Letters
zygotic twins) did not appear to be incorporated into the statistical modeling methods used, and should be considered an important contributor to that category of causal influence. John N. Constantino, MD Author Affiliation: Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri. Corresponding Author: John N. Constantino, MD, Departments of Psychiatry and Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110 ([email protected]). Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported receiving royalties from Western Psychological Services for the commercial distribution of the Social Responsiveness Scale, a quantitative measure of autistic traits. 1. Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. The familial risk of autism. JAMA. 2014;311(17):1770-1777. 2. Robinson EB, Lichtenstein P, Anckarsäter H, Happé F, Ronald A. Examining and interpreting the female protective effect against autistic behavior. Proc Natl Acad Sci U S A. 2013;110(13):5258-5262.
of the potential important results of an analysis such as ours is to facilitate and stimulate a discussion about the specific causes of the disorder. One way to address current concerns about behavioral genetic models of heritability is to complement them with modeling methods using molecular data to estimate heritable and nonheritable factors. We agree with Constantino that de novo mutations would inflate the nonshared environment component term and this may be important. Sven Sandin, PhD Abraham Reichenberg, PhD Author Affiliations: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (Sandin); Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, New York (Reichenberg). Corresponding Author: Sven Sandin, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-17177 Stockholm, Sweden ([email protected]).
3. Constantino JN, Charman T. Gender bias, female resilience, and the sex ratio in autism. J Am Acad Child Adolesc Psychiatry. 2012;51(8):756-758.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
4. Hallmayer J, Cleveland S, Torres A, et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry. 2011; 68(11):1095-1102.
1. Grønborg TK, Schendel DE, Parner ET. Recurrence of autism spectrum disorders in full- and half-siblings and trends over time: a population-based cohort study. JAMA Pediatr. 2013;167(10):947-953.
In Reply We share Dr Constantino’s interest in determining if there are differences in the etiology of ASD between males and females. We did not compare the heritability of ASD between males and females in the study for 2 reasons. First, even a large population-based study such as ours has limited power to detect statistically significant sex differences in heritability. Second, we addressed the question of sex effects in our recurrence risk analysis. We did not observe important or statistically significant differences in recurrence risk in siblings and cousins for the different sibling and cousin sex combinations. The relative risk for males or females was not dependent on the sex of the proband. Furthermore, an epidemiological study from Denmark also did not find support for sex-related differences in recurrence risk.1 We look forward to seeing this topic addressed further in future populationbased studies. Several factors may affect concordance rates. Some earlier twin studies used interviews, rating scales, or both to score different autistic traits and applied preselected cutoffs to define autism.2,3 The pairwise concordance using such an approach may differ from pairwise concordance based on clinical diagnosis as reflected in our study. The source population, methods of ascertainment, handling of time trends, and participation rates may also affect observed concordance rates. The models we fitted are complex and, like any statistical model, do come with some underlying assumptions. Furthermore, the models can only give crude estimates of the sources and nature of the disease, and therefore we were cautious not to overinterpret our estimates or speculate what the exact sources underlying our estimates might be. Yet one jama.com
2. Lundström S, Chang Z, Råstam M, et al. Autism spectrum disorders and autistic like traits: similar etiology in the extreme end and the normal variation. Arch Gen Psychiatry. 2012;69(1):46-52. 3. Lichtenstein P, Carlström E, Råstam M, Gillberg C, Anckarsäter H. The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. Am J Psychiatry. 2010;167(11):1357-1363.
Certification of Mobile Apps for Health Care To the Editor A Viewpoint by Dr Powell and colleagues1 highlighted just how difficult it is for patients and clinicians to identify safe, effective mobile apps for health care, with the thousands of apps in the marketplace having received little review or clinical evaluation. The authors called for more “rigorous certification criteria and unbiased accrediting bodies,” claiming the need for certification of apps. Although certification of apps sounds reasonable, we do not believe it is a scalable strategy that will address more than a small fraction of the market. Happtique, a commercial app certification company, recently suspended their app certification program, underscoring the concept of health app certification as a flawed proposition.2 The number of features, diversity of information, and rapid pace of development are key market factors that make certification difficult to achieve. Powell et al1 cited examples of organizations, such as the nonprofit Health On the Net Foundation and the for-profit Underwriters Laboratories, that purport to be successful at disseminating credible consumer information. However, the Health On the Net Foundation’s HONcode takes 12 to 18 months to review a website.3 The challenge in both certification and clinical evidence is that traditional methods have not adapted to the fastpaced nature of technology. Traditional randomized clinical trials are expensive, lengthy endeavors, which mHealth researchers have often lamented.4 Researchers aiming to JAMA September 17, 2014 Volume 312, Number 11
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University Of Connecticut Health Center User on 05/11/2015
1155
Letters
systematically evaluate apps have found that the applications they were evaluating were being updated as frequently as every 3 weeks. A clinical trial that began the institutional review board approval process in October 2011 using the just-released iPhone 4S would be using outdated technology less than 1 year later because the iPhone 5 was released in September 2012. In the interim, with tens of thousands of apps vying for attention, perhaps empowering the end user to become app literate2 is a quicker and more viable large-scale solution. This issue warrants not only further discussion and research but guidance from medical institutions, which could help empower consumers to assess whether a specific app is appropriate for their needs and enable physicians to take the lead in advancing the state of mobile health. Steven R. Chan, MD, MBA Satish Misra, MD Author Affiliations: Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento (Chan); Division of Cardiology, Johns Hopkins University, Baltimore, Maryland (Misra). Corresponding Author: Steven R. Chan, MD, MBA, Department of Psychiatry and Behavioral Sciences, University of California at Davis, 2230 Stockton Blvd, Sacramento, CA 95817 ([email protected]). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Chan reported writing for iMedicalApps and being a Doximity (healthcare mobile app) Fellow but receiving no financial compensation. Dr Misra reported being the managing editor for iMedicalApps and receiving financial compensation for his work. 1. Powell AC, Landman AB, Bates DW. In search of a few good apps. JAMA. 2014;311(18):1851-1852. 2. Misra S. Happtique’s recent setback shows that health app certification is a flawed proposition. http://www.imedicalapps.com/2014/01/happtiques -setback-future-app-certification/. Accessed April 19, 2014. 3. Health On the Net Foundation website. The certification process step by step. https://www.hon.ch/HONcode/Webmasters/StepByStep/StepByStep2.html. Accessed April 19, 2014. 4. Payne P. Do mHealth apps require randomized controlled trials? panel discusses at mHealth Summit. http://www.imedicalapps.com/2012/12/mhealth -apps-require-randomized-controlled-trials-mhealth-summit/. Accessed April 19, 2014.
In Reply We agree with Drs Chan and Misra that it is difficult to review and certify large numbers of mHealth apps and that conducting traditional randomized clinical trials of specific apps may not be reasonable given the current rate of innovation. However, we also believe it is problematic to ask clinicians and patients to fend for themselves when evaluating apps. The new challenges that the rapid innovation in apps present may require new types of solutions. Apps come in many forms and can be broadly characterized as designed for patients or health care practitioners. Just as it would be unrealistic to expect patients to have the medical literacy to evaluate many of their medical devices or pharmaceuticals, it is unrealistic to ask them to evaluate all apps. Neither patients nor clinicians are typically equipped to evaluate the security of apps. As Misra has noted,1 mistakes made in evaluating app security hampered Happtique, despite its original focus in this area. Certifying 1156
that patient data are handled securely and that privacy policies are adequate is a difficult task and will need to be handled professionally. There are multiple paths forward for app review. Thanks to recent efforts by Apple, Google, and Samsung, smartphones are going to consolidate health app data so that individual apps have access to a more complete picture of their users’ health.2 Using these data, it will be possible to perform observational studies on how apps affect health outcomes. PatientsLikeMe has successfully conducted research with patient-reported observational data, and data consolidators could similarly be used to do so for mHealth.3 If automation is applied, observational studies can be conducted at scale. These studies would help build the evidence base necessary for payers to make informed choices about coverage of appbased interventions. Also, there will be a need for handcrafted reviews of the evidence on some apps, especially in cases in which apps may pose more than a minimal risk to users or when their efficacy is not easily evaluated through automated means. PsyberGuide has taken this approach by reviewing the clinical literature supporting the use of a limited number of apps intended for psychiatric conditions.4 Although there are few direct studies of psychiatric apps, clinical evidence can come from other sources.5 Because the evidence PsyberGuide provides about efficacy is often generalized from studies of similar interventions, it is unlikely that an incremental app update would change the conclusion of a review. Although full coverage is not available yet, focused review represents a valuable asset for clinicians and patients when it is available. An era is beginning in which longitudinal health data will be ubiquitous, in large part thanks to mHealth. Because apps can collect much of the data needed to conduct field research, automating the review process has the potential to substantially lower costs. When depth is needed, focused reviewing is an option. We acknowledge that it is not yet clear how app review should best proceed but believe some form of review is essential if the desired benefits are to be obtained from mHealth. Adam C. Powell, PhD Adam B. Landman, MD David W. Bates, MD, MSc Author Affiliations: Payer + Provider Syndicate, Boston, Massachusetts (Powell); Brigham and Women’s Hospital, Boston, Massachusetts (Landman, Bates). Corresponding Author: Adam C. Powell, PhD, Payer + Provider Syndicate, 8 Garrison St, Boston, MA 02116 ([email protected]). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Powell reported receiving personal fees from mHealthCoach and Verbal Applications. Dr Landman reported developing 2 mobile health apps: CliniCam and NFC e-MAR. CliniCam was funded by the Brigham and Women’s Hospital (BWH) Health Information Technology Innovation Program; NFC e-MAR was funded by the BWH Biomedical Research Institute Translatable Technologies and Care Innovation Grant. Dr Bates reported being supported in part through the
JAMA September 17, 2014 Volume 312, Number 11
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University Of Connecticut Health Center User on 05/11/2015
jama.com
Letters
Libretto Consortium, sponsored by the Gordon and Betty Moore Foundation, and receiving personal fees from Medicalis; receiving patent royalties from Medicalis for radiology decision support software; chairing the US Food and Drug Administration Safety and Innovation Act workgroup, which has advised the US Food and Drug Administration, the Federal Communications Commission, and the Office of the National Coordinator for Health Information Technology including mobile technology; and serving as a member of the Health Information Technology policy committee. 1. Misra S. Happtique’s recent setback shows that health app certification is a flawed proposition. http://www.imedicalapps.com/2014/01/happtiques -setback-future-app-certification/. Accessed June 18, 2014. 2. Apple’s venture into mobile medical applications: a game changer? http: //seekingalpha.com/article/2267553-apples-venture-into-mobile-medical -applications-a-game-changer. Accessed June 18, 2014. 3. PatientsLikeMe website. Data for good. http://www.patientslikeme.com /research/dataforgood. Accessed June 18, 2014. 4. PsyberGuide website. Product list. http://psyberguide.org/product-listing/. Accessed June 18, 2014. 5. Chan SR, Torous J, Hinton L, Yellowlees P. Mobile tele-mental health: increasing applications and a move to hybrid models of care. Healthcare. 2014;2 (2):220-223.
CORRECTION Incorrect Data in a Table: In the Grand Rounds report entitled “Resistant Hypertension: A Review of Diagnosis and Management” published in the June 4, 2014, issue of JAMA (2014;311[21]:2216-2224. doi:10:1001/jama.2014.5180), an incorrect dose range was presented in Table 2. In the Lisinopril row, the dosing range should be “5-80 mg/d.” This article was corrected online.
jama.com
Guidelines for Letters Letters discussing a recent JAMA article should be submitted within 4 weeks of the article's publication in print. Letters received after 4 weeks will rarely be considered. Letters should not exceed 400 words of text and 5 references and may have no more than 3 authors. Letters reporting original research should not exceed 600 words of text and 6 references and may have no more than 7 authors. They may include up to 2 tables or figures but online supplementary material is not allowed. All letters should include a word count. Letters must not duplicate other material published or submitted for publication. Letters not meeting these specifications are generally not considered. Letters being considered for publication ordinarily will be sent to the authors of the JAMA article, who will be given the opportunity to reply. Letters will be published at the discretion of the editors and are subject to abridgement and editing. Further instructions can be found at http://jama.com/public /InstructionsForAuthors.aspx. A signed statement for authorship criteria and responsibility, financial disclosure, copyright transfer, and acknowledgment and the ICMJE Form for Disclosure of Potential Conflicts of Interest are required before publication. Letters should be submitted via the JAMA online submission and review system at http: //manuscripts.jama.com. For technical assistance, please contact [email protected]. Section Editor: Jody W. Zylke, MD, Deputy Editor.
JAMA September 17, 2014 Volume 312, Number 11
Copyright 2014 American Medical Association. All rights reserved.
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1157
zygotic twins) did not appear to be incorporated into the statistical modeling methods used, and should be considered an important contributor to that category of causal influence. John N. Constantino, MD Author Affiliation: Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri. Corresponding Author: John N. Constantino, MD, Departments of Psychiatry and Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110 ([email protected]). Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported receiving royalties from Western Psychological Services for the commercial distribution of the Social Responsiveness Scale, a quantitative measure of autistic traits. 1. Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. The familial risk of autism. JAMA. 2014;311(17):1770-1777. 2. Robinson EB, Lichtenstein P, Anckarsäter H, Happé F, Ronald A. Examining and interpreting the female protective effect against autistic behavior. Proc Natl Acad Sci U S A. 2013;110(13):5258-5262.
of the potential important results of an analysis such as ours is to facilitate and stimulate a discussion about the specific causes of the disorder. One way to address current concerns about behavioral genetic models of heritability is to complement them with modeling methods using molecular data to estimate heritable and nonheritable factors. We agree with Constantino that de novo mutations would inflate the nonshared environment component term and this may be important. Sven Sandin, PhD Abraham Reichenberg, PhD Author Affiliations: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (Sandin); Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, New York (Reichenberg). Corresponding Author: Sven Sandin, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-17177 Stockholm, Sweden ([email protected]).
3. Constantino JN, Charman T. Gender bias, female resilience, and the sex ratio in autism. J Am Acad Child Adolesc Psychiatry. 2012;51(8):756-758.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
4. Hallmayer J, Cleveland S, Torres A, et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry. 2011; 68(11):1095-1102.
1. Grønborg TK, Schendel DE, Parner ET. Recurrence of autism spectrum disorders in full- and half-siblings and trends over time: a population-based cohort study. JAMA Pediatr. 2013;167(10):947-953.
In Reply We share Dr Constantino’s interest in determining if there are differences in the etiology of ASD between males and females. We did not compare the heritability of ASD between males and females in the study for 2 reasons. First, even a large population-based study such as ours has limited power to detect statistically significant sex differences in heritability. Second, we addressed the question of sex effects in our recurrence risk analysis. We did not observe important or statistically significant differences in recurrence risk in siblings and cousins for the different sibling and cousin sex combinations. The relative risk for males or females was not dependent on the sex of the proband. Furthermore, an epidemiological study from Denmark also did not find support for sex-related differences in recurrence risk.1 We look forward to seeing this topic addressed further in future populationbased studies. Several factors may affect concordance rates. Some earlier twin studies used interviews, rating scales, or both to score different autistic traits and applied preselected cutoffs to define autism.2,3 The pairwise concordance using such an approach may differ from pairwise concordance based on clinical diagnosis as reflected in our study. The source population, methods of ascertainment, handling of time trends, and participation rates may also affect observed concordance rates. The models we fitted are complex and, like any statistical model, do come with some underlying assumptions. Furthermore, the models can only give crude estimates of the sources and nature of the disease, and therefore we were cautious not to overinterpret our estimates or speculate what the exact sources underlying our estimates might be. Yet one jama.com
2. Lundström S, Chang Z, Råstam M, et al. Autism spectrum disorders and autistic like traits: similar etiology in the extreme end and the normal variation. Arch Gen Psychiatry. 2012;69(1):46-52. 3. Lichtenstein P, Carlström E, Råstam M, Gillberg C, Anckarsäter H. The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. Am J Psychiatry. 2010;167(11):1357-1363.
Certification of Mobile Apps for Health Care To the Editor A Viewpoint by Dr Powell and colleagues1 highlighted just how difficult it is for patients and clinicians to identify safe, effective mobile apps for health care, with the thousands of apps in the marketplace having received little review or clinical evaluation. The authors called for more “rigorous certification criteria and unbiased accrediting bodies,” claiming the need for certification of apps. Although certification of apps sounds reasonable, we do not believe it is a scalable strategy that will address more than a small fraction of the market. Happtique, a commercial app certification company, recently suspended their app certification program, underscoring the concept of health app certification as a flawed proposition.2 The number of features, diversity of information, and rapid pace of development are key market factors that make certification difficult to achieve. Powell et al1 cited examples of organizations, such as the nonprofit Health On the Net Foundation and the for-profit Underwriters Laboratories, that purport to be successful at disseminating credible consumer information. However, the Health On the Net Foundation’s HONcode takes 12 to 18 months to review a website.3 The challenge in both certification and clinical evidence is that traditional methods have not adapted to the fastpaced nature of technology. Traditional randomized clinical trials are expensive, lengthy endeavors, which mHealth researchers have often lamented.4 Researchers aiming to JAMA September 17, 2014 Volume 312, Number 11
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University Of Connecticut Health Center User on 05/11/2015
1155
Letters
systematically evaluate apps have found that the applications they were evaluating were being updated as frequently as every 3 weeks. A clinical trial that began the institutional review board approval process in October 2011 using the just-released iPhone 4S would be using outdated technology less than 1 year later because the iPhone 5 was released in September 2012. In the interim, with tens of thousands of apps vying for attention, perhaps empowering the end user to become app literate2 is a quicker and more viable large-scale solution. This issue warrants not only further discussion and research but guidance from medical institutions, which could help empower consumers to assess whether a specific app is appropriate for their needs and enable physicians to take the lead in advancing the state of mobile health. Steven R. Chan, MD, MBA Satish Misra, MD Author Affiliations: Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento (Chan); Division of Cardiology, Johns Hopkins University, Baltimore, Maryland (Misra). Corresponding Author: Steven R. Chan, MD, MBA, Department of Psychiatry and Behavioral Sciences, University of California at Davis, 2230 Stockton Blvd, Sacramento, CA 95817 ([email protected]). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Chan reported writing for iMedicalApps and being a Doximity (healthcare mobile app) Fellow but receiving no financial compensation. Dr Misra reported being the managing editor for iMedicalApps and receiving financial compensation for his work. 1. Powell AC, Landman AB, Bates DW. In search of a few good apps. JAMA. 2014;311(18):1851-1852. 2. Misra S. Happtique’s recent setback shows that health app certification is a flawed proposition. http://www.imedicalapps.com/2014/01/happtiques -setback-future-app-certification/. Accessed April 19, 2014. 3. Health On the Net Foundation website. The certification process step by step. https://www.hon.ch/HONcode/Webmasters/StepByStep/StepByStep2.html. Accessed April 19, 2014. 4. Payne P. Do mHealth apps require randomized controlled trials? panel discusses at mHealth Summit. http://www.imedicalapps.com/2012/12/mhealth -apps-require-randomized-controlled-trials-mhealth-summit/. Accessed April 19, 2014.
In Reply We agree with Drs Chan and Misra that it is difficult to review and certify large numbers of mHealth apps and that conducting traditional randomized clinical trials of specific apps may not be reasonable given the current rate of innovation. However, we also believe it is problematic to ask clinicians and patients to fend for themselves when evaluating apps. The new challenges that the rapid innovation in apps present may require new types of solutions. Apps come in many forms and can be broadly characterized as designed for patients or health care practitioners. Just as it would be unrealistic to expect patients to have the medical literacy to evaluate many of their medical devices or pharmaceuticals, it is unrealistic to ask them to evaluate all apps. Neither patients nor clinicians are typically equipped to evaluate the security of apps. As Misra has noted,1 mistakes made in evaluating app security hampered Happtique, despite its original focus in this area. Certifying 1156
that patient data are handled securely and that privacy policies are adequate is a difficult task and will need to be handled professionally. There are multiple paths forward for app review. Thanks to recent efforts by Apple, Google, and Samsung, smartphones are going to consolidate health app data so that individual apps have access to a more complete picture of their users’ health.2 Using these data, it will be possible to perform observational studies on how apps affect health outcomes. PatientsLikeMe has successfully conducted research with patient-reported observational data, and data consolidators could similarly be used to do so for mHealth.3 If automation is applied, observational studies can be conducted at scale. These studies would help build the evidence base necessary for payers to make informed choices about coverage of appbased interventions. Also, there will be a need for handcrafted reviews of the evidence on some apps, especially in cases in which apps may pose more than a minimal risk to users or when their efficacy is not easily evaluated through automated means. PsyberGuide has taken this approach by reviewing the clinical literature supporting the use of a limited number of apps intended for psychiatric conditions.4 Although there are few direct studies of psychiatric apps, clinical evidence can come from other sources.5 Because the evidence PsyberGuide provides about efficacy is often generalized from studies of similar interventions, it is unlikely that an incremental app update would change the conclusion of a review. Although full coverage is not available yet, focused review represents a valuable asset for clinicians and patients when it is available. An era is beginning in which longitudinal health data will be ubiquitous, in large part thanks to mHealth. Because apps can collect much of the data needed to conduct field research, automating the review process has the potential to substantially lower costs. When depth is needed, focused reviewing is an option. We acknowledge that it is not yet clear how app review should best proceed but believe some form of review is essential if the desired benefits are to be obtained from mHealth. Adam C. Powell, PhD Adam B. Landman, MD David W. Bates, MD, MSc Author Affiliations: Payer + Provider Syndicate, Boston, Massachusetts (Powell); Brigham and Women’s Hospital, Boston, Massachusetts (Landman, Bates). Corresponding Author: Adam C. Powell, PhD, Payer + Provider Syndicate, 8 Garrison St, Boston, MA 02116 ([email protected]). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Powell reported receiving personal fees from mHealthCoach and Verbal Applications. Dr Landman reported developing 2 mobile health apps: CliniCam and NFC e-MAR. CliniCam was funded by the Brigham and Women’s Hospital (BWH) Health Information Technology Innovation Program; NFC e-MAR was funded by the BWH Biomedical Research Institute Translatable Technologies and Care Innovation Grant. Dr Bates reported being supported in part through the
JAMA September 17, 2014 Volume 312, Number 11
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University Of Connecticut Health Center User on 05/11/2015
jama.com
Letters
Libretto Consortium, sponsored by the Gordon and Betty Moore Foundation, and receiving personal fees from Medicalis; receiving patent royalties from Medicalis for radiology decision support software; chairing the US Food and Drug Administration Safety and Innovation Act workgroup, which has advised the US Food and Drug Administration, the Federal Communications Commission, and the Office of the National Coordinator for Health Information Technology including mobile technology; and serving as a member of the Health Information Technology policy committee. 1. Misra S. Happtique’s recent setback shows that health app certification is a flawed proposition. http://www.imedicalapps.com/2014/01/happtiques -setback-future-app-certification/. Accessed June 18, 2014. 2. Apple’s venture into mobile medical applications: a game changer? http: //seekingalpha.com/article/2267553-apples-venture-into-mobile-medical -applications-a-game-changer. Accessed June 18, 2014. 3. PatientsLikeMe website. Data for good. http://www.patientslikeme.com /research/dataforgood. Accessed June 18, 2014. 4. PsyberGuide website. Product list. http://psyberguide.org/product-listing/. Accessed June 18, 2014. 5. Chan SR, Torous J, Hinton L, Yellowlees P. Mobile tele-mental health: increasing applications and a move to hybrid models of care. Healthcare. 2014;2 (2):220-223.
CORRECTION Incorrect Data in a Table: In the Grand Rounds report entitled “Resistant Hypertension: A Review of Diagnosis and Management” published in the June 4, 2014, issue of JAMA (2014;311[21]:2216-2224. doi:10:1001/jama.2014.5180), an incorrect dose range was presented in Table 2. In the Lisinopril row, the dosing range should be “5-80 mg/d.” This article was corrected online.
jama.com
Guidelines for Letters Letters discussing a recent JAMA article should be submitted within 4 weeks of the article's publication in print. Letters received after 4 weeks will rarely be considered. Letters should not exceed 400 words of text and 5 references and may have no more than 3 authors. Letters reporting original research should not exceed 600 words of text and 6 references and may have no more than 7 authors. They may include up to 2 tables or figures but online supplementary material is not allowed. All letters should include a word count. Letters must not duplicate other material published or submitted for publication. Letters not meeting these specifications are generally not considered. Letters being considered for publication ordinarily will be sent to the authors of the JAMA article, who will be given the opportunity to reply. Letters will be published at the discretion of the editors and are subject to abridgement and editing. Further instructions can be found at http://jama.com/public /InstructionsForAuthors.aspx. A signed statement for authorship criteria and responsibility, financial disclosure, copyright transfer, and acknowledgment and the ICMJE Form for Disclosure of Potential Conflicts of Interest are required before publication. Letters should be submitted via the JAMA online submission and review system at http: //manuscripts.jama.com. For technical assistance, please contact [email protected]. Section Editor: Jody W. Zylke, MD, Deputy Editor.
JAMA September 17, 2014 Volume 312, Number 11
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University Of Connecticut Health Center User on 05/11/2015
1157
