Background There is an increasing need to integrate patient-generated health data (PGHD) into health information systems (HISs). The use of health information standards based on the dual model allows the achievement of semantic interoperability among systems. Although there is evidence in the use of the Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR) framework for standardized communication between mobile apps and electronic health records (EHRs), the use of European Norm/International Organization for Standardization (EN/ISO) 13606 has not been explored yet, despite some advantages over FHIR in terms of modeling and formalization of clinical knowledge, as well as flexibility in the creation of new concepts. Objective This study aims to design and implement a methodology based on the dual-model paradigm to communicate clinical information between a patient mobile app (Xemio Research) and an institutional ontology-based clinical repository (OntoCR) without loss of meaning. Methods This paper is framed within Artificial intelligence Supporting CAncer Patients across Europe (ASCAPE), a project that aims to use artificial intelligence (AI)/machine learning (ML) mechanisms to support cancer patients’ health status and quality of life (QoL). First, the variables “side effect” and “daily steps” were defined and represented with EN/ISO 13606 archetypes. Next, ontologies that model archetyped concepts and map them to the standard were created and uploaded to OntoCR, where they were ready to receive instantiated patient data. Xemio Research used a conversion module in the ASCAPE Local Edge to transform data entered into the app to create EN/ISO 13606 extracts, which were sent to an Application Programming Interface (API) in OntoCR that maps each element in the normalized XML files to its corresponding location in the ontology. This way, instantiated data of patients are stored in the clinical repository. Results Between December 22, 2020, and April 4, 2022, 1100 extracts of 47 patients were successfully communicated (234/1100, 21.3%, extracts of side effects and 866/1100, 78.7%, extracts of daily activity). Furthermore, the creation of EN/ISO 13606–standardized archetypes allows the reuse of clinical information regarding daily activity and side effects, while with the creation of ontologies, we extended the knowledge representation of our clinical repository. Conclusions Health information interoperability is one of the requirements for continuity of health care. The dual model allows the separation of knowledge and information in HISs. EN/ISO 13606 was chosen for this project because of the operational mechanisms it offers for data exchange, as well as its flexibility for modeling knowledge and creating new concepts. To the best of our knowledge, this is the first experience reported in the literature of effective communication of EN/ISO 13606 EHR extracts between a patient mobile app and an institutional clinical repository using a scalable standard-agnostic methodology that can be applied to other projects, data sources, and institutions.

BACKGROUND The field of mHealth has grown exponentially in the last decade due to the widespread use of smartphones and the advancements in mobile technology, which has created opportunities to find solutions to unmet healthcare needs for patients with chronic diseases. Furthermore, healthcare is entering a new value-based paradigm, founded on three main pillars: efficiency, safety, and value for patients. OBJECTIVE The objective of this review is to summarize the current knowledge on the impact of mHealth on patient-reported outcomes in breast cancer (BC) patients. METHODS Three databases were systematically searched to identify studies that met eligibility criteria: PubMed, PsychInfo, and Google Scholar. Relevant systematic reviews and the references of the research articles they contained were also searched in case that studies were missed during the initial search. Searches were made on December 17th, 2021. Two investigators independently reviewed the titles and abstracts of the identified studies and then read the full text of all selected papers. In case a discrepancy was found, It was discussed with a third investigator in order to make a final decision. The quality of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. RESULTS Twenty-two unique studies involving 3,502 patients were included. The focus of the interventions in the studies included in the review were physical activity (11 studies), tailored information for better self-management of the disease (8 studies), mental health therapies (6 studies), symptom tracker (4 studies), and others (6 studies). All interventions were at least 8 weeks long of duration, with a median duration of 12 weeks (interquartile range 4-18 weeks). mHealth interventions showed better results on symptom burden, fatigue, quality of life and physical activity. Likewise, tailored information, symptom tracker, nutrition and physical activity were the interventions that yielded better results. Apps with interactive support had a higher rate of positive findings, while interventions targeted to survivors showed worse results. CONCLUSIONS mHealth applications in BC patients is a highly heterogeneous field. Our study suggests that interventions focused on newly diagnosed patients or patients while on chemotherapy, interventions with interactive human support and those with a duration of 12 weeks or more showed better results in terms of patient-reported outcome. Interventions must be adapted to each patient’s characteristics and disease stage to meet their specific needs at the time of deployment. Positive impact on endpoints show what can be achieved with the right mHealth intervention. The reproducibility of the studies reporting mHealth interventions is currently uncertain.

MSM is known to provide anti‐inflammatory and anti‐oxidant effects in both animals and humans. Because both exercise and chronic disease have the potential to induce inflammation and oxidative stress in skeletal muscle, MSM may be a novel therapy to counter the negative consequences of these stressors on skeletal muscle function. Recent evidence has shown that MSM supplementation in human subjects can increase serum MSM concentrations to 2–3 mM. These serum concentrations of MSM have been associated with reduced muscle pain and reduced markers of muscle damage (creatine kinase) following damaging exercise. Therefore, MSM may protect muscle against damage or favorably influence the adaptive capacity of skeletal muscle under stress. However, it is not known if MSM induces this protection by directly acting on skeletal muscle. Therefore, our objective was to determine if MSM may provide cytoprotection from oxidative stress, or enhance the recovery processes in C2C12 myoblasts. We found that treating C2C12 myoblasts with increasing concentrations of MSM (0–200 mM) for 24, 48 and 72 hours decreased cell metabolism (via Alamar Blue) at high concentrations (100 & 200 mM); however this decline was not associated with increased cell death (via Trypan Blue). Flow cytometry analysis showed MSM treatment (200 mM) trapped myoblasts in G1 phase (+51%) and reduced the number of cells moving into S phase (DNA synthesis; −38%) or G2+M phase(mitosis; −43%) of cell division. MSM had no effect on C2C12 differentiation (d1, d4, d6). High concentrations of MSM (100 & 200 mM) were able to reduce cell death (−36% & −89% respectively) induced by oxidative stress (tert‐butyl hydrogen peroxide; 20 uM). Because heat shock proteins (HSPs) are known to be cytoprotective, we determined if increasing concentrations of MSM induced HSP expression; however, we found no changes in HSP70 and HSP27 expression. Lastly, lower concentrations (12.5 mM) of MSM enhanced wound closure (+35%) from a scratch assay 24 following treatment, while higher concentrations (200 mM) were associated with an impaired closure rate (−51%). While more applied research is needed, these findings suggest that MSM may directly alter the skeletal muscle response to stress and injury. Therefore, MSM supplementation may serve as an ergogenic aide to protect skeletal muscle from injury.Support or Funding InformationFunded by Bergstrom Nutrition to CDT

In this anonymous survey with high participation of service users, the e-Answers initiative was evaluated positively.