Overview of Wearable Healthcare Devices for Clinical Decision Support in the Prehospital Setting

Prehospital medical care is a major challenge for both civilian and military situations as resources are limited, yet critical triage and treatment decisions must be rapidly made. Prehospital medicine is further complicated during mass casualty situations or remote applications that require more extensive medical treatments to be monitored. It is anticipated on the future battlefield where air superiority will be contested that prolonged field care will extend to as much 72 h in a prehospital environment. Traditional medical monitoring is not practical in these situations and, as such, wearable sensor technology may help support prehospital medicine. However, sensors alone are not sufficient in the prehospital setting where limited personnel without specialized medical training must make critical decisions based on physiological signals. Machine learning-based clinical decision support systems can instead be utilized to interpret these signals for diagnosing injuries, making triage decisions, or driving treatments. Here, we summarize the challenges of the prehospital medical setting and review wearable sensor technology suitability for this environment, including their use with medical decision support triage or treatment guidance options. Further, we discuss recommendations for wearable healthcare device development and medical decision support technology to better support the prehospital medical setting. With further design improvement and integration with decision support tools, wearable healthcare devices have the potential to simplify and improve medical care in the challenging prehospital environment.

Ethics of Wearable-Based Out-of-Hospital Cardiac Arrest Detection

Out-of-hospital cardiac arrest is a major health problem, and immediate treatment is essential for improving the chances of survival. The development of technological solutions to detect out-of-hospital cardiac arrest and alert emergency responders is gaining momentum; multiple research consortia are currently developing wearable technology for this purpose. For the responsible design and implementation of this technology, it is necessary to attend to the ethical implications. This review identifies relevant ethical aspects of wearable-based out-of-hospital cardiac arrest detection according to four key principles of medical ethics. First, aspects related to beneficence concern the effectiveness of the technology. Second, nonmaleficence requires preventing psychological distress associated with wearing the device and raises questions about the desirability of screening. Third, grounded in autonomy are empowerment, the potential reidentification from continuously collected data, issues of data access, bystander privacy, and informed consent. Finally, justice concerns include the risks of algorithmic bias and unequal technology access. Based on this overview and relevant legislation, we formulate design recommendations. We suggest that key elements are device accuracy and reliability, dynamic consent, purpose limitation, and personalization. Further empirical research is needed into the perspectives of stakeholders, including people at risk of out-of-hospital cardiac arrest and their next-of-kin, to achieve a successful and ethically balanced integration of this technology in society.

The willingness to continue using wearable devices among the elderly: SEM and FsQCA analysis

BACKGROUND

With population aging and the scarcity of resources for elderly individuals, wearable devices pose opportunities and challenges for elderly care institutions. However, few studies have examined the effects of technical characteristics, personal characteristics, and health promotion on the willingness of elderly individuals to continue using wearable devices.

OBJECTIVE

This study explored the effects of technical characteristics and personal characteristics on the willingness of elderly individuals to continue using wearable devices through health promotion, drawing on the technology acceptance model and the value attitude behaviour model.

METHODS

We obtained 265 valid samples through questionnaire surveys and used structural equation modelling (SEM) and fuzzy set qualitative comparative analysis (FsQCA) to clarify the complex causal patterns of elderly people's willingness to continue using wearable devices.

RESULTS

The SEM results showed that perceived usefulness, perceived reliability, self-perceived ageing, and health promotion affected willingness to continue using wearable devices. However, perceived ease of use had no effect. FsQCA showed that elderly individuals are highly willing to continue using wearable devices, yielding five solutions. Perceived ageing was essential in four of these solutions. The impact of perceived ease of use on continued use intention was dynamic and complex.

CONCLUSIONS

This study used two methods to provide insight into the willingness of elderly individuals to continue using wearable devices. In addition, this study discussed associated implications, limitations, and future research directions.

Information Needs and Communication Strategies for People with Coronary Heart Disease: A Scoping Review

A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies, including digital interventions. We conducted a scoping review involving a search of four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages, hence flexibility and a suite of resources and strategies is optimal.

Impact of technology, health and consumer-related factors on continued usage intention of wearable fitness tracking (WFT) devices

Purpose

This paper aims to explore factors impacting wearable fitness tracking (WFT) device continued usage intention from perspectives of technology attributes (autonomy benefits), health attributes (self-health management benefits, diet-control benefits and health self-efficacy), and consumer attributes (age, gender, technological innovativeness, symbolic benefits, social benefits and hedonic benefits).

Design/methodology/approach

The study integrates constructs from the technology acceptance theories and the health promotion model to develop the research model and hypothesis. The empirical analysis was conducted using data from 217 respondents from India. Logistic regression was used to identify factors that discriminate between groups with low and high continued usage intentions.

Findings

Results indicate higher continued usage intention for WFT devices is driven by perceived benefits-health, autonomy, social and hedonic, and individual characteristics-technological innovativeness and perceived health self-efficacy. Further, perceived symbolic benefits, diet control benefits, age, and gender does not discriminate between the groups with low and high continued usage intentions.

Research limitations/implications

The results may be limited to the context of the sample and the factors considered. The study suggests future research areas.

Practical implications

The paper offers insights for marketers, governments, insurance firms, and related healthcare services on promoting higher usage of WFT devices to yield dual benefits of preventive healthcare and higher profitability.

Originality/value

The study extends existing research by examining factors across consumer, health, and technological domains in a single framework and adds to the limited research in the context of usage of WFT devices in developing countries.

Robot Coworkers: The Vision of Future Hoteliers

The purpose of this study is to understand how future employees in the hospitality and tourism industry envision the use of artificial intelligence in the organizations where they wish to work in the future. Through open-ended questions applied to undergraduate and master’s students in the area of tourism and hospitality, we capture their opinions when thinking about the partial or total use of robots in hospitality. Despite the increasing implementation of artificial intelligence in hospitality and tourism, existing research mainly focuses on current hoteliers and/or customers. However, anticipating how digital generations expect their future roles in a close engagement with robots allows researchers to predict and focus their attention on future problems. Their statements were subjected to a qualitative content analysis methodology, based on themes and sentiment. Participants expressed a negative view of the presence of robots in hospitality, mostly associated with a fear of job loss. Many also reported that interacting with robots is negative for both staff and customers due to robots’ lack of emotions. However, there is some division concerning the impact of robots on service quality: some believe that the service will be more efficient and with fewer failures; others believe that the limitations of robots will lead to worse service. The findings suggest that the acceptability and desirability of robotization may vary depending on the level of robotization in hotels, on the type of customer, and on the level of service provided.

Augmenting Human Appearance Through Technological Design Layers

Augmenting human appearance with the means of technology can focus on different layers attached to or around the body. In this article, we present a categorization of human appearance and expression, with augmenting skin and its appendages, clothing and textile, accessories, body parts, and digital aura around the body. We report a non-systematic review of related works in each category and discuss their means in expressing functional, hedonic, and social aspects. In conclusion, our study contributes design perspectives on augmenting human appearances, as well as reveals challenges and opportunities.

Living With Assistive Robotics: Exploring the Everyday Use of Exoskeleton for Persons With Spinal Cord Injury

Background: Recent advancements in sensor technology and artificial intelligence mechanisms have led to a rapid increase in research and development of robotic orthoses or “exoskeletons” to support people with mobility problems. The purpose of this case study was to provide insight into the lived reality of using the assistive robotic exoskeleton ReWalk.

Method: We used ethnographic techniques to explore the everyday experience and use of the assistive robotic device.

Results: We found that the appropriation and integration of the technology within the patient's everyday lives required a social and collaborative effort, which continued into use. The decisions to utilise the technology (or not) was closely tied to physical, social, cultural, environmental, and psychological factors. Consequently, there was much variation in patients' perception of the technology and opportunities for support. Four themes emerged:

(a) Meaning of mobility—physical mobility represents more than functional ability. Its present socio-cultural meaning is associated with an individual's self-identity and life priorities.

(b) Accomplishing body-technique—integration with the body requires a long process of skill acquisition and re-embodiment.

(c) Adaptation and adjustment in use—successful use of the technology was characterised by ongoing adjustment and adaptation of the technology and ways of using it.

(d) Human element—introduction and sustained use of the exoskeleton demand a social and collaborative effort across the user's professional and lay resources.

Conclusions: This study highlights that the development and implementation of the technology need to be grounded in a deep understanding of the day-to-day lives and experiences of the people that use them.

The case for wearable proximity devices to inform physical distancing among healthcare workers

Objective

Despite the importance of physical distancing in reducing SARS-CoV-2 transmission, this practice is challenging in healthcare. We piloted use of wearable proximity beacons among healthcare workers (HCWs) in an inpatient unit to highlight considerations for future use of trackable technologies in healthcare settings.

Materials and Methods

We performed a feasibility pilot study in a non-COVID adult medical unit from September 28 to October 28, 2020. HCWs wore wearable proximity beacons, and interactions defined as <6 feet for ≥5 s were recorded. Validation was performed using direct observations.

Results

A total of 6172 close proximity interactions were recorded, and with the removal of 2033 false-positive interactions, 4139 remained. The highest proportion of interactions occurred between 7:00 Am–9:00 Am. Direct observations of HCWs substantiated these findings.

Discussion

This pilot study showed that wearable beacons can be used to monitor and quantify HCW interactions in inpatient settings.

Conclusion

Technology can be used to track HCW physical distancing.

Physical distancing, or social distancing, is important in preventing COVID-19. It is hard for healthcare workers (HCWs) to physically distance at work. We tested a device (proximity beacon) that HCWs could wear to measure their distance from each other among HCWs on a medical unit. The device measured any time HCWs were within 6 feet of each other for at least 5 s. We watched HCWs who were close to each other. The devices and our observations showed that 7:00 Am—9:00 Am was the highest risk time for not physically distancing. This study shows that wearable devices can be a tool to monitor HCWs physical distancing on a hospital unit.

Review of Materials and Fabrication Methods for Flexible Nano and Micro-Scale Physical and Chemical Property Sensors

The use of flexible sensors has tripled over the last decade due to the increased demand in various fields including health monitoring, food packaging, electronic skins and soft robotics. Flexible sensors have the ability to be bent and stretched during use and can still maintain their electrical and mechanical properties. This gives them an advantage over rigid sensors that lose their sensitivity when subject to bending. Advancements in 3D printing have enabled the development of tailored flexible sensors. Various additive manufacturing methods are being used to develop these sensors including inkjet printing, aerosol jet printing, fused deposition modelling, direct ink writing, selective laser melting and others. Hydrogels have gained much attention in the literature due to their self-healing and shape transforming. Self-healing enables the sensor to recover from damages such as cracks and cuts incurred during use, and this enables the sensor to have a longer operating life and stability. Various polymers are used as substrates on which the sensing material is placed. Polymers including polydimethylsiloxane, Poly(N-isopropylacrylamide) and polyvinyl acetate are extensively used in flexible sensors. The most widely used nanomaterials in flexible sensors are carbon and silver due to their excellent electrical properties. This review gives an overview of various types of flexible sensors (including temperature, pressure and chemical sensors), paying particular attention to the application areas and the corresponding characteristics/properties of interest required for such. Current advances/trends in the field including 3D printing, novel nanomaterials and responsive polymers, and self-healable sensors and wearables will also be discussed in more detail.

Development of a Self-Powered Piezo-Resistive Smart Insole Equipped with Low-Power BLE Connectivity for Remote Gait Monitoring

The evolution of low power electronics and the availability of new smart materials are opening new frontiers to develop wearable systems for medical applications, lifestyle monitoring, and performance detection. This paper presents the development and realization of a novel smart insole for monitoring the plantar pressure distribution and gait parameters; indeed, it includes a piezoresistive sensing matrix based on a Velostat layer for transducing applied pressure into an electric signal. At first, an accurate and complete characterization of Velostat-based pressure sensors is reported as a function of sizes, support material, and pressure trend. The realization and testing of a low-cost and reliable piezoresistive sensing matrix based on a sandwich structure are discussed. This last is interfaced with a low power conditioning and processing section based on an Arduino Lilypad board and an analog multiplexer for acquiring the pressure data. The insole includes a 3-axis capacitive accelerometer for detecting the gait parameters (swing time and stance phase time) featuring the walking. A Bluetooth Low Energy (BLE) 5.0 module is included for transmitting in real-time the acquired data toward a PC, tablet or smartphone, for displaying and processing them using a custom Processing^® application. Moreover, the smart insole is equipped with a piezoelectric harvesting section for scavenging energy from walking. The onfield tests indicate that for a walking speed higher than 1 ms^-1, the device's power requirements (i.e., P¯=5.84&nbsp;mW) was fulfilled. However, more than 9 days of autonomy are guaranteed by the integrated 380-mAh Lipo battery in the total absence of energy contributions from the harvesting section.

Why Are Digital Health Care Systems Still Poorly Designed, and Why Is Health Care Practice Not Asking for More? Three Paths Toward a Sustainable Digital Work Environment

Knowledge of how to design digital systems that are ergonomically sound, high in usability, and optimized for the user, context, and task has existed for some time. Despite this, there are still too many examples of new digital health care systems that are poorly designed and that could negatively affect both the work environment of health care staff and patient safety. This could be because of a gap between the theoretical knowledge of design and ergonomics and the practical implementation of this knowledge in procuring and developing digital health care systems. Furthermore, discussions of digitalization are often at a general level and risk neglecting the nature of direct interaction with the digital system. This is problematic since it is at this detailed level that work environment and patient safety issues materialize in practice. In this paper, we illustrate such issues with two scenarios concerned with contemporary electronic health care records, based on field studies in two health care settings. We argue that current methods and tools for designing and evaluating digital systems in health care must cater both to the holistic level and to the details of interaction and ergonomics. It must also be acknowledged that health care professionals are neither designers nor engineers, so expectations of them during the development of digital systems must be realistic. We suggest three paths toward a more sustainable digital work environment in health care: (1) better tools for evaluating the digital work environment in the field; (2) generic formulations of qualitative requirements related to usability and for adaptation to the user, context, and task, to be used in procurement; and (3) the introduction of digital ergonomics as an embracing concept capturing several of the ergonomic challenges (including physical, cognitive, and organizational aspects) involved in implementing and using digital systems.

Pre-Emption of Affliction Severity Using HRV Measurements from a Smart Wearable; Case-Study on SARS-Cov-2 Symptoms

Smart wristbands and watches have become an important accessory to fitness, but their application to healthcare is still in a fledgling state. Their long-term wear facilitates extensive data collection and evolving sensitivity of smart wristbands allows them to read various body vitals. In this paper, we hypothesized the use of heart rate variability (HRV) measurements to drive an algorithm that can pre-empt the onset or worsening of an affliction. Due to its significance during the time of the study, SARS-Cov-2 was taken as the case study, and a hidden Markov model (HMM) was trained over its observed symptoms. The data used for the analysis was the outcome of a study hosted by Welltory. It involved the collection of SAR-Cov-2 symptoms and reading of body vitals using Apple Watch, Fitbit, and Garmin smart bands. The internal states of the HMM were made up of the absence and presence of a consistent decline in standard deviation of NN intervals (SSDN), the root mean square of the successive differences (rMSSD) in R-R intervals, and low frequency (LF), high frequency (HF), and very low frequency (VLF) components of the HRV measurements. The emission probabilities of the trained HMM instance confirmed that the onset or worsening of the symptoms had a higher probability if the HRV components displayed a consistent decline state. The results were further confirmed through the generation of probable hidden states sequences using the Viterbi algorithm. The ability to pre-empt the exigent state of an affliction would not only lower the chances of complications and mortality but may also help in curbing its spread through intelligence-backed decisions.

Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey

BACKGROUND

Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults.

OBJECTIVE

The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults.

METHODS

Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis.

RESULTS

About 30% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33%) use the devices every day, with a majority (82.38% weighted) willing to share the health data from wearables with their care providers. Women (16.25%), White individuals (19.74%), adults aged 18-50 years (19.52%), those with some level of college education or college graduates (25.60%), and those with annual household incomes greater than US $75,000 (17.66%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95% CI 0.96-1.65), White individuals (OR 1.65, 95% CI 0.97-2.79), college graduates (OR 1.05, 95% CI 0.31-3.51), and those with annual household incomes greater than US $75,000 (OR 2.6, 95% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95% CI 0.98-1.39), were overweight (OR 1.16, 95% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health.

CONCLUSIONS

The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society.

Digital Health Innovations to Improve Cardiovascular Disease Care

PURPOSE OF REVIEW

To review the current evidence supporting the use of digital health technologies in cardiovascular disease (CVD) care.

RECENT FINDINGS

Studies have evaluated the impact of the use of digital health technologies to improve CVD outcomes through several modalities: text-messaging programmes, smartphone applications (apps) and wearable devices. Text-messaging programmes are to date the most studied type of digital health interventions, and studies have demonstrated reduced CVD risk and improved medication adherence. Literature supporting the use of smartphone apps is also growing but remains limited, with some studies favouring the use of health apps but others showing negative results. Wearable devices are the latest type of technology investigated, and studies have shown positive outcomes in terms of physical activity and detection of arrhythmias. Digital health is a growing and evolving area of investigation. To date, the scientific evidence overall supports the use of such technologies in CVD care and management. Future research using new models are needed to continue to evaluate these new technologies.