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Yang PC, Jha A, Xu W, Song Z, Jamp P, Teuteberg JJ. Cloud-Based Machine Learning Platform to Predict Clinical Outcomes at Home for Patients With Cardiovascular Conditions Discharged From Hospital: Clinical Trial. JMIR Cardio 2024; 8:e45130. [PMID: 38427393 PMCID: PMC10943420 DOI: 10.2196/45130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/31/2023] [Accepted: 09/19/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Hospitalizations account for almost one-third of the US $4.1 trillion health care cost in the United States. A substantial portion of these hospitalizations are attributed to readmissions, which led to the establishment of the Hospital Readmissions Reduction Program (HRRP) in 2012. The HRRP reduces payments to hospitals with excess readmissions. In 2018, >US $700 million was withheld; this is expected to exceed US $1 billion by 2022. More importantly, there is nothing more physically and emotionally taxing for readmitted patients and demoralizing for hospital physicians, nurses, and administrators. Given this high uncertainty of proper home recovery, intelligent monitoring is needed to predict the outcome of discharged patients to reduce readmissions. Physical activity (PA) is one of the major determinants for overall clinical outcomes in diabetes, hypertension, hyperlipidemia, heart failure, cancer, and mental health issues. These are the exact comorbidities that increase readmission rates, underlining the importance of PA in assessing the recovery of patients by quantitative measurement beyond the questionnaire and survey methods. OBJECTIVE This study aims to develop a remote, low-cost, and cloud-based machine learning (ML) platform to enable the precision health monitoring of PA, which may fundamentally alter the delivery of home health care. To validate this technology, we conducted a clinical trial to test the ability of our platform to predict clinical outcomes in discharged patients. METHODS Our platform consists of a wearable device, which includes an accelerometer and a Bluetooth sensor, and an iPhone connected to our cloud-based ML interface to analyze PA remotely and predict clinical outcomes. This system was deployed at a skilled nursing facility where we collected >17,000 person-day data points over 2 years, generating a solid training database. We used these data to train our extreme gradient boosting (XGBoost)-based ML environment to conduct a clinical trial, Activity Assessment of Patients Discharged from Hospital-I, to test the hypothesis that a comprehensive profile of PA would predict clinical outcome. We developed an advanced data-driven analytic platform that predicts the clinical outcome based on accurate measurements of PA. Artificial intelligence or an ML algorithm was used to analyze the data to predict short-term health outcome. RESULTS We enrolled 52 patients discharged from Stanford Hospital. Our data demonstrated a robust predictive system to forecast health outcome in the enrolled patients based on their PA data. We achieved precise prediction of the patients' clinical outcomes with a sensitivity of 87%, a specificity of 79%, and an accuracy of 85%. CONCLUSIONS To date, there are no reliable clinical data, using a wearable device, regarding monitoring discharged patients to predict their recovery. We conducted a clinical trial to assess outcome data rigorously to be used reliably for remote home care by patients, health care professionals, and caretakers.
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Affiliation(s)
- Phillip C Yang
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alokkumar Jha
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - William Xu
- Emory University, Atlanta, GA, United States
| | - Zitao Song
- North Carolina State University, Raleigh, NC, United States
| | - Patrick Jamp
- Electrical Engineering, University of California, Los Angeles, Mountain View, CA, United States
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Makimoto H, Kohro T. Adopting artificial intelligence in cardiovascular medicine: a scoping review. Hypertens Res 2024; 47:685-699. [PMID: 37907600 DOI: 10.1038/s41440-023-01469-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/03/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
Recent years have witnessed significant transformations in cardiovascular medicine, driven by the rapid evolution of artificial intelligence (AI). This scoping review was conducted to capture the breadth of AI applications within cardiovascular science. Employing a structured approach, we sourced relevant articles from PubMed, with an emphasis on journals encompassing general cardiology and digital medicine. We applied filters to highlight cardiovascular articles published in journals focusing on general internal medicine, cardiology and digital medicine, thereby identifying the prevailing trends in the field. Following a comprehensive full-text screening, a total of 140 studies were identified. Over the preceding 5 years, cardiovascular medicine's interplay with AI has seen an over tenfold augmentation. This expansive growth encompasses multiple cardiovascular subspecialties, including but not limited to, general cardiology, ischemic heart disease, heart failure, and arrhythmia. Deep learning emerged as the predominant methodology. The majority of AI endeavors in this domain have been channeled toward enhancing diagnostic and prognostic capabilities, utilizing resources such as hospital datasets, electrocardiograms, and echocardiography. A significant uptrend was observed in AI's application for omics data analysis. However, a clear gap persists in AI's full-scale integration into the clinical decision-making framework. AI, particularly deep learning, has demonstrated robust applications across cardiovascular subspecialties, indicating its transformative potential in this field. As we continue on this trajectory, ensuring the alignment of technological progress with medical ethics becomes crucial. The abundant digital health data today further accentuates the need for meticulous systematic reviews, tailoring them to each cardiovascular subspecialty.
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Affiliation(s)
- Hisaki Makimoto
- Data Science Center/Cardiovascular Center, Jichi Medical University, Shimotsuke, Japan.
| | - Takahide Kohro
- Data Science Center/Cardiovascular Center, Jichi Medical University, Shimotsuke, Japan
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Mehta A, Spitz J, Sharma S, Bonomo J, Brewer LC, Mehta LS, Sharma G. Addressing Social Determinants of Health in Maternal Cardiovascular Health. Can J Cardiol 2024:S0828-282X(24)00174-0. [PMID: 38387722 DOI: 10.1016/j.cjca.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain the number-one cause of maternal mortality, with over two-thirds of cases being preventable. Social determinants of health (SDoH) encompass the nonmedical social and environmental factors that an individual experiences that have a significant impact on their health. These stressors disproportionately affect socially disadvantaged and minority populations. Pregnancy is a physiologically stressful state that can unmask underlying CVD risk factors and lead to adverse pregnancy outcomes (APOs). Disparities in APOs are particularly pronounced among individuals of color and those from economically disadvantaged backgrounds. This variation underscores healthcare inequity and access, a failure of the healthcare system. Besides short-term negative effects, APOs also are associated strongly with long-term CVDs. APOs therefore must be identified as a cue for early intervention, for the prevention and management of CVD risk factors. This review explores the intricate relationship among maternal morbidity and mortality, SDoH, and cardiovascular health, and the implementation of health policy efforts to reduce the negative impact of SDoH in this patient population. The review emphasizes the importance of comprehensive strategies to improve maternal health outcomes.
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Affiliation(s)
- Adhya Mehta
- Department of Internal Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA
| | - Jared Spitz
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - Sneha Sharma
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jason Bonomo
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laxmi S Mehta
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA.
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Sundquist K, Schwartz JE, Burg MM, Davidson KW, Diaz KM. Use of a Single-Item Ecological Momentary Assessment to Measure Daily Exercise: Agreement with Accelerometer-Measured Exercise. SENSORS (BASEL, SWITZERLAND) 2024; 24:946. [PMID: 38339663 PMCID: PMC10857316 DOI: 10.3390/s24030946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
Accelerometers have been used to objectively quantify physical activity, but they can pose a high burden. This study was conducted to determine the feasibility of using a single-item smartphone-based ecological momentary assessment (EMA) in lieu of accelerometers in long-term assessment of daily exercise. Data were collected from a randomized controlled trial of intermittently exercising, otherwise healthy adults (N = 79; 57% female, mean age: 31.9 ± 9.5 years) over 365 days. Smartphone-based EMA self-reports of exercise entailed daily end-of-day responses about physical activity; the participants also wore a Fitbit device to measure physical activity. The Kappa statistic was used to quantify the agreement between accelerometer-determined (24 min of moderate-to-vigorous physical activity [MVPA] within 30 min) and self-reported exercise. Possible demographic predictors of agreement were assessed. Participants provided an average of 164 ± 87 days of complete data. The average within-person Kappa was κ = 0.30 ± 0.22 (range: -0.15-0.73). Mean Kappa ranged from 0.16 to 0.30 when the accelerometer-based definition of an exercise bout varied in duration from 15 to 30 min of MVPA within any 30 min period. Among the correlates examined, sex was significantly associated with agreement; mean agreement was higher among women (κ = 0.37) than men (κ = 0.20). Agreement between EMA self-reported and accelerometer-measured exercise was fair, suggesting that long-term exercise monitoring through a single-item EMA may be acceptable.
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Affiliation(s)
| | - Joseph E. Schwartz
- Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY 11794, USA;
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Matthew M. Burg
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - Karina W. Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY 11030, USA;
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549, USA
| | - Keith M. Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA
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Gupta V, Kariotis S, Rajab MD, Errington N, Alhathli E, Jammeh E, Brook M, Meardon N, Collini P, Cole J, Wild JM, Hershman S, Javed A, Thompson AAR, de Silva T, Ashley EA, Wang D, Lawrie A. Unsupervised machine learning to investigate trajectory patterns of COVID-19 symptoms and physical activity measured via the MyHeart Counts App and smart devices. NPJ Digit Med 2023; 6:239. [PMID: 38135699 PMCID: PMC10746711 DOI: 10.1038/s41746-023-00974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Previous studies have associated COVID-19 symptoms severity with levels of physical activity. We therefore investigated longitudinal trajectories of COVID-19 symptoms in a cohort of healthcare workers (HCWs) with non-hospitalised COVID-19 and their real-world physical activity. 121 HCWs with a history of COVID-19 infection who had symptoms monitored through at least two research clinic visits, and via smartphone were examined. HCWs with a compatible smartphone were provided with an Apple Watch Series 4 and were asked to install the MyHeart Counts Study App to collect COVID-19 symptom data and multiple physical activity parameters. Unsupervised classification analysis of symptoms identified two trajectory patterns of long and short symptom duration. The prevalence for longitudinal persistence of any COVID-19 symptom was 36% with fatigue and loss of smell being the two most prevalent individual symptom trajectories (24.8% and 21.5%, respectively). 8 physical activity features obtained via the MyHeart Counts App identified two groups of trajectories for high and low activity. Of these 8 parameters only 'distance moved walking or running' was associated with COVID-19 symptom trajectories. We report a high prevalence of long-term symptoms of COVID-19 in a non-hospitalised cohort of HCWs, a method to identify physical activity trends, and investigate their association. These data highlight the importance of tracking symptoms from onset to recovery even in non-hospitalised COVID-19 individuals. The increasing ease in collecting real-world physical activity data non-invasively from wearable devices provides opportunity to investigate the association of physical activity to symptoms of COVID-19 and other cardio-respiratory diseases.
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Affiliation(s)
- Varsha Gupta
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Bioinformatics Institute, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - Sokratis Kariotis
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Department of Neuroscience, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Mohammed D Rajab
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Niamh Errington
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Elham Alhathli
- Department of Neuroscience, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Nursing, Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Emmanuel Jammeh
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Martin Brook
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK
| | - Naomi Meardon
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul Collini
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Joby Cole
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK
| | - Steven Hershman
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Ali Javed
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Thushan de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Euan A Ashley
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Dennis Wang
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Bioinformatics Institute, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Department of Computer Science, University of Sheffield, Sheffield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Lawrie
- National Heart and Lung Institute, Imperial College London, London, UK.
- Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK.
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Lenfant T, Ravaud P, Montori VM, Berntsen GR, Tran VT. Five principles for the development of minimally disruptive digital medicine. BMJ 2023; 383:2960. [PMID: 38114257 DOI: 10.1136/bmj.p2960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Tiphaine Lenfant
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Médecine Interne, Hôpital Européen Georges Pompidou, Paris, France
| | - Philippe Ravaud
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, USA2 AP HEGP
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Gro R Berntsen
- Norwegian Center for e-healthresearch, University hospital of North Norway, Unit for Primary Care, Institute of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Viet-Thi Tran
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
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Yu H, Chen X, Xia J, Hou L. Effect of intelligent hypertension management system on blood pressure: protocol for a randomised controlled multicentre trial. BMJ Open 2023; 13:e074580. [PMID: 38086588 PMCID: PMC10729063 DOI: 10.1136/bmjopen-2023-074580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/16/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Hypertension is one of the most serious global health problems, and its prevention and treatment mainly rely on lifestyle intervention and medication. However, the current situation of hypertension control in China is still not ideal. Self-monitoring of blood pressure is expected to be a new way to control hypertension. Intervention and the Intelligent Hypertension Management System (IHMS), an information platform relying on the network and smartphone, may help patients self-monitor their blood pressure at home, allowing for intelligent management of hypertension. The aim of this trial is to investigate whether IHMS can effectively reduce blood pressure in patients with hypertension. METHODS AND ANALYSIS This is a multiple-centre, prospective, randomised, controlled study. 320 eligible subjects will be randomly divided into the IHMS management group (n=160) and the conventional care group (n=160). Subjects in the IHMS management group will be required to take their blood pressure daily at regular intervals at home and get treatment as directed by the IHMS; the control group will receive conventional treatment. The primary outcome of the trial is the net change in systolic blood pressure at the end point of follow-up after 3 months. The mixed-effects model will be used to compare the primary outcome that there is a greater reduction in blood pressure in the intervention group than in the control group. ETHICS AND DISSEMINATION The Ethics Committee of Shanghai Tongren Hospital has reviewed and approved the trial protocols, informed consent and subject information. The findings from the study will be disseminated through publications and conference presentations. The findings of the trial will be published in journals and presented at academic conferences. TRIAL REGISTRATION NUMBER NCT05526300.
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Affiliation(s)
- Haiyang Yu
- Department of cardiology, Shanghai Songjiang District Central Hospital, Songjiang, Shanghai, China
| | - Xiang Chen
- Department of cardiology, Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiachun Xia
- Department of cardiology, Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Hou
- Department of cardiology, Shanghai Songjiang District Central Hospital, Songjiang, Shanghai, China
- Department of cardiology, Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
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Harrold LR, Zueger P, Nowell WB, Blachley T, Schrader A, Lakin PR, Curtis D, Stradford L, Venkatachalam S, Tundia N, Patel PA. A Real-World Effectiveness Study Using a Mobile Application to Evaluate Early Outcomes with Upadacitinib in Rheumatoid Arthritis. Rheumatol Ther 2023; 10:1519-1533. [PMID: 37728861 PMCID: PMC10654297 DOI: 10.1007/s40744-023-00594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION The impact of upadacitinib on rheumatoid arthritis (RA) symptoms was evaluated during the first 12 weeks of treatment via patient-reported outcomes (PROs) using a mobile health application (app). METHODS Participating rheumatologists from the CorEvitas RA Registry (prospective, observational cohort) recruited patients with RA initiating upadacitinib treatment. A modified version of the ArthritisPower® app was used to collect PROs, including the Routine Assessment of Patient Index Data 3 (RAPID3), duration of morning joint stiffness, and the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue 7a Short Form at baseline and weeks 1-4, 8, and 12. RAPID3 responses over time were assessed using Kaplan-Meier estimation to determine the proportion of patients achieving disease activity improvement and minimal clinically important difference (MCID). Results were analyzed for all patients initiating upadacitinib and a subsample of TNF inhibitor (TNFi)-experienced patients with moderate to severe disease at baseline. RESULTS A total of 103 patients with RA initiating upadacitinib (62.1% TNFi-experienced) were included. At week 12, 53 patients (51.4%) completed the study and provided PRO data via the app. Among all patients, improvements in RAPID3, pain, morning stiffness, and fatigue were observed at week 1 and were maintained or further improved through week 12. At week 12, 37.5% of patients achieved RAPID3 low disease activity. Starting at week 1, improvements in RAPID3 disease activity category (19.4% of patients) and achievement of MCID (16.3%) were reported, with nearly 50% of patients achieving these outcomes by week 4 (RAPID3 category: 48.8%; MCID: 49.2%) and 60% by week 12 (RAPID3 category: 59.6%; MCID: 59.8%). TNFi-experienced patients generally reported similar outcomes. Patient-reported medication convenience and compliance were generally high. CONCLUSIONS In this real-world cohort of patients with RA, treatment with upadacitinib was associated with early and significant improvement in RAPID3, pain, morning stiffness, and fatigue regardless of prior TNFi experience. Clinically meaningful improvement in RAPID3 patient-reported disease activity was observed as early as week 1, with continued improvement reported through week 12.
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Affiliation(s)
- Leslie R Harrold
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA.
- University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | | | - Amy Schrader
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA
| | - Paul R Lakin
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA
| | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, NY, USA
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Hirten RP, Danieletto M, Landell K, Zweig M, Golden E, Orlov G, Rodrigues J, Alleva E, Ensari I, Bottinger E, Nadkarni GN, Fuchs TJ, Fayad ZA. Development of the ehive Digital Health App: Protocol for a Centralized Research Platform. JMIR Res Protoc 2023; 12:e49204. [PMID: 37971801 PMCID: PMC10690532 DOI: 10.2196/49204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The increasing use of smartphones, wearables, and connected devices has enabled the increasing application of digital technologies for research. Remote digital study platforms comprise a patient-interfacing digital application that enables multimodal data collection from a mobile app and connected sources. They offer an opportunity to recruit at scale, acquire data longitudinally at a high frequency, and engage study participants at any time of the day in any place. Few published descriptions of centralized digital research platforms provide a framework for their development. OBJECTIVE This study aims to serve as a road map for those seeking to develop a centralized digital research platform. We describe the technical and functional aspects of the ehive app, the centralized digital research platform of the Hasso Plattner Institute for Digital Health at Mount Sinai Hospital, New York, New York. We then provide information about ongoing studies hosted on ehive, including usership statistics and data infrastructure. Finally, we discuss our experience with ehive in the broader context of the current landscape of digital health research platforms. METHODS The ehive app is a multifaceted and patient-facing central digital research platform that permits the collection of e-consent for digital health studies. An overview of its development, its e-consent process, and the tools it uses for participant recruitment and retention are provided. Data integration with the platform and the infrastructure supporting its operations are discussed; furthermore, a description of its participant- and researcher-facing dashboard interfaces and the e-consent architecture is provided. RESULTS The ehive platform was launched in 2020 and has successfully hosted 8 studies, namely 6 observational studies and 2 clinical trials. Approximately 1484 participants downloaded the app across 36 states in the United States. The use of recruitment methods such as bulk messaging through the EPIC electronic health records and standard email portals enables broad recruitment. Light-touch engagement methods, used in an automated fashion through the platform, maintain high degrees of engagement and retention. The ehive platform demonstrates the successful deployment of a central digital research platform that can be modified across study designs. CONCLUSIONS Centralized digital research platforms such as ehive provide a novel tool that allows investigators to expand their research beyond their institution, engage in large-scale longitudinal studies, and combine multimodal data streams. The ehive platform serves as a model for groups seeking to develop similar digital health research programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49204.
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Affiliation(s)
- Robert P Hirten
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matteo Danieletto
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kyle Landell
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Micol Zweig
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eddye Golden
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Georgy Orlov
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jovita Rodrigues
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eugenia Alleva
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
| | - Ipek Ensari
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erwin Bottinger
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Girish N Nadkarni
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas J Fuchs
- Hasso Plattner Institute for Digital Health at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Perumal TM, Wolf D, Berchtold D, Pointeau G, Zhang YP, Cheng WY, Lipsmeier F, Sprengel J, Czech C, Chiriboga CA, Lindemann M. Digital measures of respiratory and upper limb function in spinal muscular atrophy: design, feasibility, reliability, and preliminary validity of a smartphone sensor-based assessment suite. Neuromuscul Disord 2023; 33:845-855. [PMID: 37722988 DOI: 10.1016/j.nmd.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 09/20/2023]
Abstract
Spinal muscular atrophy (SMA) is characterized by progressive muscle weakness and paralysis. Motor function is monitored in the clinical setting using assessments including the 32-item Motor Function Measure (MFM-32), but changes in disease severity between clinical visits may be missed. Digital health technologies may assist evaluation of disease severity by bridging gaps between clinical visits. We developed a smartphone sensor-based assessment suite, comprising nine tasks, to assess motor and muscle function in people with SMA. We used data from the risdiplam phase 2 JEWELFISH trial to assess the test-retest reliability and convergent validity of each task. In the first 6 weeks, 116 eligible participants completed assessments on a median of 6.3 days per week. Eight of the nine tasks demonstrated good or excellent test-retest reliability (intraclass correlation coefficients >0.75 and >0.9, respectively). Seven tasks showed a significant association (P < 0.05) with related clinical measures of motor function (individual items from the MFM-32 or Revised Upper Limb Module scales) and seven showed significant association (P < 0.05) with disease severity measured using the MFM-32 total score. This cross-sectional study supports the feasibility, reliability, and validity of using smartphone-based digital assessments to measure function in people living with SMA.
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Affiliation(s)
- Thanneer Malai Perumal
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland.
| | - Detlef Wolf
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Doris Berchtold
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Grégoire Pointeau
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Yan-Ping Zhang
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Wei-Yi Cheng
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Florian Lipsmeier
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Jörg Sprengel
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Christian Czech
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
| | | | - Michael Lindemann
- F. Hoffmann-La Roche Ltd, Roche Innovation Center Basel, Grenzacherstrasse 124, Basel 4070, Switzerland
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11
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Dang T, Spathis D, Ghosh A, Mascolo C. Human-centred artificial intelligence for mobile health sensing: challenges and opportunities. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230806. [PMID: 38026044 PMCID: PMC10646451 DOI: 10.1098/rsos.230806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
Abstract
Advances in wearable sensing and mobile computing have enabled the collection of health and well-being data outside of traditional laboratory and hospital settings, paving the way for a new era of mobile health. Meanwhile, artificial intelligence (AI) has made significant strides in various domains, demonstrating its potential to revolutionize healthcare. Devices can now diagnose diseases, predict heart irregularities and unlock the full potential of human cognition. However, the application of machine learning (ML) to mobile health sensing poses unique challenges due to noisy sensor measurements, high-dimensional data, sparse and irregular time series, heterogeneity in data, privacy concerns and resource constraints. Despite the recognition of the value of mobile sensing, leveraging these datasets has lagged behind other areas of ML. Furthermore, obtaining quality annotations and ground truth for such data is often expensive or impractical. While recent large-scale longitudinal studies have shown promise in leveraging wearable sensor data for health monitoring and prediction, they also introduce new challenges for data modelling. This paper explores the challenges and opportunities of human-centred AI for mobile health, focusing on key sensing modalities such as audio, location and activity tracking. We discuss the limitations of current approaches and propose potential solutions.
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Affiliation(s)
- Ting Dang
- University of Cambridge, Cambridge, UK
- Nokia Bell Labs, Cambridge, UK
| | - Dimitris Spathis
- University of Cambridge, Cambridge, UK
- Nokia Bell Labs, Cambridge, UK
| | - Abhirup Ghosh
- University of Cambridge, Cambridge, UK
- University of Birmingham, Birmingham, UK
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12
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Callahan A, Ashley E, Datta S, Desai P, Ferris TA, Fries JA, Halaas M, Langlotz CP, Mackey S, Posada JD, Pfeffer MA, Shah NH. The Stanford Medicine data science ecosystem for clinical and translational research. JAMIA Open 2023; 6:ooad054. [PMID: 37545984 PMCID: PMC10397535 DOI: 10.1093/jamiaopen/ooad054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To describe the infrastructure, tools, and services developed at Stanford Medicine to maintain its data science ecosystem and research patient data repository for clinical and translational research. Materials and Methods The data science ecosystem, dubbed the Stanford Data Science Resources (SDSR), includes infrastructure and tools to create, search, retrieve, and analyze patient data, as well as services for data deidentification, linkage, and processing to extract high-value information from healthcare IT systems. Data are made available via self-service and concierge access, on HIPAA compliant secure computing infrastructure supported by in-depth user training. Results The Stanford Medicine Research Data Repository (STARR) functions as the SDSR data integration point, and includes electronic medical records, clinical images, text, bedside monitoring data and HL7 messages. SDSR tools include tools for electronic phenotyping, cohort building, and a search engine for patient timelines. The SDSR supports patient data collection, reproducible research, and teaching using healthcare data, and facilitates industry collaborations and large-scale observational studies. Discussion Research patient data repositories and their underlying data science infrastructure are essential to realizing a learning health system and advancing the mission of academic medical centers. Challenges to maintaining the SDSR include ensuring sufficient financial support while providing researchers and clinicians with maximal access to data and digital infrastructure, balancing tool development with user training, and supporting the diverse needs of users. Conclusion Our experience maintaining the SDSR offers a case study for academic medical centers developing data science and research informatics infrastructure.
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Affiliation(s)
- Alison Callahan
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Euan Ashley
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
- Department of Genetics, School of Medicine, Stanford University, Stanford, California, USA
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, USA
| | - Somalee Datta
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Priyamvada Desai
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Todd A Ferris
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Jason A Fries
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Michael Halaas
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Curtis P Langlotz
- Department of Radiology, School of Medicine, Stanford University, Stanford, California, USA
| | - Sean Mackey
- Department of Anesthesia, School of Medicine, Stanford University, Stanford, California, USA
| | - José D Posada
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Michael A Pfeffer
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, USA
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13
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Javed A, Kim DS, Hershman SG, Shcherbina A, Johnson A, Tolas A, O’Sullivan JW, McConnell MV, Lazzeroni L, King AC, Christle JW, Oppezzo M, Mattsson CM, Harrington RA, Wheeler MT, Ashley EA. Personalized digital behaviour interventions increase short-term physical activity: a randomized control crossover trial substudy of the MyHeart Counts Cardiovascular Health Study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:411-419. [PMID: 37794870 PMCID: PMC10545510 DOI: 10.1093/ehjdh/ztad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Indexed: 10/06/2023]
Abstract
Aims Physical activity is associated with decreased incidence of the chronic diseases associated with aging. We previously demonstrated that digital interventions delivered through a smartphone app can increase short-term physical activity. Methods and results We offered enrolment to community-living iPhone-using adults aged ≥18 years in the USA, UK, and Hong Kong who downloaded the MyHeart Counts app. After completion of a 1-week baseline period, e-consented participants were randomized to four 7-day interventions. Interventions consisted of: (i) daily personalized e-coaching based on the individual's baseline activity patterns, (ii) daily prompts to complete 10 000 steps, (iii) hourly prompts to stand following inactivity, and (iv) daily instructions to read guidelines from the American Heart Association (AHA) website. After completion of one 7-day intervention, participants subsequently randomized to the next intervention of the crossover trial. The trial was completed in a free-living setting, where neither the participants nor investigators were blinded to the intervention. The primary outcome was change in mean daily step count from baseline for each of the four interventions, assessed in a modified intention-to-treat analysis (modified in that participants had to complete 7 days of baseline monitoring and at least 1 day of an intervention to be included in analyses). This trial is registered with ClinicalTrials.gov, NCT03090321. Conclusion Between 1 January 2017 and 1 April 2022, 4500 participants consented to enrol in the trial (a subset of the approximately 50 000 participants in the larger MyHeart Counts study), of whom 2458 completed 7 days of baseline monitoring (mean daily steps 4232 ± 73) and at least 1 day of one of the four interventions. Personalized e-coaching prompts, tailored to an individual based on their baseline activity, increased step count significantly (+402 ± 71 steps from baseline, P = 7.1⨯10-8). Hourly stand prompts (+292 steps from baseline, P = 0.00029) and a daily prompt to read AHA guidelines (+215 steps from baseline, P = 0.021) were significantly associated with increased mean daily step count, while a daily reminder to complete 10 000 steps was not (+170 steps from baseline, P = 0.11). Digital studies have a significant advantage over traditional clinical trials in that they can continuously recruit participants in a cost-effective manner, allowing for new insights provided by increased statistical power and refinement of prior signals. Here, we present a novel finding that digital interventions tailored to an individual are effective in increasing short-term physical activity in a free-living cohort. These data suggest that participants are more likely to react positively and increase their physical activity when prompts are personalized. Further studies are needed to determine the effects of digital interventions on long-term outcomes.
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Affiliation(s)
- Ali Javed
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daniel Seung Kim
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Steven G Hershman
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Biofourmis, Boston, MA, USA
| | - Anna Shcherbina
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Anders Johnson
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alexander Tolas
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jack W O’Sullivan
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- identifeye HEALTH, Redwood City, CA, USA
| | - Laura Lazzeroni
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Abby C King
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marily Oppezzo
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - C Mikael Mattsson
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert A Harrington
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
| | - Euan A Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
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14
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Liu P, Wang Z, Liu N, Peres MA. A scoping review of the clinical application of machine learning in data-driven population segmentation analysis. J Am Med Inform Assoc 2023; 30:1573-1582. [PMID: 37369006 PMCID: PMC10436153 DOI: 10.1093/jamia/ocad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Data-driven population segmentation is commonly used in clinical settings to separate the heterogeneous population into multiple relatively homogenous groups with similar healthcare features. In recent years, machine learning (ML) based segmentation algorithms have garnered interest for their potential to speed up and improve algorithm development across many phenotypes and healthcare situations. This study evaluates ML-based segmentation with respect to (1) the populations applied, (2) the segmentation details, and (3) the outcome evaluations. MATERIALS AND METHODS MEDLINE, Embase, Web of Science, and Scopus were used following the PRISMA-ScR criteria. Peer-reviewed studies in the English language that used data-driven population segmentation analysis on structured data from January 2000 to October 2022 were included. RESULTS We identified 6077 articles and included 79 for the final analysis. Data-driven population segmentation analysis was employed in various clinical settings. K-means clustering is the most prevalent unsupervised ML paradigm. The most common settings were healthcare institutions. The most common targeted population was the general population. DISCUSSION Although all the studies did internal validation, only 11 papers (13.9%) did external validation, and 23 papers (29.1%) conducted methods comparison. The existing papers discussed little validating the robustness of ML modeling. CONCLUSION Existing ML applications on population segmentation need more evaluations regarding giving tailored, efficient integrated healthcare solutions compared to traditional segmentation analysis. Future ML applications in the field should emphasize methods' comparisons and external validation and investigate approaches to evaluate individual consistency using different methods.
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Affiliation(s)
- Pinyan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Ziwen Wang
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Marco Aurélio Peres
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
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15
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Wang X, Pathiravasan CH, Zhang Y, Trinquart L, Borrelli B, Spartano NL, Lin H, Nowak C, Kheterpal V, Benjamin EJ, McManus DD, Murabito JM, Liu C. Association of Depressive Symptom Trajectory With Physical Activity Collected by mHealth Devices in the Electronic Framingham Heart Study: Cohort Study. JMIR Ment Health 2023; 10:e44529. [PMID: 37450333 PMCID: PMC10382951 DOI: 10.2196/44529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Few studies have examined the association between depressive symptom trajectories and physical activity collected by mobile health (mHealth) devices. OBJECTIVE We aimed to investigate if antecedent depressive symptom trajectories predict subsequent physical activity among participants in the electronic Framingham Heart Study (eFHS). METHODS We performed group-based multi-trajectory modeling to construct depressive symptom trajectory groups using both depressive symptoms (Center for Epidemiological Studies-Depression [CES-D] scores) and antidepressant medication use in eFHS participants who attended 3 Framingham Heart Study research exams over 14 years. At the third exam, eFHS participants were instructed to use a smartphone app for submitting physical activity index (PAI) surveys. In addition, they were provided with a study smartwatch to track their daily step counts. We performed linear mixed models to examine the association between depressive symptom trajectories and physical activity including app-based PAI and smartwatch-collected step counts over a 1-year follow-up adjusting for age, sex, wear hour, BMI, smoking status, and other health variables. RESULTS We identified 3 depressive symptom trajectory groups from 722 eFHS participants (mean age 53, SD 8.5 years; n=432, 60% women). The low symptom group (n=570; mean follow-up 287, SD 109 days) consisted of participants with consistently low CES-D scores, and a small proportion reported antidepressant use. The moderate symptom group (n=71; mean follow-up 280, SD 118 days) included participants with intermediate CES-D scores, who showed the highest and increasing likelihood of reporting antidepressant use across 3 exams. The high symptom group (n=81; mean follow-up 252, SD 116 days) comprised participants with the highest CES-D scores, and the proportion of antidepressant use fell between the other 2 groups. Compared to the low symptom group, the high symptom group had decreased PAI (mean difference -1.09, 95% CI -2.16 to -0.01) and the moderate symptom group walked fewer daily steps (823 fewer, 95% CI -1421 to -226) during the 1-year follow-up. CONCLUSIONS Antecedent depressive symptoms or antidepressant medication use was associated with lower subsequent physical activity collected by mHealth devices in eFHS. Future investigation of interventions to improve mood including via mHealth technologies to help promote people's daily physical activity is needed.
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Affiliation(s)
- Xuzhi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | | | - Yuankai Zhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, United States
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
| | - Belinda Borrelli
- Center for Behavioral Science Research, Boston University Henry M Goldman School of Dental Medicine, Boston, MA, United States
| | - Nicole L Spartano
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | | | | | - Emelia J Benjamin
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - David D McManus
- Cardiology Division, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Joanne M Murabito
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, United States
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
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16
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Pugmire J, Wilkes M, Wolfberg A, Zahradka N. Healthcare provider experiences of deploying a continuous remote patient monitoring pilot program during the COVID-19 pandemic: a structured qualitative analysis. Front Digit Health 2023; 5:1157643. [PMID: 37483317 PMCID: PMC10359814 DOI: 10.3389/fdgth.2023.1157643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To describe the healthcare provider (HCP) experience of launching a COVID-19 remote patient monitoring (CRPM) program during the global COVID-19 pandemic. Methods We conducted qualitative, semi-structured interviews with eight HCPs involved in deploying the CRPM pilot program in the Military Health System (MHS) from June to December 2020. Interviews were audio recorded, transcribed, and analyzed thematically using an inductive approach. We then deductively mapped themes from interviews to the updated Consolidated Framework for Implementation Research (CFIR). Results We identified the following main themes mapped to CFIR domains listed in parentheses: external and internal environments (outer and inner settings), processes around implementation (implementation process domain), the right people (individuals domain), and program characteristics (innovation domain). Participants believed that buy-in from leadership and HCPs was critical for successful program implementation. HCP participants showed qualities of clinical champions and believed in the CRPM program. Conclusion The MHS deployed a successful remote patient monitoring pilot program during the global COVID-19 pandemic. HCPs found the CRPM program and the technology enabling the program to be acceptable, feasible, and usable. HCP participants exhibited characteristics of clinical champions. Leadership engagement was the most often-cited key factor for successful program implementation.
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Affiliation(s)
- Juliana Pugmire
- Clinical Research, Current Health Ltd., Edinburgh, United Kingdom
| | - Matt Wilkes
- Clinical Research, Current Health Ltd., Edinburgh, United Kingdom
| | - Adam Wolfberg
- Clinical Research, Current Health Inc., Boston, MA, United States
| | - Nicole Zahradka
- Clinical Research, Current Health Inc., Boston, MA, United States
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Khan MS, Usman MS, Talha KM, Van Spall HGC, Greene SJ, Vaduganathan M, Khan SS, Mills NL, Ali ZA, Mentz RJ, Fonarow GC, Rao SV, Spertus JA, Roe MT, Anker SD, James SK, Butler J, McGuire DK. Leveraging electronic health records to streamline the conduct of cardiovascular clinical trials. Eur Heart J 2023; 44:1890-1909. [PMID: 37098746 DOI: 10.1093/eurheartj/ehad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 02/05/2023] [Accepted: 03/07/2023] [Indexed: 04/27/2023] Open
Abstract
Conventional randomized controlled trials (RCTs) can be expensive, time intensive, and complex to conduct. Trial recruitment, participation, and data collection can burden participants and research personnel. In the past two decades, there have been rapid technological advances and an exponential growth in digitized healthcare data. Embedding RCTs, including cardiovascular outcome trials, into electronic health record systems or registries may streamline screening, consent, randomization, follow-up visits, and outcome adjudication. Moreover, wearable sensors (i.e. health and fitness trackers) provide an opportunity to collect data on cardiovascular health and risk factors in unprecedented detail and scale, while growing internet connectivity supports the collection of patient-reported outcomes. There is a pressing need to develop robust mechanisms that facilitate data capture from diverse databases and guidance to standardize data definitions. Importantly, the data collection infrastructure should be reusable to support multiple cardiovascular RCTs over time. Systems, processes, and policies will need to have sufficient flexibility to allow interoperability between different sources of data acquisition. Clinical research guidelines, ethics oversight, and regulatory requirements also need to evolve. This review highlights recent progress towards the use of routinely generated data to conduct RCTs and discusses potential solutions for ongoing barriers. There is a particular focus on methods to utilize routinely generated data for trials while complying with regional data protection laws. The discussion is supported with examples of cardiovascular outcome trials that have successfully leveraged the electronic health record, web-enabled devices or administrative databases to conduct randomized trials.
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Affiliation(s)
- Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Rd., Durham, NC 27705, USA
| | - Muhammad Shariq Usman
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Rd., Durham, NC 27705, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ziad A Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital and Heart Center, Roslyn, NY, USA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Rd., Durham, NC 27705, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sunil V Rao
- Division of Cardiology, New York University Langone Health System, New York, NY, USA
| | - John A Spertus
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- Kansas City's Healthcare Institute for Innovations in Quality, University of Missouri, Kansas, MO, USA
| | - Matthew T Roe
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Rd., Durham, NC 27705, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Stefan K James
- Department of Medical Sciences, Scientific Director UCR, Uppsala University, Uppsala, Uppland, Sweden
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA
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Hicks JL, Boswell MA, Althoff T, Crum AJ, Ku JP, Landay JA, Moya PML, Murnane EL, Snyder MP, King AC, Delp SL. Leveraging Mobile Technology for Public Health Promotion: A Multidisciplinary Perspective. Annu Rev Public Health 2023; 44:131-150. [PMID: 36542772 PMCID: PMC10523351 DOI: 10.1146/annurev-publhealth-060220-041643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Health behaviors are inextricably linked to health and well-being, yet issues such as physical inactivity and insufficient sleep remain significant global public health problems. Mobile technology-and the unprecedented scope and quantity of data it generates-has a promising but largely untapped potential to promote health behaviors at the individual and population levels. This perspective article provides multidisciplinary recommendations on the design and use of mobile technology, and the concomitant wealth of data, to promote behaviors that support overall health. Using physical activity as anexemplar health behavior, we review emerging strategies for health behavior change interventions. We describe progress on personalizing interventions to an individual and their social, cultural, and built environments, as well as on evaluating relationships between mobile technology data and health to establish evidence-based guidelines. In reviewing these strategies and highlighting directions for future research, we advance the use of theory-based, personalized, and human-centered approaches in promoting health behaviors.
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Affiliation(s)
- Jennifer L Hicks
- Department of Bioengineering, Stanford University, Stanford, California, USA;
| | - Melissa A Boswell
- Department of Bioengineering, Stanford University, Stanford, California, USA;
| | - Tim Althoff
- Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington, USA
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Joy P Ku
- Department of Bioengineering, Stanford University, Stanford, California, USA;
| | - James A Landay
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Paula M L Moya
- Department of English and the Center for Comparative Studies in Race and Ethnicity, Stanford University, Stanford, California, USA
| | | | - Michael P Snyder
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Abby C King
- Department of Epidemiology and Population Health, and Department of Medicine (Stanford Prevention Research Center), Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Scott L Delp
- Department of Bioengineering and Department of Mechanical Engineering, Stanford University, Stanford, California, USA
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Xiao T, Dong X, Lu Y, Zhou W. High-Resolution and Multidimensional Phenotypes Can Complement Genomics Data to Diagnose Diseases in the Neonatal Population. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:204-215. [PMID: 37197647 PMCID: PMC10110825 DOI: 10.1007/s43657-022-00071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 05/19/2023]
Abstract
Advances in genomic medicine have greatly improved our understanding of human diseases. However, phenome is not well understood. High-resolution and multidimensional phenotypes have shed light on the mechanisms underlying neonatal diseases in greater details and have the potential to optimize clinical strategies. In this review, we first highlight the value of analyzing traditional phenotypes using a data science approach in the neonatal population. We then discuss recent research on high-resolution, multidimensional, and structured phenotypes in neonatal critical diseases. Finally, we briefly introduce current technologies available for the analysis of multidimensional data and the value that can be provided by integrating these data into clinical practice. In summary, a time series of multidimensional phenome can improve our understanding of disease mechanisms and diagnostic decision-making, stratify patients, and provide clinicians with optimized strategies for therapeutic intervention; however, the available technologies for collecting multidimensional data and the best platform for connecting multiple modalities should be considered.
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Affiliation(s)
- Tiantian Xiao
- Division of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, 399 Wanyuan Road, Shanghai, 201102 China
- Department of Neonatology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000 China
| | - Xinran Dong
- Center for Molecular Medicine, Pediatric Research Institute, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102 China
| | - Yulan Lu
- Center for Molecular Medicine, Pediatric Research Institute, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102 China
| | - Wenhao Zhou
- Division of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, 399 Wanyuan Road, Shanghai, 201102 China
- Center for Molecular Medicine, Pediatric Research Institute, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102 China
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20
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Standardised Practice-Based Oral Health Data Collection: A Pilot Study in Different Countries. Int Dent J 2023:S0020-6539(23)00040-0. [PMID: 36925392 DOI: 10.1016/j.identj.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The Oral Health Observatory (OHO), launched in 2014 by FDI World Dental Federation, aims to provide a coordinated approach to international oral health data collection. A feasibility project involving 12 countries tested the implementation of the methodology and data collection tools and assessed data quality from 6 countries. METHODS National dental associations (NDAs) recruited dentists following a standardised sampling method. Dentists and patients completed paired questionnaires (N = 7907) about patients' demographics, dental attendance, oral health-related behaviours, oral impacts, and clinical measures using a mobile app. In addition, participating dentists (n = 93) completed an evaluation survey, and NDAs completed a survey and participated in workshops to assess implementation feasibility. RESULTS Feasibility data are presented from the 12 participating countries. In addition, the 6 countries most advanced with data collection as of July 2020 (China, Colombia, India, Italy, Japan, and Lebanon) were included in the assessment of data quality and qualitative evaluation of implementation feasibility. All NDAs in these 6 countries reported interest in collecting standardised, international data for policy and communication activities and to understand service use and needs. Eighty-two percent of dentists (n = 76) reported a patient response rate of between 80% and 100%. More than 70% (n = 71) of dentists were either satisfied or very satisfied with the patient recruitment and data collection methods. There were variations in patient oral health and behaviours across countries, such as self-reporting twice-daily brushing which ranged from 45% in India to 83% in Colombia. CONCLUSIONS OHO provides a feasible model for collecting international standardised data in dental practices. Reducing time implications, ensuring mobile app reliability, and allowing practitioners to access patient-reported outcomes to inform practice may enhance implementation.
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21
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Trinquart L, Liu C, McManus DD, Nowak C, Lin H, Spartano NL, Borrelli B, Benjamin EJ, Murabito JM. Increasing Engagement in the Electronic Framingham Heart Study: Factorial Randomized Controlled Trial. J Med Internet Res 2023; 25:e40784. [PMID: 36662544 PMCID: PMC9898831 DOI: 10.2196/40784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/02/2022] [Accepted: 12/01/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Smartphone apps and mobile health devices offer innovative ways to collect longitudinal cardiovascular data. Randomized evidence regarding effective strategies to maintain longitudinal engagement is limited. OBJECTIVE This study aimed to evaluate smartphone messaging interventions on remote transmission of blood pressure (BP) and heart rate (HR) data. METHODS We conducted a 2 × 2 × 2 factorial blinded randomized trial with randomization implemented centrally to ensure allocation concealment. We invited participants from the Electronic Framingham Heart Study (eFHS), an e-cohort embedded in the FHS, and asked participants to measure their BP (Withings digital cuff) weekly and wear their smartwatch daily. We assessed 3 weekly notification strategies to promote adherence: personalized versus standard; weekend versus weekday; and morning versus evening. Personalized notifications included the participant's name and were tailored to whether or not data from the prior week were transmitted to the research team. Intervention notification messages were delivered weekly automatically via the eFHS app. We assessed if participants transmitted at least one BP or HR measurement within 7 days of each notification after randomization. Outcomes were adherence to BP and HR transmission at 3 months (primary) and 6 months (secondary). RESULTS Of the 791 FHS participants, 655 (82.8%) were eligible and randomized (mean age 53, SD 9 years; 392/655, 59.8% women; 596/655, 91% White). For the personalized versus standard notifications, 38.9% (126/324) versus 28.8% (94/327) participants sent BP data at 3 months (difference=10.1%, 95% CI 2.9%-17.4%; P=.006), but no significant differences were observed for HR data transmission (212/324, 65.4% vs 209/327, 63.9%; P=.69). Personalized notifications were associated with increased BP and HR data transmission versus standard at 6 months (BP: 107/291, 36.8% vs 66/295, 22.4%; difference=14.4%, 95% CI 7.1- 21.7%; P<.001; HR: 186/281, 66.2% vs 158/281, 56.2%; difference=10%, 95% CI 2%-18%; P=.02). For BP and HR primary or secondary outcomes, there was no evidence of differences in data transmission for notifications sent on weekend versus weekday or morning versus evening. CONCLUSIONS Personalized notifications increased longitudinal adherence to BP and HR transmission from mobile and digital devices among eFHS participants. Our results suggest that personalized messaging is a powerful tool to promote adherence to mobile health systems in cardiovascular research. TRIAL REGISTRATION ClinicalTrials.gov NCT03516019; https://clinicaltrials.gov/ct2/show/NCT03516019.
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Affiliation(s)
- Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, United States
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Cardiology Division, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | | | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nicole L Spartano
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, United States
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Belinda Borrelli
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Henry M Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Emelia J Benjamin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Joanne M Murabito
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, United States
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Framingham, MA, United States
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22
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Daniore P, Nittas V, Gille F, von Wyl V. Promoting participation in remote digital health studies: An expert interview study. Digit Health 2023; 9:20552076231212063. [PMID: 38025101 PMCID: PMC10644759 DOI: 10.1177/20552076231212063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Remote digital health studies are on the rise and promise to reduce the operational inefficiencies of in-person research. However, they encounter specific challenges in maintaining participation (enrollment and retention) due to their exclusive reliance on technology across all study phases. Objective The goal of this study was to collect experts' opinions on how to facilitate participation in remote digital health studies. Method We conducted 13 semi-structured interviews with principal investigators, researchers, and software developers who had recent experiences with remote digital health studies. Informed by the Unified Theory of Acceptance and Use of Technology (UTAUT) framework, we performed a thematic analysis and mapped various approaches to successful study participation. Results Our analyses revealed four themes: (1) study planning to increase participation, where experts suggest that remote digital health studies should be planned based on adequate knowledge of what motivates, engages, and disengages a target population; (2) participant enrollment, highlighting that enrollment strategies should be selected carefully, attached to adequate support, and focused on inclusivity; (3) participant retention, with strategies that minimize the effort and complexity of study tasks and ensure that technology is adapted and responsive to participant needs, and (4) requirements for study planning focused on the development of relevant guidelines to foster participation in future studies. Conclusions Our findings highlight the significant requirements for seamless technology and researcher involvement in enabling high remote digital health study participation. Future studies can benefit from collected experiences and the development of guidelines to inform planning that balances participant and scientific requirements.
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Affiliation(s)
- Paola Daniore
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
| | - Vasileios Nittas
- Department of Behavioral and Social Sciences, Brown University, Providence, USA
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Felix Gille
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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23
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Factors associated with long-term use of digital devices in the electronic Framingham Heart Study. NPJ Digit Med 2022; 5:195. [PMID: 36572707 PMCID: PMC9792462 DOI: 10.1038/s41746-022-00735-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
Long-term use of digital devices is critical for successful clinical or research use, but digital health studies are challenged by a rapid drop-off in participation. A nested e-cohort (eFHS) is embedded in the Framingham Heart Study and uses three system components: a new smartphone app, a digital blood pressure (BP) cuff, and a smartwatch. This study aims to identify factors associated with the use of individual eFHS system components over 1-year. Among 1948 eFHS enrollees, we examine participants who returned surveys within 90 days (n = 1918), and those who chose to use the smartwatch (n = 1243) and BP cuff (n = 1115). For each component, we investigate the same set of candidate predictors for usage and use generalized linear mixed models to select predictors (P < 0.1, P value from Z test statistic), adjusting for age, sex, and time (app use: 3-month period, device use: weekly). A multivariable model with the predictors selected from initial testing is used to identify factors associated with use of components (P < 0.05, P value from Z test statistic) adjusting for age, sex, and time. In multivariable models, older age is associated with higher use of all system components. Female sex and higher education levels are associated with higher completion of app-based surveys whereas higher scores for depressive symptoms, and lower than excellent self-rated health are associated with lower use of the smartwatch over the 12-month follow-up. Our findings show that sociodemographic and health related factors are significantly associated with long-term use of digital devices. Future research is needed to test interventional strategies focusing on these factors to evaluate improvement in long-term engagement.
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24
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Minamimoto R, Yamada Y, Sugawara Y, Fujii M, Kotabe K, Iso K, Yokoyama H, Kurihara K, Iwasaki T, Horikawa D, Saito K, Kajiwara H, Matsunaga F. Variation in blood pressure and heart rate of radiological technologists in worktime tracked by a wearable device: A preliminary study. PLoS One 2022; 17:e0276483. [PMCID: PMC9671413 DOI: 10.1371/journal.pone.0276483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this preliminary study was to measure the systolic BP (SBP) and diastolic BP (DBP) and heart rate (HR) of radiological technologists by WD, and evaluate variation among individuals by worktime, day of the week, job, and workplace. Measurements were obtained using a wristwatch-type WD with optical measurement technology that can measure SBP and DBP every 10 minutes and HR every 30 minutes. SBP, DBP, and HR data obtained at baseline and during work time were combined with the hours of work, day of the week, job, and workplace recorded by the participants in 8 consecutive weeks. We calculated the mean, the ratio to baseline and coefficient of variation [CV(%)] for SBP, DBP, and HR. SBP, DBP, and HR values were significantly higher during work hours than at baseline (p<0.03). The ratio to baseline values ranged from 1.02 to 1.26 for SBP and from 1.07 to 1.30 for DBP. The ratio to baseline for SBP and DBP showed CV(%) of approximately 10% according to the day of the week and over the study period. For HR, ratio to baseline ranged from 0.95 to 1.29. The ratio of mean BP to baseline was >1.2 at the time of starting work, middle and after lunch, and at 14:00. The ratio to baseline of SBP were 1.2 or more for irradiation, equipment accuracy control, registration of patient data, dose verification and conference time, and were also working in CT examination room, treatment planning room, linac room, and the office. CV(%) of BP and HR were generally stable for all workplaces. WD measurements of SBP, DBP, and HR were higher during working hours than at baseline and varied by the individuals, work time, job, and workplace. This method may enable evaluation of unconscious workload in individuals.
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Affiliation(s)
- Ryogo Minamimoto
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | - Yui Yamada
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuharu Sugawara
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Megumi Fujii
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuki Kotabe
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kakeru Iso
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroki Yokoyama
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keiichi Kurihara
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tsubasa Iwasaki
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Horikawa
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kaori Saito
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hironori Kajiwara
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Futoshi Matsunaga
- Department of Radiology, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
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Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
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Bührmann L, Van Daele T, Rinn A, De Witte NAJ, Lehr D, Aardoom JJ, Loheide-Niesmann L, Smit J, Riper H. The feasibility of using Apple's ResearchKit for recruitment and data collection: Considerations for mental health research. Front Digit Health 2022; 4:978749. [PMID: 36386044 PMCID: PMC9663471 DOI: 10.3389/fdgth.2022.978749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
In 2015, Apple launched an open-source software framework called ResearchKit. ResearchKit provides an infrastructure for conducting remote, smartphone-based research trials through the means of Apple's App Store. Such trials may have several advantages over conventional trial methods including the removal of geographic barriers, frequent assessments of participants in real-life settings, and increased inclusion of seldom-heard communities. The aim of the current study was to explore the feasibility of participant recruitment and the potential for data collection in the non-clinical population in a smartphone-based trial using ResearchKit. As a case example, an app called eMovit, a behavioural activation (BA) app with the aim of helping users to build healthy habits was used. The study was conducted over a 9-month period. Any iPhone user with access to the App Stores of The Netherlands, Belgium, and Germany could download the app and participate in the study. During the study period, the eMovit app was disseminated amongst potential users via social media posts (Twitter, Facebook, LinkedIn), paid social media advertisements (Facebook), digital newsletters and newspaper articles, blogposts and other websites. In total, 1,788 individuals visited the eMovit landing page. A total of 144 visitors subsequently entered Apple's App Store through that landing page. The eMovit product page was viewed 10,327 times on the App Store. With 79 installs, eMovit showed a conversion rate of 0.76% from product view to install of the app. Of those 79 installs, 53 users indicated that they were interested to participate in the research study and 36 subsequently consented and completed the demographics and the participants quiz. Fifteen participants completed the first PHQ-8 assessment and one participant completed the second PHQ-8 assessment. We conclude that from a technological point of view, the means provided by ResearchKit are well suited to be integrated into the app process and thus facilitate conducting smartphone-based studies. However, this study shows that although participant recruitment is technically straightforward, only low recruitment rates were achieved with the dissemination strategies applied. We argue that smartphone-based trials (using ResearchKit) require a well-designed app dissemination process to attain a sufficient sample size. Guidelines for smartphone-based trial designs and recommendations on how to work with challenges of mHealth research will ensure the quality of these trials, facilitate researchers to do more testing of mental health apps and with that enlarge the evidence-base for mHealth.
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Affiliation(s)
- Leah Bührmann
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Location VUMC, Department Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Correspondence: Leah Bührmann
| | - Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Alina Rinn
- Department of Health Psychology and Applied Biological Psychology, Leuphana University, Lüneburg, Germany
| | - Nele A. J. De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Leuphana University, Lüneburg, Germany
| | - Jiska Joëlle Aardoom
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Lisa Loheide-Niesmann
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jan Smit
- Amsterdam UMC, Location VUMC, Department Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Location VUMC, Department Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Turku University of Medicine, Turku, Finland
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27
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Johnson A, Hershman SG, Javed A, Mattsson CM, Christle J, Oppezzo M, Ashley EA. Mobile Health Study Incorporating Novel Fitness Test. J Cardiovasc Transl Res 2022:10.1007/s12265-022-10317-x. [PMID: 36136239 DOI: 10.1007/s12265-022-10317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
Mobile health (mHealth) is a rapidly expanding field within precision medicine and precision health that provides healthcare support and interventions using mobile technologies, such as smartphones and smartwatches. The growing ubiquity of commercial wireless signals and smartphones allows mHealth technologies to have a substantially broader reach than traditional healthcare networks. My Fitness Counts, a cross-platform My Heart Counts spinout study, is a pioneer cross-platform mHealth study for measuring cardiovascular fitness levels. The study uses Real-World Insights, a platform designed to host mHealth studies. In this paper, we present insights gained through the quality control process undertaken prior to the release of the cross-platform mHealth study My Fitness Counts. Through extensive testing of the 21 iOS and 11 Android builds of the application, over 70 bugs were identified and corrected during the 5-month development process of My Fitness Counts.
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Affiliation(s)
- Anders Johnson
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, USA.
| | - Steven G Hershman
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, USA
| | - Ali Javed
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, USA
| | - C Mikael Mattsson
- Stanford University, Stanford, USA.,Silicon Valley Exercise Analytics Inc. (SVEXA), Menlo Park, CA, USA
| | - Jeffrey Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, USA
| | | | - Euan A Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, USA
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28
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Rodriguez E, Peer K, Fruh V, James K, Williams A, de Figueiredo Veiga A, Winter MR, Shea A, Aschengrau A, Lane KJ, Mahalingaiah S. Digital Global Recruitment for Women’s Health Research: Cross-sectional Study. JMIR Form Res 2022; 6:e39046. [PMID: 35969168 PMCID: PMC9520381 DOI: 10.2196/39046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background
With the increased popularity of mobile menstrual tracking apps and boosted Facebook posts, there is a unique opportunity to recruit research study participants from across the globe via these modalities to evaluate women’s health. However, no studies to date have assessed the feasibility of using these recruitment sources for epidemiological research on ovulation and menstruation.
Objective
The objective of this study was to assess the feasibility of recruiting a diverse sample of women to an epidemiological study of ovulation and menstruation (OM) health (OM Global Health Study) using digital recruitment sources. The feasibility and diversity were assessed via click and participation rates, geographic location, BMI, smoking status, and other demographic information.
Methods
Participants were actively recruited via in-app messages using the menstrual tracking app Clue (BioWink GmbH) and a boosted Facebook post by DivaCup (Diva International Inc.). Other passive recruitment methods also took place throughout the recruitment period (eg, email communications, blogs, other social media). The proportion of participants who visited the study website after viewing and clicking the hypertext link (click rates) in the in-app messages and boosted Facebook post and the proportion of participants who completed the surveys per the number of completed consent and eligibility screeners (participation rates) were used to quantify the success of recruiting participants to the study website and study survey completion, respectively. Survey completion was defined as finishing the pregnancy and birth history section of the OM Global Health Study questionnaire.
Results
The recruitment period was from February 27, 2018, through January 24, 2020. In-app messages and the boosted Facebook post were seen by 104,000 and 21,400 people, respectively. Overall, 215 participants started the OM Global Health Study survey, of which 140 (65.1%), 39 (18.1%), and 36 (16.8%) participants were recruited via the app, the boosted Facebook post, and other passive recruitment methods, respectively. The click rate via the app was 18.9% (19,700 clicks/104,000 ad views) and 1.6% via the boosted Facebook post (340 clicks/21,400 ad views.) The overall participation rate was 44.6% (198/444), and the average participant age was 21.8 (SD 6.1) years. In terms of geographic and racial/ethnic diversity, 91 (44.2%) of the participants resided outside the United States and 147 (70.7%) identified as non-Hispanic White. In-app recruitment produced the most geographically diverse stream, with 44 (32.8%) of the 134 participants in Europe, 77 (57.5%) in North America, and 13 (9.8%) in other parts of the world. Both human error and nonhuman procedural breakdowns occurred during the recruitment process, including a computer programming error related to age eligibility and a hacking attempt by an internet bot.
Conclusions
In-app messages using the menstrual tracking app Clue were the most successful method for recruiting participants from many geographic regions and producing the greatest numbers of started and completed surveys. This study demonstrates the utility of digital recruitment to enroll participants from diverse geographic locations and provides some lessons to avoid technical recruitment errors in future digital recruitment strategies for epidemiological research.
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Affiliation(s)
- Erika Rodriguez
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Komal Peer
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Victoria Fruh
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Kaitlyn James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Anna Williams
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | | | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, United States
| | | | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
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29
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Wearables in Cardiovascular Disease. J Cardiovasc Transl Res 2022:10.1007/s12265-022-10314-0. [PMID: 36085432 DOI: 10.1007/s12265-022-10314-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Wearable devices stand to revolutionize the way healthcare is delivered. From consumer devices that provide general health information and screen for medical conditions to medical-grade devices that allow collection of larger datasets that include multiple modalities, wearables have a myriad of potential uses, especially in cardiovascular disorders. In this review, we summarize the underlying technologies employed in these devices and discuss the regulatory and economic aspects of such devices as well as the future implications of their use.
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30
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Chaibub Neto E, Perumal TM, Pratap A, Tediarjo A, Bot BM, Mangravite L, Omberg L. Disentangling personalized treatment effects from “time-of-the-day” confounding in mobile health studies. PLoS One 2022; 17:e0271766. [PMID: 35925980 PMCID: PMC9352058 DOI: 10.1371/journal.pone.0271766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Ideally, a patient’s response to medication can be monitored by measuring changes in performance of some activity. In observational studies, however, any detected association between treatment (“on-medication” vs “off-medication”) and the outcome (performance in the activity) might be due to confounders. In particular, causal inferences at the personalized level are especially vulnerable to confounding effects that arise in a cyclic fashion. For quick acting medications, effects can be confounded by circadian rhythms and daily routines. Using the time-of-the-day as a surrogate for these confounders and the performance measurements as captured on a smartphone, we propose a personalized statistical approach to disentangle putative treatment and “time-of-the-day” effects, that leverages conditional independence relations spanned by causal graphical models involving the treatment, time-of-the-day, and outcome variables. Our approach is based on conditional independence tests implemented via standard and temporal linear regression models. Using synthetic data, we investigate when and how residual autocorrelation can affect the standard tests, and how time series modeling (namely, ARIMA and robust regression via HAC covariance matrix estimators) can remedy these issues. In particular, our simulations illustrate that when patients perform their activities in a paired fashion, positive autocorrelation can lead to conservative results for the standard regression approach (i.e., lead to deflated true positive detection), whereas negative autocorrelation can lead to anticonservative behavior (i.e., lead to inflated false positive detection). The adoption of time series methods, on the other hand, leads to well controlled type I error rates. We illustrate the application of our methodology with data from a Parkinson’s disease mobile health study.
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Affiliation(s)
- Elias Chaibub Neto
- Sage Bionetworks, Seattle, Washington, United States of America
- * E-mail:
| | | | - Abhishek Pratap
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Aryton Tediarjo
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Brian M. Bot
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Lara Mangravite
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Larsson Omberg
- Sage Bionetworks, Seattle, Washington, United States of America
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31
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Deriving stair-climbing performance outcome measures using the smartphone barometer: Results of an algorithm development study. Contemp Clin Trials 2022; 120:106862. [PMID: 35907489 DOI: 10.1016/j.cct.2022.106862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022]
Abstract
As we seek to gain richer insights to understand intervention effects, and increasingly decentralise aspects of clinical trials to simplify participation, there is a growing interest in leveraging wearables and sensors to generate novel and informative clinical outcome measures for at-home assessment. The sensors embedded within smartphone technology provide one approach to capture of this data, and may be particularly useful when patients are already using mobile devices for at-home capture of other clinical trials data, such as patient-reported outcomes. We describe the results of an initial algorithm development study to determine whether the atmospheric pressure data provided by an onboard smartphone sensor is sufficiently informative to enable detection of a small height gain, such as that achieved during a short stair climb performance test. We were able to sufficiently distinguish height changes of 0.6 m in indoor conditions, representing around 4 stairs on an average staircase. This suggests that the smartphone barometer may indeed be suitable for inclusion within future work developing a stair-climbing performance outcome test instrumented using a mobile application.
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Rubin DS, Ranjeva SL, Urbanek JK, Karas M, Madariaga MLL, Huisingh-Scheetz M. Smartphone-Based Gait Cadence to Identify Older Adults with Decreased Functional Capacity. Digit Biomark 2022; 6:61-70. [PMID: 36156872 PMCID: PMC9386413 DOI: 10.1159/000525344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Functional capacity assessment is a critical step in the preoperative evaluation to identify patients at increased risk of cardiac complications and disability after major noncardiac surgery. Smartphones offer the potential to objectively measure functional capacity but are limited by inaccuracy in patients with poor functional capacity. Open-source methods exist to analyze accelerometer data to estimate gait cadence (steps/min), which is directly associated with activity intensity. Here, we used an updated Step Test smartphone application with an open-source method to analyze accelerometer data to estimate gait cadence and functional capacity in older adults. <b><i>Methods:</i></b> We performed a prospective observational cohort study within the Frailty, Activity, Body Composition and Energy Expenditure in Aging study at the University of Chicago. Participants completed the Duke Activity Status Index (DASI) and performed an in-clinic 6-min walk test (6MWT) while using the Step Test application on a study smartphone. Gait cadence was measured from the raw accelerometer data using an adaptive empirical pattern transformation method, which has been previously validated. A 6MWT distance of 370 m was used as an objective threshold to identify patients at high risk. We performed multivariable logistic regression to predict walking distance using a priori explanatory variables. <b><i>Results:</i></b> Sixty patients were enrolled in the study. Thirty-seven patients completed the protocol and were included in the final data analysis. The median (IQR) age of the overall cohort was 71 (69–74) years, with a body mass index of 31 (27–32). There were no differences in any clinical characteristics or functional measures between participants that were able to walk 370 m during the 6MWT and those that could not walk that distance. Median (IQR) gait cadence for the entire cohort was 110 (102–114) steps/min during the 6MWT. Median (IQR) gait cadence was higher in participants that walked more than 370 m during the 6MWT 112 (108–118) versus 106 (96–114) steps/min; <i>p</i> = 0.0157). The final multivariable model to identify participants that could not walk 370 m included only median gait cadence. The Youden’s index cut-point was 107 steps/min with a sensitivity of 0.81 (95% CI: 0.77, 0.85) and a specificity of 0.57 (95% CI: 0.55, 0.59) and an AUCROC of 0.69 (95% CI: 0.51, 0.87). <b><i>Conclusions:</i></b> Our pilot study demonstrates the feasibility of using gait cadence as a measure to estimate functional capacity. Our study was limited by a smaller than expected sample size due to COVID-19, and thus, a prospective study with preoperative patients that measures outcomes is necessary to validate our findings.
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Affiliation(s)
- Daniel S. Rubin
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois, USA
- *Daniel S. Rubin,
| | - Sylvia L. Ranjeva
- Department of Anesthesia, Massachusetts General Hospital, Harvard, Boston, Massachusetts, USA
| | - Jacek K. Urbanek
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marta Karas
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria Lucia L. Madariaga
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago, Chicago, Illinois, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics, University of Chicago, Chicago, Illinois, USA
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Harris PA, Swafford J, Serdoz ES, Eidenmuller J, Delacqua G, Jagtap V, Taylor RJ, Gelbard A, Cheng AC, Duda SN. MyCap: a flexible and configurable platform for mobilizing the participant voice. JAMIA Open 2022; 5:ooac047. [PMID: 35673353 PMCID: PMC9165428 DOI: 10.1093/jamiaopen/ooac047] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
This paper provides a description of the MyCap data collection platform, utilization metrics, and vignettes associated with use from diverse research institutions. MyCap is a participant-facing mobile application for survey data collection and the automated administration of active tasks (activities performed by participants using mobile device sensors under semi-controlled conditions). Launched in 2018, MyCap is a no-code solution for research teams conducting longitudinal studies, integrates tightly with REDCap and is available at no cost to research teams at academic, nonprofit, or government organizations. MyCap has been deployed at multiple research institutions with application usage logged across 135 countries in 2021. Vignettes demonstrate that MyCap empowered research teams to explore and implement novel methods of information collection and use. MyCap’s integration with REDCap provides a comprehensive data collection ecosystem and is best suited for longitudinal studies with frequent requests for information from participants.
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Affiliation(s)
- Paul A Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Swafford
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily S Serdoz
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica Eidenmuller
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Giovanni Delacqua
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vaishali Jagtap
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Taylor
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Gelbard
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alex C Cheng
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Catto JWF, Khetrapal P, Ricciardi F, Ambler G, Williams NR, Al-Hammouri T, Khan MS, Thurairaja R, Nair R, Feber A, Dixon S, Nathan S, Briggs T, Sridhar A, Ahmad I, Bhatt J, Charlesworth P, Blick C, Cumberbatch MG, Hussain SA, Kotwal S, Koupparis A, McGrath J, Noon AP, Rowe E, Vasdev N, Hanchanale V, Hagan D, Brew-Graves C, Kelly JD. Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer: A Randomized Clinical Trial. JAMA 2022; 327:2092-2103. [PMID: 35569079 PMCID: PMC9109000 DOI: 10.1001/jama.2022.7393] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Robot-assisted radical cystectomy is being performed with increasing frequency, but it is unclear whether total intracorporeal surgery improves recovery compared with open radical cystectomy for bladder cancer. OBJECTIVES To compare recovery and morbidity after robot-assisted radical cystectomy with intracorporeal reconstruction vs open radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of patients with nonmetastatic bladder cancer recruited at 9 sites in the UK, from March 2017-March 2020. Follow-up was conducted at 90 days, 6 months, and 12 months, with final follow-up on September 23, 2021. INTERVENTIONS Participants were randomized to receive robot-assisted radical cystectomy with intracorporeal reconstruction (n = 169) or open radical cystectomy (n = 169). MAIN OUTCOMES AND MEASURES The primary outcome was the number of days alive and out of the hospital within 90 days of surgery. There were 20 secondary outcomes, including complications, quality of life, disability, stamina, activity levels, and survival. Analyses were adjusted for the type of diversion and center. RESULTS Among 338 randomized participants, 317 underwent radical cystectomy (mean age, 69 years; 67 women [21%]; 107 [34%] received neoadjuvant chemotherapy; 282 [89%] underwent ileal conduit reconstruction); the primary outcome was analyzed in 305 (96%). The median number of days alive and out of the hospital within 90 days of surgery was 82 (IQR, 76-84) for patients undergoing robotic surgery vs 80 (IQR, 72-83) for open surgery (adjusted difference, 2.2 days [95% CI, 0.50-3.85]; P = .01). Thromboembolic complications (1.9% vs 8.3%; difference, -6.5% [95% CI, -11.4% to -1.4%]) and wound complications (5.6% vs 16.0%; difference, -11.7% [95% CI, -18.6% to -4.6%]) were less common with robotic surgery than open surgery. Participants undergoing open surgery reported worse quality of life vs robotic surgery at 5 weeks (difference in mean European Quality of Life 5-Dimension, 5-Level instrument scores, -0.07 [95% CI, -0.11 to -0.03]; P = .003) and greater disability at 5 weeks (difference in World Health Organization Disability Assessment Schedule 2.0 scores, 0.48 [95% CI, 0.15-0.73]; P = .003) and at 12 weeks (difference in WHODAS 2.0 scores, 0.38 [95% CI, 0.09-0.68]; P = .01); the differences were not significant after 12 weeks. There were no statistically significant differences in cancer recurrence (29/161 [18%] vs 25/156 [16%] after robotic and open surgery, respectively) and overall mortality (23/161 [14.3%] vs 23/156 [14.7%]), respectively) at median follow-up of 18.4 months (IQR, 12.8-21.1). CONCLUSIONS AND RELEVANCE Among patients with nonmetastatic bladder cancer undergoing radical cystectomy, treatment with robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy resulted in a statistically significant increase in days alive and out of the hospital over 90 days. However, the clinical importance of these findings remains uncertain. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN13680280; ClinicalTrials.gov Identifier: NCT03049410.
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Affiliation(s)
- James W. F. Catto
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
- Division of Surgery and Interventional Science, University College London, London, England
| | - Pramit Khetrapal
- Division of Surgery and Interventional Science, University College London, London, England
| | | | - Gareth Ambler
- Department of Statistical Science, University College London, London, England
| | - Norman R. Williams
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, England
| | - Tarek Al-Hammouri
- Division of Surgery and Interventional Science, University College London, London, England
| | - Muhammad Shamim Khan
- Department of Urology, Guys and St Thomas’ NHS Foundation Trust, London, England
| | - Ramesh Thurairaja
- Department of Urology, Guys and St Thomas’ NHS Foundation Trust, London, England
| | - Rajesh Nair
- Department of Urology, Guys and St Thomas’ NHS Foundation Trust, London, England
| | - Andrew Feber
- Division of Surgery and Interventional Science, University College London, London, England
| | - Simon Dixon
- Health Economics and Decision Science, NIHR Research Design Service Yorkshire and the Humber, University of Sheffield, Sheffield, England
| | - Senthil Nathan
- Division of Surgery and Interventional Science, University College London, London, England
| | - Tim Briggs
- Division of Surgery and Interventional Science, University College London, London, England
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, University College London, London, England
| | - Imran Ahmad
- Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Jaimin Bhatt
- Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Philip Charlesworth
- The Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, England
| | - Christopher Blick
- The Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, England
| | - Marcus G. Cumberbatch
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Syed A. Hussain
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
- Department of Medical Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Sanjeev Kotwal
- Pyrah Department of Urology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | | | - John McGrath
- Department of Urology, Royal Devon University Hospitals Foundation Trust and University of Exeter, Exeter, England
| | - Aidan P. Noon
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Edward Rowe
- Department of Urology, North Bristol NHS Trust, Bristol, England
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, University of Hertfordshire, Hatfield, England
| | | | - Daryl Hagan
- Department of Statistical Science, University College London, London, England
| | - Chris Brew-Graves
- Department of Statistical Science, University College London, London, England
| | - John D. Kelly
- Division of Surgery and Interventional Science, University College London, London, England
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35
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Daniore P, Nittas V, von Wyl V. Enrollment and retention of participants in remote digital health studies: a scoping review and framework proposal (Preprint). J Med Internet Res 2022; 24:e39910. [PMID: 36083626 PMCID: PMC9508669 DOI: 10.2196/39910] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Paola Daniore
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
| | - Vasileios Nittas
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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36
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Feigin VL, Owolabi M, Hankey GJ, Pandian J, Martins SC. Digital Health in Primordial and Primary Stroke Prevention: A Systematic Review. Stroke 2022; 53:1008-1019. [PMID: 35109683 DOI: 10.1161/strokeaha.121.036400] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The stroke burden continues to grow across the globe, disproportionally affecting developing countries. This burden cannot be effectively halted and reversed without effective and widely implemented primordial and primary stroke prevention measures, including those on the individual level. The unprecedented growth of smartphone and other digital technologies with digital solutions are now being used in almost every area of health, offering a unique opportunity to improve primordial and primary stroke prevention on the individual level. However, there are several issues that need to be considered to advance development and use this important digital strategy for primordial and primary stroke prevention. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we provide a systematic review of the current knowledge, challenges, and opportunities of digital health in primordial and primary stroke prevention.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand (V.L.F.).,Institute for Health Metrics Evaluation, University of Washington, Seattle (V.L.F.).,Research Centre of Neurology, Moscow, Russia (V.L.F.)
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan and Blossom Specialist Medical Center, Ibadan, Nigeria (M.O.O.)
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia. Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.)
| | | | - Sheila C Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento & Brazilian Stroke Network (S.M.)
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Hermans ANL, Gawałko M, Hillmann HAK, Sohaib A, van der Velden RMJ, Betz K, Verhaert D, Scherr D, Meier J, Sultan A, Steven D, Terentieva E, Pisters R, Hemels M, Voorhout L, Lodziński P, Krzowski B, Gupta D, Kozhuharov N, Gruwez H, Vernooy K, Pluymaekers NAHA, Hendriks JM, Manninger M, Duncker D, Linz D. Self-Reported Mobile Health-Based Risk Factor and CHA2DS2-VASc-Score Assessment in Patients With Atrial Fibrillation: TeleCheck-AF Results. Front Cardiovasc Med 2022; 8:757587. [PMID: 35127847 PMCID: PMC8809453 DOI: 10.3389/fcvm.2021.757587] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe TeleCheck-AF approach is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring through teleconsultation. We evaluated feasibility and accuracy of self-reported mHealth-based AF risk factors and CHA2DS2-VASc-score in atrial fibrillation (AF) patients managed within this approach.Materials and MethodsConsecutive patients from eight international TeleCheck-AF centers were asked to complete an app-based 10-item questionnaire related to risk factors, associated conditions and CHA2DS2-VASc-score components. Patient's medical history was retrieved from electronic health records (EHR).ResultsAmong 994 patients, 954 (96%) patients (38% female, median age 65 years) completed the questionnaire and were included in this analysis. The accuracy of self-reported assessment was highest for pacemaker and anticoagulation treatment and lowest for heart failure and arrhythmias. Patients who knew that AF increases the stroke risk, more often had a 100% or ≥80% correlation between EHR- and app-based results compared to those who did not know (27 vs. 14% or 84 vs. 77%, P = 0.001). Thromboembolic events were more often reported in app (vs. EHR) in all countries, whereas higher self-reported hypertension and anticoagulant treatment were observed in Germany and heart failure in the Netherlands. If the app-based questionnaire alone was used for clinical decision-making on anticoagulation initiation, 26% of patients would have been undertreated and 6.1%—overtreated.ConclusionSelf-reported mHealth-based assessment of AF risk factors is feasible. It shows high accuracy of pacemaker and anticoagulation treatment, nevertheless, displays limited accuracy for some of the CHA2DS2-VASc-score components. Direct health care professional assessment of risk factors remains indispensable to ensure high quality clinical-decision making.
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Affiliation(s)
- Astrid N. L. Hermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Monika Gawałko
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Henrike A. K. Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Afzal Sohaib
- Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
- Department of Cardiology, King George Hospital, Ilford, United Kingdom
| | - Rachel M. J. van der Velden
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Konstanze Betz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Dominique Verhaert
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Daniel Scherr
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Department of Cardiology, University Clinic of Medicine, Medical University of Graz, Graz, Austria
| | - Julia Meier
- Department of Cardiology, University Clinic of Medicine, Medical University of Graz, Graz, Austria
| | - Arian Sultan
- Department of Electrophysiology, University of Cologne, Heart Center, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, University of Cologne, Heart Center, Cologne, Germany
| | - Elena Terentieva
- Department of Electrophysiology, University of Cologne, Heart Center, Cologne, Germany
| | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
| | - Martin Hemels
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
| | - Leonard Voorhout
- Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
| | - Piotr Lodziński
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Krzowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Nikola Kozhuharov
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henri Gruwez
- Department of Cardiology, Hospital East-Limburg, Genk, Belgium
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Nikki A. H. A. Pluymaekers
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Jeroen M. Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Martin Manninger
- Department of Cardiology, University Clinic of Medicine, Medical University of Graz, Graz, Austria
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Dominik Linz
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Baillieul S, Dekkers M, Brill AK, Schmidt MH, Detante O, Pépin JL, Tamisier R, Bassetti CLA. Sleep apnoea and ischaemic stroke: current knowledge and future directions. Lancet Neurol 2021; 21:78-88. [PMID: 34942140 DOI: 10.1016/s1474-4422(21)00321-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
Sleep apnoea, one of the most common chronic diseases, is a risk factor for ischaemic stroke, stroke recurrence, and poor functional recovery after stroke. More than half of stroke survivors present with sleep apnoea during the acute phase after stroke, with obstructive sleep apnoea being the most common subtype. Following a stroke, sleep apnoea frequency and severity might decrease over time, but moderate to severe sleep apnoea is nevertheless present in up to a third of patients in the chronic phase after an ischaemic stroke. Over the past few decades evidence suggests that treatment for sleep apnoea is feasible during the acute phase of stroke and might favourably affect recovery and long-term outcomes. Nevertheless, sleep apnoea still remains underdiagnosed and untreated in many cases, due to challenges in the detection and prediction of post-stroke sleep apnoea, uncertainty as to the optimal timing for its diagnosis, and a scarcity of clear treatment guidelines (ie, uncertainty on when to treat and the optimal treatment strategy). Moreover, the pathophysiology of sleep apnoea associated with stroke, the proportion of stroke survivors with obstructive and central sleep apnoea, and the temporal evolution of sleep apnoea subtypes following stroke remain to be clarified. To address these shortcomings, the management of sleep apnoea associated with stroke should be integrated into a multidisciplinary diagnostic, treatment, and follow-up strategy.
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Affiliation(s)
- Sébastien Baillieul
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Martijn Dekkers
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland
| | - Anne-Kathrin Brill
- Department of Pulmonary Medicine, Inselspital, University Hospital, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Ohio Sleep Medicine Institute, Dublin, OH, USA
| | - Olivier Detante
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1216, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
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Goodday SM, Karlin E, Alfarano A, Brooks A, Chapman C, Desille R, Karlin DR, Emami H, Woods NF, Boch A, Foschini L, Wildman M, Cormack F, Taptiklis N, Pratap A, Ghassemi M, Goldenberg A, Nagaraj S, Walsh E, Friend S. An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study. JMIR Form Res 2021; 5:e32165. [PMID: 34726607 PMCID: PMC8668021 DOI: 10.2196/32165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results A total of 365 participants enrolled and started the study, and 81.0% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, and 72.86% of the time, respectively. Conclusions This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111
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Affiliation(s)
- Sarah M Goodday
- 4YouandMe, Seattle, WA, United States.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | - Daniel R Karlin
- 4YouandMe, Seattle, WA, United States.,MindMed, New York, NY, United States.,Tufts University School of Medicine, Boston, MA, United States
| | - Hoora Emami
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Adrien Boch
- Evidation Health Inc, San Mateo, CA, United States
| | | | | | - Francesca Cormack
- Cambridge Cognition, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Abhishek Pratap
- Krembil Center for Neuroinformatics, Center for Addiction and Mental Health, Toronto, ON, Canada.,Vector Institute, Toronto, ON, Canada.,University of Washington, Seattle, WA, United States.,King's College London, London, United Kingdom
| | - Marzyeh Ghassemi
- Vector Institute, Toronto, ON, Canada.,Institute for Medical Engineering and Science, MIT, Cambridge, MA, United States.,Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, United States
| | - Anna Goldenberg
- Vector Institute, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Department of Computer Science, University of Toronto, Toronto, ON, Canada.,Canadian Institute for Advanced Research, Toronto, ON, Canada
| | - Sujay Nagaraj
- Vector Institute, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Elaine Walsh
- School of Nursing, University of Washington, Seattle, WA, United States
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- 4YouandMe, Seattle, WA, United States
| | - Stephen Friend
- 4YouandMe, Seattle, WA, United States.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Amagai S, Pila S, Kaat AJ, Nowinski CJ, Gershon RC. Challenges in Participant Engagement and Retention using Mobile Health Apps: A Literature Review (Preprint). J Med Internet Res 2021; 24:e35120. [PMID: 35471414 PMCID: PMC9092233 DOI: 10.2196/35120] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps. Objective This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention. Methods We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention. Results Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained. Conclusions Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention.
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Affiliation(s)
- Saki Amagai
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah Pila
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Aaron J Kaat
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cindy J Nowinski
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Richard C Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Characterisation of Temporal Patterns in Step Count Behaviour from Smartphone App Data: An Unsupervised Machine Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111476. [PMID: 34769991 PMCID: PMC8583116 DOI: 10.3390/ijerph182111476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022]
Abstract
The increasing ubiquity of smartphone data, with greater spatial and temporal coverage than achieved by traditional study designs, have the potential to provide insight into habitual physical activity patterns. This study implements and evaluates the utility of both K-means clustering and agglomerative hierarchical clustering methods in identifying weekly and yearlong physical activity behaviour trends. Characterising the demographics and choice of activity type within the identified clusters of behaviour. Across all seven clusters of seasonal activity behaviour identified, daylight saving was shown to play a key role in influencing behaviour, with increased activity in summer months. Investigation into weekly behaviours identified six clusters with varied roles, of weekday versus weekend, on the likelihood of meeting physical activity guidelines. Preferred type of physical activity likewise varied between clusters, with gender and age strongly associated with cluster membership. Key relationships are identified between weekly clusters and seasonal activity behaviour clusters, demonstrating how short-term behaviours contribute to longer-term activity patterns. Utilising unsupervised machine learning, this study demonstrates how the volume and richness of secondary app data can allow us to move away from aggregate measures of physical activity to better understand temporal variations in habitual physical activity behaviour.
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Golbus JR, Pescatore NA, Nallamothu BK, Shah N, Kheterpal S. Wearable device signals and home blood pressure data across age, sex, race, ethnicity, and clinical phenotypes in the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) study: a prospective, community-based observational study. Lancet Digit Health 2021; 3:e707-e715. [PMID: 34711377 DOI: 10.1016/s2589-7500(21)00138-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Wearable technology has rapidly entered consumer markets and has health-care potential; however, wearable device data for diverse populations are scarce. We therefore aimed to describe and compare key wearable signals (ie, heart rate, step count, and home blood pressure measurements) across age, sex, race, ethnicity, and clinical phenotypes. METHODS In the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) prospective observational study, we enrolled participants from Michigan Medicine, Ann Abor, MI, USA, and followed them up for at least 90 days. Patients were included if they were aged 18 years or older, were fluent in English, owned an iPhone 6 or newer model with a supported iOS version, and had regular access to the internet throughout the study period. All participants were provided with an Apple Watch Series 3 or 4, an Omron Evolv Wireless Blood Pressure Monitor, and the MyDataHelps study smartphone application. Participants were asked to wear their watch for 12 h per day or longer and to do daily or weekly tasks, including home blood pressure measurements and breathing tasks. Heart rate, blood pressure, step counts, and distance walked were collected. The study was divided into two phases: an intensive 45-day collection phase (phase 1); and a 3-year longitudinal monitoring phase (phase 2). Here we report the first 90 days of data for all participants, which includes all of phase 1 and the first 45 days of phase 2. Participants' electronic health records were used to establish clinical diagnoses for analysis. FINDINGS We enrolled 6765 eligible participants between Aug 14, 2018, and Dec 19, 2019, of whom 6454 participants from Michigan Medicine completed the phase 1 study protocol and were included in this analysis (3482 [54%] women and 2972 [46%] men; 3657 [57%] participants were White, with 1094 [17%] Asian and 1090 [17%] Black participants). On days when participants wore their smart watches, median daily watch wear time was 15·5 h (IQR 14-17). Participants contributed a total of 1 107 320 blood pressure and 202 198 347 heart rate measurements over 90 days, with 172 (SD 50) blood pressure and 31 329 (SD 24 620) heart rate measurements per participant. Mean systolic blood pressure was 122 mm Hg (SD 10) and mean diastolic blood pressure was 77 mm Hg (SD 8), with 167 312 (15%) measurements having a systolic blood pressure higher than 140 mm Hg or diastolic blood pressure higher than 90 mm Hg. Mean resting heart rate was 64 beats per min (SD 8). Blood pressure and resting heart rate varied by sex, age, race, and ethnicity, with higher blood pressures in males and lower heart rate in participants aged 65 years or older (p<0·0001). Participants took 7511 steps per day (SD 2805) and walked 6009 metres per day (SD 2608), varying across demographic and clinical subgroups. INTERPRETATION These data could inform clinical trial design, interpretation of wearable data in clinical practice, and health-care interventions. FUNDING Apple, University of Michigan.
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Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicole A Pescatore
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, MI, USA; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI, USA
| | - Nirav Shah
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
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Outcomes of a smartphone-based application with live health-coaching post-percutaneous coronary intervention. EBioMedicine 2021; 72:103593. [PMID: 34657825 PMCID: PMC8577401 DOI: 10.1016/j.ebiom.2021.103593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background The interval between inpatient hospitalization for symptomatic coronary artery disease (CAD) and post-discharge office consultation is a vulnerable period for adverse events. Methods Content was customized on a smartphone app-based platform for hospitalized patients receiving percutaneous coronary intervention (PCI) which included education, tracking, reminders and live health coaches. We conducted a single-arm open-label pilot study of the app at two academic medical centers in a single health system, with subjects enrolled 02/2018–05/2019 and 1:3 propensity-matched historical controls from 01/2015–12/2017. To evaluate feasibility and efficacy, we assessed 30-day hospital readmission (primary), outpatient cardiovascular follow-up, and cardiac rehabilitation (CR) enrollment as recorded in the health system. Outcomes were assessed by Cox Proportional Hazards model. Findings 118 of 324 eligible (36·4%) 21–85 year-old patients who underwent PCI for symptomatic CAD who owned a smartphone or tablet enrolled. Mean age was 62.5 (9·7) years, 87 (73·7%) were male, 40 of 118 (33·9%) had type 2 diabetes mellitus, 68 (57·6%) enrolled underwent PCI for MI and 59 (50·0%) had previously known CAD; demographics were similar among matched historical controls. No significant difference existed in all-cause readmission within 30 days (8·5% app vs 9·6% control, ARR -1.1% absolute difference, 95% CI -7·1–4·8, p = 0·699) or 90 days (16·1% app vs 19·5% control, p = 0.394). Rates of both 90-day CR enrollment (HR 1·99, 95% CI 1·30–3·06) and 1-month cardiovascular follow up (HR 1·83, 95% CI 1·43–2·34) were greater with the app. Weekly engagement at 30- and 90-days, as measured by percentage of weeks with at least one day of completion of tasks, was mean (SD) 73·5% (33·9%) and 63·5% (40·3%). Spearman correlation analyses indicated similar engagement across age, sex, and cardiovascular risk factors. Interpretations A post-PCI smartphone app with live health coaches yielded similarly high engagement across demographics and safely increased attendance in cardiac rehabilitation. Larger prospective randomized controlled trials are necessary to test whether this app improves cardiovascular outcomes following PCI. Funding National Institutes of Health, Boston Scientific. Clinical trial registration NCT03416920 (https://clinicaltrials.gov/ct2/show/NCT03416920).
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Requirements and Architecture of a Cloud Based Insomnia Therapy and Diagnosis Platform: A Smart Cities Approach. SMART CITIES 2021. [DOI: 10.3390/smartcities4040070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Insomnia is the most common sleep disorder worldwide. Its effects generate economic costs in the millions but could be effectively reduced using digitally provisioned cognitive behavioural therapy. However, traditional acquisition and maintenance of the necessary technical infrastructure requires high financial and personnel expenses. Sleep analysis is still mostly done in artificial settings in clinical environments. Nevertheless, innovative IT infrastructure, such as mHealth and cloud service solutions for home monitoring, are available and allow context-aware service provision following the Smart Cities paradigm. This paper aims to conceptualise a digital, cloud-based platform with context-aware data storage that supports diagnosis and therapy of non-organic insomnia. In a first step, requirements needed for a remote diagnosis, therapy, and monitoring system are identified. Then, the software architecture is drafted based on the above mentioned requirements. Lastly, an implementation concept of the software architecture is proposed through selecting and combining eleven cloud computing services. This paper shows how treatment and diagnosis of a common medical issue could be supported effectively and cost-efficiently by utilising state-of-the-art technology. The paper demonstrates the relevance of context-aware data collection and disease understanding as well as the requirements regarding health service provision in a Smart Cities context. In contrast to existing systems, we provide a cloud-based and requirement-driven reference architecture. The applied methodology can be used for the development, design, and evaluation of other remote and context-aware diagnosis and therapy systems. Considerations of additional aspects regarding cost, methods for data analytics as well as general data security and safety are discussed.
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Soto JT, Hershman SG, Ashley EA. Combining digital data and artificial intelligence for cardiovascular health. Cardiovasc Res 2021; 117:e116-e117. [PMID: 34320165 DOI: 10.1093/cvr/cvab211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jessica Torres Soto
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Steve G Hershman
- Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Euan A Ashley
- Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA
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Li VOK, Lam JCK, Han Y, Cheung LYL, Downey J, Kaistha T, Gozes I. Editorial: Designing a Protocol Adopting an Artificial Intelligence (AI)-Driven Approach for Early Diagnosis of Late-Onset Alzheimer's Disease. J Mol Neurosci 2021; 71:1329-1337. [PMID: 34106406 DOI: 10.1007/s12031-021-01865-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Victor O K Li
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China.
| | - Jacqueline C K Lam
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China.
| | - Yang Han
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China
| | - Lawrence Y L Cheung
- Department of Linguistics & Modern Languages, The Chinese University of Hong Kong, Hong Kong, China
| | - Jocelyn Downey
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China
| | - Tushar Kaistha
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China
| | - Illana Gozes
- The Elton Laboratory for Molecular Neuroendocrinology, Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Adams Super Center for Brain Studies and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
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Inomata T, Iwagami M, Nakamura M, Shiang T, Yoshimura Y, Fujimoto K, Okumura Y, Eguchi A, Iwata N, Miura M, Hori S, Hiratsuka Y, Uchino M, Tsubota K, Dana R, Murakami A. Characteristics and Risk Factors Associated With Diagnosed and Undiagnosed Symptomatic Dry Eye Using a Smartphone Application. JAMA Ophthalmol 2021; 138:58-68. [PMID: 31774457 DOI: 10.1001/jamaophthalmol.2019.4815] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The incidence of dry eye disease has increased; the potential for crowdsource data to help identify undiagnosed dry eye in symptomatic individuals remains unknown. Objective To assess the characteristics and risk factors associated with diagnosed and undiagnosed symptomatic dry eye using the smartphone app DryEyeRhythm. Design, Setting, and Participants A cross-sectional study using crowdsourced data was conducted including individuals in Japan who downloaded DryEyeRhythm and completed the entire questionnaire; duplicate users were excluded. DryEyeRhythm was released on November 2, 2016; the study was conducted from November 2, 2016, to January 12, 2018. Exposures DryEyeRhythm data were collected on demographics, medical history, lifestyle, subjective symptoms, and disease-specific symptoms, using the Ocular Surface Disease Index (100-point scale; scores 0-12 indicate normal, healthy eyes; 13-22, mild dry eye; 23-32, moderate dry eye; 33-100, severe dry eye symptoms), and the Zung Self-Rating Depression Scale (total of 20 items, total score ranging from 20-80, with ≥40 highly suggestive of depression). Main Outcomes and Measures Multivariate-adjusted logistic regression analysis was used to identify risk factors for symptomatic dry eye and to identify risk factors for undiagnosed symptomatic dry eye. Results A total of 21 394 records were identified in our database; 4454 users, included 899 participants (27.3%) with diagnosed and 2395 participants (72.7%) with undiagnosed symptomatic dry eye, completed all questionnaires and their data were analyzed. A total of 2972 participants (66.7%) were women; mean (SD) age was 27.9 (12.6) years. The identified risk factors for symptomatic vs no symptomatic dry eye included younger age (odds ratio [OR], 0.99; 95% CI, 0.987-0.999, P = .02), female sex (OR, 1.99; 95% CI, 1.61-2.46; P < .001), pollinosis (termed hay fever on the questionnaire) (OR, 1.35; 95% CI, 1.18-1.55; P < .001), depression (OR, 1.78; 95% CI, 1.18-2.69; P = .006), mental illnesses other than depression or schizophrenia (OR, 1.87; 95% CI, 1.24-2.82; P = .003), current contact lens use (OR, 1.27; 95% CI, 1.09-1.48; P = .002), extended screen exposure (OR, 1.55; 95% CI, 1.25-1.91; P < .001), and smoking (OR, 1.65; 95% CI, 1.37-1.98; P < .001). The risk factors for undiagnosed vs diagnosed symptomatic dry eye included younger age (OR, 0.96; 95% CI, 0.95-0.97; P < .001), male sex (OR, 0.55; 95% CI, 0.42-0.72; P < .001), as well as absence of collagen disease (OR, 95% CI, 0.23; 0.09-0.60; P = .003), mental illnesses other than depression or schizophrenia (OR, 0.50; 95% CI, 0.36-0.69; P < .001), ophthalmic surgery other than cataract surgery and laser-assisted in situ keratomileusis (OR, 0.41; 95% CI, 0.27-0.64; P < .001), and current (OR, 0.64; 95% CI, 0.54-0.77; P < .001) or past (OR, 0.45; 95% CI, 0.34-0.58; P < .001) contact lens use. Conclusions and Relevance This study's findings suggest that crowdsourced research identified individuals with diagnosed and undiagnosed symptomatic dry eye and the associated risk factors. These findings could play a role in earlier prevention or more effective interventions for dry eye disease.
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Affiliation(s)
- Takenori Inomata
- Faculty of Medicine, Department of Ophthalmology, Juntendo University, Tokyo Japan.,Faculty of Medicine, Department of Strategic Operating Room Management and Improvement, Juntendo University, Tokyo, Japan
| | - Masao Iwagami
- Faculty of Medicine, Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Nakamura
- Graduate School of Engineering, Department of Bioengineering, Precision Health, The University of Tokyo, Tokyo, Japan
| | - Tina Shiang
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Keiichi Fujimoto
- Faculty of Medicine, Department of Ophthalmology, Juntendo University, Tokyo Japan
| | - Yuichi Okumura
- Faculty of Medicine, Department of Ophthalmology, Juntendo University, Tokyo Japan.,Faculty of Medicine, Department of Strategic Operating Room Management and Improvement, Juntendo University, Tokyo, Japan
| | - Atsuko Eguchi
- Faculty of Medicine, Department of Hospital Administration, Juntendo University, Tokyo, Japan
| | - Nanami Iwata
- Faculty of Medicine, Department of Ophthalmology, Juntendo University, Tokyo Japan
| | - Maria Miura
- Faculty of Medicine, Department of Ophthalmology, Juntendo University, Tokyo Japan
| | - Satoshi Hori
- Faculty of Medicine, Department of Electric Medical Intelligence Management, Juntendo University, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Faculty of Medicine, Department of Ophthalmology, Juntendo University, Tokyo Japan
| | - Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Reza Dana
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Akira Murakami
- Faculty of Medicine, Department of Ophthalmology, Juntendo University, Tokyo Japan
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Ding EY, Pathiravasan CH, Schramm E, Borrelli B, Liu C, Trinquart L, Kornej J, Benjamin EJ, Murabito JM, McManus DD. Design, deployment, and usability of a mobile system for cardiovascular health monitoring within the electronic Framingham Heart Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:171-178. [PMID: 35265906 PMCID: PMC8890046 DOI: 10.1016/j.cvdhj.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The electronic Framingham Heart Study (eFHS) is an ongoing nested study, which includes FHS study participants, examining associations between health data from mobile devices with cardiovascular risk factors and disease. Objective To describe application (app) design, report user characteristics, and describe usability and survey response rates. Methods Eligible FHS participants were consented and offered a smartwatch (Apple Watch), a digital blood pressure (BP) cuff, and the eFHS smartphone app for administering surveys remotely. We assessed usability of the new app using 2 domains (functionality, aesthetics) of the Mobile App Rating Scale (MARS) and assessed survey completion rates at baseline and 3 months. Results A total of 196 participants were recruited using the enhanced eFHS app. Of these, 97 (49.5%) completed the MARS instrument. Average age of participants was 53 ± 9 years, 51.5% were women, and 93.8% were white. Eighty-six percent of participants completed at least 1 measure on the baseline survey, and 50% completed the 3-month assessment. Overall subjective score of the app was 4.2 ± 0.7 on a scale from 1 to 5 stars. Of those who shared their health data with others, 46% shared their BP and 7.7% shared their physical activity with a health care provider. Conclusion Participants rated the new, enhanced eFHS app positively overall. Mobile app survey completion rates were high, consistent with positive in-app ratings from participants. These mobile data collection modalities offer clinicians new opportunities to engage in conversations about health behaviors.
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Affiliation(s)
- Eric Y. Ding
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Address reprint requests and correspondence: Mr Eric Ding, Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA 01655.
| | | | | | - Belinda Borrelli
- Department of Health Policy & Health Services Research, Boston University School of Dental Medicine, Boston, Massachusetts
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jelena Kornej
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emelia J. Benjamin
- Boston University and National Heart, Lung, and Blood Institute, Framingham Heart Study, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Joanne M. Murabito
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Boston University and National Heart, Lung, and Blood Institute, Framingham Heart Study, Boston, Massachusetts
| | - David D. McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Groenendaal W, Lee S, van Hoof C. Wearable Bioimpedance Monitoring: Viewpoint for Application in Chronic Conditions. JMIR BIOMEDICAL ENGINEERING 2021. [DOI: 10.2196/22911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Currently, nearly 6 in 10 US adults are suffering from at least one chronic condition. Wearable technology could help in controlling the health care costs by remote monitoring and early detection of disease worsening. However, in recent years, there have been disappointments in wearable technology with respect to reliability, lack of feedback, or lack of user comfort. One of the promising sensor techniques for wearable monitoring of chronic disease is bioimpedance, which is a noninvasive, versatile sensing method that can be applied in different ways to extract a wide range of health care parameters. Due to the changes in impedance caused by either breathing or blood flow, time-varying signals such as respiration and cardiac output can be obtained with bioimpedance. A second application area is related to body composition and fluid status (eg, pulmonary congestion monitoring in patients with heart failure). Finally, bioimpedance can be used for continuous and real-time imaging (eg, during mechanical ventilation). In this viewpoint, we evaluate the use of wearable bioimpedance monitoring for application in chronic conditions, focusing on the current status, recent improvements, and challenges that still need to be tackled.
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Sverdlov O, Ryeznik Y, Wong WK. Opportunity for efficiency in clinical development: An overview of adaptive clinical trial designs and innovative machine learning tools, with examples from the cardiovascular field. Contemp Clin Trials 2021; 105:106397. [PMID: 33845209 DOI: 10.1016/j.cct.2021.106397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
Modern data analysis tools and statistical modeling techniques are increasingly used in clinical research to improve diagnosis, estimate disease progression and predict treatment outcomes. What seems less emphasized is the importance of the study design, which can have a serious impact on the study cost, time and statistical efficiency. This paper provides an overview of different types of adaptive designs in clinical trials and their applications to cardiovascular trials. We highlight recent proliferation of work on adaptive designs over the past two decades, including some recent regulatory guidelines on complex trial designs and master protocols. We also describe the increasing role of machine learning and use of metaheuristics to construct increasingly complex adaptive designs or to identify interesting features for improved predictions and classifications.
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Affiliation(s)
- Oleksandr Sverdlov
- Early Development Biostatistics, Novartis Pharmaceuticals Corporation, USA.
| | - Yevgen Ryeznik
- Department of Pharmaceutical Biosciences, Uppsala University, Sweden
| | - Weng Kee Wong
- Department of Biostatistics, University of California Los Angeles, USA
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