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Sohn A, Turner AM, Speier W, Fonarow GC, Ong MK, Arnold CW. Patients with Heart Failure: Internet Use and Mobile Health Perceptions. Appl Clin Inform 2024; 15:709-716. [PMID: 38382633 PMCID: PMC11357730 DOI: 10.1055/a-2273-5278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Heart failure is a complex clinical syndrome noted on approximately one in eight death certificates in the United States. Vital to reducing complications of heart failure and preventing hospital readmissions is adherence to heart failure self-care routines. Mobile health offers promising opportunities for enhancing self-care behaviors by facilitating tracking and timely reminders. OBJECTIVES We sought to investigate three characteristics of heart failure patients with respect to their heart failure self-care behaviors: (1) internet use to search for heart failure information; (2) familiarity with mobile health apps and devices; and (3) perceptions of using activity trackers or smartwatches to aid in their heart failure self-care. METHODS Forty-nine heart failure patients were asked about their internet and mobile health usage. The structured interview included questions adapted from the Health Information National Trends Survey. RESULTS Over 50% of the patients had utilized the internet to search for heart failure information in the past 12 months, experience using health-related apps, and thoughts that an activity tracker or smartwatch could help them manage heart failure. Qualitative analysis of the interviews revealed six themes: trust in their physicians, alternatives to mobile health apps, lack of need for mobile health devices, financial barriers to activity tracker and smartwatch ownership, benefits of tracking and reminders, and uncertainty of their potential due to lack of knowledge. CONCLUSION Trust in their physicians was a major factor for heart failure patients who reported not searching for health information on the internet. While those who used mobile health technologies found them useful, patients who did not use them were generally unaware of or unknowledgeable about them. Considering patients' preferences for recommendations from their physicians and tendency to search for heart failure information including treatment and management options, patient-provider discussions about mobile health may improve patient knowledge and impact their usage.
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Affiliation(s)
- Albert Sohn
- Department of Medical Education and Clinical Sciences, Washington State University, Spokane, Washington, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States
| | - Anne M. Turner
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
| | - William Speier
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States
| | - Gregg C. Fonarow
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Michael K. Ong
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, California, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
| | - Corey W. Arnold
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, California, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, United States
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, United States
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Keogh A, Brennan C, Johnston W, Dickson J, Leslie SJ, Burke D, Megyesi P, Caulfield B. Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study. JMIR Form Res 2024; 8:e52442. [PMID: 38427410 PMCID: PMC10959238 DOI: 10.2196/52442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice. OBJECTIVE This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. METHODS A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. RESULTS Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. CONCLUSIONS The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs.
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Affiliation(s)
- Alison Keogh
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Carol Brennan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - William Johnston
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
| | - Jane Dickson
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland
- Cardiology, Beacon Hospital, Dublin, Ireland
| | | | - David Burke
- Cardiology, Beacon Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Megyesi
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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McCarthy M, Jevotovsky D, Mann D, Veerubhotla A, Muise E, Whiteson J, Rizzo JR. Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice. Rehabil Nurs 2023; 48:209-215. [PMID: 37723623 PMCID: PMC10840984 DOI: 10.1097/rnj.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity. DESIGN AND METHODS This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings. RESULTS The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress. CLINICAL RELEVANCE If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services. CONCLUSION RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.
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Affiliation(s)
- Margaret McCarthy
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Devin Mann
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Jonathan Whiteson
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - John Ross Rizzo
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Lee KCS, Breznen B, Ukhova A, Martin SS, Koehler F. Virtual healthcare solutions in heart failure: a literature review. Front Cardiovasc Med 2023; 10:1231000. [PMID: 37745104 PMCID: PMC10513031 DOI: 10.3389/fcvm.2023.1231000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care for patients with heart failure (HF). By enabling non-invasive remote monitoring and two-way, real-time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care. This literature review summarizes clinical evidence related to virtual healthcare (VHC), defined as a care team + connected devices + a digital solution in post-release care of patients with HF. Searches were conducted on Embase (06/12/2020). A total of 171 studies were included for data extraction and evidence synthesis: 96 studies related to VHC efficacy, and 75 studies related to AI in HF. In addition, 15 publications were included from the search on studies scaling up VHC solutions in HF within the real-world setting. The most successful VHC interventions, as measured by the number of reported significant results, were those targeting reduction in rehospitalization rates. In terms of relative success rate, the two most effective interventions targeted patient self-care and all-cause hospital visits in their primary endpoint. Among the three categories of VHC identified in this review (telemonitoring, remote patient management, and patient self-empowerment) the integrated approach in remote patient management solutions performs the best in decreasing HF patients' re-admission rates and overall hospital visits. Given the increased amount of data generated by VHC technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes, and predicting treatment outcomes. Currently, most AI algorithms are developed using data gathered in clinic and only a few studies deploy AI in the context of VHC. Most successes have been reported in predicting HF outcomes. Since the field of VHC in HF is relatively new and still in flux, this is not a typical systematic review capturing all published studies within this domain. Although the standard methodology for this type of reviews was followed, the nature of this review is qualitative. The main objective was to summarize the most promising results and identify potential research directions.
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Affiliation(s)
| | - Boris Breznen
- Evidence Synthesis, Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | | | - Seth Shay Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Friedrich Koehler
- Deutsches Herzzentrum der Charité (DHZC), Centre for Cardiovascular Telemedicine, Campus Charité Mitte, Berlin, Germany
- Division of Cardiology and Angiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Madujibeya I, Lennie TA, Pelzel J, Moser DK. Patients' Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis. JMIR Form Res 2023; 7:e39525. [PMID: 37581912 PMCID: PMC10466157 DOI: 10.2196/39525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients' experiences using mHealth apps for self-care in real-world settings. OBJECTIVE The purpose of this study was to explore patients' experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. METHODS Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients' responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). RESULTS Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). CONCLUSIONS Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care.
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Affiliation(s)
- Ifeanyi Madujibeya
- Research and Interventions for Cardiovascular Health Heart Program, College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Terry A Lennie
- Center for Nutritional Sciences, College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Jamie Pelzel
- Heart and Vascular Center, CentraCare, St Cloud, MN, United States
| | - Debra K Moser
- Research and Interventions for Cardiovascular Health Heart Program, College of Nursing, University of Kentucky, Lexington, KY, United States
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Zaman S, Padayachee Y, Shah M, Samways J, Auton A, Quaife NM, Sweeney M, Howard JP, Tenorio I, Bachtiger P, Kamalati T, Pabari PA, Linton NWF, Mayet J, Peters NS, Barton C, Cole GD, Plymen CM. Smartphone-Based Remote Monitoring in Heart Failure With Reduced Ejection Fraction: Retrospective Cohort Study of Secondary Care Use and Costs. JMIR Cardio 2023; 7:e45611. [PMID: 37351921 PMCID: PMC10334716 DOI: 10.2196/45611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. OBJECTIVE The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. METHODS We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. RESULTS A total of 146 patients (mean age 63 years; 42/146, 29% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (P=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; P=.02) and unplanned admissions (HR 0.26; P=.02). There were no differences in elective admissions (HR 1.03, P=.96) or outpatient use (HR 1.40; P=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP £465, US $581 vs GBP £1850, US $2313, respectively; P=.04). CONCLUSIONS This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM.
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Affiliation(s)
| | - Yorissa Padayachee
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Moulesh Shah
- Imperial College Health Partners, London, United Kingdom
| | - Jack Samways
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Alice Auton
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Nicholas M Quaife
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | | | - Indira Tenorio
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | | | - Punam A Pabari
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | - Jamil Mayet
- Imperial College London, London, United Kingdom
| | | | - Carys Barton
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | - Carla M Plymen
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
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7
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Auton A, Zaman S, Padayachee Y, Samways JW, Quaife NM, Sweeney M, Tenorio I, Linton NWF, Cole GD, Peters NS, Mayet J, Barton C, Plymen C. Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives. JMIR Nurs 2023; 6:e44630. [PMID: 37279054 PMCID: PMC10282903 DOI: 10.2196/44630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Community-based management by heart failure specialist nurses (HFSNs) is key to improving self-care in heart failure with reduced ejection fraction. Remote monitoring (RM) can aid nurse-led management, but in the literature, user feedback evaluation is skewed in favor of the patient rather than nursing user experience. Furthermore, the ways in which different groups use the same RM platform at the same time are rarely directly compared in the literature. We present a balanced semantic analysis of user feedback from patient and nurse perspectives of Luscii, a smartphone-based RM strategy combining self-measurement of vital signs, instant messaging, and e-learning. OBJECTIVE This study aims to (1) evaluate how patients and nurses use this type of RM (usage type), (2) evaluate patients' and nurses' user feedback on this type of RM (user experience), and (3) directly compare the usage type and user experience of patients and nurses using the same type of RM platform at the same time. METHODS We performed a retrospective usage type and user experience evaluation of the RM platform from the perspective of both patients with heart failure with reduced ejection fraction and the HFSNs using the platform to manage them. We conducted semantic analysis of written patient feedback provided via the platform and a focus group of 6 HFSNs. Additionally, as an indirect measure of tablet adherence, self-measured vital signs (blood pressure, heart rate, and body mass) were extracted from the RM platform at onboarding and 3 months later. Paired 2-tailed t tests were used to evaluate differences between mean scores across the 2 timepoints. RESULTS A total of 79 patients (mean age 62 years; 35%, 28/79 female) were included. Semantic analysis of usage type revealed extensive, bidirectional information exchange between patients and HFSNs using the platform. Semantic analysis of user experience demonstrates a range of positive and negative perspectives. Positive impacts included increased patient engagement, convenience for both user groups, and continuity of care. Negative impacts included information overload for patients and increased workload for nurses. After the patients used the platform for 3 months, they showed significant reductions in heart rate (P=.004) and blood pressure (P=.008) but not body mass (P=.97) compared with onboarding. CONCLUSIONS Smartphone-based RM with messaging and e-learning facilitates bilateral information sharing between patients and nurses on a range of topics. Patient and nurse user experience is largely positive and symmetrical, but there are possible negative impacts on patient attention and nurse workload. We recommend RM providers involve patient and nurse users in platform development, including recognition of RM usage in nursing job plans.
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Affiliation(s)
- Alice Auton
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | - Jack W Samways
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | - Indira Tenorio
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nick W F Linton
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Graham D Cole
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Jamil Mayet
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Carys Barton
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Carla Plymen
- Imperial College Healthcare NHS Trust, London, United Kingdom
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Carlozzi NE, Choi SW, Wu Z, Troost JP, Lyden AK, Miner JA, Graves CM, Wang J, Yan X, Sen S. An app-based just-in-time-adaptive self-management intervention for care partners: The CareQOL feasibility pilot study. Rehabil Psychol 2022; 67:497-512. [PMID: 36355640 PMCID: PMC10157671 DOI: 10.1037/rep0000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE/OBJECTIVE The primary objective of this study was to establish the feasibility and acceptability of an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention (JITAI) in three distinct groups of care partners (care partners of persons with spinal cord injury [SCI], Huntington's disease [HD], or hematopoietic cell transplantation [HCT]). RESEARCH METHOD/DESIGN Seventy care partners were enrolled in this study (n = 19 SCI; n = 21 HD, n = 30 HCT). This three-month (90 day) randomized control trial involved wearing a Fitbit to track sleep and steps, providing daily reports of health-related quality of life (HRQOL), and completing end of month HRQOL surveys. Care partners in the JITAI group also received personalized pushes (i.e., text-based phone notifications that include brief tips or suggestions for improving self-care). At the end of three-months, care partners in both groups completed a feasibility and acceptability questionnaire. RESULTS Most (98.6%) care partners completed the study, average compliance was 88% for daily HRQOL surveys, 96% for daily steps, and 85% for daily sleep (from wearing the Fitbit), and all monthly surveys were completed with the exception of one missed 3-month assessment. The acceptability of the protocol was high; ratings exceeded 80% agreement for the different elements of the study. Improvements were seen for the majority of the HRQOL measures. There was no evidence of measurement reactivity. CONCLUSIONS/IMPLICATIONS Findings provide strong support for the acceptability and feasibility of an intensive data collection protocol that involved the administration of a JITAI. Although this trial was not powered to establish efficacy, findings indicated improvements across a variety of different HRQOL measures (~1/3 of which were statistically significant). (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI
| | - Jonathan P. Troost
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI
| | - Angela K. Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI
| | - Jennifer A. Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Christopher M. Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Jitao Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Xinghui Yan
- School of Information, University of Michigan, Ann Arbor, MI
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
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9
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Gerges S, Hallit S. Pros and cons of telemedicine: implications in cardiology and cardiovascular medicine. Future Cardiol 2022; 18:843-847. [PMID: 36148847 DOI: 10.2217/fca-2022-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The COVID-19 pandemic has highlighted the vitalness of telehealth in our medical world, where considering a restructuring of healthcare services has become paramount. Indeed, in the context of this still ongoing pandemic, medical institutions must strive to improve telehealth technologies and implement solid future research directions in this growing field - to be able to persevere in meeting the needs of the patients. As long as no conclusive evidence exists regarding the fields where telemedicine is most worthwhile, healthcare systems will always keep the dread of wasting resources on developing ineffective programs. We gathered that telemedicine has been attributed a considerable attention in managing cardiac/cardiovascular conditions; nevertheless, further studies with solid designs are still needed to confirm its validity/utility within these specialties.
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Affiliation(s)
- Sarah Gerges
- School of Medicine & Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon
| | - Souheil Hallit
- School of Medicine & Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, P.O. Box 60096, Lebanon
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10
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Uchmanowicz I, Wleklik M, Foster M, Olchowska-Kotala A, Vellone E, Kaluzna-Oleksy M, Szczepanowski R, Uchmanowicz B, Reczuch K, Jankowska EA. Digital health and modern technologies applied in patients with heart failure: Can we support patients’ psychosocial well-being? Front Psychol 2022; 13:940088. [PMID: 36275212 PMCID: PMC9580561 DOI: 10.3389/fpsyg.2022.940088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marva Foster
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, MA, United States
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Science, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Ercole Vellone
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marta Kaluzna-Oleksy
- Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Bartosz Uchmanowicz
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Bartosz Uchmanowicz,
| | - Krzysztof Reczuch
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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11
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Madujibeya I, Lennie T, Aroh A, Chung ML, Moser D. Measures of Engagement With mHealth Interventions in Patients With Heart Failure: Scoping Review. JMIR Mhealth Uhealth 2022; 10:e35657. [PMID: 35994345 PMCID: PMC9446141 DOI: 10.2196/35657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/04/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the potential of mobile health (mHealth) interventions to facilitate the early detection of signs of heart failure (HF) decompensation and provide personalized management of symptoms, the outcomes of such interventions in patients with HF have been inconsistent. As engagement with mHealth is required for interventions to be effective, poor patient engagement with mHealth interventions may be associated with mixed evidence. It is crucial to understand how engagement with mHealth interventions is measured in patients with HF, and the effects of engagement on HF outcomes. Objective In this review, we aimed to describe measures of patient engagement with mHealth interventions and the effects of engagement on HF outcomes. Methods We conducted a systematic literature search in 7 databases for relevant studies published in the English language from 2009 to September 2021 and reported the descriptive characteristics of the studies. We used content analysis to identify themes that described patient engagement with mHealth interventions in the qualitative studies included in the review. Results We synthesized 32 studies that operationalized engagement with mHealth interventions in 4771 patients with HF (3239/4771, 67.88%, male), ranging from a sample of 7 to 1571 (median 53.3) patients, followed for a median duration of 90 (IQR 45-180) days. Patient engagement with mHealth interventions was measured only quantitatively based on system usage data in 72% (23/32) of the studies, only qualitatively based on data from semistructured interviews and focus groups in 6% (2/32) of studies, and by a combination of both quantitative and qualitative data in 22% (7/32) of studies. System usage data were evaluated using 6 metrics of engagement: number of physiological parameters transmitted (19/30, 63% studies), number of HF questionnaires completed (2/30, 7% studies), number of log-ins (4/30, 13% studies), number of SMS text message responses (1/30, 3% studies), time spent (5/30, 17% studies), and the number of features accessed and screen viewed (4/30, 13% studies). There was a lack of consistency in how the system usage metrics were reported across studies. In total, 80% of the studies reported only descriptive characteristics of system usage data. The emotional, cognitive, and behavioral domains of patient engagement were identified through qualitative studies. Patient engagement levels ranged from 45% to 100% and decreased over time. The effects of engagement on HF knowledge, self-care, exercise adherence, and HF hospitalization were inconclusive. Conclusions The measures of patient engagement with mHealth interventions in patients with HF are underreported and lack consistency. The application of inferential analytical methods to engagement data is extremely limited. There is a need for a working group on mHealth that may consolidate the previous operational definitions of patient engagement into an optimal and standardized measure.
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Affiliation(s)
- Ifeanyi Madujibeya
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Terry Lennie
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Adaeze Aroh
- Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, United States
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Debra Moser
- College of Nursing, University of Kentucky, Lexington, KY, United States
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12
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Radhakrishnan K, DeMain AS, Julien C, Leggio K, O'Hair M, Hebért Arsers ET, Lee G, Baranowski T. A Sensor-Controlled Digital Game for Heart Failure Self-Care Based on Behavioral Change Frameworks. SEGAH ... IEEE ... INTERNATIONAL CONFERENCE ON SERIOUS GAMES AND APPLICATIONS FOR HEALTH : BOOK OF PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON SERIOUS GAMES AND APPLICATIONS FOR HEALTH 2022; 2022:10.1109/segah54908.2022.9978594. [PMID: 37817860 PMCID: PMC10564567 DOI: 10.1109/segah54908.2022.9978594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Self-care behaviors are critical to manage the adverse impact of heart failure disease. However, engaging in self-care behaviors such as physical activity or daily weight-monitoring can be difficult due to lack of knowledge or motivation. Digital games can serve as an alternative to traditional patient education to provide information and motivate engagement in critical self-care behaviors. In this paper, we describe a sensor-controlled digital game (SCDG) in which game play is driven by the player's real life self-care behaviors. We also present the design and development of the next iteration of the SCDG based on playtesting results and behavioral theoretical frameworks.
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Affiliation(s)
| | | | - Christine Julien
- Cockrell School of Engineering, The University of Texas-Austin, Austin, USA
| | - Katelyn Leggio
- School of Nursing, The University of Texas-Austin, Austin, USA
| | | | | | - Grace Lee
- Cockrell School of Engineering, The University of Texas-Austin, Austin, USA
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13
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Hernández-Quiroz F, Murugesan S, Flores-Rivas C, Piña-Escobedo A, Juárez-Hernández JI, García-Espitia M, Chávez-Carbajal A, Nirmalkar K, García-Mena J. A high-throughput DNA sequencing study of fecal bacteria of seven Mexican horse breeds. Arch Microbiol 2022; 204:382. [PMID: 35687150 DOI: 10.1007/s00203-022-03009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/02/2022]
Abstract
Horses are non-ruminant, herbivorous mammals, been used through history for various purposes, with a gut microbiota from cecum to the colon, possessing remarkable fermentative capacity. We studied the fecal microbiota of Azteca, Criollo, Frisian, Iberian, Pinto, Quarter and Spanish horse breeds living in Mexico by next-generation DNA sequencing of 16S rRNA gene libraries. Dominant phyla Firmicutes, Bacteroidetes, Proteobacteria, Spirochaetes, Fibrobacteres, Actinobacteria and Verrucomicrobia have different relative abundances among breeds, with contrasted alpha and beta diversities as well. Heatmap analysis revealed that Ruminococcaceae, Lachnospiraceae, Mogibacteriaceae families, and order Clostridiales are more abundant in Spanish, Azteca, Quarter and Criollo breeds. The LEfSe analysis displayed higher abundance of order Bacteroidales, family BS11, and genera Faecalibacterium, Comamonas, Collinsella, Acetobacter, and Treponema in Criollo, Azteca, Iberian, Spanish, Frisian, Pinto, and Quarter horse breeds. The conclusion is that dominant bacterial taxa, found in fecal samples of horse breeds living in Mexico, have different relative abundances.
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Affiliation(s)
- Fernando Hernández-Quiroz
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico.,Computer Science Department, University of Nebraska-Lincoln (UNL), Lincoln, NE, USA
| | - Selvasankar Murugesan
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico.,Division of Translational Medicine, Research Department, Sidra Medicine, 26999, Doha, Qatar
| | - Cintia Flores-Rivas
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico
| | - Alberto Piña-Escobedo
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico
| | - Josué Isaac Juárez-Hernández
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico
| | - Matilde García-Espitia
- Escuela Nacional de Medicina y Homeopatía del Instituto Politécnico Nacional, Guillermo Massieu Helguera 239, CDMX, 07320, Ciudad de México, Mexico
| | - Alejandra Chávez-Carbajal
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Khemlal Nirmalkar
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico.,Biodesign Center for Health through Microbiomes, Arizona State 16 University, Tempe, AZ, USA
| | - Jaime García-Mena
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av IPN 2508 Col Zacatenco, CDMX, 07360, Ciudad de México, Mexico.
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14
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Smart Home Technology Solutions for Cardiovascular Diseases: A Systematic Review. APPLIED SYSTEM INNOVATION 2022. [DOI: 10.3390/asi5030051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of mortality globally. Despite improvement in therapies, people with CVD lack support for monitoring and managing their condition at home and out of hospital settings. Smart Home Technologies have potential to monitor health status and support people with CVD in their homes. We explored the Smart Home Technologies available for CVD monitoring and management in people with CVD and acceptance of the available technologies to end-users. We systematically searched four databases, namely Medline, Web of Science, Embase, and IEEE, from 1990 to 2020 (search date 18 March 2020). “Smart-Home” was defined as a system using integrated sensor technologies. We included studies using sensors, such as wearable and non-wearable devices, to capture vital signs relevant to CVD at home settings and to transfer the data using communication systems, including the gateway. We categorised the articles for parameters monitored, communication systems and data sharing, end-user applications, regulations, and user acceptance. The initial search yielded 2462 articles, and the elimination of duplicates resulted in 1760 articles. Of the 36 articles eligible for full-text screening, we selected five Smart Home Technology studies for CVD management with sensor devices connected to a gateway and having a web-based user interface. We observed that the participants of all the studies were people with heart failure. A total of three main categories—Smart Home Technology for CVD management, user acceptance, and the role of regulatory agencies—were developed and discussed. There is an imperative need to monitor CVD patients’ vital parameters regularly. However, limited Smart Home Technology is available to address CVD patients’ needs and monitor health risks. Our review suggests the need to develop and test Smart Home Technology for people with CVD. Our findings provide insights and guidelines into critical issues, including Smart Home Technology for CVD management, user acceptance, and regulatory agency’s role to be followed when designing, developing, and deploying Smart Home Technology for CVD.
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15
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Effect of a Smart Pill Bottle Reminder Intervention on Medication Adherence, Self-efficacy, and Depression in Breast Cancer Survivors. Cancer Nurs 2022; 45:E874-E882. [PMID: 34661562 PMCID: PMC9584037 DOI: 10.1097/ncc.0000000000001030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Globally, breast cancer has been identified as the most common cancer among women. The clinical efficacy of adjuvant oral antiestrogen therapy-including tamoxifen and aromatase inhibitors-has been proven to be clinically efficacious for breast cancer survivors. However, medication adherence for these therapies remains suboptimal among breast cancer survivors. OBJECTIVE The aim of this study was to evaluate the effect of a reminder intervention-a smart pill bottle paired with the Pillsy mobile application-on medication adherence, medication self-efficacy, and depression, among breast cancer survivors who were undergoing oral antiestrogen therapy. METHODS This study is a randomized controlled trial. Sixty-one women were allocated to an experimental group (n = 31) and the control group (n = 30). The experimental group received the reminder intervention of a smart pill bottle for 4 weeks. Study outcomes were identified as medication adherence, medication self-efficacy, and depression. RESULTS Fifty-seven women completed the follow-up measurement. Significant differences in favor of the experimental group were noted for medication adherence ( P = .004) and medication self-efficacy ( P = .004). There was no statistically significant difference between the 2 groups with regard to depression ( P = .057). CONCLUSIONS Reminder intervention using smart pill bottles was effective in improving medication adherence and medication self-efficacy among breast cancer survivors undergoing oral antiestrogen therapy. IMPLICATIONS FOR PRACTICE A smart pill bottle method of intervention can be a useful reminder strategy to improve medication adherence among breast cancer survivors.
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16
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Radhakrishnan K, Julien C, Baranowski T, O'Hair M, Lee G, Sagna De Main A, Allen C, Viswanathan B, Thomaz E, Kim M. Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial. JMIR Serious Games 2021; 9:e29044. [PMID: 34747701 PMCID: PMC8663490 DOI: 10.2196/29044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. OBJECTIVE The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. METHODS English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants' knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. RESULTS A total of 38 participants with HF-intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)-were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)-IG (15/19, 79%) and CG (16/19, 84%)-had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)-IG (14/19, 74%) and CG (13/19, 68%)-participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. CONCLUSIONS Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983.
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Affiliation(s)
| | - Christine Julien
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | | | | | - Grace Lee
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | - Atami Sagna De Main
- School of Nursing, The University of Texas Austin, Austin, TX, United States
| | - Catherine Allen
- School of Nursing, The University of Texas Austin, Austin, TX, United States
| | - Bindu Viswanathan
- Department of Statistics and Data Sciences, The University of Texas Austin, Austin, TX, United States
| | - Edison Thomaz
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | - Miyong Kim
- School of Nursing, The University of Texas Austin, Austin, TX, United States
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