Mobile e-Health: The Unwired Evolution of Telemedicine

Telemedicine Effectiveness in the First Elective Orthopedic Care Compared to a Standard Face-to-face Visit

Objective  The study aimed to compare whether the diagnoses of orthopedic diseases at telemedicine (TM) consultations are the same as those established at face-to-face visits. Method  Primary, observational, prospective, analytical study, with subjects from the local municipal network who were referred to the orthopedics outpatient clinic from May to June 2021. Subjects underwent two assessments: a telemedicine (TM) consultation and a face-to-face (FF) visit. Two different physicians attended to the patients and established a diagnosis. The physician performing the FF visit was not aware of the previous diagnoses. We compared the diagnoses obtained at both modalities to assess the degree of similarity. In addition, we determined the time required for consultations and the degree of satisfaction of the physicians. Results  We evaluated 43 patients and seven physicians, totaling 44 TM and 43 FF visits. The diagnostic similarity index was 81.4%. TM consultations were shorter (mean time, 4.8 minutes) than FF visits. Physicians were less satisfied with TM in the four criteria evaluated (respective scores of 79.1, 23.3, 46.6, and 37.2). Conclusion  TM consultations have a diagnoses agreement higher than 80% compared with FF visits. On the other hand, TM consultations were faster, and physicians were less satisfied with them in comparison with FF visits.

Telemedicine in Spine Surgery: Global Perspectives and Practices

STUDY DESIGN

Cross-sectional, anonymous, international survey.

OBJECTIVES

The COVID-19 pandemic has resulted in the rapid adoption of telemedicine in spine surgery. This study sought to determine the extent of adoption and global perspectives on telemedicine in spine surgery.

METHODS

All members of AO Spine International were emailed an anonymous survey covering the participant's experiences with and perceptions of telemedicine. Descriptive statistics were used to depict responses. Responses were compared among regions.

RESULTS

485 spine surgeons participated in the survey. Telemedicine usage rose from <10.0% to >39.0% of all visits. A majority of providers (60.5%) performed at least one telemedicine visit. The format of "telemedicine" varied widely by region: European (50.0%) and African (45.2%) surgeons were more likely to use phone calls, whereas North (66.7%) and South American (77.0%) surgeons more commonly used video (P < 0.001). North American providers used telemedicine the most during COVID-19 (>60.0% of all visits). 81.9% of all providers "agreed/strongly agreed" telemedicine was easy to use. Respondents tended to "agree" that imaging review, the initial appointment, and postoperative care could be performed using telemedicine. Almost all (95.4%) surgeons preferred at least one in-person visit prior to the day of surgery.

CONCLUSION

Our study noted significant geographical differences in the rate of telemedicine adoption and the platform of telemedicine utilized. The results suggest a significant increase in telemedicine utilization, particularly in North America. Spine surgeons found telemedicine feasible for imaging review, initial visits, and follow-up visits although the vast majority still preferred at least one in-person preoperative visit.

Contributions of digital social research to develop Telemedicine in Calabria (Southern Italy): identification of inequalities in post-COVID-19

The paper discusses the role that sociology and digital social research methods could play in developing E-health and Telemedicine, specifically after the COVID-19 pandemic, and the possibility of dealing with new pandemics. In this article, we will reflect on an interdisciplinary research pilot project carried out by a team of sociologists, medical doctors, and software engineers at The University of Calabria (Italy), to give a proof of concept of the importance to develop Telemedicine through the contribution of digital social research. We apply a web and app survey to administrate a structured questionnaire to a self-selected sample of the University Community. Digital social research has highlighted socioeconomic and cultural gaps that affect the perception of Telemedicine in the University Community. In particular, gender, age, educational, and professional levels influence medical choices and behaviors during Covid-19. There is often an unconscious involvement in Telemedicine (people use it but don't know it is Telemedicine), and an optimistic perception grows with age, education, professional, and income levels; equally important are the comprehension of digital texts and the effective use of Telemedicine. Limited penetration of technological advances must be addressed primarily by overcoming sociocultural and economic barriers and developing knowledge and understanding of digital environments. The key findings of this study could help direct public and educational policies to reduce existing gaps and promote Telemedicine in Calabria.

Mobile healthcare platforms' sustainability: The perspective of health information quality

As an emerging form of medical organization, Chinese mobile healthcare (mHealth) platforms are inherently linked to the continuous use of users, which depends on the quality of the health information provided. However, improving the health information quality of mHealth platforms is still a problem that needs to be studied and solved in order to make the platforms sustainable. Based on the reputation mechanism, this study creates a behavioral evolutionary game model for health information providers (physicians) and managers (mHealth platforms), explores the evolution process and evolutionarily stable strategy of the behaviors in various situations, and uses numerical simulation technology to analyze mHealth platforms' constraints and the influencing factors of health information quality. This study presents three key findings. First, considering reputation, health information managers and mHealth platform providers should not unilaterally optimize health information. Instead, mHealth platforms should have active quality control, and physician groups should provide high-quality health information, which is the ideal evolution of the model. Second, the rewards that physicians receive from patients and mHealth platforms for providing quality health information, the reputation benefits, the penalties that physicians suffer for providing low-quality health information, and the increased probability and cost of rent-seeking behavior that physicians may choose can effectively promote the choice of physicians to provide high-quality health information. Third, the reputation gain of mHealth platforms, the probability of mHealth platforms being exposed, and increased losses suffered from exposure can effectively promote the choice of mHealth platforms to control the quality of health information. This study can provide a theoretical basis for mHealth platforms' health information quality control, which is conducive to the healthy and sustainable development of mHealth platforms and the improvement of user satisfaction.

eHealth: A Survey of Architectures, Developments in mHealth, Security Concerns and Solutions

The ramifications of the COVID-19 pandemic have contributed in part to a recent upsurge in the study and development of eHealth systems. Although it is almost impossible to cover all aspects of eHealth in a single discussion, three critical areas have gained traction. These include the need for acceptable eHealth architectures, the development of mobile health (mHealth) technologies, and the need to address eHealth system security concerns. Existing survey articles lack a synthesis of the most recent advancements in the development of architectures, mHealth solutions, and innovative security measures, which are essential components of effective eHealth systems. Consequently, the present article aims at providing an encompassing survey of these three aspects towards the development of successful and efficient eHealth systems. Firstly, we discuss the most recent innovations in eHealth architectures, such as blockchain-, Internet of Things (IoT)-, and cloud-based architectures, focusing on their respective benefits and drawbacks while also providing an overview of how they might be implemented and used. Concerning mHealth and security, we focus on key developments in both areas while discussing other critical topics of importance for eHealth systems. We close with a discussion of the important research challenges and potential future directions as they pertain to architecture, mHealth, and security concerns. This survey gives a comprehensive overview, including the merits and limitations of several possible technologies for the development of eHealth systems. This endeavor offers researchers and developers a quick snapshot of the information necessary during the design and decision-making phases of the eHealth system development lifecycle. Furthermore, we conclude that building a unified architecture for eHealth systems would require combining several existing designs. It also points out that there are still a number of problems to be solved, so more research and investment are needed to develop and deploy functional eHealth systems.

The behavioral intention to adopt mobile health services: The moderating impact of mobile self-efficacy

This study explored the moderating impact of mobile self-efficacy on the adoption of mobile health services. The UTAUT was used as the theoretical foundation for this study. The results have indicated that mobile self-efficacy was significant in moderating the impact of both performance expectancy (β = -0.005, p < 0.05) and effort expectancy (β = -010, p < 0.05) on the adoption of mobile health services. In addition, it was revealed to our surprise that both performance (β = 0.521, t = 9.311, p > 0.05) and effort expectancy (β = 0.406, t = 7.577, p > 0.05) do not determine the behavioral intention to use mobile health services. Effort expectancy and behavioral intention to use were also, respectively, not significant in influencing performance expectancy (β = 0.702, t = 12.601, p > 0.05) and intention to recommend the adoption of mobile health services (β = 0.866, t = 13.814, p > 0.05). Mobile self-efficacy, however, was found to significantly predict the citizen's intention to recommend the adoption of mobile health services (β = 0.139, t = 2.548, p < 0.05). The implications of these findings on mobile health are discussed.

Effectiveness of telehealth interventions among traumatic brain injury survivors: A systematic review and meta-analysis

INTRODUCTION

Traumatic brain injury (TBI) represents a major cause of death and disability worldwide. Brain damage is associated with physical and psychological difficulties among TBI survivors. Diverse face-to-face and telehealth programs exist to help survivors cope with these burdens. However, the effectiveness of telehealth interventions among TBI survivors remains inconclusive.

METHODS

A systematic review and meta-analysis of randomized control trials were conducted. Relevant full-text articles were retrieved from seven databases, from database inception to January 2022, including Academic Search Complete, CINAHL, EMBASE, Cochrane, MEDLINE, PubMed, and Web of Science. Bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was performed using a random-effects model to calculate the pooled effect size of telehealth interventions for TBI survivors. STATA 16.0 was used for statistical analysis.

RESULTS

In total, 17 studies (N = 3158) applying telehealth interventions among TBI survivors were included in the analysis. Telehealth interventions decreased neurobehavioural symptom (standardized mean difference: -0.13; 95% confidence interval [CI]: -0.36 to 0.10), reduce depression (standardized mean difference: -0.32; 95% CI: -0.79 to 0.14), and increase symptom management self-efficacy (standardized mean difference: 0.22; 95% CI: 0.02-0.42).

DISCUSSION

Telehealth interventions are promising avenues for healthcare delivery due to advances in technology and information. Telehealth programs may represent windows of opportunity, combining traditional treatment with rehabilitation to increase symptom management self-efficacy among TBI patients during recovery. Future telehealth programs can focus on developing the contents of telehealth modules based on evidence from this study.

Development of a mobile phone camera-based transcutaneous bilirubinometer for low-resource settings

Newborns in high-income countries are routinely screened for neonatal jaundice using transcutaneous bilirubinometery (TcB). In low-and middle-income countries, TcB is not widely used due to a lack of availability; however, mobile-phone approaches for TcB could help expand screening opportunities. We developed a mobile phone-based approach for TcB and validated the method with a 37 patient multi-ethnic pilot study. We include a custom-designed snap-on adapter that is used to create a spatially resolved diffuse reflectance detection configuration with the illumination provided by the mobile-phone LED flash. Monte-Carlo models of reflectance from neonatal skin were used to guide the design of an adapter for filtered red-green-blue (RGB) mobile-phone camera reflectance measurements. We extracted measures of reflectance from multiple optimized spatial-offset regions-of-interest (ROIs) and a linear model was developed and cross-validated. This resulted in a correlation between total serum bilirubin and mobile-phone TcB estimated bilirubin with a R ²= 0.42 and Bland-Altman limits of agreement of +6.4 mg/dL to -7.0 mg/dL. These results indicate that a mobile phone with a modified adapter can be utilized to measure neonatal bilirubin values, thus creating a novel tool for neonatal jaundice screening in low-resource settings.

Factors affecting doctor’s recommendation for mobile health services

Objective

As a new medical service mode, the value of mobile health (mHealth） services has received increasing attention and recognition. However, compared with the owners of mobile devices, the user scale of mHealth services is still small. It is well known that doctors’ recommendations have an important impact on what kind of medical service patients choose. To explore the key factors affecting doctors’ recommendation of mHealth services to patients, and to provide countermeasures for mHealth service providers and hospital managers, so as to promote doctors to recommend mHealth services to more patients.

Methods

Through literature review, expert consultation and pre-test, a questionnaire including 22 questions was designed, and 114 valid questionnaires were collected by online research. Net Promoter Score (NPS) was used to evaluate doctors’ recommendation willingness, and multivariate logistics analysis was used to evaluate the key factors affecting doctors’ recommendation willingness.

Results

The NPS of doctors was 6.06%, among which the recommenders, neutrals and critics accounted for 29.56%, 46.96% and 23.48%, respectively. The attitude towards mHealth services and whether they pay attention to and/or are willing to try new technologies are the key factors affecting the doctors’ recommendation, and the usefulness for patients most often emphasized by mHealth service providers to doctors does not affect doctors’ recommendation willingness. In addition, whether mHealth services can help doctors establish personal brands may be a potential factor to enhance doctors’ recommendation willingness.

Conclusion

In order to improve the recommendation willingness of doctors, mHealth service providers and hospital managers should focus on doctors who have a positive attitude towards mHealth services and are highly innovative (which often means younger and lower professional levels). At the same time, they should think about how to use mHealth services to help doctors establish personal brands in the future.

Use of digital technologies in mental health during COVID-19

Abstract Most countries did not have a consolidated digital health structure before the pandemic. Both social distancing and mental health problems resulting from the situation justify the urgency of discussions on web-mediated interventions. The objective of this work is to present the panorama of technological mediation in mental health services and their specificities in the context of the pandemic. This paper is grounded on a critical look at the migration from face-to-face care to the Internet environment, highlighting: the international experiences using digital technologies in the pandemic context; the challenges in online consultations, emphasizing the importance of the ethical, technical/technological, and clinical domains, which are recurring issues in the international literature; the challenges and perspectives in the use of technologies. It is essential to develop strategies aligned with government incentives, aiming at the quality of the offered services and the guarantee of an adequate hybrid qualification.

An ID-Associated Application to Facilitate Patient-Tailored Management of Multiple Sclerosis

Despite improvements in diagnosis and treatment, multiple sclerosis (MS) is the leading neurological cause of disability in young adults. As a chronic disease, MS requires complex and challenging management. In this context, eHealth has gained an increasing relevance. Here, we aim to summarize beneficial features of a mobile app recently implemented in clinical MS routine as well as beyond MS. PatientConcept is a CE-certified, ID-associated multilingual software application allowing patients to record relevant health data without disclosing any identifying data. Patients can voluntarily share their health data with selected physicians. Since its implementation in 2018, about 3000 MS patients have used PatientConcept. Initially developed as a physician–patient communication platform, the app maps risk management plans of all current disease modifying therapies and thereby facilitates adherence to specified monitoring appointments. It also allows continuous monitoring of various PROs (Patient Reported Outcomes), enabling a broad overview of the disease course. In addition, various studies/projects currently assess monitoring, follow-up, diagnostics and telemetric evaluations of patients with other diseases beyond MS. Altogether, PatientConcept offers a broad range of possibilities to support physician–patient communication, implementation of risk management plans and assessment of PROs. It is a promising tool to facilitate patient-tailored management of MS and other chronic diseases.

Human Factors and Requirements of People with Cognitive Impairment, Their Caregivers, and Healthcare Professionals for mHealth Apps Including Reminders, Games, and Geolocation Tracking: A Survey-Questionnaire Study

Background:

Mobile Health (mHealth) apps can delay the cognitive decline of people with dementia (PwD), by providing both objective assessment and cognitive enhancement.

Objective:

This patient involvement survey aims to explore human factors, needs and requirements of PwD, their caregivers, and Healthcare Professionals (HCPs) with respect to supportive and interactive mHealth apps, such as brain games, medication reminders, and geolocation trackers through a constructive questionnaire.

Methods:

Following the principles of user-centered design to involve end-users in design we constructed a questionnaire, containing both open-ended and closed-ended questions as well as multiple choice and Likert scale, in order to investigate the specific requirements and preferences for mHealth apps. We recruited 48 participants including people with cognitive impairment (n = 15), caregivers (n = 16), and HCPs (n = 17) and administered the questionnaire.

Results:

All participants are likely to use mHealth apps, with the primary desired features being the improvement of memory and cognition, assistance on medication treatment, and perceived ease to use. HCPs, caregivers, and PwD consider brain games as an important technology-based, non-pharmaceutical intervention. Both caregivers and patients are willing to use a medication reminder app frequently. Finally, caregivers are worried about the patient wandering. Therefore, global positioning system tracking would be particularly important to them. On the other hand, patients are concerned about their privacy, but are still willing to use a geolocation app for cases of emergency.

Conclusion:

This research contributes to mHealth app design and potential adoption. All three groups agree that mHealth services could facilitate care and ameliorate behavioral and cognitive disturbances of patients.

Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review

Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training-with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow-much less skill development-lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.

A Displacement Estimated Method for Real Time Tissue Ultrasound Elastography

As an important means of medical imaging, elastic imaging is an indispensable part of mobile telemedicine. Ultrasound elastography has become a research hotspot because it can accurately measure soft tissue lesions. Displacement estimation is the most important step in ultrasound elastography. At present, the phase zero search method is an accurate and fast displacement estimation method. However, when the displacement exceeds 1/4 wavelength, it is invalid. The accuracy of block matching method is not high, but it is suitable for large displacement, so it can overcome this shortcoming. It is worth noting that the quality-guided block matching method has good robustness under complex mutation conditions. It can provide prior knowledge to increase the robustness of the phase-zero search under large displacement conditions. So we propose a novel displacement estimation method for real time tissue ultrasound elastography, which combines the quality-guided block matching method and the phase-zero search method. The experimental results show that this method is more accurate, faster and robust than other displacement estimation methods.

Telemedicine in Orthopaedic Surgery: Challenges and Opportunities

Improvements in technology and a push toward value-based health care have poised the telemedicine industry for growth; however, despite the benefits of virtual care, widespread implementation had not occurred until the coronavirus 2019 (COVID-19) pandemic. Powerful barriers have hindered the widespread adoption of telemedicine, including lack of awareness, implementation costs, inefficiencies introduced, difficulty performing physical examinations, overall lack of perceived benefit of virtual care, negative financial implications, concern for medicolegal liability, and regulatory restrictions. Some of these challenges have been addressed with temporary state and federal mandates in response to the COVID-19 pandemic; however, continued investment in systems and technology as well as refinement of regulations around telemedicine are needed to sustain widespread adoption by patients and providers.

The Role of Engagement in Teleneurorehabilitation: A Systematic Review

The growing understanding of the importance of involving patients with neurological diseases in their healthcare routine either for at-home management of their chronic conditions or after the hospitalization period has opened the research for new rehabilitation strategies to enhance patient engagement in neurorehabilitation. In addition, the use of new digital technologies in the neurorehabilitation field enables the implementation of telerehabilitation systems such as virtual reality interventions, video games, web-based interventions, mobile applications, web-based or telephonic telecoach programs, in order to facilitate the relationship between clinicians and patients, and to motivate and activate patients to continue with the rehabilitation process at home. Here we present a systematic review that aims at reviewing the effectiveness of different engagement strategies and the different engagement assessments while using telerehabilitation systems in patients with neurological disorders. We used PICO's format to define the question of the review, and the systematic review protocol was designed following the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographical data was collected by using the following bibliographic databases: PubMed, EMBASE, Scopus, and Web of Science. Eighteen studies were included in this systematic review for full-text analyses. Overall, the reviewed studies using engagement strategies through telerehabilitation systems in patients with neurological disorders were mainly focused on patient self-management and self-awareness, patient motivation, and patient adherence subcomponents of engagement, that are involved in by the behavioral, cognitive, and emotional dimensions of engagement. Conclusion: The studies commented throughout this systematic review pave the way for the design of new telerehabilitation protocols, not only focusing on measuring quantitative or qualitative measures but measuring both of them through a mixed model intervention design (1). The future clinical studies with a mixed model design will provide more abundant data regarding the role of engagement in telerehabilitation, leading to a possibly greater understanding of its underlying components.

Importance of Photography Education to Improve Image Quality for Accurate Remote Diagnoses in Dental Trauma Patients: Observational Study

Background

High-quality photos are critical for the remote diagnosis of dental trauma and thus are beneficial to the prognosis. The quality of the images obtained using a cell phone depends on the level of dental and photography knowledge of the person who is taking the photos.

Objective

This study aimed to determine the efficacy of photography education in improving images used for the remote diagnosis of dental trauma.

Methods

The subjects comprised 30 laypeople and 30 dentists who were randomly assigned to 15 subgroups with 2 subjects in each. Each subject was asked to take photos of their own anterior teeth and those of their partner on the assumption that an accident occurred using both an iPhone 4s and iPhone 6. Education about how to take an appropriate photo of the anterior teeth for teleconsultation purposes was then provided, after which photos were taken again. Photos were assessed by a dentist for their usefulness in diagnosis.

Results

This study analyzed 965 photos: 441 taken by laypeople and 524 taken by dentists. Photos taken after providing education had significantly higher scores for all assessment items than those taken before education (P<.05). The scores were also significantly higher for photos taken using the rear camera than those taken using the front camera (P<.02). The iPhone 6 did not have overwhelming advantages. The photos taken by dentists had significantly higher scores than those taken by laypeople for most of the evaluated items.

Conclusions

Both laypeople and dentists might find photography education useful for when they are taking photos to be used in teleconsultations. The type of cell phone does not significantly affect the usefulness of such photos.

A Framework for Competencies for the Use of Mobile Technologies in Psychiatry and Medicine: Scoping Review

BACKGROUND

To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured.

OBJECTIVE

This paper sought out competencies for mobile technologies and/or an approach to define them.

METHODS

A scoping review was conducted to answer the following research question, "What skills are needed for clinicians and trainees to provide quality care via mHealth, have they been published, and how can they be made measurable and reproducible to teach and assess them?" The review was conducted in accordance with the 6-stage scoping review process starting with a keyword search in PubMed/Medical Literature Analysis and Retrieval System Online, APA PsycNET, Cochrane, EMBASE, PsycINFO, Web of Science, and Scopus. The literature search focused on keywords in 4 concept areas: (1) competencies, (2) mobile technologies, (3) telemedicine mode, and (4) health. Moreover, 2 authors independently, in parallel, screened the search results for potentially relevant studies based on titles and abstracts. The authors reviewed the full-text articles for final inclusion based on inclusion/exclusion criteria. Inclusion criteria were keywords used from concept area 1 (competencies) and 2 (mobile technologies) and either 3 (telemedicine mode) or 4 (health). Exclusion criteria included, but were not limited to, keywords used from a concept area in isolation, discussion of skills abstractly, outline or listing of what clinicians need without detail, and listing immeasurable behaviors.

RESULTS

From a total of 1232 results, the authors found 78 papers eligible for a full-text review and found 14 papers directly relevant to the 4 key concepts. Although few studies specifically discussed skills, the majority were clinical studies, and the literature included no lists of measurable behaviors or competency sets for mobile technology. Therefore, a framework for mobile technology competencies was built according to the review, expert consensus, and recommendations of the Institute of Medicine's Health Professions Education Summit and Accreditation Council of Graduate Medical Education framework. This framework borrows from existing competency framework domains in telepsychiatry and social media (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication) and added domains of mHealth clinical decision support, device/technology assessment/selection, and information flow management across an electronic health record platform. mHealth Asynchronous components require additional traditional learning, teaching, supervisory and evaluation practices. Interactive curricula with case-, problem-, and system-based teaching may help faculty focus on decision making and shape skills and attitudes to complement clinical exposure.

CONCLUSIONS

Research is needed on how to customize implementation and evaluation of mHealth competencies and to ensure skill development is linked to the quality of care. This will require the management of organizational change with technology and the creation of a positive electronic culture in a complex policy and regulatory environment.

An Efficient Mobile-Healthcare Emergency Framework

Mobile technologies are capable of offering individual level health care services to users. Mobile Healthcare (m-Healthcare) frameworks, which feature smartphone (SP) utilizations of ubiquitous computing made possible by applying wireless Body Sensor Networks (BSNs), have been introduced recently to provide SP clients with health condition monitoring and access to medical attention when necessary. However, in a vulnerable m-Healthcare framework, clients' personal info and sensitive data can easily be poached by intruders or any malicious party, causing serious security problems and confidentiality issues. In 2013, Lu et al. proposed a mobile-Healthcare emergency framework based on privacy-preserving opportunistic computing (SPOC), claiming that their splendid SPOC construction can opportunistically gather SP resources such as computing power and energy to handle computing-intensive Personal Health Information (PHI) with minimal privacy disclosure during an emergency. To balance between the risk of personal health information exposure and the essential PHI processing and transmission, Lu et al. presented a patient-centric privacy ingress control framework based on an attribute-based ingress control mechanism and a Privacy-Preserving Scalar Product Computation (PPSPC) technique. In spite of the ingenious design, however, Lu et al.'s framework still has some security flaws in such aspects as client anonymity and mutual authentication. In this article, we shall offer an improved version of Lu et al.'s framework with the security weaknesses mended and the computation efficiency further boosted. In addition, we shall also present an enhanced mobile-Healthcare emergency framework using Partial Discrete Logarithm (PDL) which does not only achieve flawless mutual authentication as well as client anonymity but also reduce the computation cost.

Target women: Equity in access to mHealth technology in a non-communicable disease care intervention in Kenya

Background

Non-Communicable Diseases (NCDs) constitute 40 million deaths annually. Eighty-percent of these deaths occur in Low- and Middle-Income Countries. MHealth provides a potentially highly effective modality for global public health, however access is poorly understood. The objective of our study was to assess equity in access to mHealth in an NCD intervention in Kenya.

Methods

This is a secondary analysis of a complex NCD intervention targeting slum residents in Kenya. The primary outcomes were: willingness to receive SMS, whether SMS was received, and access to SMS compared to alternative health information modalities. Age, sex, level of education, level of income, type of work, number of hours worked, and home environment were explanatory variables considered. Multivariable regression analyses were used to test for association using likelihood ratio testing.

Results

7,618 individual participants were included in the analysis. The median age was 44 years old. Majority (75%, n = 3,691/ 4,927) had only attended up to primary (elementary) school. Majority reported earning “KShs 7,500 or greater” (27%, n = 1,276/ 4,736). Age and level of income had evidence of association with willingness to receive SMS, and age, sex and number of hours work with whether SMS was received. SMS was the health information modality with highest odds of being accessed in older age groups (OR 4.70, 8.72 and 28.89, for age brackets 60–69, 70–79 and 80 years or older, respectively), among women (OR = 1.86, 95% CI 1.19–2.89), and second only to Baraazas (community gatherings) among those with lowest income.

Conclusion

Women had the greatest likelihood of receiving SMS. SMS performed equitably well amongst marginalized populations (elderly, women, and low-income) as compared to alternative health information modalities, though sensitization prior to implementation of mHealth interventions may be needed. These findings provide guidance for developing mHealth interventions targeting marginalized populations in these settings.

Mobile Health, Smartphone/Device, and Apps for Psychiatry and Medicine: Competencies, Training, and Faculty Development Issues

Faculty and trainees need clinical skills, knowledge, and attitudes to ensure quality care using technology. Clinical faculty teach, supervise, and role model skills for trainees and interprofessional team members. Mobile health, smartphone/device, and app competencies may be situated within the graduate medical education milestone domains. This article outlines these competencies and aligns them with clinical care, teaching methods, and evaluation. These competencies have similarities and differences from in-person and telepsychiatric care and additional dimensions like clinical decision support, technology selection, and information flow management across an e-platform. Health systems must integrate in-person and technology-based care, while maintaining the therapeutic relationship.

The mTST - An mHealth approach for training and quality assurance of tuberculin skin test administration and reading

Background

The Tuberculin Skin Test (TST) is a relatively simple test for detecting latent tuberculosis infection (LTBI) but requires regular quality assurance to ensure proper technique for administration and reading. The objective of this study was to estimate the accuracy and reproducibility of an mhealth approach (the mTST) to measure the size of swelling immediately following TST administration (TST injection bleb) and after 48–72 hours (TST induration).

Methods

Five non-clinical and one clinical reviewer measured the size of TST injection blebs, and TST indurations using smartphone acquired photos of sites of TST administration and readings in patients, or saline injections in volunteers. The reference standard was the onsite measurement (measured by an experienced TB nurse) of the actual TST injection bleb, or induration. Agreement of reviewers’ measurements with the reference standard, as well as agreement within and between reviewers, was estimated using Cohen's kappa coefficient.

Results

Using the mTST method to assess bleb size in 64 photos of different TST injections, agreement between reviewers, and the reference standard was very good to excellent (κ ranged from 0.75 to 0.87), and within-reviewer reproducibility of readings was excellent (κ ranged from 0.86 to 0.96). Using the mTST method to assess TST induration in 72 photos, reviewers were able to detect no induration (<5mm) and induration of 15mm or greater with accuracy of 95% and 92% respectively, but accuracy was only 20% and 77% for reactions of 5-9mm and 10-14mm respectively.

Conclusion

The mTST approach appears to be a reliable tool to assess TST administration. The mTST approach was accurate to read indurations of 0-4mm or 15+mm, but less accurate for reactions of 5-14mm. We believe the mTST approach could be useful for training and quality assurance in locations where on-site supervision is not possible.

A Mixed-Methods Study of Users' Journey Mapping Experience and Acceptance of Telehealthcare Technology in Taiwan

Background: The integration of telehealthcare technologies into geriatric care has clear advantages, but poses challenges for key stakeholders, including the telehealthcare service industry, smart device developers, marketers and, of course, users. The purpose of this study was to gain insight into user experience and acceptance of telehealthcare technology in Taiwan. Materials and Methods: Taking an integrated mixed-methods approach, 51 participants-33 women (64.71%) and 18 men (35.29%) (mean age: 52.1 years)-were examined before, during, and after using a telehealthcare device. A questionnaire was used to assess users' acceptance of the technology. Interviews were conducted to gather feedback. Results: The quantitative analysis revealed that (1) effort expectancy and relatives significantly influenced users' behavior intentions, (2) error and memorability significantly affected users' satisfaction, and (3) intention and satisfaction significantly affected users' behavior. The qualitative analysis revealed two key implications. First, participants generally were not satisfied with the telehealthcare device. Second, participants suggested the redesign of the telehealthcare device to reduce operating errors and time consumption to meet users' needs. Conclusions: Contemporary telehealthcare devices do not meet users' needs. Participants were made to adapt to the equipment rather than the equipment tailored to meet their needs. Although there were key benefits from home telehealthcare, the systems require enhanced technology, improved usability, and an expanded scale of services backed by government before widespread implementation can successfully proceed.

Digital Follow-Up and the Perspective of Patient-Centered Care in Oncology: What's the PROblem?

There is accumulating evidence from randomized trials suggesting that digital patient-centered care allows a more reliable detection of tumour-related symptoms and adverse events - with a direct impact on overall survival. Consequently, a variety of unsynchronized approaches were kicked off to (electronically) measure patient-reported outcomes (PROs). Despite increasing evidence that PRO data are highly relevant for patient care, the data generated in these initial projects lack standardized processing pathways in order to impact clinical routine; therefore, potential future routine PRO assessments require adequate analysis, storage and processing to allow a robust, reproducible and reliable incorporation into routine clinical decision-making. Here, we discuss relevant challenges of digital follow-up that need to be tackled to render PRO data as relevant to physicians as laboratory or biomarker data.

New Technologies for Glaucoma Detection

This review describes some of the most recent advances in the development and application of new technologies for detecting and managing glaucoma, including imaging, visual function testing, and tonometry. The widespread availability of mobile technology in the developing world is improving health care delivery, for example, with smartphones and mobile applications that allow patient data to be assessed remotely by health care providers.

Social Media Users' Perception of Telemedicine and mHealth in China: Exploratory Study

BACKGROUND

The use of telemedicine and mHealth has increased rapidly in the People's Republic of China. While telemedicine and mHealth have great potential, wide adoption of this technology depends on how patients, health care providers, and other stakeholders in the Chinese health sector perceive and accept the technology.

OBJECTIVE

To explore this issue, we aimed to examine a social media platform with a dedicated focus on health information technology and informatics in China. Our goal is to utilize the findings to support further research.

METHODS

In this exploratory study, we selected a social media platform-HC3i.cn-to examine the perception of telemedicine and mHealth in China. We performed keyword analysis and analyzed the prevalence and term frequency-inverse document frequency of keywords in the selected social media platform; furthermore, we performed qualitative analysis.

RESULTS

We organized the most prominent 16 keywords from 571 threads into 8 themes: (1) Question versus Answer; (2) Hospital versus Clinic; (3) Market versus Company; (4) Doctor versus Nurse; (5) Family versus Patient; (6) iPad versus Tablet; (7) System versus App; and (8) Security versus Caregiving. Social media participants perceived not only significant opportunities associated with telemedicine and mHealth but also barriers to overcome to realize these opportunities.

CONCLUSIONS

We identified interesting issues in this paper by studying a social media platform in China. Among other things, participants in the selected platform raised concerns about quality and costs associated with the provision of telemedicine and mHealth, despite the new technology's great potential to address different issues in the Chinese health sector. The methods applied in this paper have some limitations, and the findings may not be generalizable. We have discussed directions for further research.

What Predicts Patients' Adoption Intention Toward mHealth Services in China: Empirical Study

Background

With the increasing concerns about the health of individuals in China and the development of information technology, mHealth enables patients to access health information and interact with doctors anytime and anywhere. Examining patients’ willingness to use mHealth is considered critical because its success depends on the adoption of patients.

Objective

The objective of our study was to explore the determinants of mHealth service adoption among Chinese patients using an extended technology acceptance model (TAM) with trust and perceived risks.

Methods

We conducted a questionnaire-based survey in 3 large hospitals in China and analyzed the data using structural equation modeling.

Results

The results corroborated that the proposed model fits well. Trust, perceived usefulness, and perceived ease of use positively correlated with mHealth service adoption. Privacy and performance risks negatively correlated with the patients’ trust and adoption intention toward mHealth services. In addition, patients’ age and chronic diseases can help predict their trust level and adoption intention toward mHealth, respectively.

Conclusions

We concluded that the TAM generally works in the context of mHealth adoption, although its significance has declined. In addition to technical factors, trust and perceived risks are critical for explaining mHealth service adoption among Chinese patients.

Design and Development of a Context-Aware Knowledge-Based Module for Identifying Relevant Information and Information Gaps in Patients With Type 1 Diabetes Self-Collected Health Data

Background

Patients with diabetes use an increasing number of self-management tools in their daily life. However, health institutions rarely use the data generated by these services mainly due to (1) the lack of data reliability, and (2) medical workers spending too much time extracting relevant information from the vast amount of data produced. This work is part of the FullFlow project, which focuses on self-collected health data sharing directly between patients’ tools and EHRs.

Objective

The main objective is to design and implement a prototype for extracting relevant information and documenting information gaps from self-collected health data by patients with type 1 diabetes using a context-aware approach. The module should permit (1) clinicians to assess the reliability of the data and to identify issues to discuss with their patients, and (2) patients to understand the implication their lifestyle has on their disease.

Methods

The identification of context and the design of the system relied on (1) 2 workshops in which the main author participated, 1 patient with type 1 diabetes, and 1 clinician, and (2) a co-design session involving 5 patients with type 1 diabetes and 4 clinicians including 2 endocrinologists and 2 diabetes nurses. The software implementation followed a hybrid agile and waterfall approach. The testing relied on load, and black and white box methods.

Results

We created a context-aware knowledge-based module able to (1) detect potential errors, and information gaps from the self-collected health data, (2) pinpoint relevant data and potential causes of noticeable medical events, and (3) recommend actions to follow to improve the reliability of the data issues and medical issues to be discussed with clinicians. The module uses a reasoning engine following a hypothesize-and-test strategy built on a knowledge base and using contextual information. The knowledge base contains hypotheses, rules, and plans we defined with the input of medical experts. We identified a large set of contextual information: emotional state (eg, preferences, mood) of patients and medical workers, their relationship, their metadata (eg, age, medical specialty), the time and location of usage of the system, patient-collected data (eg, blood glucose, basal-bolus insulin), patients’ goals and medical standards (eg, insulin sensitivity factor, in range values). Demonstrating the usage of the system revealed that (1) participants perceived the system as useful and relevant for consultation, and (2) the system uses less than 30 milliseconds to treat new cases.

Conclusions

Using a knowledge-based system to identify anomalies concerning the reliability of patients’ self-collected health data to provide information on potential information gaps and to propose relevant medical subjects to discuss or actions to follow could ease the introduction of self-collected health data into consultation. Combining this reasoning engine and the system of the FullFlow project could improve the diagnostic process in health care.

Applications of Space Technologies to Global Health: Scoping Review

Background

Space technology has an impact on many domains of activity on earth, including in the field of global health. With the recent adoption of the United Nations’ Sustainable Development Goals that highlight the need for strengthening partnerships in different domains, it is useful to better characterize the relationship between space technology and global health.

Objective

The aim of this study was to identify the applications of space technologies to global health, the key stakeholders in the field, as well as gaps and challenges.

Methods

We used a scoping review methodology, including a literature review and the involvement of stakeholders, via a brief self-administered, open-response questionnaire. A distinct search on several search engines was conducted for each of the four key technological domains that were previously identified by the UN Office for Outer Space Affairs’ Expert Group on Space and Global Health (Domain A: remote sensing; Domain B: global navigation satellite systems; Domain C: satellite communication; and Domain D: human space flight). Themes in which space technologies are of benefit to global health were extracted. Key stakeholders, as well as gaps, challenges, and perspectives were identified.

Results

A total of 222 sources were included for Domain A, 82 sources for Domain B, 144 sources for Domain C, and 31 sources for Domain D. A total of 3 questionnaires out of 16 sent were answered. Global navigation satellite systems and geographic information systems are used for the study and forecasting of communicable and noncommunicable diseases; satellite communication and global navigation satellite systems for disaster response; satellite communication for telemedicine and tele-education; and global navigation satellite systems for autonomy improvement, access to health care, as well as for safe and efficient transportation. Various health research and technologies developed for inhabited space flights have been adapted for terrestrial use.

Conclusions

Although numerous examples of space technology applications to global health exist, improved awareness, training, and collaboration of the research community is needed.

Informational interventions on paternal outcomes during the perinatal period: A systematic review

PROBLEM

The perinatal period is a stressful transition for new parents.

BACKGROUND

Various forms of educational interventions are available and are found to be efficacious in improving maternal and child outcomes. Such interventions for fathers were scarce and western-centric. Fathers should be educated as they have an impact on maternal and child outcomes.

AIM

This review aims to evaluate the efficacy of quantitatively-studied informational support-focused interventions for fathers using paternal outcomes only.

METHODS

The search was carried out in six databases: Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, Embase, Psychological Information Database, and MedNar. Cochrane Collaboration's tools were used to assess the eligibility of the studies.

FINDINGS

A total of 17 studies with 18 interventions were identified and included in the narrative synthesis. Most interventions were delivered to the Western population during the antenatal or postpartum period. The method of delivery for these interventions was mainly face-to-face, with inconclusive findings on various paternal psychosocial outcomes.

DISCUSSION

Limited father-inclusive interventions were available. Technology-based longitudinal studies with interventions carried out across the perinatal period with longer follow-up periods were recommended for interventions providing informational support for fathers. Future studies can also examine paternal physical health and behavioural outcomes. Interventions in culturally-diverse populations should be designed and tested for their efficacies as fathers have different informational needs, especially in Asia.

CONCLUSION

Informational interventions for fathers were found to be lacking and recommendations for future studies on educational interventions for fathers were discussed.

m-Health: Lessons Learned by m-Experiences

m-Health is an emerging area that is transforming how people take part in the control of their wellness condition. This vision is changing traditional health processes by discharging hospitals from the care of people. Important advantages of continuous monitoring can be reached but, in order to transform this vision into a reality, some factors need to be addressed. m-Health applications should be shared by patients and hospital staff to perform proper supervised health monitoring. Furthermore, the uses of smartphones for health purposes should be transformed to achieve the objectives of this vision. In this work, we analyze the m-Health features and lessons learned by the experiences of systems developed by MAmI Research Lab. We have focused on three main aspects: m-interaction, use of frameworks, and physical activity recognition. For the analysis of the previous aspects, we have developed some approaches to: (1) efficiently manage patient medical records for nursing and healthcare environments by introducing the NFC technology; (2) a framework to monitor vital signs, obesity and overweight levels, rehabilitation and frailty aspects by means of accelerometer-enabled smartphones and, finally; (3) a solution to analyze daily gait activity in the elderly, carrying a single inertial wearable close to the first thoracic vertebra.

Clinical Application of a Smartphone-Based Ophthalmic Camera adapter in Under-Resourced Settings in Nepal

Background

The ability to obtain high quality ocular images utilizing smartphone technology is of special interest in under-resourced parts of the world where traditional ocular imaging devices are cost-prohibitive, difficult to transport, and require a trained technician for operation.

Purpose

The purpose of this study was to explore potential anterior and posterior segment ocular imaging use cases for a smartphone-based ophthalmic camera adapter (Paxos Scope, Digisight Technologies, San Francisco, CA, USA) in under-resourced settings in Nepal.

Methods

From September to November of 2015 we utilized the Paxos Scope smartphone camera adapter coupled with an iPhone 5 to explore anterior and posterior segment clinical applications for this mobile technology. We used the device at a tertiary eye care facility, a rural eye hospital and a rural cataract outreach camp. We tested the device's capability for high quality photo-documentation in clinic, in the operating room, and in the outreach camp setting. Images were automatically uploaded to a secure, cloud-based electronic medical record system that facilitated sharing of images with other providers for telemedicine purposes.

Results

Herein we present 17 ocular images documenting a wide variety of anterior and posterior segment pathology using the Paxos Scope from clinical cases seen in a variety of settings in Nepal.

Conclusions

We found the quality of both the anterior and posterior segment images to be excellent in the clinic, the operating room, and the outreach camp settings. We found the device to be versatile and user-friendly, with a short learning curve. The Paxos Scope smartphone camera adapter may provide an affordable, high-quality, mobile ocular imaging option for under-resourced parts of the world.

What Do Men Want from a Health Screening Mobile App? A Qualitative Study

There is a lack of mobile app which aims to improve health screening uptake developed for men. As part of the study to develop an effective mobile app to increase health screening uptake in men, we conducted a needs assessment to find out what do men want from a health screening mobile app. In-depth interviews and focus group discussions were conducted with 31 men from a banking institution in Kuala Lumpur. The participants were purposely sampled according to their job position, age, ethnicity and screening status. The recruitment was stopped once data saturation was achieved. The audio-recorded interviews were transcribed verbatim and analyzed using thematic approach. Three themes emerged from the analysis and they were: content, feature and dissemination. In terms of the content, men wanted the app to provide information regarding health screening and functions that can assess their health; which must be personalized to them and are trustable. The app must have user-friendly features in terms of information delivery, ease of use, attention allocation and social connectivity. For dissemination, men proposed that advertisements, recommendations by health professionals, providing incentive and integrating the app as into existing systems may help to increase the dissemination of the app. This study identified important factors that need to be considered when developing a mobile app to improve health screening uptake. Future studies on mobile app development should elicit users' preference and need in terms of its content, features and dissemination strategies to improve the acceptability and the chance of successful implementation.

Understanding the perception towards using mHealth applications in practice

The objective of this study was to investigate physicians’ perceptions to use mobile health applications in practice, and to identify influencing factors to use the technology. An mHealth technology acceptance model was proposed (M-TAM), and a cross-sectional survey was implemented using structured questionnaire to collect data. Online tools were used for inviting participants (physicians) and data collection from Turkey. The data was analyzed using Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). A total of 128 physicians participated in the survey. The model explained the perception of physicians towards mHealth application use by 51% of total variance. The influential factors were identified as Effort Expectancy, Mobile Anxiety, Perceived Service Availability and Technical Training and Support. The study provided a new model to the literature of health information technology. Findings of the research contributed by unveiling latent constructs and their influence on physicians’ perceptions towards a new healthcare technology: mHealth applications.

Blood Culture Testing via a Mobile App That Uses a Mobile Phone Camera: A Feasibility Study

Background

To evaluate patients with fever of unknown origin or those with suspected bacteremia, the precision of blood culture tests is critical. An inappropriate step in the test process or error in a parameter could lead to a false-positive result, which could then affect the direction of treatment in critical conditions. Mobile health apps can be used to resolve problems with blood culture tests, and such apps can hence ensure that point-of-care guidelines are followed and processes are monitored for blood culture tests.

Objective

In this pilot project, we aimed to investigate the feasibility of using a mobile blood culture app to manage blood culture test quality. We implemented the app at a university hospital in South Korea to assess the potential for its utilization in a clinical environment by reviewing the usage data among a small group of users and by assessing their feedback and the data related to blood culture sampling.

Methods

We used an iOS-based blood culture app that uses an embedded camera to scan the patient identification and sample number bar codes. A total of 4 medical interns working at 2 medical intensive care units (MICUs) participated in this project, which spanned 3 weeks. App usage and blood culture sampling parameters (including sampler, sampling site, sampling time, and sample volume) were analyzed. The compliance of sampling parameter entry was also measured. In addition, the participants’ opinions regarding patient safety, timeliness, efficiency, and usability were recorded.

Results

In total, 356/644 (55.3%) of all blood culture samples obtained at the MICUs were examined using the app, including 254/356 (71.3%) with blood collection volumes of 5-7 mL and 256/356 (71.9%) with blood collection from the peripheral veins. The sampling volume differed among the participants. Sampling parameters were completely entered in 354/356 cases (99.4%). All the participants agreed that the app ensured good patient safety, disagreed on its timeliness, and did not believe that it was efficient. Although the bar code scanning speed was acceptable, the Wi-Fi environment required improvement. Moreover, the participants requested feedback regarding their sampling quality.

Conclusions

Although this app could be used in the clinical setting, improvements in the app functions, environment network, and internal policy of blood culture testing are needed to ensure hospital-wide use.

A Robust and Anonymous Two Factor Authentication and Key Agreement Protocol for Telecare Medicine Information Systems

Nowadays people can get many services including health-care services from distributed information systems remotely via public network. By considering that these systems are built on public network, they are vulnerable to many malicious attacks. Hence it is necessary to introduce an effective mechanism to protect both users and severs. Recently many two-factor authentication schemes have been proposed to achieve this goal. In 2016, Li et al. demonstrated that Lee et al.'s scheme was not satisfactory to be deployed in practice because of its security weaknesses and then proposed a security enhanced scheme to overcome these drawbacks. In this paper, we analyze Li et al.'s scheme is still not satisfactory to be applied in telecare medicine information systems (TMIS) because it fails to withstand off-line dictionary attack and known session-specific temporary information attack. Moreover, their scheme cannot provide card revocation services for lost smart card. In order to solve these security problems, we propose an improved scheme. Then we analyze our scheme by using BAN-logic model and compare the improved scheme with related schemes to prove that our scheme is advantageous to be applied in practice.

Clinical Validation of a Smartphone-Based Adapter for Optic Disc Imaging in Kenya

IMPORTANCE

Visualization and interpretation of the optic nerve and retina are essential parts of most physical examinations.

OBJECTIVE

To design and validate a smartphone-based retinal adapter enabling image capture and remote grading of the retina.

DESIGN, SETTING, AND PARTICIPANTS

This validation study compared the grading of optic nerves from smartphone images with those of a digital retinal camera. Both image sets were independently graded at Moorfields Eye Hospital Reading Centre. Nested within the 6-year follow-up (January 7, 2013, to March 12, 2014) of the Nakuru Eye Disease Cohort in Kenya, 1460 adults (2920 eyes) 55 years and older were recruited consecutively from the study. A subset of 100 optic disc images from both methods were further used to validate a grading app for the optic nerves. Data analysis was performed April 7 to April 12, 2015.

MAIN OUTCOMES AND MEASURES

Vertical cup-disc ratio for each test was compared in terms of agreement (Bland-Altman and weighted κ) and test-retest variability.

RESULTS

A total of 2152 optic nerve images were available from both methods (also 371 from the reference camera but not the smartphone, 170 from the smartphone but not the reference camera, and 227 from neither the reference camera nor the smartphone). Bland-Altman analysis revealed a mean difference of 0.02 (95% CI, -0.21 to 0.17) and a weighted κ coefficient of 0.69 (excellent agreement). The grades of an experienced retinal photographer were compared with those of a lay photographer (no health care experience before the study), and no observable difference in image acquisition quality was found.

CONCLUSIONS AND RELEVANCE

Nonclinical photographers using the low-cost smartphone adapter were able to acquire optic nerve images at a standard that enabled independent remote grading of the images comparable to those acquired using a desktop retinal camera operated by an ophthalmic assistant. The potential for task shifting and the detection of avoidable causes of blindness in the most at-risk communities makes this an attractive public health intervention.

Impact of wearable technology on psychosocial factors of osteoarthritis management: a qualitative study

OBJECTIVES

To identify the impact the use of wearable technology could have in patients with osteoarthritis in terms of communication with healthcare providers and patients' empowerment to manage their condition.

DESIGN

Qualitative study using focus groups with patients with osteoarthritis; data from patients' responses were analysed using Framework Methodology.

PARTICIPANTS

21 patients with knee osteoarthritis from the London area (age range 45-65 years) participated in a total of four focus groups. Recruitment continued until data saturation.

SETTING

The study was conducted in a university setting.

RESULTS

Patients' responses suggested a positive attitude on the impact wearable technology could have on the management of osteoarthritis. It was perceived that the use of wearable devices would benefit patients in terms of feeling in control of their condition, providing them with awareness of their progress, empowering in terms of self-management and improving communication with their clinician.

CONCLUSIONS

This paper suggests positive patient perspectives on the perceived benefits wearable technology could have on the management of osteoarthritis. The data that could be collected with the use of wearable technology could be beneficial both to patients and clinicians. The information obtained from this study suggests that introducing wearable technology into patient-centred care could enhance patient experience in the field of osteoarthritis and beyond.

Usability Evaluation of a Mobile Monitoring System to Assess Symptoms After a Traumatic Injury: A Mixed-Methods Study

BACKGROUND

Victims of trauma are at high risk for mental health conditions such as posttraumatic stress disorder and depression. Regular assessment of mental health symptoms in the post-trauma period is necessary to identify those at greatest risk and provide treatment. The multiple demands of the acute post-trauma period present numerous barriers to such assessments. Mobile apps are a method by which to overcome these barriers in order to regularly assess symptoms, identify those at risk, and connect patients to needed services.

OBJECTIVE

The current study conducted a usability evaluation of a system to monitor mental health symptoms after a trauma. The system was developed to promote ease of use and facilitate quick transmission of data.

METHODS

A sample of 21 adults with a history of trauma completed a standardized usability test in a laboratory setting followed by a qualitative interview.

RESULTS

Usability testing indicated that the app was easy to use and that patients were able to answer several questions in less than 1 minute (mean [SD] 29.37 [7.53]; range 15-57). Qualitative analyses suggested that feedback should be included in such an app and recommendations for the type of feedback were offered.

CONCLUSIONS

The results of the current study indicate that a mobile app to monitor post-trauma mental health symptoms would be well received by victims. Personalized feedback to the user was identified as critical to promote the usability of the software.

VehiHealth: An Emergency Routing Protocol for Vehicular Ad Hoc Network to Support Healthcare System

Survival of a patient depends on effective data communication in healthcare system. In this paper, an emergency routing protocol for Vehicular Ad hoc Network (VANET) is proposed to quickly forward the current patient status information from the ambulance to the hospital to provide pre-medical treatment. As the ambulance takes time to reach the hospital, ambulance doctor can provide sudden treatment to the patient in emergency by sending patient status information to the hospital through the vehicles using vehicular communication. Secondly, the experienced doctors respond to the information by quickly sending a treatment information to the ambulance. In this protocol, data is forwarded through that path which has less link breakage problem between the vehicles. This is done by calculating an intersection value I v a l u e for the neighboring intersections by using the current traffic information. Then the data is forwarded through that intersection which has minimum I v a l u e . Simulation results show VehiHealth performs better than P-GEDIR, GyTAR, A-STAR and GSR routing protocols in terms of average end-to-end delay, number of link breakage, path length, and average response time.

Caregiver-mediated therapy for an adult with visual and intellectual impairment suffering from separation anxiety

BACKGROUND

Separation anxiety among intellectually disabled (ID) persons with comorbid visual impairment could be rooted in a weak sense of person permanence. Technology-assisted Therapy for Separation Anxiety (TTSA) was used to address this problem.

AIMS

The primary aim was to determine whether technology alone or including caregivers was the best option, and whether TTSA decreased separation anxiety and challenging behaviour. Also, how the caregivers and the client experienced TTSA.

METHODS AND PROCEDURES

A pre-experimental, quantitative approach (AB1C1B2C2D) was used for this single-subject study. The frequency of the client's text messages was recorded daily. The variables were monitored with standardised instruments and caregivers rated the intensity and frequency of the client's anxious and challenging behaviour. The social validity was evaluated by means of questionnaires.

OUTCOMES AND RESULTS

There was a significant decrease in the anxious and angry messages sent, and in anxious and challenging behaviour, in the phase in which the caregivers were included, compared with the phase in which technology alone was used. The client and the caregivers were positive about TTSA.

CONCLUSION AND IMPLICATION

Technology and the caregivers reactions reduces the anxiety and challenging behaviour. It might also aid the acquisition of the concept of person permanence.

Regulatory frameworks for mobile medical applications

A mobile application (app) is a software program that runs on mobile communication devices such as a smartphone. The concept of a mobile medical app has gained popularity and diffusion but its reference regulatory context has raised discussion and concerns. Theoretically, a mobile app can be developed and uploaded easily by any person or entity. Thus, if an app can have some effects on the health of the users, it is mandatory to identify its reference regulatory context and the applicable prescriptions.

Ethical E-Health

E-health is a rising star that marks the collaboration of medical science and information technology, a ray of hope promising a glorious future of health and prosperity, an easy solution to rely on when in need of medical assistance. But the question arises is E-health an absolute spotless option? In this paper we question the integrity with which e-health is being practised, is the code of ethics being diligently followed? And if not then is ethical e-health entirely impossible? It is of utmost importance to encourage the motivational thinkers who have taken the initiative to provide a better and quicker solution to all health problems by integrating health services and information technology. To do so it becomes necessary to remove the barriers in the way of ethical E-health.