusions: EHR-integrated telehealth offers substantial potential to improve healthcare delivery in Riyadh’s hospitals by enhancing access, convenience, and patient engagement. However, maximizing these benefits in Saudi Arabia’s evolving healthcare landscape requires addressing identified barriers, particularly in platform stability, inter-branch integration, insurance linkages, and patient support resources. Findings are grounded in a single-hospital sample and are intended to inform improvements in similar hospital settings in Saudi Arabia rather than national generalization.

Date Submitted: Nov 7, 2025. Open Peer Review Period: Nov 25, 2025 - Jan 20, 2026.

Date Submitted: Nov 10, 2025. Open Peer Review Period: Nov 25, 2025 - Jan 20, 2026.

Date Submitted: Nov 21, 2025. Open Peer Review Period: Nov 24, 2025 - Jan 19, 2026.

Date Submitted: Nov 24, 2025. Open Peer Review Period: Nov 25, 2025 - Jan 20, 2026.

Background: Addressing the adverse impacts of climate change on human health requires a global effort across multiple sectors. People living in low- and middle-income countries are particularly vulnerable to the health crises induced by climate change. Therefore, context specific solutions to tackle such challenges are essential to ensure preventive measures are in place for mitigating such risks. Objective: This #Protocol aims to outline an integrated, participatory approach to cocreate multisectoral interventions tailored to specific environmental and health challenges in Bangladesh, India, and Indonesia. This work is done as part of the Global Health #Research Centre for Non-Communicable Diseases and Environmental Change, funded by the National Institute for Health and Care #Research. The overall aim is to collaboratively design and assess interventions that deliver dual benefits for planetary and human health. Methods: To address the multisectoral nature of the challenges, this #Study will adopt a cocreation methodology that blends co-design and coproduction approaches. While the problem areas are specific to each context—tackling air pollution due to plastic burning in Indonesia, improving dietary diversity of public food procurement systems and managing extreme heat in India, and mitigating drinking water salinity in Bangladesh—the underlying cocreation framework is consistent and can be adapted to the needs of each #Study setting. The workflow consists of 4 key stages guided by an existing cocreation framework: planning, developing, evaluation, and reporting, with the 6 core elements of the Medical #Research Council’s complex intervention development framework embedded throughout the process. Drawing on the Double Diamond design process, the cocreation stage involves the following phases: codevelopment of a theory of change to explore potential context-specific interventions, short-listing of intervention components through gap analysis and prioritization, co-designing and coproducing selected intervention components, and assessing appropriateness and feasibility of intervention implementation. The cocreation process will be evaluated using the #Research Quality Plus for Co‑Production framework to ensure methodological rigor and quality. Results: Cocreation will take place over 6 months. Sampling and recruitment of cocreators (key stakeholders across sectors) have been completed in all 3 countries, with each cocreator group consisting of 20-30 members. We have developed the tools for the cocreation phase, informed by the findings from formative #Research, and received the necessary ethics approval to conduct these activities. We will generate a series of academic and nonacademic outputs on the cocreation process to disseminate the findings, as well as training materials for implementers to facilitate future adoption in similar settings. Conclusions: The cocreation of multisectoral interventions to tackle both environmental change and health is a comparatively new domain of implementation #Research. This #Protocol addresses the complex, multidimensional, and unique nature of such interventions by developing a structured and scientifically sound approach to be implemented in real-life settings.

Background: Multimorbidity, the presence of 2 or more chronic conditions, is becoming increasingly prevalent worldwide, resulting in significant impacts on health care systems. For people with multimorbidity, self-management is challenging, requiring engagement in several tasks. #Digital health platforms have been widely acknowledged as having the potential to enhance self-management practices for those with chronic conditions. However, limited longitudinal studies have explored the effectiveness of #Digital health platforms that support multimorbidity self-management or issues relating to their implementation and scalability in practice. Objective: The aim of this #Study is to determine the effectiveness and implementation of a #Digital health platform, ProACT, with support services including clinical triage and a care network (consisting of informal and formal caregivers and health care professionals) compared to the use of the platform alone and compared to standard care. Methods: An effectiveness-implementation type 1 hybrid #Study will be conducted across 3 European countries. A total of 720 older adults aged 65 years or older with multimorbidity (2 or more of the following: #Diabetes, a chronic respiratory disease, chronic heart failure, and chronic heart disease) will be recruited and randomized into 1 of 3 trial arms. Those in trial arm 1 will be invited to have up to 5 care network members participate with them, resulting in a maximum of 1500 care network participants. Effectiveness will be assessed through a 3-arm pragmatic #RCT #ClinicalTrial, while implementation issues will be addressed via a process evaluation. Primary outcomes for participants with multimorbidity are quality of life and health care use, while secondary outcomes focus on the potential of the ProACT platform to support multimorbidity self-management (eg, self-efficacy, usability, engagement, and symptom stabilization). Primary outcomes for informal caregivers in the care network include caring burden, while secondary outcomes for all care network members include usability, engagement, satisfaction, and overall experiences with ProACT. Additional outcomes related to the process evaluation include the reach, uptake, and fidelity of implementation of ProACT and the way organizations implement and deliver ProACT; how they differ in this regard; and the factors underpinning these differences. A range of qualitative and quantitative data will be collected and analyzed to assess these outcomes. Results: Enrollment in the trial began in September 2022, and the trial is anticipated to end by March 2026. Trial outcomes will be submitted for publication in 2026. Conclusions: The generation of evidence-based support for the routine use of the ProACT platform in applied settings would represent considerable impact. With health care services under increasing strain and traditionally designed to support those with single morbidities, it is more important than ever to develop actionable insights and resources to empower persons with multimorbidity to self-manage their complex care needs at home, with support from their caregivers. Trial Registration: ISRCTN Registry ISRCTN34134007; https://www.isrctn.com/ISRCTN34134007

Date Submitted: Nov 11, 2025. Open Peer Review Period: Nov 25, 2025 - Jan 20, 2026.

Background: Currently, conventional medicine for stroke treatment remains at a standstill. Korean medicine (KM), which is in high demand in Korea, has been shown to have a therapeutic effect on stroke; however, considering the absence of epidemiological and clinical characteristics of patients receiving KM for stroke in Korea and prospective, large-scale, long-term studies on the efficacy and safety of KM, the acquisition of data from KM treatments on stroke is essential. Objective: We aimed to collect and analyze data on the major clinical characteristics of patients with stroke receiving KM treatment and investigate the effectiveness and safety of KM in the Korean population. Methods: The Registry of Stroke in Korean Medicine Hospital (RoS-KoMH) is a prospective, multicenter, observational disease registry aimed at collecting data from 500 sets of patients at multiple timepoints. Eligible adult patients diagnosed with cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage who visited 4 KM hospitals as outpatients or inpatients will be continuously registered using the electronic case report form. Baseline data at the first visit; KM treatment, rehabilitation therapy, and concomitant therapy during the visit; stroke evaluation every 4 weeks after the first visit; laboratory findings at discharge or the last visit; and safety evaluation information after each acupuncture or pharmacopuncture treatment will be collected. Results: The #Study was funded on August 19, 2020, by the Ministry of Health and Welfare, Republic of Korea, and recruitment for the #Study started on November 3, 2021. As of September 25, 2024, a total of 410 participants have been recruited. Conclusions: The RoS-KoMH #Study is the first and largest multicenter, prospective registry to record comprehensive data on KM treatment of stroke. The results of this #Study will provide high-quality evidence on the current state of stroke treatment using KM in actual clinical practice, as well as treatment effectiveness and safety, and will consequently contribute to the promotion and standardization of therapeutic interventions for stroke in Korea. Trial Registration: Clinical #Research Information Service KCT0008494; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23999&search_page=L&search_lang=&class_yn=

Background: Learner autonomy—the ability to self-direct and regulate learning—is a key determinant of success in online education, yet its quantifiable impact in voluntary noncredit courses remains unclear. Understanding how autonomy translates into measurable behaviors and outcomes in clinical skills training may inform more effective online learning design and learning outcomes. Objective: This study aims to quantify the association between behavioral indicators of learner autonomy and performance in a voluntary noncredit online cardiac auscultation course. Methods: We conducted a prospective, self‑controlled, single‑center study. A total of 199 registrants (n=122 physicians and n=77 medical students) were recruited via WeChat and attended four weekly 2‑hour synchronous sessions using authentic patient heart sound recordings with imaging‑based explanations. The primary outcome was the final posttraining quiz score (0-100); training effectiveness was assessed by the pre‑ to posttraining score change. The autonomy indicators were full participation (attendance at all four sessions), in‑class engagement (number of responses to brief content‑aligned prompts posed approximately every 10-15 minutes; responses recorded for participation monitoring only), and postclass review (frequency/duration of reviewing recordings and materials). Analyses included Wilcoxon signed rank tests, χ2 tests, multivariable linear regression, and receiver operating characteristic profiling of “excellent learners” (top 10% improvement). Results: Of the 199 registrants, 146 (73.4%) attended ≥1 session and 46 (23.1%) completed all sessions. Median test scores improved from 40 (IQR 20-50) to 70 (IQR 50-83; P

Date Submitted: Oct 31, 2025. Open Peer Review Period: Nov 25, 2025 - Jan 20, 2026.

Background: Heart Failure (HF) is a public #health concern with a wider impact on quality of life and cost of care. One of the major challenges in HF is the higher rate of unplanned readmissions and sub-optimal performance of models to predict the readmissions. Hence, in this study, we implemented embeddings-based approaches to generate features for improving model performance. Objective: The objective of this study is to evaluate and compare the effectiveness of different feature embedding approaches for improving the prediction of unplanned readmissions in #patients with heart failure. Methods: We compared three embedding approaches including word2vec on terminology codes and CUIs, and BERT on descriptive text of concept with baseline (one hot-encoding).We compared AUROC and F1 scores for the logistic regression, XGBoost and ANN models using these embedding approaches. The model was tested on the heart failure cohort (n=21,031) identified using least restrictive phenotyping methods from MIMIC-IV dataset. Results: We found that the embedding approaches significantly improved the performance of the prediction models. The XGBoost performed better for all approaches. The word2vec embeddings (0.65) trained on the dataset outperformed embeddings from pre-trained BERT model (0.59) using descriptive text. Conclusions: Embedding methods, particularly word2vec trained on EHR data, can better discriminate HF readmission cases compared to both one-hot encoding and pre-trained BERT embeddings on concept descriptions making it a viable approach of automation feature selection. The observed AUROC improvement (0.65 vs. 0.54) may support more effective risk stratification and targeted clinical interventions.

Date Submitted: Nov 6, 2025. Open Peer Review Period: Nov 6, 2025 - Dec 5, 2025.

Date Submitted: Oct 29, 2025. Open Peer Review Period: Nov 24, 2025 - Jan 19, 2026.

Date Submitted: Nov 18, 2025. Open Peer Review Period: Nov 24, 2025 - Jan 19, 2026.

Date Submitted: Nov 21, 2025. Open Peer Review Period: Nov 24, 2025 - Jan 19, 2026.

Date Submitted: Nov 23, 2025. Open Peer Review Period: Nov 24, 2025 - Jan 19, 2026.

Date Submitted: Nov 24, 2025. Open Peer Review Period: Nov 24, 2025 - Nov 9, 2026.

Date Submitted: Nov 20, 2025. Open Peer Review Period: Nov 20, 2025 - Jan 15, 2026.