A Vendor-Independent Mobile Health Monitoring Platform for Digital Health Studies: Development and Usability Study

ICT in Nursing and Patient Healthcare Management: Scoping Review and Case Studies

Over the past few decades, Information and Communication Technologies (ICT) have revolutionized the fields of nursing and patient healthcare management. This scoping review and the accompanying case studies shed light on the extensive scope and impact of ICT in these critical healthcare domains. The scoping review explores the wide array of ICT tools employed in nursing care and patient healthcare management. These tools encompass electronic health records systems, mobile applications, telemedicine solutions, remote monitoring systems, and more. This article underscores how these technologies have enhanced the efficiency, accuracy, and accessibility of clinical information, contributing to improved patient care. ICT revolution has revitalized nursing care and patient management, improving the quality of care and patient satisfaction. This review and the accompanying case studies emphasize the ongoing potential of ICT in the healthcare sector and call for further research to maximize its benefits.

Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study

Juvenile idiopathic arthritis can be influenced by pain, medication adherence, and physical activity. A new digital health intervention, InteractiveClinics, aims to monitor these modifiable risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smartwatch to record their pain levels and take their medications, using a customised mobile app synchronised to a secure web-based platform. Daily physical activity levels were automatically recorded by wearing a smartwatch. Using a quantitative descriptive research design, feasibility and user adoption were evaluated. The web-based data revealed the following: Pain: mean app usage: 68% (SD 30, range: 28.6% to 100%); pain score: 2.9 out of 10 (SD 1.8, range: 0.3 to 6.2 out of 10). Medication adherence: mean app usage: 20.7% (SD, range: 0% to 71.4%), recording 39% (71/182) of the expected daily and 37.5% (3/8) of the weekly medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), one to six additional medications (mean 3.5, SD 2.4) for 2-6 days. Physical activity: watch wearing behaviour: 69.7% (439/630), recording low levels of moderate-to-vigorous physical activity (mean: 11.8, SD: 13.5 min, range: 0-47 min). To conclude, remote monitoring of real-time data is feasible. However, further research is needed to increase adoption rates among children.

Linking coastal environmental and health observations for human wellbeing

Coastal areas have long been attractive places to live, work, and recreate and remain so even in the face of growing threats from global environmental change. At any moment, a significant portion of the human population is exposed to both positive and negative health effects associated with coastal locations. Some locations may be "hotspots" of concern for human health due to ongoing climatic and other changes, accentuating the need for better understanding of coastal environment-human health linkages. This paper describes how environmental and health data could be combined to create a coastal environmental and human health observing system. While largely based on information from the US and Europe, the concept should be relevant to almost any coastal area. If implemented, a coastal health observing system would connect a variety of human health data and environmental observations for individuals and communities, and where possible cohorts. Health data would be derived from questionnaires and other personal sources, clinical examinations, electronic health records, wearable devices, and syndromic surveillance, plus information on vulnerability and health-relevant community characteristics, and social media observations. Environmental data sources would include weather and climate, beach and coastal conditions, sentinel species, occurrences of harmful organisms and substances, seafood safety advisories, and distribution, proximity, and characteristics of health-promoting green and blue spaces. Where available, information on supporting resources could be added. Establishment of a linked network of coastal health observatories could provide powerful tools for understanding the positive and negative health effects of coastal living, lead to better health protections and enhanced wellbeing, and provide significant benefits to coastal residents, including the historically disadvantaged, as well as the military, hospitals and emergency departments, academic medical, public health, and environmental health programs, and others. Early networks could provide best practices and lessons learned to assist later entries.

Hurdles to developing and scaling remote patients' health management tools and systems: a scoping review

BACKGROUND

Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact.

AIM

The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS's adoption and scalability.

METHODS

A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases.

RESULTS

Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof.

CONCLUSION

The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.

Hypertensive disorders of pregnancy: definition, management, and out-of-office blood pressure measurement

Hypertensive disorders of pregnancy increase the risk of adverse maternal and fetal outcomes. In 2018, the Japanese classification of hypertensive disorders of pregnancy was standardized with those of other countries, and a hypertensive disorder of pregnancy was considered to be present if hypertension existed during pregnancy and up to 12 weeks after delivery. Strategies for the prevention of hypertensive disorders of pregnancy have become much clearer, but further research is needed on appropriate subjects and methods of administration, and these have not been clarified in Japan. Although guidelines for the use of antihypertensive drugs are also being studied and standardized with those of other countries, the use of calcium antagonists before 20 weeks of gestation is still contraindicated in Japan because of the safety concerns that were raised regarding possible fetal anomalies associated with their use at the time of their market launch. Chronic hypertension is now included in the definition of hypertensive disorders of pregnancy, and blood pressure measurement is a fundamental component of the diagnosis of hypertensive disorders of pregnancy. Out-of-office blood pressure measurements, including ambulatory and home blood pressure measurements, are important for pregnant and nonpregnant women. Although conditions such as white-coat hypertension and masked hypertension have been reported, determining their occurrence in pregnancy is complicated by the gestational week. This narrative review focused on recent reports on hypertensive disorders of pregnancy, including those related to blood pressure measurement and classification.

Technologies for Interoperable Internet of Medical Things Platforms to Manage Medical Emergencies in Home Care and Prehospital Care: Protocol for a Scoping Review (Preprint)

Background

Population growth and aging have highlighted the need for more effective home and prehospital care. Interconnected medical devices and applications, which comprise an infrastructure referred to as the Internet of Medical Things (IoMT), have enabled remote patient monitoring and can be important tools to cope with these demographic changes. However, developing IoMT platforms requires profound knowledge of clinical needs and challenges related to interoperability and how these can be managed with suitable technologies.

Objective

The purpose of this scoping review is to summarize the best practices and technologies to overcome interoperability concerns in IoMT platform development for medical emergencies in home and prehospital care.

Methods

This scoping review will be conducted in accordance with Arksey and O’Malley’s 5-stage framework and adhere to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols) guidelines. Only peer-reviewed articles published in English will be considered. The databases/web search engines that will be used are IEEE Xplore, PubMed, Scopus, Google Scholar, National Center for Biotechnology Information, SAGE Journals, and ScienceDirect. The search process for relevant literature will be divided into 4 different steps. This will ensure that a suitable approach is followed in terms of search terms, limitations, and eligibility criteria. Relevant articles that meet the inclusion criteria will be screened in 2 stages: abstract and title screening and full-text screening. To reduce selection bias, the screening process will be performed by 2 reviewers.

Results

The results of the preliminary search indicate that there is sufficient literature to form a good foundation for the scoping review. The search was performed in April 2022, and a total of 4579 articles were found. The main clinical focus is the prevention and management of falls, but other medical emergencies, such as heart disease and stroke, are also considered. Preliminary results show that little attention has been given to real-time IoMT platforms that can be deployed in real-world care settings. The final results are expected to be presented in a scoping review in 2023 and will be disseminated through scientific conference presentations, oral presentations, and publication in a peer-reviewed journal.

Conclusions

This scoping review will provide insights and recommendations regarding how interoperable real-time IoMT platforms can be developed to handle medical emergencies in home and prehospital care. The findings of this research could be used by researchers, clinicians, and implementation teams to facilitate future development and interdisciplinary discussions.

International Registered Report Identifier (IRRID)

DERR1-10.2196/40243

Data Collection Mechanisms in Health and Wellness Apps: Review and Analysis

Background

There has been a steady rise in the availability of health wearables and built-in smartphone sensors that can be used to collect health data reliably and conveniently from end users. Given the feature overlaps and user tendency to use several apps, these are important factors impacting user experience. However, there is limited work on analyzing the data collection aspect of mobile health (mHealth) apps.

Objective

This study aims to analyze what data mHealth apps across different categories usually collect from end users and how these data are collected. This information is important to guide the development of a common data model from current widely adopted apps. This will also inform what built-in sensors and wearables, a comprehensive mHealth platform should support.

Methods

In our empirical investigation of mHealth apps, we identified app categories listed in a curated mHealth app library, which was then used to explore the Google Play Store for health and medical apps that were then filtered using our selection criteria. We downloaded these apps from a mirror site hosting Android apps and analyzed them using a script that we developed around the popular AndroGuard tool. We analyzed the use of Bluetooth peripherals and built-in sensors to understand how a given app collects health data.

Results

We retrieved 3251 apps meeting our criteria, and our analysis showed that 10.74% (349/3251) of these apps requested Bluetooth access. We found that 50.9% (259/509) of the Bluetooth service universally unique identifiers to be known in these apps, with the remainder being vendor specific. The most common health-related Bluetooth Low Energy services using known universally unique identifiers were Heart Rate, Glucose, and Body Composition. App permissions showed the most used device module or sensor to be the camera (669/3251, 20.57%), closely followed by location (598/3251, 18.39%), with the highest occurrence in the staying healthy app category.

Conclusions

We found that not many health apps used built-in sensors or peripherals for collecting health data. The small number of the apps using Bluetooth, with an even smaller number of apps using standard Bluetooth Low Energy services, indicates a wider use of proprietary algorithms and custom services, which restrict the device use. The use of standard profiles could open this ecosystem further and could provide end users more options for apps. The relatively small proportion of apps using built-in sensors along with a high reliance on manual data entry suggests the need for more research into using sensors for data collection in health and fitness apps, which may be more desirable and improve end user experience.

Smartphone App to Self-Monitor Nausea During Pediatric Chemotherapy Treatment: User-Centered Design Process

Background

Nausea and vomiting are common and distressing side effects for children receiving chemotherapy. Limited evidence is available to guide antiemetic recommendations; therefore, prospective and reliable evaluation of antiemetic efficacy is needed. Smartphone apps can be used to effortlessly and precisely collect patient-reported outcomes in real time.

Objective

Our objective was to develop a smartphone app to monitor nausea and vomiting episodes in pediatric cancer patients aged 0 to 18 years and to test its usability and adherence to its use.

Methods

We used a user-centered design process and the evolutionary prototype model to develop and evaluate the app. Multidisciplinary group discussions and several rounds of patient feedback and modification were conducted. We translated the validated Pediatric Nausea Assessment Tool to assess nausea severity in children aged 4 to 18 years. The child’s own term for nausea was interactively incorporated in the nausea severity question, with response options expressed as 4 illustrative faces. Parent-reported outcomes were used for children aged 0 to 3 years. Reminders were sent using push notifications in order to ensure high response rates. Children aged 0 to 18 years who were undergoing chemotherapy were recruited from the Department of Pediatric Oncology at Copenhagen University Hospital Rigshospitalet to evaluate the app.

Results

The app’s most important function was to record nausea severity in children. After assistance from a researcher, children aged 4 to 18 years were able to report their symptoms in the app, and parents were able to report symptoms for their children aged 0 to 3 years. Children (n=20, aged 2.0-17.5 years) and their parents evaluated the app prospectively during a collective total of 60 chemotherapy cycles. They expressed that the app was user-friendly, intuitive, and that the time spent on data entry was fair. The response rates were on average 92%, 93%, and 80% for the day before, the first day of, and the next 3 days after chemotherapy, respectively. Researchers and clinicians were able to obtain an overview of the patient’s chemotherapy dates and responses through a secure and encrypted web-based administrative portal. Data could be downloaded for further analysis.

Conclusions

The user-friendly app could be used to facilitate future pediatric antiemetic trials and to refine antiemetic treatment during chemotherapy.