@Article{info:doi/10.2196/72675,
author="Yang, Alina",
title="Pediatric Hearts and Minds: Reimagining Health Education Through Play and Narrative",
journal="JMIR Pediatr Parent",
year="2025",
month="Mar",
day="13",
volume="8",
pages="e72675",
keywords="congenital heart disease",
keywords="children health literacy",
keywords="health education",
keywords="health education interventions",
keywords="patient-centered care",
keywords="design",
keywords="pediatric",
keywords="PRISMA",
doi="10.2196/72675",
url="https://pediatrics.jmir.org/2025/1/e72675"
}


@Article{info:doi/10.2196/64814,
author="Barbazi, Neda
and Shin, Youn Ji
and Hiremath, Gurumurthy
and Lauff, Anne Carlye",
title="Exploring Health Educational Interventions for Children With Congenital Heart Disease: Scoping Review",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="24",
volume="8",
pages="e64814",
keywords="congenital heart disease",
keywords="children health literacy",
keywords="health education",
keywords="health education interventions",
keywords="patient-centered care",
keywords="design",
keywords="pediatric",
keywords="PRISMA",
abstract="Background: Congenital heart disease (CHD) is the most common birth defect, affecting 40,000 births annually in the United States. Despite advances in medical care, CHD is often a chronic condition requiring continuous management and education. Effective care management depends on children's understanding of their condition. This highlights the need for targeted health educational interventions to enhance health literacy among children with CHD. Objective: This scoping review aims to map and explore existing health educational interventions for children with CHD. The review identifies the types of interventions, target populations, delivery methods, and assessed outcomes. The goal is to consolidate fragmented research, identify gaps, and establish future research agendas. Methods: Comprehensive searches were conducted in February 2024 using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework across multiple databases: APA PsycINFO, MedlinePlus via Ovid, Web of Science, ACM Digital Library, Scopus, and EBSCOhost (CINAHL Complete, CINAHL Ultimate, Health Source: Nursing/Academic Edition, and ERIC). The search covered health care, design, and human-computer interaction disciplines to capture the interdisciplinary nature of CHD health educational interventions. There was no predefined time limit due to the limited number of relevant studies. Eligible studies were in English, published in peer-reviewed journals, and focused on primary data about educational health interventions for children with CHD. We extracted and synthesized data using thematic analysis. Results: The review identified 11 studies: 9 randomized controlled trials and 2 observational studies. These used 6 educational strategies: 3D patient-specific models (n=3), habit formation interventions (n=2), empowerment-based health education programs (n=2), rehabilitation interventions (n=2), web-based portals (n=1), and videotape presentations (n=1). Interventions ranged from brief outpatient sessions to 1.5-year programs, with follow-up from none to 24 months. Studies aimed to improve coping, self-management, and knowledge for children with CHD and their families. The most frequently used assessment method was the independent samples t test (n=4) for pre- and postassessments, and all 11 studies used questionnaires, 8 of which incorporated qualitative feedback. The target participants for these interventions were children aged 13 years and older (n=3), parents (n=2), and children of various ages and their parents (n=6). Outcomes included improved children's health literacy, reduced parental burden, and increased health care provider efficiency. Conclusions: This review underscores the critical need for tailored educational interventions for children with CHD. Current research mainly focuses on adolescents and relies heavily on parental involvement, possibly overlooking the specific needs of younger children younger than 13 years of age. It is essential to develop engaging, age-appropriate interventions that actively involve children with CHD in their health care journey. Effective health educational interventions are crucial in empowering these young patients and improving their long-term health outcomes. ",
doi="10.2196/64814",
url="https://pediatrics.jmir.org/2025/1/e64814"
}


@Article{info:doi/10.2196/47951,
author="Mastorci, Francesca
and Lazzeri, Lodovica Maria Francesca
and Ait-Ali, Lamia
and Marcheschi, Paolo
and Quadrelli, Paola
and Mariani, Massimiliano
and Margaryan, Rafik
and Penn{\`e}, Wanda
and Savino, Marco
and Prencipe, Giuseppe
and Sirbu, Alina
and Ferragina, Paolo
and Priami, Corrado
and Tommasi, Alessandro
and Zavattari, Cesare
and Festa, Pierluigi
and Dalmiani, Stefano
and Pingitore, Alessandro",
title="Home-Based Intervention Tool for Cardiac Telerehabilitation: Protocol for a Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="22",
volume="14",
pages="e47951",
keywords="cardiac rehabilitation",
keywords="exercise",
keywords="patient education",
keywords="patient-centered approach",
keywords="eHealth",
keywords="artificial intelligence",
abstract="Background: Among cardiovascular diseases, adult patients with congenital heart disease represent a population that has been continuously increasing, which is mainly due to improvement of the pathophysiological framing, including the development of surgical and reanimation techniques. However, approximately 20\% of these patients will require surgery in adulthood and 40\% of these cases will necessitate reintervention for residual defects or sequelae of childhood surgery. In this field, cardiac rehabilitation (CR) in the postsurgical phase has an important impact on the patient by improving psychophysical and clinical recovery in reducing fatigue and dyspnea to ultimately increase survival. In this context, compliance with the rehabilitation program is a key element for the therapeutic benefits of the program. The increase of mobile health care devices and software has greatly extended self-care capabilities across the spectrum of health care activities. Moreover, the possibility of telemonitoring the progress of this self-care provides elements of empowerment and awareness of one's state of health. As a branch of telehealth, CR can be optimized and facilitated using remote telemedicine devices. Objective: The principal goal of the Innovation in Postoperative Rehabilitation Training and Monitoring (IPOTERI) study is to design, realize, and test a composite and integrated system for postsurgical rehabilitation therapies at home specialized for cardiac surgery. The secondary aims are to implement the system in a ``real-life'' context of postcardiac surgical rehabilitation, and to create a data set and a data collection methodology to prototype data analytics algorithms and artificial intelligence techniques for customizing the rehabilitation pathway. Methods: The IPOTERI method consists of a telemonitoring platform that guarantees continuity of postoperative care, an intelligent home station based on an Android app for the patient with a user-friendly interface to record vital signals (electrocardiogram, blood pressure, oxygen saturation, and body weight) and access the planning of rehabilitation activities, and a decision support system that communicates with hospital medical records to transmit alerts and specific support information for the formulation and updating of the treatment and care plan. Results: The pilot test started in June 2023 (protocol number 20406/2021) including 50 patients who will be monitored for 12-14 weeks using the developed platform, as described in the Procedures subsection of the Methods section. Conclusions: The IPOTERI approach, based on the processing of data recorded during the monitoring of telemedicine devices used at home during the postsurgical rehabilitation of a cardiac patient, together with clinical data from the perioperative and postoperative periods could have positive effects on adherence to the rehabilitation program and clinical improvement as well as result in overall improvement of quality of life. International Registered Report Identifier (IRRID): DERR1-10.2196/47951 ",
doi="10.2196/47951",
url="https://www.researchprotocols.org/2025/1/e47951",
url="http://www.ncbi.nlm.nih.gov/pubmed/39841521"
}


@Article{info:doi/10.2196/57641,
author="Zhu, Jinpu
and Yang, Fushuang
and Wang, Yang
and Wang, Zhongtian
and Xiao, Yao
and Wang, Lie
and Sun, Liping",
title="Accuracy of Machine Learning in Discriminating Kawasaki Disease and Other Febrile Illnesses: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="18",
volume="26",
pages="e57641",
keywords="machine learning",
keywords="artificial intelligence",
keywords="Kawasaki disease",
keywords="febrile illness",
keywords="coronary artery lesions",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Kawasaki disease (KD) is an acute pediatric vasculitis that can lead to coronary artery aneurysms and severe cardiovascular complications, often presenting with obvious fever in the early stages. In current clinical practice, distinguishing KD from other febrile illnesses remains a significant challenge. In recent years, some researchers have explored the potential of machine learning (ML) methods for the differential diagnosis of KD versus other febrile illnesses, as well as for predicting coronary artery lesions (CALs) in people with KD. However, there is still a lack of systematic evidence to validate their effectiveness. Therefore, we have conducted the first systematic review and meta-analysis to evaluate the accuracy of ML in differentiating KD from other febrile illnesses and in predicting CALs in people with KD, so as to provide evidence-based support for the application of ML in the diagnosis and treatment of KD. Objective: This study aimed to summarize the accuracy of ML in differentiating KD from other febrile illnesses and predicting CALs in people with KD. Methods: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched until September 26, 2023. The risk of bias in the included original studies was appraised using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Stata (version 15.0; StataCorp) was used for the statistical analysis. Results: A total of 29 studies were incorporated. Of them, 20 used ML to differentiate KD from other febrile illnesses. These studies involved a total of 103,882 participants, including 12,541 people with KD. In the validation set, the pooled concordance index, sensitivity, and specificity were 0.898 (95\% CI 0.874-0.922), 0.91 (95\% CI 0.83-0.95), and 0.86 (95\% CI 0.80-0.90), respectively. Meanwhile, 9 studies used ML for early prediction of the risk of CALs in children with KD. These studies involved a total of 6503 people with KD, of whom 986 had CALs. The pooled concordance index in the validation set was 0.787 (95\% CI 0.738-0.835). Conclusions: The diagnostic and predictive factors used in the studies we included were primarily derived from common clinical data. The ML models constructed based on these clinical data demonstrated promising effectiveness in differentiating KD from other febrile illnesses and in predicting coronary artery lesions. Therefore, in future research, we can explore the use of ML methods to identify more efficient predictors and develop tools that can be applied on a broader scale for the differentiation of KD and the prediction of CALs. ",
doi="10.2196/57641",
url="https://www.jmir.org/2024/1/e57641"
}


@Article{info:doi/10.2196/54598,
author="McCullough, May Julie Elizabeth
and Sinclair, Marlene
and Gillender, Jonathan
and McCrossan, Brian
and Slater, F. Paul
and Browne, Rosie
and Casey, Frank",
title="Touching Technology---Parents' Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Oct",
day="22",
volume="7",
pages="e54598",
keywords="congenital heart disease",
keywords="pediatric cardiology",
keywords="pediatric cardiologist",
keywords="pediatric",
keywords="parent",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="virtual medicine",
keywords="remote consultation",
keywords="telephone consultation",
keywords="video consultation",
keywords="remote patient monitoring",
keywords="technology acceptance",
keywords="videoconferencing consultations",
abstract="Background: Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology. Objective: This project aimed to investigate parents' experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown. Methods: This study's design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual's intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents' experiences were explored using recorded interviews and analyzed thematically. Results: In total, 29 children aged 4?1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents' prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child's medical team. Furthermore, parents noted the savings on time, money, and childcare. Conclusions: While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents. ",
doi="10.2196/54598",
url="https://pediatrics.jmir.org/2024/1/e54598"
}


@Article{info:doi/10.2196/64216,
author="Taylor, Marin
and Bondi, Christina Bianca
and Andrade, F. Brendan
and Au-Young, H. Stephanie
and Chau, Vann
and Danguecan, Ashley
and D{\'e}sir{\'e}, Naddley
and Guo, Ting
and Ostojic-Aitkens, Dragana
and Wade, Shari
and Miller, Steven
and Williams, Samantha Tricia",
title="Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="4",
volume="13",
pages="e64216",
keywords="congenital heart disease",
keywords="neurodevelopmental outcomes",
keywords="web-based mental health care",
keywords="stepped care",
keywords="positive parenting",
keywords="family well-being",
keywords="mental health",
keywords="I-InTERACT-North",
abstract="Background: Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. Objective: This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Methods: Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95\% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Results: Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. Conclusions: This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. Trial Registration: ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251 International Registered Report Identifier (IRRID): DERR1-10.2196/64216 ",
doi="10.2196/64216",
url="https://www.researchprotocols.org/2024/1/e64216",
url="http://www.ncbi.nlm.nih.gov/pubmed/39365658"
}


@Article{info:doi/10.2196/30533,
author="Stunden, Chelsea
and Zakani, Sima
and Martin, Avery
and Moodley, Shreya
and Jacob, John",
title="Replicating Anatomical Teaching Specimens Using 3D Modeling Embedded Within a Multimodal e-Learning Course: Pre-Post Study Exploring the Impact on Medical Education During COVID-19",
journal="JMIR Med Educ",
year="2021",
month="Nov",
day="17",
volume="7",
number="4",
pages="e30533",
keywords="congenital heart disease",
keywords="cardiac anatomy, pathologic anatomy",
keywords="education",
keywords="learning aids",
keywords="3D models",
abstract="Background: The COVID-19 pandemic has had significant effects on anatomy education. During the pandemic, students have had no access to cadavers, which has been the principal method of learning anatomy. We created and tested a customized congenital heart disease e-learning course for medical students that contained interactive 3D models of anonymized pediatric congenital heart defects. Objective: The aim of this study is to assess whether a multimodal e-learning course contributed to learning outcomes in a cohort of first-year undergraduate medical students studying congenital heart diseases. The secondary aim is to assess student attitudes and experiences associated with multimodal e-learning. Methods: The pre-post study design involved 290 first-year undergraduate medical students. Recruitment was conducted by course instructors. Data were collected before and after using the course. The primary outcome was knowledge acquisition (test scores). The secondary outcomes included attitudes and experiences, time to complete the modules, and browser metadata. Results: A total of 141 students were included in the final analysis. Students' knowledge significantly improved by an average of 44.6\% (63/141) when using the course (SD 1.7\%; Z=?10.287; P<.001). Most students (108/122, 88.3\%) were highly motivated to learn with the course, and most (114/122, 93.5\%) reported positive experiences with the course. There was a strong correlation between attitudes and experiences, which was statistically significant (rs=0.687; P<.001; n=122). No relationships were found between the change in test scores and attitudes (P=.70) or experiences (P=.47). Students most frequently completed the e-learning course with Chrome (109/141, 77.3\%) and on Apple macOS (86/141, 61\%) or Windows 10 (52/141, 36.9\%). Most students (117/141, 83\%) had devices with high-definition screens. Most students (83/141, 58.9\%) completed the course in <3 hours. Conclusions: Multimodal e-learning could be a viable solution in improving learning outcomes and experiences for undergraduate medical students who do not have access to cadavers. Future research should focus on validating long-term learning outcomes. ",
doi="10.2196/30533",
url="https://mededu.jmir.org/2021/4/e30533",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787589"
}


@Article{info:doi/10.2196/20633,
author="Kim, Byeol
and Loke, Yue-Hin
and Mass, Paige
and Irwin, R. Matthew
and Capeland, Conrad
and Olivieri, Laura
and Krieger, Axel",
title="A Novel Virtual Reality Medical Image Display System for Group Discussions of Congenital Heart Disease: Development and Usability Testing",
journal="JMIR Cardio",
year="2020",
month="Dec",
day="8",
volume="4",
number="1",
pages="e20633",
keywords="virtual reality",
keywords="cardiac diagnostics",
keywords="usability study",
keywords="congenital heart disease",
keywords="group collaboration",
abstract="Background: The complex 3-dimensional (3D) nature of anatomical abnormalities in congenital heart disease (CHD) necessitates multidisciplinary group discussions centered around the review of medical images such as magnetic resonance imaging. Currently, group viewings of medical images are constrained to 2-dimensional (2D) cross-sectional displays of 3D scans. However, 2D display methods could introduce additional challenges since they require physicians to accurately reconstruct the images mentally into 3D anatomies for diagnosis, staging, and planning of surgery or other therapies. Virtual reality (VR) software may enhance diagnosis and care of CHD via 3D visualization of medical images. Yet, present-day VR developments for medicine lack the emphasis on multiuser collaborative environments, and the effect of displays and level of immersion for diagnosing CHDs have not been studied. Objective: The objective of the study was to evaluate and compare the diagnostic accuracies and preferences of various display systems, including the conventional 2D display and a novel group VR software, in group discussions of CHD. Methods: A total of 22 medical trainees consisting of 1 first-year, 10 second-year, 4 third-year, and 1 fourth-year residents and 6 medical students, who volunteered for the study, were formed into groups of 4 to 5 participants. Each group discussed three diagnostic cases of CHD with varying structural complexity using conventional 2D display and group VR software. A group VR software, Cardiac Review 3D, was developed by our team using the Unity engine. By using different display hardware, VR was classified into nonimmersive and full-immersive settings. The discussion time, diagnostic accuracy score, and peer assessment were collected to capture the group and individual diagnostic performances. The diagnostic accuracies for each participant were scored by two experienced cardiologists following a predetermined answer rubric. At the end of the study, all participants were provided a survey to rank their preferences of the display systems for performing group medical discussions. Results: Diagnostic accuracies were highest when groups used the full-immersive VR compared with the conventional and nonimmersive VR ($\chi$22=9.0, P=.01) displays. Differences between the display systems were more prominent with increasing case complexity ($\chi$22=14.1, P<.001) where full-immersive VR had accuracy scores that were 54.49\% and 146.82\% higher than conventional and nonimmersive VR, respectively. The diagnostic accuracies provided by the two cardiologists for each participant did not statistically differ from each other (t=--1.01, P=.31). The full-immersive VR was ranked as the most preferred display for performing group CHD discussions by 68\% of the participants. Conclusions: The most preferred display system among medical trainees for visualizing medical images during group diagnostic discussions is full-immersive VR, with a trend toward improved diagnostic accuracy in complex anatomical abnormalities. Immersion is a crucial feature of displays of medical images for diagnostic accuracy in collaborative discussions. ",
doi="10.2196/20633",
url="http://cardio.jmir.org/2020/1/e20633/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289675"
}