Gamification and Coaching in Remote Monitoring and Care Platforms

Nowadays, several e-health systems are equipped with advanced features for patients monitoring and care. Among these features, gamification and operations supporting the patients' adherence to therapeutic and care plans have been found to be quite useful and valuable. Among others, the introduction of intelligent patient coaching and the provisions of recommendations are very popular. The aim of this paper is to present specific gamification and coaching approaches that could be employed in the context of an existing eHealth system for remote monitoring and care for elders. The "Points, Badges and Leaderboards" gamification approach was followed. Specifically, parameters related to the application usage (daily points), the physical activity (number of daily steps), the sleep quality (sleep score) and other measurements (i.e. weight) were utilized to accommodate elders needs for motivation and engagement. Regarding the coaching, motivational messages and notification for the mobile devices were selected to deliver the relative information to the elders. A prototype health information system with a corresponding mobile application was adapted to include gamification and coaching features to motivate elders in order to achieve the maximum adherence on their monitoring and care health plans. The paper presents the design issues and summarizes the technical details.

Pervasive Monitoring of Public Health and Well-Being in Urban Areas with Blue-Green Solutions

The urban environment seems to affect the citizens' health. The implementation of Blue-Green Solutions (BGS) in urban areas have been used to promote public health and citizens well-being. The aim of this paper is to present the development of an mHealth app for monitoring patients and citizens health status in areas where BGS will be applied. The "HEART by BioAsssist" application could be used as a health and other data collection tool as well as an "intelligent assistant" to monitor and promote patient's physical activity in areas with Blue-Green Solutions.

Lactate and Lactate-to-Pyruvate Ratio in Critically Ill COVID-19 Patients: A Pilot Study

A limited number of coronavirus disease-19 (COVID-19) cases may require treatment in an intensive care unit (ICU). Arterial blood lactate levels are routinely measured in the ICU to estimate disease severity, predict poor outcomes, and monitor therapeutic handlings. A number of studies have suggested that, simultaneously with lactate, pyruvate should also be measured, providing augmented prognostic ability, and a better understanding of the underlying metabolic alterations in ICU patients. Hence, the aim of the present study was to elucidate the relationship between lactate levels and the lactate-to-pyruvate (LP) ratio with the clinical outcome in mechanically ventilated COVID-19 patients. Lactate and pyruvate were serially measured during the first 24 h of ICU stay. A group of ICU non-COVID-19 patients was used as a comparison group. The majority of COVID-19 patients (82.5%) had normal lactate levels and a normal LP ratio on ICU admission (normal metabolic pattern). A small, yet significant, percentage of patients had either elevated lactate levels or a high LP ratio (abnormal metabolic pattern); these patients exhibited a significantly higher risk of ICU mortality compared to the patients with a normal metabolic pattern (72.7% vs. 34.6%, p = 0.04). In our critically ill COVID-19 patients, elevated lactate levels or high LP ratios on admission to the ICU could be associated with poor clinical outcome.

Quantifying Citizens' Well-Being in Areas with Natural Based Solutions Using Mobile Computing

Urban planners, architects and civil engineers are integrating Nature-Based Solutions (NBS) to address contemporary environmental, social, health and economic challenges. Many studies claim that NBS are poised to improve citizens' well-being in urban areas. NBS can also benefit Public Health, as they can contribute to optimising environmental parameters (such as urban heat island effects, floods, etc.), as well as to the reduction of diseases, as for example cardiovascular ones and the overall mortality rate. In addition, the usage of mobile health (mHealth) solutions has been broadly applied to support citizens' well-being as they can offer monitoring of their physical and physiological status and promote a healthier lifestyle. The aim of this paper is to present the specifications, the design and the development of a mobile app for monitoring citizens' well-being in areas where NBS have been applied. The users' physical activity and vital signs are recorded by wearable devices and the users' locations are recorded by the proposed mobile application. All collected data are transferred to the cloud platform where data management mechanisms aggregate data from different sources for combined analysis. The mobile application is currently available for Android and iOS devices and it is compatible with most smart devices and wearables. The "euPOLIS by BioAssist" application can be used as a health and other data collection tool to investigate citizen's well-being improvement in areas with NBS.

Chios Hospital Information System Assessment

A very important aspect for organizations that provide healthcare services is to have fully functional and successful information systems. A successful hospital information system can contribute to high quality healthcare services provided to the patients of the hospital. In this paper, is presented the evaluation of the information system of Chios Hospital, "Skylitsio". The survey was conducted using a questionnaire which consists demographic questions and questions that measure the factors of the DeLone & McLean success model. The participants of the survey were 71 users of the clinical information system. Cronbach's alpha reliability test, descriptive statistics, and further data analyses to investigate the relations between the factors of the DeLone & McLean success model were performed. Based on the results, the users of the information system are satisfied with it, as well as they find the system useful and easy to use. The average value of the "information quality" is 3.78 out of 5, the "system quality" is 3.61, the "service quality" is 3.45, the "use" is 3.83, the "user satisfaction" is 3.46, and the "user benefit" is 3.76. The research concludes with a validation of the DeLone & McLean success model and it seems that the information system of the General Hospital of Chios is successful based on the users' opinions.

Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) Could Provide Better Accuracy Than Creatinine in Predicting Acute Kidney Injury Development in Critically Ill Patients

Acute kidney injury (AKI) is one of the most common complications in critically ill patients. In recent years, studies have focused on exploring new biomarkers for the early diagnosis and prognosis of AKI. The aim of this study was to investigate serum prognostic biomarkers (neutrophil gelatinase-associated lipocalin, NGAL, and creatinine) of AKI in critically ill patients. The study included 266 critically ill, initially nonseptic, patients admitted to a multidisciplinary ICU. Serum levels of NGAL and creatinine were measured at ICU admission. ROC curves were generated to estimate the prognostic value of the biomarkers, while a logistic regression analysis was performed to assess their association with an increased AKI risk. Patients were divided in two groups based on the development (n = 98) or not (n = 168) of AKI during their ICU stay. Serum NGAL levels at ICU admission were significantly higher in those who subsequently developed AKI compared to those who did not (p < 0.0001). NGAL was shown to be more accurate in predicting AKI development than creatinine; furthermore, NGAL levels were associated with an increased risk of AKI development (1.005 (1.002–1.008), p < 0.0001). In the present study, we were able to demonstrate that increased serum NGAL levels at ICU admission might be predictive of AKI development during ICU hospitalization. Further studies are needed to support NGAL as a prognostic marker of acute kidney injury.

An Online Information Tool for Diabetic Retinopathy

Regardless of the type of diabetes, patients with diabetes are 25 times more likely to develop vision problems or even blindness than non-diabetics. Diabetic Retinopathy is the most common cause of new cases of blindness in adults. The aim of this paper is to present a pilot online tool to provide information regarding the Diabetic Retinopathy. The tool was developed using a Content Management System. To compile the content of the website, a literature review was conducted. The online information tool is addressed to all potential stakeholders on this subject, for the provision of knowledge and targeted information according to their information needs. The online tool also aims to raise the public awareness about the Diabetic Retinopathy and health promotion.

Could Soluble Endothelial Protein C Receptor Levels Recognize SARS-CoV2-Positive Patients Requiring Hospitalization?

INTRODUCTION

The endothelial protein C receptor (EPCR) is a protein that regulates the protein C anticoagulant and anti-inflammatory pathways. A soluble form of EPCR (sEPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in COVID-19 has not been explored. In this study, we investigated whether sEPCR levels were related to COVID-19 patients' requirement for hospitalization.

METHODS

Plasma sEPCR levels were measured on hospital admission in 84 COVID-19 patients, and in 11 non-hospitalized SARS-CoV2-positive patients approximately 6 days after reported manifestation of their symptoms. Multiple logistic regression analysis was performed to identify potential risk factors for hospitalization and receiver operating characteristic (ROC) curves were generated to assess their value.

RESULTS

In our cohort, hospitalized patients had considerably higher sEPCR levels upon admission compared with outpatients [107.5 (76.7-156.3) vs. 44.6 (12.1-84.4) ng/mL; P < 0.0001)]. The ROC curve using hospitalization as the classification variable and sEPCR levels as the prognostic variable generated an area under the curve at 0.845 (95% CI = 0.710-0.981, P < 0.001). Additionally, we investigated the predictive value of sEPCR combined with BMI, age, or D-dimers.

CONCLUSIONS

In our cohort, sEPCR levels in COVID-19 patients upon hospital admission appear considerably elevated compared with outpatients; this could lead to impaired APC activities and might contribute to the pro-coagulant phenotype reported in such patients. sEPCR measurement might be useful as a point-of-care test in SARS-CoV2-positive patients.

Evaluating the Role of the Interleukin-23/17 Axis in Critically Ill COVID-19 Patients

Studies have hypothesized a potential role of the interleukin (IL)-23/17 axis in coronavirus disease 2019 (COVID-19). However, to date, levels of IL-23 and 17 have not been compared between critically ill COVID-19 patients and critically ill non-COVID-19 patients. IL-23 and 17 were measured on admission to the intensive care unit (ICU) in critically ill COVID-19 (N = 38) and critically ill non-COVID-19 (N = 34) patients with an equal critical illness severity. Critically ill non-COVID-19 patients did not have sepsis or septic shock on ICU admission. None of the enrolled patients had previously received corticosteroids. In our study, circulating IL-17 levels were higher in the COVID-19 patients. More specifically, critically ill COVID-19 patients had levels of 0.78 (0.05-1.8) pg/mL compared to 0.11 (0.05-0.9) pg/mL in the critically ill non-COVID-19 patients (p = 0.04). In contrast, IL-23 levels were comparable between groups. A group of patients hospitalized in the specialized COVID-19 clinic (N = 16) was also used to evaluate IL-17 and IL-23 levels with respect to COVID-19 severity. Non-critically ill COVID-19 patients had undetectable levels of both cytokines. Our results support the notion of inhibiting IL-17 in critical COVID-19 infection.

Soluble Angiotensin Converting Enzyme 2 (ACE2) Is Upregulated and Soluble Endothelial Nitric Oxide Synthase (eNOS) Is Downregulated in COVID-19-induced Acute Respiratory Distress Syndrome (ARDS)

A damaged endothelium is an underlying condition of the many complications of COVID-19 patients. The increased mortality risk associated with diseases that have underlying endothelial dysfunction, such as acute respiratory distress syndrome (ARDS), suggests that endothelial (e) nitric oxide synthase (NOS)-derived nitric oxide could be an important defense mechanism. Additionally, intravenous recombinant angiotensin converting enzyme 2 (ACE2) was recently reported as an effective therapy in severe COVID-19, by blocking viral entry, and thus reducing lung injury. Very few studies exist on the prognostic value of endothelium-related protective molecules in severe COVID-19 disease. To this end, serum levels of eNOS, inducible (i) NOS, adrenomedullin (ADM), soluble (s) ACE2 levels, and serum (s) ACE activity were measured on hospital admission in 89 COVID-19 patients, hospitalized either in a ward or ICU, of whom 68 had ARDS, while 21 did not. In our cohort, the COVID-19-ARDS patients had considerably lower eNOS levels compared to the COVID-19 non-ARDS patients. On the other hand, sACE2 was significantly higher in the ARDS patients. iNOS, ADM and sACE activity did not differ. Our results might support the notion of two distinct defense mechanisms in COVID-19-derived ARDS; eNOS-derived nitric oxide could be one of them, while the dramatic rise in sACE2 may also represent an endogenous mechanism involved in severe COVID-19 complications, such as ARDS. These results could provide insight to therapeutical applications in COVID-19.

Endothelial, Immunothrombotic, and Inflammatory Biomarkers in the Risk of Mortality in Critically Ill COVID-19 Patients: The Role of Dexamethasone

Endothelial dysfunction, coagulation and inflammation biomarkers are increasingly emerging as prognostic markers of poor outcomes and mortality in severe and critical COVID-19. However, the effect of dexamethasone has not been investigated on these biomarkers. Hence, we studied potential prognostic biomarkers of mortality in critically ill COVID-19 patients who had either received or not dexamethasone. Biomarker serum levels were measured on intensive care unit (ICU) admission (within 24 h) in 37 dexamethasone-free and 29 COVID-19 patients who had received the first dose (6 mg) of dexamethasone. Receiver operating characteristic (ROC) curves were generated to assess their value in ICU mortality prediction, while Kaplan-Meier analysis was used to explore associations between biomarkers and survival. In the dexamethasone-free COVID-19 ICU patients, non-survivors had considerably higher levels of various endothelial, immunothrombotic and inflammatory biomarkers. In the cohort who had received one dexamethasone dose, non-survivors had higher ICU admission levels of only soluble (s) vascular cell adhesion molecule-1 (VCAM-1), soluble urokinase-type plasminogen activator receptor (suPAR) and presepsin. As determined from the generated ROC curves, sVCAM-1, suPAR and presepsin could still be reliable prognostic ICU mortality biomarkers, following dexamethasone administration (0.7 < AUC < 0.9). Moreover, the Kaplan-Meier survival analysis showed that patients with higher than the median values for sVCAM-1 or suPAR exhibited a greater mortality risk than patients with lower values (Log-Rank test, p < 0.01). In our single-center study, sVCAM-1, suPAR and presepsin appear to be valuable prognostic biomarkers in assessing ICU mortality risk in COVID-19 patients, even following dexamethasone administration.

Knowledge and Perceptions of Undergraduate and Postgraduate Nursing Students About the Use of 3D Digital Printing in Healthcare

3D printing is applicable in various fields. The purpose of this study was to explore the knowledge and perceptions of undergraduate and postgraduate nursing students in relation to the use of 3D printing. A questionnaire was developed including questions about demographics, the students' knowledge about, and the student's attitude towards the 3D printing technology. Descriptive statistics and correlations were examined. The average knowledge score was 2.6 out of 6 and the perception score was 7.7 out of 10. Only gender was found to be related with 3D printing knowledge. Gender, age, and educational level were related with students' attitude towards 3D printing.

ICU Admission Levels of Endothelial Biomarkers as Predictors of Mortality in Critically Ill COVID-19 Patients

Endotheliopathy is suggested to be an important feature of COVID-19 in hospitalized patients. To determine whether endotheliopathy is involved in COVID-19-associated mortality, markers of endothelial damage were assessed in critically ill COVID-19 patients upon intensive care unit (ICU) admission. Thirty-eight critically ill COVID-19 patients were included in this observational study, 10 of whom died in the ICU. Endothelial biomarkers, including soluble (s)E-selectin, sP-selectin, angiopoietin 1 and 2 (Ang-1 and Ang-2, respectively), soluble intercellular adhesion molecule 1 (sICAM-1), vascular endothelial growth factor (VEGF), soluble vascular endothelial (VE)-cadherin, and von Willebrand factor (vWf), were measured upon ICU admission. The ICU cohort was subsequently divided into survivors and non-survivors; Kaplan-Meier analysis was used to explore associations between biomarkers and survival, while receiver operating characteristic (ROC) curves were generated to determine their potential prognostic value. sE-selectin, sP-selectin, Ang-2, and sICAM-1 were significantly elevated in ICU non-survivors compared to survivors, and also associated with a higher mortality probability in the Kaplan-Meier analysis. The prognostic values of sE-selectin, Ang-2, and sICAM-1 from the generated ROC curves were greater than 0.85. Hence, we conclude that in our cohort, ICU non-survivors had higher levels of specific endothelial markers compared to survivors. Elevated levels of these markers upon ICU admission could possibly predict mortality in COVID-19.

Citizens' Opinions About a Digital Health Insurance Record

An Electronic Health Insurance Record (EHIR) could give all the information needed to the insured citizens, informing them about the history of benefits and the health expenses. The aim of this work is to evaluate a Digital Health Insurance Record system as well as to explore the benefits of using this system, both for society and for each citizen individually. A quantitative survey was carried out using a questionnaire shared among 180 people in Greece in 2019. The questionnaire consisted of 25 closed-ended questions, 3 of which related to demographics and the remaining 22 related to the use and benefits of use of the EHIR system. Most of all people who took part in this study believe that EHIR can contribute positively giving both social benefits and benefits for the patients. An important finding of the study is the concern expressed by respondents about the security of the system in the management of sensitive personal data. Based on citizens' opinions a Digital Health Insurance Record can provide a lot of benefits to citizens and to the society as well as to the national health insurance system.

The Drug Addicts' Usage of Information and Communication Technologies

Information and Communication Technologies (ICT) are broadly used to support people's daily needs. Individuals addicted to psychoactive drugs sometimes present social exclusion as well as, limitations to the usage of ICT such as Internet, devices and applications. The aim of this paper is to present the findings of a pilot study related to the use of Information and Communication Technologies by Drug Addicts. A survey was conducted on 204 users of psychoactive substances. According to the results, the majority of the drug addicts seem to use ICT on a daily basis, showing their preference on Smartphones compared to other devices. The Internet access and the usage of Social Media and Communication Networks by addicted individuals is quite high, probably because they are willing to reintegrate into the society through Social Networks. Age is often related to the usage of ICT on Drug Addicts.

The Dissemination and Communication Plan and Activities of the CrowdHEALTH Project: "Collective Wisdom Driving Public Health Policies"

Determining the dissemination and communication plans and activities of research projects is an important part for transferring research outputs to the target audience. This paper presents the dissemination and communication plans and activities of the CrowdHEALTH project. Towards this end, the methodology and results are presented in this paper.

Sun4Patients Web Platform: Facilitating Long-Term Monitoring of Stroke Patients

SUN4Patients is an observational study for the monitoring of patients with first ever acute stroke. For the support of this study, an online platform has been developed which facilitates the collection of various information related to hospital discharge, health services utilization and loss of productivity of the patients. This paper presents the main characteristics of the platform and the methodology followed for its design and implementation.

Determining and Evaluating the Dissemination and Exploitation Plans and Activities for the CrowdHEALTH Project: The Role of the Impact Creation Board

Determining and evaluating the dissemination and exploitation plans and activities of research projects can be a challenging task. This paper presents an overview of the role of the Impact Creation Board in the identification and assessment of the dissemination and exploitation plan and activities for the CrowdHEALTH project "Collective wisdom driving public health policies". Towards this end, a stepwise methodology was applied and the feedback from the Impact Creation Board members, and results of each step were analyzed and shared with the consortium.

An Online Prevention Tool for Ophthalmological Disorders

The information of the general population regarding the prevention of eye diseases is crucial. This work presents the design and development of an online prevention tool for the information and education of the general population about ophthalmological diseases. A literature review was conducted for the collection of all necessary and up-to-date information regarding the diseases selected. The phases of requirement analysis, design, development and evaluation were followed. The online tool developed, proved to accomplish the aims of usability and usefulness in the prevention of eye diseases and their complications.

Physicians' and Pharmacists' Opinions Regarding the e-Prescription Systems

The e-Prescription systems are modern and efficient prescribing tools which can affect the quality of the healthcare services. The aim of this study is to evaluate the e-Prescription systems in Greece based the users' opinions. The survey was conducted in 2019 among 157 randomly selected healthcare profesionals through an on-line survey tool. The 51.2% of the sample were pharmacists and 48.8% physicians. 80.7% believe that the e-Prescription systems are reliable. More than the half of the professionals has the view that the e-Prescription systems are useful. Regarding to the ease of use, the e-Prescription systems, seem to can not fulfill sufficiently the participants' requirements.

How to Extract and Explore Big Data for Fraud Detection in the Healthcare Sector: The EOPYY Case Study

Big Data technologies can contribute to medical fraud detection. The aim of this paper is to present the methodological approach of the Hellenic National Organization for the Provision of Health Services (EOPYY) in data analysis to detect financial or medical fraud. To analyze the data for fraud detection, a selection of prescription data from the year 2018 were examined. The Local Correlation Integral algorithm was applied to detect any outliers on the dataset. The results revealed that 7 out of 879 cases could be characterized as outliers. These outliers must be further investigated to determine if they have been associated with fraud. According to the results of this study, this outliers' detection approach can support and help the fraud detection process conducted by the auditing services in Healthcare sector.

Health in All Policy Making Utilizing Big Data

INTRODUCTION

Health in all Policies (HiAP) is a valuable method for effective Healthcare policy development. Big data analysis can be useful to both individuals and clinicians so that the full potential of big data is employed.

AIM

The present paper deals with Health in All Policies, and how the use of Big Data can lead and support the development of new policies.

METHODS

To this end, in the context of the CrowdHEALTH project, data from heterogeneous sources will be exploited and the Policy Development Toolkit (PDT) model will be used. In order to facilitate new insights to healthcare by exploiting all available data sources.

RESULTS

In the case study that is being proposed, the NOHS Story Board (inpatient and outpatient health care) utilizing data from reimbursement of disease-related groups (DRGs), as well as medical costs for outpatient data, will be analyzed by the PDT.

CONCLUSION

PDT seems promising as an efficient decision support system for policymakers to align with HiAP as it offers Causal Analysis by calculating the total cost (expenses) per ICD-10, Forecasting Information by measuring the clinical effectiveness of reimbursement cost per medical condition, per gender and per age for outpatient healthcare, and Risk Stratification by investigating Screening Parameters, Indexes (Indicators) and other factors related to healthcare management. Thus, PDT could also support HiAP by helping policymakers to tailor various policies according to their needs, such as reduction of healthcare cost, improvement of clinical effectiveness and restriction of fraud.

Disseminating Research Outputs: The CrowdHEALTH Project

INTRODUCTION

Dissemination benefits come from the outputs integration and implementation by the key audience, who will also determine the relevance and usability of the disseminated content.

AIM

One of the CrowdHEALTH project's objectives is the transition from patient health records towards the Holistic Health Records (HHRs) and Social HHR. The CrowdHEALTH project aims at integrating high volumes of health-related data collected from various sources to support policy-making decisions.

METHODS

The European Federation for Medical Informatics (EFMI) supports the development of an effective Communication and Collaboration Plan identifying the messages, the tools and channels in disseminating the project and its outcomes to the target audience based on the McGuire approach.

RESULTS

The process for defining the dissemination strategy is a cyclic one as shown in the following figure involving review of each step periodically The next step was to define the four dimension dissemination approach based on McGuire attributes of persuasive communication. The objectives, target groups, key messages, the tools and channels where defined at this stage.

CONCLUSION

The CrowdHEALTH project and its outcomes were disseminated with a variety of tools and channels such as scientific journals, conferences, exhibitions and social media communication.

Disseminating Research Findings: The Crowdhealth Paradigm

The CrowdHEALTH project intends to integrate high volumes of health-related heterogeneous data from multiple sources with the aim of supporting policy making decisions. The European Federation of Medical Informatics supports the development of an effective Communication and Collaboration Plan.A dissemination strategy has been applied for this purpose considering appropriate messages, target audience, tools, and channels to achieve the highest impact and the first results of social media dissemination are presented here.

Measuring the Intention of Using Augmented Reality Technology in the Health Domain

Augmented Reality technology can provide useful tools and devices to support healthcare services. The aim of this study is to investigate the intention of IT and health care scientists' to use Augmented Reality technology in Healthcare. A survey was conducted using a questionnaire based on a theoretical research model. According to the results, the participants seem to have positive perception about using the Augmented Reality technology in health domain, and they intend to use it.