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Abstract
BACKGROUND The coronavirus pandemic of 2019 (COVID-19) forced worldwide recognition and implementation of telehealth as a means of providing continuity of care by varied health care institutions. Diabetes is a global health threat with rates that continue to accelerate, thereby causing an increased need for clinicians to provide diabetes care and education to keep up with demand. Utilizing technology to provide education via phone/smartphone, video/audio, web, text message, mobile apps, or a combination of these methods can help improve patient access and clinical outcomes, cut costs, and close gaps in care. METHODS While numerous publications have summarized the various tools and technologies available for capturing remote clinical data and their relevance to diabetes care and self-management, this review focuses on self-educational telehealth tools available for diabetes self-management, their advantages and disadvantages, and factors that need to be considered prior to implementation. Recent relevant studies indexed by PubMed were included. RESULTS The widespread use and popularity of phones/smartphones, tablets, computers, and the Internet by patients of all age groups, cultures, socioeconomic and geographic areas allow for increased outreach, flexibility, and engagement with diabetes education, either in combination or as an adjunct to traditional in-person visits. Demonstrated benefits of using health technologies for diabetes self-management education include improved lifestyle habits, reduced hemoglobin A1C levels, decreased health care costs, and better medication adherence. Potential drawbacks include lack of regulation, need for staff training on methodologies used, the requirement for patients to be tech savvy, privacy concerns, lag time with technology updates/glitches, and the need for more long-term research data on efficacy. CONCLUSIONS Telehealth technologies for diabetes self-education improve overall clinical outcomes and have come a long way. With increasing numbers of patients with diabetes, it is expected that more optimal and user-friendly methodologies will be developed to fully engage and help patients communicate with their physicians.
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Affiliation(s)
- Vidya Sharma
- Department of Nutrition & Dietetics, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Ramaswamy Sharma
- Department of Cell Systems and Anatomy, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
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Comparison of different smartphone cameras to evaluate conjunctival hyperaemia in normal subjects. Sci Rep 2019; 9:1339. [PMID: 30718684 PMCID: PMC6362079 DOI: 10.1038/s41598-018-37925-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022] Open
Abstract
Despite the significant advantages that smartphones’ cameras can provide in teleophthalmology and artificial intelligence applications, their use as black-box systems for clinical data acquisition, without adequate information of the quality of photographs can compromise data accuracy. The aim of this study is to compare the objective and subjective quantification of conjunctival redness in images obtained with calibrated and non-calibrated cameras, in different lighting conditions and optical magnifications. One hundred ninety-two pictures of the eye were taken in 4 subjects using 3 smartphone cameras{Bq, Iphone, Nexus}, 2 lighting levels{high 815 lx, low 122 lx} and 2 magnification levels{high 10x, low 6x}. Images were duplicated: one set was white balanced and color corrected (calibrated) and the other was left as it was. Each image was subjective and objectively evaluated. There were no significant differences in subjective evaluation in any of the conditions whereas many statistically significant main effects and interaction effects were shown for all the objective metrics. The clinician’s evaluation was not affected by different cameras, lighting conditions or optical magnifications, demonstrating the effectiveness of the human eye’s color constancy properties. However, calibration of a smartphone’s camera is essential when extracting objective data from images.
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Bellfield EJ, Sharp LK, Xia Y, Gerber BS. Use of a Mobile App to Facilitate Blood Glucose Monitoring in Adolescents With Type 1 Diabetes: Single-Subject Nonrandomized Clinical Trial. JMIR Diabetes 2018; 3:e3. [PMID: 30291085 PMCID: PMC6238847 DOI: 10.2196/diabetes.8357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 11/16/2022] Open
Abstract
Background Cloud-based glucose monitoring programs allow users with diabetes to wirelessly synchronize their glucometers to their mobile phones. They also provide visualization and remote access of their data through its mobile app. There have been very few studies evaluating their effectiveness in managing diabetes among adolescents with type 1 diabetes (T1D). Objective The purpose of this study was to assess the feasibility of using a mobile app to improve daily average blood glucose (BG) levels and increase BG monitoring frequency. Methods We used an ABA single-subject prospective study design. We recruited five participants aged 13 to 17 years with uncontrolled T1D, glycated hemoglobin A1c 9.0%-10.7%, self-monitoring behavior of ≤5 checks/day, and on multiple daily insulin injections. The study consisted of 4-week intervals of three phases: (1) phase A: usual glucose monitoring log (fax); (2) phase B: mobile app; and (3) phase A': second phase A. A certified diabetes educator and endocrinologist reviewed logs and provided recommendations weekly. Data were analyzed using a quasi-Poisson model to adjust for overdispersion among individual participants, and a generalized estimating equation model for overall intervention effect in aggregate. Results For mean daily BG (mg/dL) levels, participant 1 had decreased values on the mobile app (298 to 281, P=.03) and maintained in phase A'. Participant 4 had an increase in mean daily BG in phase A' (175 to 185, P=.01), whereas participant 5 had a decrease in mean daily BG in phase A' (314 to 211, P=.04). For daily monitoring (checks/day), participant 3 increased in phase B (4.6 to 8.3, P=.01) and maintained in phase A'. Participant 5 also had increased daily monitoring at each phase (2.1 to 2.4, P=.01; 2.4 to 3.4, P=.02). For the five participants combined, the overall mean BG and BG checks per day in phase A were mean 254.8 (SD 99.2) and mean 3.6 (SD 2.0), respectively, mean 223.1 (SD 95.7) and mean 4.5 (SD 3.0) in phase B, and mean 197.5 (SD 81.3) and mean 3.7 (SD 2.1) in phase A'. Compared to phase A, mean glucose levels declined during phase B and remained lower during phase A' (P=.002). There was no overall change in BG checks by phase (P=.25). However, mean BG levels negatively correlated with daily BG checks (r=–.47, P<.001). Although all participants had positive opinions about the app, its utilization was highly variable. Conclusions We demonstrated modest feasibility of adolescents with uncontrolled T1D utilizing a glucose monitoring mobile app. Further study is needed to better determine its effects on BG level and monitoring frequency. Psychosocial factors and motivational barriers likely influence adoption and continuous use of technology for diabetes management.
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Affiliation(s)
- Edward J Bellfield
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, United States
| | - Lisa K Sharp
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States.,Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Yinglin Xia
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States.,Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Ben S Gerber
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States.,Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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Rodriguez-Paras C, Tippey K, Brown E, Sasangohar F, Creech S, Kum HC, Lawley M, Benzer JK. Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review. JMIR Mhealth Uhealth 2017; 5:e156. [PMID: 29074470 PMCID: PMC5680516 DOI: 10.2196/mhealth.7318] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/05/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent mental health issue among veterans. Access to PTSD treatment is influenced by geographic (ie, travel distance to facilities), temporal (ie, time delay between services), financial (ie, eligibility and cost of services), and cultural (ie, social stigma) barriers. OBJECTIVE The emergence of mobile health (mHealth) apps has the potential to bridge many of these access gaps by providing remote resources and monitoring that can offer discrete assistance to trauma survivors with PTSD and enhance patient-clinician relationships. In this study, we investigate the current mHealth capabilities relevant to PTSD. METHODS This study consists of two parts: (1) a review of publicly available PTSD apps designed to determine the availability of PTSD apps, which includes more detailed information about three dominant apps and (2) a scoping literature review performed using a systematic method to determine app usage and efforts toward validation of such mHealth apps. App usage relates to how the end users (eg, clinicians and patients) are interacting with the app, whereas validation is testing performed to ensure the app's purpose and specifications are met. RESULTS The results suggest that though numerous apps have been developed to aid in the diagnosis and treatment of PTSD symptoms, few apps were designed to be integrated with clinical PTSD treatment, and minimal efforts have been made toward enhancing the usability and validation of PTSD apps. CONCLUSIONS These findings expose the need for studies relating to the human factors evaluation of such tools, with the ultimate goal of increasing access to treatment and widening the app adoption rate for patients with PTSD.
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Affiliation(s)
- Carolina Rodriguez-Paras
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Kathryn Tippey
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elaine Brown
- Health Science Center, School of Public Health, Louisiana State University, New Orleans, LA, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Suzannah Creech
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, TX, United States
| | - Hye-Chung Kum
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
| | - Justin K Benzer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, TX, United States
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, United States
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James S, Perry L, Gallagher R, Lowe J. Diabetes Educators: Perceived Experiences, Supports and Barriers to Use of Common Diabetes-Related Technologies. J Diabetes Sci Technol 2016; 10:1115-21. [PMID: 27417141 PMCID: PMC5032969 DOI: 10.1177/1932296816660326] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Various technologies are commonly used to support type 1 diabetes management (continuous subcutaneous insulin infusion therapy, continuous glucose monitoring systems, smartphone and tablet applications, and video conferencing) and may foster self-care, communication, and engagement with health care services. Diabetes educators are key professional supporters of this patient group, and ideally positioned to promote and support technology use. The aim of this study was to examine diabetes educators' perceived experiences, supports, and barriers to use of common diabetes-related technologies for people with type 1 diabetes. METHODS This qualitative ethnographic study recruited across metropolitan, regional and rural areas of Australia using purposive sampling of Australian Diabetes Educators Association members. Data were collected by semistructured telephone interviews and analyzed using thematic analysis. RESULTS Participants (n = 31) overwhelmingly indicated that overall the use of technology in the care of patients with type 1 diabetes was burdensome for them. They identified 3 themes involving common diabetes-related technologies: access to technology, available support, and technological advances. Overall, these themes demonstrated that while care was usually well intentioned it was more often fragmented and inconsistent. Most often care was provided by a small number of diabetes educators who had technology expertise. CONCLUSIONS To realize the potential benefits of these relatively new but common diabetes technologies, many diabetes educators need to attain and retain the skills required to deliver this essential component of care. Furthermore, policy and strategy review is required, with reconfiguration of services to better support care delivery.
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Affiliation(s)
- Steven James
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Lin Perry
- University of Technology Sydney/South East Sydney Local Health District, Prince of Wales Hospital, Randwick, NSW, Australia
| | | | - Julia Lowe
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Ryan EA, Holland J, Stroulia E, Bazelli B, Babwik SA, Li H, Senior P, Greiner R. Improved A1C Levels in Type 1 Diabetes with Smartphone App Use. Can J Diabetes 2016; 41:33-40. [PMID: 27570203 DOI: 10.1016/j.jcjd.2016.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/03/2016] [Accepted: 06/08/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Smartphones are a potentially useful tool in diabetes care. We have developed an application (app) linked to a website, Intelligent Diabetes Management (IDM), which serves as both an insulin bolus calculator and an electronic diabetes diary. We have prospectively studied whether patients using this app improved control of their glucose levels. METHODS Patients with type 1 diabetes were recruited. There was a 4-week observation period, midway during which we offered to review the participants' records. The app was then downloaded and participants' diabetes regimens entered on the synchronized IDM website. At 2, 4, 8, 12 and 16 weeks of the active phase, their records were reviewed online, and feedback was provided electronically. The primary endpoint was change in levels of glycated hemoglobin (A1C). RESULTS Of the 31 patients recruited, 18 completed the study. These 18 made 572±98 entries per person on the IDM system over the course of the study (≈5.1/day). Their ages were 40.0±13.9 years, the durations of their diabetes were 27.3±14.9 years and 44% used insulin pumps. The median A1C level fell from 8.1% (7.5 to 9.0, IQ range) to 7.8% (6.9 to 8.3; p<0.001). During the observation period, glucose records were reviewed for 50% of the participants. In the active phase, review of the glucose diaries took less time on the IDM website than using personal glucose records in the observation period, median 6 minutes (5 to 7.5 IQ range) vs. 10 minutes (7.5 to 10.5 IQ range; p<0.05). CONCLUSIONS Our smartphone app enables online review of glucose records, requires less time for clinical staff and is associated with improved glucose control.
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Affiliation(s)
- Edmond A Ryan
- Divisions of Endocrinology and Metabolism and Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - Joanna Holland
- Divisions of Endocrinology and Metabolism and Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Eleni Stroulia
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Blerina Bazelli
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie A Babwik
- Divisions of Endocrinology and Metabolism and Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Haipeng Li
- Alberta Innovates Centre for Machine Learning, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Senior
- Divisions of Endocrinology and Metabolism and Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Russ Greiner
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada; Alberta Innovates Centre for Machine Learning, University of Alberta, Edmonton, Alberta, Canada
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Recio-Rodríguez JI, Martín-Cantera C, González-Viejo N, Gómez-Arranz A, Arietaleanizbeascoa MS, Schmolling-Guinovart Y, Maderuelo-Fernandez JA, Pérez-Arechaederra D, Rodriguez-Sanchez E, Gómez-Marcos MA, García-Ortiz L. Effectiveness of a smartphone application for improving healthy lifestyles, a randomized clinical trial (EVIDENT II): study protocol. BMC Public Health 2014; 14:254. [PMID: 24628961 PMCID: PMC4003852 DOI: 10.1186/1471-2458-14-254] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New technologies could facilitate changes in lifestyle and improve public health. However, no large randomized, controlled studies providing scientific evidence of the benefits of their use have been made. The aims of this study are to develop and validate a smartphone application, and to evaluate the effect of adding this tool to a standardized intervention designed to improve adherence to the Mediterranean diet and to physical activity. An evaluation is also made of the effect of modifying habits upon vascular structure and function, and therefore on arterial aging. METHODS/DESIGN A randomized, double-blind, multicenter, parallel group clinical trial will be carried out. A total of 1215 subjects under 70 years of age from the EVIDENT trial will be included. Counseling common to both groups (control and intervention) will be provided on adaptation to the Mediterranean diet and on physical activity. The intervention group moreover will receive training on the use of a smartphone application designed to promote a healthy diet and increased physical activity, and will use the application for three months. The main study endpoints will be the changes in physical activity, assessed by accelerometer and the 7-day Physical Activity Recall (PAR) interview, and adaptation to the Mediterranean diet, as evaluated by an adherence questionnaire and a food frequency questionnaire (FFQ). Evaluation also will be made of vascular structure and function based on central arterial pressure, the radial augmentation index, pulse velocity, the cardio-ankle vascular index, and carotid intima-media thickness. DISCUSSION Confirmation that the new technologies are useful for promoting healthier lifestyles and that their effects are beneficial in terms of arterial aging will have important clinical implications, and may contribute to generalize their application in favor of improved population health. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02016014.
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Affiliation(s)
- José I Recio-Rodríguez
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
| | - Carlos Martín-Cantera
- Primary Health care Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | | | - Amparo Gómez-Arranz
- Casa de Barco Health Center, Castilla y León Health Service, Valladolid, Spain
| | | | - Yolanda Schmolling-Guinovart
- Río Tajo Health Center, Castilla-La Mancha Health Service, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | | | | | | | - Manuel A Gómez-Marcos
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
| | - Luis García-Ortiz
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
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Abstract
The number of diabetes management mobile applications (apps) available on the market has grown exponentially since 2009; however, most patients lack the skills necessary for finding relevant health care information. Thus, clinical best practices emphasize the need for ongoing patient education. Despite the importance of education in clinical guidelines, very few of these apps include education in their top functionalities. Most diabetes management mobile apps are not medical devices by definition, according to the U.S. Food and Drug Administration, and therefore do not require clearance or approval for market, and very few have been subject to clinical evaluation. There has been little research on the use of diabetes management mobile apps, marginalizing the role of diabetes professionals and educators in a burgeoning market, hungry for information and an improved quality of life. Still, mobile technology holds great promise as a platform for self-management. Health care providers must not only educate patients about these resources, but take steps to ensure that mobile apps follow accepted best practices and guidelines.
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Affiliation(s)
- Brian Brandell
- bioMetric Holdings Inc., 02000 SW Palatine Hill Rd., Portland, OR 97219.
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Schwartz FL, Marling CR. Use of Automated Bolus Calculators for Diabetes Management. EUROPEAN ENDOCRINOLOGY 2013; 9:92-95. [PMID: 29922360 DOI: 10.17925/ee.2013.09.02.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/25/2013] [Indexed: 11/24/2022]
Abstract
Fewer than 30 % of patients with diabetes who are on insulin therapy achieve target glycated haemoglobin (HbA1C) levels. Automated bolus calculators (ABCs) are now almost universally used for patients on insulin pump therapy to calculate pre-meal insulin doses. Use of ABCs in glucose monitors and smart phone applications have the potential to improve glucose control in a larger population of individuals with diabetes on insulin therapy by overcoming the fear of hypoglycaemia and assisting those with low numeracy skills.
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Affiliation(s)
- Frank L Schwartz
- Professor of Endocrinology, The Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, US
| | - Cynthia R Marling
- Associate Professor, School of Electrical Engineering and Computer Science, Russ College of Engineering and Technology, Ohio University, Athens, Ohio, US
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Wolf JA, Moreau JF, Akilov O, Patton T, English JC, Ho J, Ferris LK. Diagnostic inaccuracy of smartphone applications for melanoma detection. JAMA Dermatol 2013; 149:422-6. [PMID: 23325302 DOI: 10.1001/jamadermatol.2013.2382] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To measure the performance of smartphone applications that evaluate photographs of skin lesions and provide the user with feedback about the likelihood of malignancy. DESIGN Case-control diagnostic accuracy study. SETTING Academic dermatology department. PARTICIPANTS AND MATERIALS: Digital clinical images of pigmented cutaneous lesions (60 melanoma and 128 benign control lesions) with a histologic diagnosis rendered by a board-certified dermatopathologist, obtained before biopsy from patients undergoing lesion removal as a part of routine care. MAIN OUTCOME MEASURES Sensitivity, specificity, and positive and negative predictive values of 4 smartphone applications designed to aid nonclinician users in determining whether their skin lesion is benign or malignant. RESULTS Sensitivity of the 4 tested applications ranged from 6.8% to 98.1%; specificity, 30.4% to 93.7%; positive predictive value, 33.3% to 42.1%; and negative predictive value, 65.4% to 97.0%. The highest sensitivity for melanoma diagnosis was observed for an application that sends the image directly to a board-certified dermatologist for analysis; the lowest, for applications that use automated algorithms to analyze images. CONCLUSIONS The performance of smartphone applications in assessing melanoma risk is highly variable, and 3 of 4 smartphone applications incorrectly classified 30% or more of melanomas as unconcerning. Reliance on these applications, which are not subject to regulatory oversight, in lieu of medical consultation can delay the diagnosis of melanoma and harm users.
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Affiliation(s)
- Joel A Wolf
- University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Wolf JA, Moreau JF, Akilov O, Patton T, English JC, Ho J, Ferris LK. Diagnostic inaccuracy of smartphone applications for melanoma detection. JAMA Dermatol 2013. [PMID: 23325302 DOI: 10.1001/jamadermatol.2013.2382.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To measure the performance of smartphone applications that evaluate photographs of skin lesions and provide the user with feedback about the likelihood of malignancy. DESIGN Case-control diagnostic accuracy study. SETTING Academic dermatology department. PARTICIPANTS AND MATERIALS: Digital clinical images of pigmented cutaneous lesions (60 melanoma and 128 benign control lesions) with a histologic diagnosis rendered by a board-certified dermatopathologist, obtained before biopsy from patients undergoing lesion removal as a part of routine care. MAIN OUTCOME MEASURES Sensitivity, specificity, and positive and negative predictive values of 4 smartphone applications designed to aid nonclinician users in determining whether their skin lesion is benign or malignant. RESULTS Sensitivity of the 4 tested applications ranged from 6.8% to 98.1%; specificity, 30.4% to 93.7%; positive predictive value, 33.3% to 42.1%; and negative predictive value, 65.4% to 97.0%. The highest sensitivity for melanoma diagnosis was observed for an application that sends the image directly to a board-certified dermatologist for analysis; the lowest, for applications that use automated algorithms to analyze images. CONCLUSIONS The performance of smartphone applications in assessing melanoma risk is highly variable, and 3 of 4 smartphone applications incorrectly classified 30% or more of melanomas as unconcerning. Reliance on these applications, which are not subject to regulatory oversight, in lieu of medical consultation can delay the diagnosis of melanoma and harm users.
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Affiliation(s)
- Joel A Wolf
- University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Abstract
BACKGROUND Advancements in smartphone technology coupled with the proliferation of data connectivity has resulted in increased interest and unprecedented growth in mobile applications for diabetes self-management. The objective of this article is to determine, in a systematic review, whether diabetes applications have been helping patients with type 1 or type 2 diabetes self-manage their condition and to identify issues necessary for large-scale adoption of such interventions. METHODS The review covers commercial applications available on the Apple App Store (as a representative of commercially available applications) and articles published in relevant databases covering a period from January 1995 to August 2012. The review included all applications supporting any diabetes self-management task where the patient is the primary actor. RESULTS Available applications support self-management tasks such as physical exercise, insulin dosage or medication, blood glucose testing, and diet. Other support tasks considered include decision support, notification/alert, tagging of input data, and integration with social media. The review points to the potential for mobile applications to have a positive impact on diabetes self-management. Analysis indicates that application usage is associated with improved attitudes favorable to diabetes self-management. Limitations of the applications include lack of personalized feedback; usability issues, particularly the ease of data entry; and integration with patients and electronic health records. CONCLUSIONS Research into the adoption and use of user-centered and sociotechnical design principles is needed to improve usability, perceived usefulness, and, ultimately, adoption of the technology. Proliferation and efficacy of interventions involving mobile applications will benefit from a holistic approach that takes into account patients' expectations and providers' needs.
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Affiliation(s)
- Omar El-Gayar
- College of Business and Information Systems, Dakota State University, Madison, South Dakota 57402, USA.
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Tran J, Tran R, White JR. Smartphone-Based Glucose Monitors and Applications in the Management of Diabetes: An Overview of 10 Salient "Apps" and a Novel Smartphone-Connected Blood Glucose Monitor. Clin Diabetes 2012. [DOI: 10.2337/diaclin.30.4.173] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jacquot F, Charpentier A, Khelifi S, Gastambide D, Rigal R, Sautet A. Measuring the Cobb angle with the iPhone in kyphoses: a reliability study. INTERNATIONAL ORTHOPAEDICS 2012; 36:1655-60. [PMID: 22653103 DOI: 10.1007/s00264-012-1579-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Smartphones have gained widespread use in the healthcare field to fulfill a variety of tasks. We developed a small iPhone application to take advantage of the built-in position sensor to measure angles in a variety of spinal deformities. We present a reliability study of this tool in measuring kyphotic angles. METHODS Radiographs taken from 20 different patients' charts were presented to a panel of six operators at two different times. Radiographs were measured with the protractor and the iPhone application and statistical analysis was applied to measure intraclass correlation coefficients between both measurement methods, and to measure intra- and interobserver reliability RESULTS The intraclass correlation coefficient calculated between methods (i.e. CobbMeter application on the iPhone versus standard method with the protractor) was 0.963 for all measures, indicating excellent correlation was obtained between the CobbMeter application and the standard method. The interobserver correlation coefficient was 0.965. The intraobserver ICC was 0.977, indicating excellent reproductibility of measurements at different times for all operators. The interobserver ICC between fellowship trained senior surgeons and general orthopaedic residents was 0.989. Consistently, the ICC for intraobserver and interobserver correlations was higher with the CobbMeter application than with the regular protractor method. This difference was not statistically significant. CONCLUSION Measuring kyphotic angles with the iPhone application appears to be a valid procedure and is in no way inferior to the standard way of measuring the Cobb angle in kyphotic deformities.
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Klonoff DC. Improved outcomes from diabetes monitoring: the benefits of better adherence, therapy adjustments, patient education, and telemedicine support. J Diabetes Sci Technol 2012; 6:486-90. [PMID: 22768877 PMCID: PMC3440062 DOI: 10.1177/193229681200600301] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Visvanathan A, Gibb AP, Brady RRW. Increasing clinical presence of mobile communication technology: avoiding the pitfalls. Telemed J E Health 2011; 17:656-61. [PMID: 21780941 DOI: 10.1089/tmj.2011.0018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mobile communication technologies are employed in many diverse areas of healthcare delivery to provide improved quality and efficiency of communication and facilitate increased rapidity of data or information transfer. Mobile phones enable healthcare professionals to possess a portable platform from which to provide many healthcare-related applications and are a popular means to directly communicate with colleagues and patients. As involvement of mobile communication technology in healthcare delivery continues to rapidly expand, there are also important considerations of relevance to patient safety and security as a result. Here, we review the previous evidence of reported clinical risks associated with mobile communication technology, such as electromagnetic interference, confidentiality and data security, distraction/noise, infection control, and cross contamination. In conclusion, although mobile phones provide much putative potential improvement to healthcare delivery, further evaluation and research are required to both inform and protect health professionals and users of such technology in the healthcare environment and provide the evidence base to support the provision of clear and comprehensive guidelines.
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Affiliation(s)
- Akila Visvanathan
- Department of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, United Kingdom
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