User Needs Assessment of ASTHMAXcel Voice: A Novel Mobile Health App for Asthma Management.

Existing mobile health apps for asthma predominantly focus on patient education related to self-management. Through a federally-funded project in the U.S.

Chronic cavitary pulmonary histoplasmosis treated with isavuconazole after a hypersensitivity reaction to itraconazole.

Chronic cavitary pulmonary histoplasmosis requires prolonged treatment with itraconazole. However, hypersensitivity reactions to itraconazole, though rare, pose a challenge due to limited data on the efficacy and cross-reactivity of the newer azoles. We present a case of chronic cavitary pulmonary histoplasmosis successfully treated with isavuconazole following an itraconazole-induced hypersensitivity reaction, highlighting its potential as an alternative therapy in such cases.

Implementing and Evaluating the Clinical Outcomes of an Asthma Management Mobile Application.

The New York City borough of the Bronx has epidemic rates of asthma morbidity and mortality, and mobile health interventions are an effective way to reduce disease burden among patients. ASTHMAXcel is a mobile health platform previously shown to improve asthma control, knowledge, and quality of life. This study was designed to evaluate an adapted version (ASTHMAXcel PRO) of the platform in the out-patient primary care setting over 12 months, evaluating the digital tool's impact on asthma control in adults.

Analyzing Physician In Basket Burden and Efficiency Using K-Means Clustering.

Electronic health record (EHR) systems are essential for modern healthcare but contribute to a significant documentation burden, affecting physician workflow and well-being. While previous studies have identified differences in EHR usage across demographics, systematic methods for identifying high-burden physician groups remain limited. This study applies cluster analysis to uncover distinct EHR usage profiles and provide a framework to inform the development of targeted interventions.

GPT-4 generated answer rationales to multiple choice assessment questions in undergraduate medical education.

Background: Pre-clerkship medical students benefit from practice questions that provide rationales for answer choices. Creating these rationales is a time-intensive endeavor. Therefore, not all practice multiple choice questions (MCQ) have corresponding explanations to aid learning.

Considering different Montreal Cognitive Assessment cutoff scores for older adults with asthma.

There is a greater prevalence of cognitive impairment among ethnic and/or racial minorities, and cognitive impairment is a barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this study was to examine the relationship between cognitive impairment, assessed by using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Latino participants. In addition, we evaluated whether using two different MoCA cutoff scores influenced the association between cognitive impairment and asthma outcomes.

Right Information, Right Care, Right Patient, Right Time: Community Preferences to Inform a Self-Management Support Tool for Upper Respiratory Symptoms.

Objectives:  During and since the coronavirus disease 2019 (COVID-19) pandemic, communities have needed to cope with several conditions that cause similar upper respiratory symptoms but are managed differently. We describe community reactions to a self-management toolkit for patients with upper respiratory symptoms to inform mobile e-health app development. The toolkit is based on the "4R" (Right Information, Right Care, Right Patient, Right Time) care planning and management model.

ChatGPT Performs Worse on USMLE-Style Ethics Questions Compared to Medical Knowledge Questions.

Objectives:  The main objective of this study is to evaluate the ability of the Large Language Model Chat Generative Pre-Trained Transformer (ChatGPT) to accurately answer the United States Medical Licensing Examination (USMLE) board-style medical ethics questions compared to medical knowledge-based questions. This study has the additional objectives of comparing the overall accuracy of GPT-3.5 to GPT-4 and assessing the variability of responses given by each version.

Developing and Evaluating the DiabetesXcel Mobile Application for Adult Patients With Type 2 Diabetes.

The authors trialed a mobile application, DiabetesXcel, which included type 2 diabetes-focused educational videos and modules, in 50 adults of Bronx, NY, a region with a high prevalence of diabetes and diabetes complications. From baseline to 4 months and from baseline to 6 months, there was significantly improved quality of life, self-management, knowledge, self-efficacy, depression, A1C, and LDL cholesterol among those who used DiabetesXcel. There was also a significant decrease in diabetes-related emergency department visits and hospital admissions from baseline to 6 months.

ASTHMAXcel PRO patient satisfaction and usability field testing.

ASTHMAXcel PRO, an enhanced version of the ASTHMAXcel mobile application, has been developed to deliver comprehensive, guideline-based asthma education while also facilitating the collection of patient-reported outcomes (PROs) and enhancing user experience. To perform field testing and conduct formative and summative evaluation of the ASTHMAXcel PRO application to assess its impact on patient satisfaction, usability, and usage. Twenty-eight adult patients completed a baseline visit during which ASTHMAXcel PRO was introduced, health literacy was assessed, and demographic data were collected.

Enhancing asthma research and improving health equity through decentralized clinical trials (DCTs) and mHealth technology.

The COVID-19 pandemic led to widespread disruption and termination of clinical research and a prompt adoption of mobile health (mHealth) technologies in the healthcare space. As the United States' healthcare system has rapidly become reliant on remotely conducted activities, the implementation of decentralized methods using mHealth technology in research investigation has become a necessary alternative to traditional in-person cohort studies. The aim of this article is to: report successful and unsuccessful examples of remote asthma clinical studies, explore the benefits and potential drawbacks of virtual clinical investigation, discuss the potential impact on equity and representation in asthma research, and provide suggestions through which investigators can implement decentralized clinical trials.

Using K-Means Clustering to Identify Physician Clusters by Electronic Health Record Burden and Efficiency.

Electronic health records (EHRs) have transformed the way modern medicine is practiced, but they remain a major source of documentation burden among physicians. This study aims to use data from Signal, a tool provided by the Epic EHR, to analyze physician metadata in the Montefiore Health System via cluster analysis to assess EHR burden and efficiency. Data were obtained for a one-month period (July 2020) representing a return to normal operation post-telemedicine implementation.

Assessing Electronic Health Literacy at an Urban Academic Hospital.

Background: Residents of the Bronx suffer marked health disparities due to socioeconomic and other factors. The coronavirus disease 2019 pandemic worsened these health outcome disparities and health care access disparities, especially with the abrupt transition to online care.

Objectives: This study classified electronic health literacy (EHL) among patients at an urban, academic hospital in the Bronx, and assessed for associations between EHL levels and various demographic characteristics.

The Relationship Between Depressive Symptoms, eHealth Literacy, and Asthma Outcomes in the Context of a Mobile Health Intervention.

Objective: The ASTHMAXcel PRO mobile app provides asthma education and collects asthma outcome data. The objective of this study was to evaluate the associations between health/electronic health literacy (eHealth literacy) and depressive symptoms with app usage and clinical outcomes.

Methods: Adults with persistent asthma were recruited to use the app.

Evaluating the effect and user satisfaction of an adapted and translated mobile health application ASTHMAXcel© among adults with asthma in Pune, India.

Objective: ASTHMAXcel is a mobile application previously shown to improve asthma knowledge, control, and quality of life. In this study, we translated the application to Marathi for pilot testing in Pune, India in order to evaluate its impact on user satisfaction and asthma knowledge among adult asthma patients.

Methods: ASTHMAXcel was adapted to Marathi with the help of asthma patients and clinicians from Bharati Hospital.

Asthma history influences gait performance and associated prefrontal cortex activation patterns in older adults.

Walking and cognition are interrelated due to dependence on shared brain regions that include the prefrontal cortex (PFC). Limited literature indicates that asthma is associated with poor mobility in older adults but the mechanisms underlying this relationship are unknown. Therefore, we tested the hypothesis that asthma history was associated with poor gait performance due to limited attention resources and neural inefficiency.

The impact of smartphone applications on bowel preparation, compliance with appointments, cost-effectiveness, and patients' quality of life for the colonoscopy process: A scoping review.

The aim of this scoping review is to evaluate the impact of smartphone application (SPA) technology in patients undergoing elective colonoscopy to measure compliance with appointments, cost-effectiveness, bowel preparation, and quality of life. The scoping review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Ovid Medline, Web of Science, Science Direct, Scopus, Cochrane Library, and PubMed were screened up to Oct 14, 2020, and bibliographies of the retrieved articles were included.

Social, political, and economic determinants of access to biologics: A scoping review of structural determinants in the clinical disparities literature.

Background: The number of biologics among new medication approvals is increasing. Social, political, and economic factors influence access to these expensive medications. Disparities in access to new medications can exacerbate health disparities.

Digital Inhalers and Remote Patient Monitoring for Asthma.

Digital inhaler systems, remote patient monitoring, and remote therapeutic monitoring offer great promise as diagnostic tools and therapeutic interventions to improve adherence and inhaler technique for patients with difficult-to-control asthma. In turn, improvements in adherence and inhaler technique may translate into decreasing the need for high side effect treatments such as oral corticosteroids and costly therapies including biologics. Although more clinical trials are needed, studies that use digital inhaler systems to collect objective real-time data on medication-taking behavior via electronic medication monitors and feed this data back to patients on their mobile asthma app, and to health care professionals on the clinician dashboard to counsel patients, show positive outcomes.

Physician Electronic Health Record Usage as Affected by the COVID-19 Pandemic.

Objectives: To utilize metrics from physician action logs to analyze volume, physician efficiency and burden as impacted by telemedicine implementation during the COVID-19 (coronavirus disease 2019) pandemic, and physician characteristics such as gender, years since graduation, and specialty category.

Methods: We selected 11 metrics from Epic Signal, a functionality of the Epic electronic health record (EHR). Metrics measuring time spent in the EHR outside working hours were used as a correlate for burden.