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Vayena E, Blasimme A, Sugarman J. Decentralised clinical trials: ethical opportunities and challenges. Lancet Digit Health 2023; 5:e390-e394. [PMID: 37105800 PMCID: PMC10129131 DOI: 10.1016/s2589-7500(23)00052-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
Fuelled by adaptations to clinical trial implementation during the COVID-19 pandemic, decentralised clinical trials are burgeoning. Decentralised clinical trials involve many digital tools to facilitate research without physical contact between research teams and participants at various stages, such as recruitment, enrolment, informed consent, administering study interventions, obtaining patient-reported outcome measures, and safety monitoring. These tools can provide ways of ensuring participants' safety and research integrity, while sometimes reducing participant burden and trial cost. Research sponsors and investigators are interested in expanding the use of decentralised clinical trials. The US Food and Drug Administration and other regulators worldwide have issued guidance on how to implement such adaptations. However, there has been little focus on the distinct ethical challenges these trials pose. In this Health Policy report, which is informed by both traditional research ethics and digital ethics frameworks, we group the related ethical issues under three areas requiring increased ethical vigilance: participants' safety and rights, scientific validity, and ethics oversight. Our aim is to describe these issues, offer practical means of addressing them, and prompt the delineation of ethical standards for decentralised trials.
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Affiliation(s)
- Effy Vayena
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, Federal Institute of Technology-ETH Zurich, Zürich, Switzerland.
| | - Alessandro Blasimme
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, Federal Institute of Technology-ETH Zurich, Zürich, Switzerland
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Department of Medicine, and Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
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Schroeder T, Haug M, Gewald H. Data Privacy Concerns Using mHealth Apps and Smart Speakers: Comparative Interview Study Among Mature Adults. JMIR Form Res 2022; 6:e28025. [PMID: 35699993 PMCID: PMC9237761 DOI: 10.2196/28025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/30/2021] [Accepted: 04/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background New technologies such as mobile health (mHealth) apps and smart speakers make intensive use of sensitive personal data. Users are typically aware of this and express concerns about their data privacy. However, many people use these technologies although they think their data are not well protected. This raises specific concerns for sensitive health data. Objective This study aimed to contribute to a better understanding of data privacy concerns of mature adults using new technologies and provide insights into their data privacy expectations and associated risks and the corresponding actions of users in 2 different data contexts: mHealth apps and smart speakers. Methods This exploratory research adopted a qualitative approach, engaging with 20 mature adults (aged >45 years). In a 6-month test period, 10 (50%) participants used a smart speaker and 10 (50%) participants used an mHealth app. In interviews conducted before and after the test period, we assessed the influence of data privacy concerns on technology acceptance, use behavior, and continued use intention. Results Our results show that although participants are generally aware of the need to protect their data privacy, they accept the risk of misuse of their private data when using the technology. Surprisingly, the most frequently stated risk was not the misuse of personal health data but the fear of receiving more personalized advertisements. Similarly, surprisingly, our results indicate that participants value recorded verbal data higher than personal health data. Conclusions Older adults are initially concerned about risks to their data privacy associated with using data-intensive technologies, but those concerns diminish fairly quickly, culminating in resignation. We find that participants do not differentiate between risky behaviors, depending on the type of private data used by different technologies.
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Affiliation(s)
- Tanja Schroeder
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Center for Research on Service Sciences, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Maximilian Haug
- Center for Research on Service Sciences, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Heiko Gewald
- Center for Research on Service Sciences, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
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Steyn L, Mash RJ, Hendricks G. Use of the Vula App to refer patients in the West Coast District: A descriptive exploratory qualitative study. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 35532127 PMCID: PMC9082220 DOI: 10.4102/safp.v64i1.5491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Referral systems play a pivotal role in coordination and quality of care and should be evaluated for their utility. The Vula App is used by various disciplines and hospitals in South Africa to refer patients. The aim was to explore the perceptions of medical practitioners regarding the use of the Vula App in the West Coast District. Methods A descriptive, exploratory qualitative study used semi-structured interviews with 11 medical practitioners. The highest and lowest users of the Vula App were selected from seven district hospitals. Qualitative data analysis used the framework method and Atlas-ti. Results There were five themes: impact on the referral process, quality of care, coordination of care, continuous professional development, and how to improve the Vula App. Its use was well established in the outpatient and semi-urgent setting, but participants were hesitant to rely on it for immediate advice. Specialist advice via the Vula App enabled practitioners to manage patients remotely. The referral hand-over function had a positive impact on the coordination of care. Advice and feedback via the Vula App assisted with continuous professional development. Conclusion The Vula App is a useful tool to refer patients to the emergency centre and outpatient departments. It can improve the immediate quality of care and sequential coordination of care. It has the potential to enable continuous professional development. There is a need to standardise its use, to ensure electronic information flows back to the district and to integrate the data into the district’s health information system.
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Affiliation(s)
- Louwrens Steyn
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Nightingale RC, Ross MT, Cruz RLJ, Allenby MC, Powell SK, Woodruff MA. Frugal 3D scanning using smartphones provides an accessible framework for capturing the external ear. J Plast Reconstr Aesthet Surg 2021; 74:3066-3072. [PMID: 34088646 DOI: 10.1016/j.bjps.2021.03.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/07/2021] [Accepted: 03/13/2021] [Indexed: 11/25/2022]
Abstract
Three-dimensional (3D) scanning technologies, such as medical imaging and surface scanning, have important applications for capturing patient anatomy to create personalised prosthetics. Digital approaches for capturing anatomical detail as opposed to traditional, invasive impression techniques significantly reduces turnaround times and lower production costs while still maintaining the high aesthetic quality of the end product. While previous case studies utilise expensive 3D scanning and modelling frameworks, their clinical translation is limited due to high equipment costs. In this study, we develop and validate a low-cost framework for clinical 3D scanning of the external ear using photogrammetry and a smartphone camera. We recruited five novice operators who watched an instructional video before scanning 20 healthy adult participant ears who did not have microtia. Our results show that the smartphone-based photogrammetry methodology produces 3D scans of the external ear that were accurate to (1.5 ± 0.4) mm and were (71 ± 14) % complete compared with those from a gold standard reference scanner, with no significant difference observed between operators. A moderate to strong interrater reliability was determined for all novice operators, suggesting that all novice operators were able to capture repeatable scans. The development of this smartphone photogrammetry approach has the potential to provide a non-invasive, inexpensive and accessible means to capture patient morphology for use in clinical assessment and personalised device manufacture, specifically for ear prostheses. We also demonstrate that inexperienced operators can rapidly learn and apply smartphone photogrammetry for accurate and reliable scans of the external ear with important applications for future clinical translation.
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Affiliation(s)
- Renee C Nightingale
- Queensland University of Technology (QUT), Brisbane, Queensland, 4000, Australia
| | - Maureen T Ross
- Queensland University of Technology (QUT), Brisbane, Queensland, 4000, Australia
| | - Rena L J Cruz
- Queensland University of Technology (QUT), Brisbane, Queensland, 4000, Australia
| | - Mark C Allenby
- Queensland University of Technology (QUT), Brisbane, Queensland, 4000, Australia
| | - Sean K Powell
- Queensland University of Technology (QUT), Brisbane, Queensland, 4000, Australia.
| | - Maria A Woodruff
- Queensland University of Technology (QUT), Brisbane, Queensland, 4000, Australia
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Bui AAT, Hosseini A, Rocchio R, Jacobs N, Ross MK, Okelo S, Lurmann F, Eckel S, Dzubur E, Dunton G, Gilliland F, Sarrafzadeh M, Habre R. Biomedical REAl-Time Health Evaluation (BREATHE): toward an mHealth informatics platform. JAMIA Open 2020; 3:190-200. [PMID: 32734159 PMCID: PMC7382637 DOI: 10.1093/jamiaopen/ooaa011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/28/2020] [Accepted: 04/02/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe a configurable mobile health (mHealth) framework for integration of physiologic and environmental sensors to be used in studies focusing on the domain of pediatric asthma. MATERIALS AND METHODS The Biomedical REAl-Time Health Evaluation (BREATHE) platform connects different sensors and data streams, contextualizing an individual's symptoms and daily activities over time to understand pediatric asthma's presentation and its management. A smartwatch/smartphone combination serves as a hub for personal/wearable sensing devices collecting data on health (eg, heart rate, spirometry, medications), motion, and personal exposures (eg, particulate matter, ozone); securely transmitting information to BREATHE's servers; and interacting with the user (eg, ecological momentary assessments). Server-side integration of electronic health record data and spatiotemporally correlated information (eg, weather, traffic) elaborates on these observations. An initial panel study involving pediatric asthma patients was conducted to assess BREATHE. RESULTS Twenty subjects were enrolled, during which BREATHE accrued seven consecutive days of continuous data per individual. The data were used to confirm knowledge about asthma (use of controller inhalers, time-activity behaviors, personal air pollution exposure), and additional analyses provided insights into within-day associations of environmental triggers and asthma exacerbations. Exit surveys focusing on mHealth usability, while positive, noted several translational challenges. DISCUSSION Based on these promising results, a longitudinal panel study to evaluate individual microenvironments and exposures is ongoing. Lessons learned thus far reflect the need to address various usability aspects, including convenience and ongoing engagement. CONCLUSION BREATHE enables multi-sensor mHealth studies, capturing new types of information alongside an evolving understanding of personal exposomes.
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Affiliation(s)
- Alex A T Bui
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California, USA
| | | | - Rose Rocchio
- Mobilize Labs, UCLA, Los Angeles, California, USA
| | - Nate Jacobs
- Mobilize Labs, UCLA, Los Angeles, California, USA
| | - Mindy K Ross
- Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Sande Okelo
- Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Fred Lurmann
- Sonoma Technologies, Inc., Petaluma, California, USA
| | - Sandrah Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Eldin Dzubur
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Genevieve Dunton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Rima Habre
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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Stone TE, Jia Y, Kunaviktikul W. Mobile apps: An effective, inclusive and equitable way of delivering patient and nurse education? NURSE EDUCATION TODAY 2020; 85:104308. [PMID: 31785570 DOI: 10.1016/j.nedt.2019.104308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/04/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Teresa E Stone
- The Dean's Office, Building 4, Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, SriPhum District, Chiang Mai 50200, Thailand..
| | - Yue Jia
- The Dean's Office, Building 4, Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, SriPhum District, Chiang Mai 50200, Thailand
| | - Wipada Kunaviktikul
- The Dean's Office, Building 4, Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, SriPhum District, Chiang Mai 50200, Thailand..
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Lambe G, Linnane N, Callanan I, Butler MW. Cleaning up the paper trail - our clinical notes in open view. Int J Health Care Qual Assur 2018; 31:228-236. [PMID: 29687753 DOI: 10.1108/ijhcqa-09-2016-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Ireland's physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this paper is to: assess the protection afforded to paper records; log highest risk records; note the variations that occurred during the working week; and observe the varying protection that occurred when staff, students and public members were present. Design/methodology/approach A customised audit tool was created using Sphinx software. Data were collected for three months. All wards included in the study were visited once during four discrete time periods across the working week. The medical records trolley's location was noted and total unattended medical records, total unattended nursing records, total unattended patient lists and when nursing personnel, medical students, public and a ward secretary were visibly present were recorded. Findings During 84 occasions when the authors visited wards, unattended medical records were identified on 33 per cent of occasions, 49 per cent were found during weekend visiting hours and just 4 per cent were found during morning rounds. The unattended medical records belonged to patients admitted to a medical specialty in 73 per cent of cases and a surgical specialty in 27 per cent. Medical records were found unattended in the nurses' station with much greater frequency when the ward secretary was off duty. Unattended nursing records were identified on 67 per cent of occasions the authors visited the ward and were most commonly found unattended in groups of six or more. Practical implications This study is a timely reminder that confidential patient information is at risk from inappropriate disclosure in the hospital. There are few context-specific standards for data protection to guide healthcare professionals, particularly paper records. Nursing records are left unattended with twice the frequency of medical records and are found unattended in greater numbers than medical records. Protection is strongest when ward secretaries are on duty. Over-reliance on vigilant ward secretaries could represent a threat to confidential patient information. Originality/value While other studies identified data protection as an issue, this study assesses how data security varies inside and outside conventional working hours. It provides a rationale and an impetus for specific changes across the whole working week. By identifying the on-duty ward secretary's favourable effect on medical record security, it highlights the need for alternative arrangements when the ward secretary is off duty. Data were collected prospectively in real time, giving a more accurate healthcare record security snapshot in each data collection point.
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Affiliation(s)
- Gerard Lambe
- Acute Medical Assessment Unit, St James's Hospital, Dublin, Ireland
| | - Niall Linnane
- Department of Paediatric Surgery, Children's University Hospital , Dublin, Ireland
| | - Ian Callanan
- Clinical Audit Department, St Vincent's University Hospital , Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital , Dublin, Ireland and University College Dublin , Dublin, Ireland
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Nimkar S, Gilles EE. Improving Global Health With Smartphone Technology. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2018. [DOI: 10.4018/ijehmc.2018070101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The widespread use of smartphones makes them a popular platform for healthcare applications. This article reveals the global trends and overarching goals of mHealth initiatives that seek to enhance healthcare quality, increase access to health services, and improve global health communication. Three main themes emerged from this study: a) the impact of mHealth on international public health, b) overcoming mhealth barriers, and c) emerging mHealth technologies. The costs of developing mHealth apps and handling related data security concerns are the key barriers which need to be addressed to successfully implement global mHealth campaigns. Future directions of mHealth research are discussed, including the integration of new technologies, development of innovative healthcare systems, and overall improvement of global healthcare.
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Hosseini A, Buonocore CM, Hashemzadeh S, Hojaiji H, Kalantarian H, Sideris C, Bui AAT, King CE, Sarrafzadeh M. Feasibility of a Secure Wireless Sensing Smartwatch Application for the Self-Management of Pediatric Asthma. SENSORS 2017; 17:s17081780. [PMID: 28771168 PMCID: PMC5580199 DOI: 10.3390/s17081780] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/16/2022]
Abstract
To address the need for asthma self-management in pediatrics, the authors present the feasibility of a mobile health (mHealth) platform built on their prior work in an asthmatic adult and child. Real-time asthma attack risk was assessed through physiological and environmental sensors. Data were sent to a cloud via a smartwatch application (app) using Health Insurance Portability and Accountability Act (HIPAA)-compliant cryptography and combined with online source data. A risk level (high, medium or low) was determined using a random forest classifier and then sent to the app to be visualized as animated dragon graphics for easy interpretation by children. The feasibility of the system was first tested on an adult with moderate asthma, then usability was examined on a child with mild asthma over several weeks. It was found during feasibility testing that the system is able to assess asthma risk with 80.10 ± 14.13% accuracy. During usability testing, it was able to continuously collect sensor data, and the child was able to wear, easily understand and enjoy the use of the system. If tested in more individuals, this system may lead to an effective self-management program that can reduce hospitalization in those who suffer from asthma.
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Affiliation(s)
- Anahita Hosseini
- Department of Computer Science, University of California Los Angeles, 4732 Boelter Hall, Los Angeles, CA 90095, USA.
| | - Chris M Buonocore
- Department of Computer Science, University of California Los Angeles, 4732 Boelter Hall, Los Angeles, CA 90095, USA.
| | - Sepideh Hashemzadeh
- Department of Computer Science, University of California Los Angeles, 4732 Boelter Hall, Los Angeles, CA 90095, USA.
| | - Hannaneh Hojaiji
- Department of Electrical Engineering, University of California Los Angeles, 56-125B Engineering IV Building, 420 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Haik Kalantarian
- Department of Computer Science, University of California Los Angeles, 4732 Boelter Hall, Los Angeles, CA 90095, USA.
| | - Costas Sideris
- Department of Computer Science, University of California Los Angeles, 4732 Boelter Hall, Los Angeles, CA 90095, USA.
| | - Alex A T Bui
- Department of Radiological Sciences, University of California Los Angeles, 924 Westwood Blvd., Suite 420, Los Angeles, CA 90024, USA.
| | - Christine E King
- Department of Computer Science, University of California Los Angeles, 4732 Boelter Hall, Los Angeles, CA 90095, USA.
| | - Majid Sarrafzadeh
- Department of Computer Science, University of California Los Angeles, 4732 Boelter Hall, Los Angeles, CA 90095, USA.
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Stiles-Shields C, Montague E, Lattie EG, Kwasny MJ, Mohr DC. What might get in the way: Barriers to the use of apps for depression. Digit Health 2017; 3:2055207617713827. [PMID: 29942605 PMCID: PMC6001178 DOI: 10.1177/2055207617713827] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 05/09/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Smartphones are being used with increasing frequency to deliver behavioral interventions for depression via apps. However, barriers specific to using an app for depression are poorly defined. The purpose of the current study is to identify barriers to the use of a mobile app to deliver treatment for depression. Secondarily, design implications will be provided based upon identified barriers. Method A card sorting task that ranked and grouped barriers to the use of apps for depression was completed. Participants first completed a card sorting task identifying barriers to face-to-face treatment, as a primer to identification of treatment barriers. The sample consisted of those above (n = 9) and below (n = 11) the threshold for a referral to psychotherapy, to capture anticipated barriers for likely end users. Cluster analyses were conducted to analyze the card sorting data. Multiple analyses were conducted to identify: 1) the most important barriers, and 2) how consistently barriers were ranked as important. Result The card sorting task identified a number of primary barriers to the use of apps for depression treatment, including concerns over intervention efficacy, app functioning, privacy, cost, and lack of guidance and tailored feedback. The top face-to-face treatment barrier was cost, overlapping with mobile barriers. Conclusion This study identified perceived barriers to the use of mobile treatment apps. Identification of barriers implicates design recommendations for apps for depression.
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Affiliation(s)
- Colleen Stiles-Shields
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, USA
| | - Enid Montague
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,College of Computing and Digital Media, DePaul University, Chicago, IL, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Mary J Kwasny
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
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Vogel MME, Combs SE, Kessel KA. mHealth and Application Technology Supporting Clinical Trials: Today's Limitations and Future Perspective of smartRCTs. Front Oncol 2017; 7:37. [PMID: 28348978 PMCID: PMC5346562 DOI: 10.3389/fonc.2017.00037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
Abstract
Nowadays, applications (apps) for smartphones and tablets have become indispensable especially for young generations. The estimated number of mobile devices will exceed 2.16 billion in 2016. Over 2.2 million apps are available in the Google Play store®, and about 1.8 million apps are available in the Apple App Store®. Google and Apple distribute nearly 70,000 apps each in the category Health and Fitness, and about 33,000 and 46,000 each in medical apps. It seems like the willingness to use mHealth apps is high and the intention to share data for health research is existing. This leads to one conclusion: the time for app-accompanied clinical trials (smartRCTs) has come. In this perspective article, we would like to point out the stones put in the way while trying to implement apps in clinical research. Further, we try to offer a glimpse of what the future of smartRCT research may hold.
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Affiliation(s)
- Marco M E Vogel
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany; Institute for Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany; Institute for Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany
| | - Kerstin A Kessel
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany; Institute for Innovative Radiotherapy, Helmholtz Zentrum München, Neuherberg, Germany
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Kessel KA, Vogel MME, Schmidt-Graf F, Combs SE. Mobile Apps in Oncology: A Survey on Health Care Professionals' Attitude Toward Telemedicine, mHealth, and Oncological Apps. J Med Internet Res 2016; 18:e312. [PMID: 27884810 PMCID: PMC5146327 DOI: 10.2196/jmir.6399] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022] Open
Abstract
Background Mobile apps are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective The aim was to analyze the attitude of health care professionals (HCPs) toward telemedicine, mHealth, and mobile apps in the field of oncology. Methods We developed and conducted an online survey with 24 questions evaluating HCPs’ general attitude toward telemedicine and patients using medical mobile apps. Specific questions on the possible functionality for patients and the resulting advantages and disadvantages for both the patients’ and HCPs’ daily clinical routine were evaluated. Results A total of 108 HCPs completed the survey. In all, 88.9% (96/108) considered telemedicine useful and 84.3% (91/108) supported the idea of an oncological app complementing classical treatment. Automatic reminders, timetables, and assessment of side effects and quality of life during therapy were rated as the most important functions. In contrast, uncertainty regarding medical responsibility and data privacy were reasons mostly named by critics. Most (64.8%, 70/108) were in favor of an alert function due to data input needing further clarification, and 94% (66/70) were willing to contact the patient after a critical alert. In all, 93.5% (101/108) supported the idea of using the collected data for scientific research. Moreover, 75.0% (81/108) believed establishing a mobile app could be beneficial for the providing hospital. Conclusions A majority of HCPs are in favor of telemedicine and the use of oncological apps by patients. Assessing side effects can lead to quicker response and thus lower inconvenience for patients. Clinical data, such as life quality and treatment satisfaction, could be used to evaluate and improve the therapy workflow. Eventually, a mobile app would enhance the patients’ relationship to their treating department because they are in permanent contact.
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Affiliation(s)
- Kerstin A Kessel
- Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Marco M E Vogel
- Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Friederike Schmidt-Graf
- Klinikum rechts der Isar, Department of Neurology, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany
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Hosseini A, Buonocore CM, Hashemzadeh S, Hojaiji H, Kalantarian H, Sideris C, Bui AAT, King CE, Sarrafzadeh M. HIPAA Compliant Wireless Sensing Smartwatch Application for the Self-Management of Pediatric Asthma. ... INTERNATIONAL CONFERENCE ON WEARABLE AND IMPLANTABLE BODY SENSOR NETWORKS. INTERNATIONAL CONFERENCE ON WEARABLE AND IMPLANTABLE BODY SENSOR NETWORKS 2016; 2016:49-54. [PMID: 29354688 DOI: 10.1109/bsn.2016.7516231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Asthma is the most prevalent chronic disease among pediatrics, as it is the leading cause of student absenteeism and hospitalization for those under the age of 15. To address the significant need to manage this disease in children, the authors present a mobile health (mHealth) system that determines the risk of an asthma attack through physiological and environmental wireless sensors and representational state transfer application program interfaces (RESTful APIs). The data is sent from wireless sensors to a smartwatch application (app) via a Health Insurance Portability and Accountability Act (HIPAA) compliant cryptography framework, which then sends data to a cloud for real-time analytics. The asthma risk is then sent to the smartwatch and provided to the user via simple graphics for easy interpretation by children. After testing the safety and feasibility of the system in an adult with moderate asthma prior to testing in children, it was found that the analytics model is able to determine the overall asthma risk (high, medium, or low risk) with an accuracy of 80.10±14.13%. Furthermore, the features most important for assessing the risk of an asthma attack were multifaceted, highlighting the importance of continuously monitoring different wireless sensors and RESTful APIs. Future testing this asthma attack risk prediction system in pediatric asthma individuals may lead to an effective self-management asthma program.
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Affiliation(s)
- Anahita Hosseini
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Chris M Buonocore
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sepideh Hashemzadeh
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Hannaneh Hojaiji
- Department of Electrical Engineering, University of California, Los Angeles, CA 90095, USA
| | - Haik Kalantarian
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Costas Sideris
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Alex A T Bui
- Department of Radiological Sciences, University of California, Los Angeles, CA 90095, USA
| | - Christine E King
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Majid Sarrafzadeh
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Molina Recio G, García-Hernández L, Molina Luque R, Salas-Morera L. The role of interdisciplinary research team in the impact of health apps in health and computer science publications: a systematic review. Biomed Eng Online 2016; 15 Suppl 1:77. [PMID: 27454164 PMCID: PMC4959385 DOI: 10.1186/s12938-016-0185-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Several studies have estimated the potential economic and social impact of the mHealth development. Considering the latest study by Institute for Healthcare Informatics, more than 165.000 apps of health and medicine are offered including all the stores from different platforms. Thus, the global mHealth market was an estimated $10.5 billion in 2014 and is expected to grow 33.5 percent annually between 2015 and 2020s. In fact, apps of Health have become the third-fastest growing category, only after games and utilities. METHODS This study aims to identify, study and evaluate the role of interdisciplinary research teams in the development of articles and applications in the field of mHealth. It also aims to evaluate the impact that the development of mHealth has had on the health and computer science field, through the study of publications in specific databases for each area which have been published until nowadays. RESULTS Interdisciplinary nature is strongly connected to the scientific quality of the journal in which the work is published. This way, there are significant differences in those works that are made up by an interdisciplinary research team because of they achieve to publish in journals with higher quartiles. There are already studies that warn of methodological deficits in some studies in mHealth, low accuracy and no reproducibility. Studies of low precision and poor reproducibility, coupled with the low evidence, provide low degrees of recommendation of the interventions targeted and therefore low applicability. CONCLUSIONS From the evidence of this study, working in interdisciplinary groups from different areas greatly enhances the quality of research work as well as the quality of the publications derived from its results.
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Thilakanathan D, Calvo RA, Chen S, Nepal S, Glozier N. Facilitating Secure Sharing of Personal Health Data in the Cloud. JMIR Med Inform 2016; 4:e15. [PMID: 27234691 PMCID: PMC4902857 DOI: 10.2196/medinform.4756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/03/2015] [Accepted: 03/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. OBJECTIVE This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. METHODS We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). RESULTS We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. CONCLUSIONS We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors.
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Affiliation(s)
- Danan Thilakanathan
- Software Engineering Lab, School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia.
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Saleem K, Derhab A, Orgun MA, Al-Muhtadi J, Rodrigues JJPC, Khalil MS, Ali Ahmed A. Cost-Effective Encryption-Based Autonomous Routing Protocol for Efficient and Secure Wireless Sensor Networks. SENSORS 2016; 16:460. [PMID: 27043572 PMCID: PMC4850974 DOI: 10.3390/s16040460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/10/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022]
Abstract
The deployment of intelligent remote surveillance systems depends on wireless sensor networks (WSNs) composed of various miniature resource-constrained wireless sensor nodes. The development of routing protocols for WSNs is a major challenge because of their severe resource constraints, ad hoc topology and dynamic nature. Among those proposed routing protocols, the biology-inspired self-organized secure autonomous routing protocol (BIOSARP) involves an artificial immune system (AIS) that requires a certain amount of time to build up knowledge of neighboring nodes. The AIS algorithm uses this knowledge to distinguish between self and non-self neighboring nodes. The knowledge-building phase is a critical period in the WSN lifespan and requires active security measures. This paper proposes an enhanced BIOSARP (E-BIOSARP) that incorporates a random key encryption mechanism in a cost-effective manner to provide active security measures in WSNs. A detailed description of E-BIOSARP is presented, followed by an extensive security and performance analysis to demonstrate its efficiency. A scenario with E-BIOSARP is implemented in network simulator 2 (ns-2) and is populated with malicious nodes for analysis. Furthermore, E-BIOSARP is compared with state-of-the-art secure routing protocols in terms of processing time, delivery ratio, energy consumption, and packet overhead. The findings show that the proposed mechanism can efficiently protect WSNs from selective forwarding, brute-force or exhaustive key search, spoofing, eavesdropping, replaying or altering of routing information, cloning, acknowledgment spoofing, HELLO flood attacks, and Sybil attacks.
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Affiliation(s)
- Kashif Saleem
- Center of Excellence in Information Assurance (CoEIA), King Saud University, Riyadh 12372, Saudi Arabia.
| | - Abdelouahid Derhab
- Center of Excellence in Information Assurance (CoEIA), King Saud University, Riyadh 12372, Saudi Arabia.
| | - Mehmet A Orgun
- Intelligent Systems Group (ISG), Department of Computing, Macquarie University, Sydney, NSW 2109, Australia.
- Faculty of Information Technology, Macau University of Science and Technology, Avenida Wai Long, Macau 999078, China.
| | - Jalal Al-Muhtadi
- Center of Excellence in Information Assurance (CoEIA), King Saud University, Riyadh 12372, Saudi Arabia.
- College of Computer and Information Sciences (CCIS), King Saud University, Riyadh 12372, Saudi Arabia.
| | - Joel J P C Rodrigues
- Center of Excellence in Information Assurance (CoEIA), King Saud University, Riyadh 12372, Saudi Arabia.
- Instituto de Telecomunicações, University of Beira Interior, Marquês d'Ávila e Bolama, Covilhã 6201-001, Portugal.
- University of Fortaleza (UNIFOR), Fortaleza-CE 60115-170, Brazil.
| | - Mohammed Sayim Khalil
- Center of Excellence in Information Assurance (CoEIA), King Saud University, Riyadh 12372, Saudi Arabia.
| | - Adel Ali Ahmed
- Information Technology, FCITR, King Abdulaziz University, Rabigh 21911, Saudi Arabia.
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Hussain M, Al-Haiqi A, Zaidan AA, Zaidan BB, Kiah MLM, Anuar NB, Abdulnabi M. The landscape of research on smartphone medical apps: Coherent taxonomy, motivations, open challenges and recommendations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:393-408. [PMID: 26412009 DOI: 10.1016/j.cmpb.2015.08.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/24/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To survey researchers' efforts in response to the new and disruptive technology of smartphone medical apps, mapping the research landscape form the literature into a coherent taxonomy, and finding out basic characteristics of this emerging field represented on: motivation of using smartphone apps in medicine and healthcare, open challenges that hinder the utility, and the recommendations to improve the acceptance and use of medical apps in the literature. METHODS We performed a focused search for every article on (1) smartphone (2) medical or health-related (3) app, in four major databases: MEDLINE, Web of Science, ScienceDirect, and IEEE Xplore. Those databases are deemed broad enough to cover both medical and technical literature. RESULTS The final set included 133 articles. Most articles (68/133) are reviews and surveys that refer to actual apps or the literature to describe medical apps for a specific specialty, disease, or purpose; or to provide a general overview of the technology. Another group (43/133) carried various studies, from evaluation of apps to exploration of desired features when developing them. Few researchers (17/133) presented actual attempts to develop medical apps, or shared their experiences in doing so. The smallest portion (5/133) proposed general frameworks addressing the production or operation of apps. DISCUSSION Since 2010, researchers followed the trend of medical apps in several ways, though leaving areas or aspect for further attention. Regardless of their category, articles focus on the challenges that hinder the full utility of medical apps and do recommend mitigations to them. CONCLUSIONS Research on smartphone medical apps is active and various. We hope that this survey contribute to the understanding of the available options and gaps for other researchers to join this line of research.
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Affiliation(s)
- Muzammil Hussain
- Security Lab, Wisma R&D, Faculty of Computer Science and Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ahmed Al-Haiqi
- Security Lab, Wisma R&D, Faculty of Computer Science and Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - A A Zaidan
- Security Lab, Wisma R&D, Faculty of Computer Science and Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia.
| | - B B Zaidan
- Security Lab, Wisma R&D, Faculty of Computer Science and Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - M L M Kiah
- Security Lab, Wisma R&D, Faculty of Computer Science and Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nor Badrul Anuar
- Security Lab, Wisma R&D, Faculty of Computer Science and Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mohamed Abdulnabi
- Security Lab, Wisma R&D, Faculty of Computer Science and Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
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de la Torre-Díez I, Lopez-Coronado M, Garcia-Zapirain Soto B, Mendez-Zorrilla A. Secure Cloud-Based Solutions for Different eHealth Services in Spanish Rural Health Centers. J Med Internet Res 2015. [PMID: 26215155 PMCID: PMC4705355 DOI: 10.2196/jmir.4422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The combination of eHealth applications and/or services with cloud technology provides health care staff—with sufficient mobility and accessibility for them—to be able to transparently check any data they may need without having to worry about its physical location. Objective The main aim of this paper is to put forward secure cloud-based solutions for a range of eHealth services such as electronic health records (EHRs), telecardiology, teleconsultation, and telediagnosis. Methods The scenario chosen for introducing the services is a set of four rural health centers located within the same Spanish region. iCanCloud software was used to perform simulations in the proposed scenario. We chose online traffic and the cost per unit in terms of time as the parameters for choosing the secure solution on the most optimum cloud for each service. Results We suggest that load balancers always be fitted for all solutions in communication together with several Internet service providers and that smartcards be used to maintain identity to an appropriate extent. The solutions offered via private cloud for EHRs, teleconsultation, and telediagnosis services require a volume of online traffic calculated at being able to reach 2 Gbps per consultation. This may entail an average cost of €500/month. Conclusions The security solutions put forward for each eHealth service constitute an attempt to centralize all information on the cloud, thus offering greater accessibility to medical information in the case of EHRs alongside more reliable diagnoses and treatment for telecardiology, telediagnosis, and teleconsultation services. Therefore, better health care for the rural patient can be obtained at a reasonable cost.
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Affiliation(s)
- Isabel de la Torre-Díez
- Grupo de Telemedicina y eSalud, Departamento de Teoría de la Señal y Comunicaciones e Ingeniería Telemática, University of Valladolid, Valladolid, Spain
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21
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Privacy and Security in Mobile Health Apps: A Review and Recommendations. J Med Syst 2014; 39:181. [DOI: 10.1007/s10916-014-0181-3] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/28/2014] [Indexed: 11/26/2022]
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22
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Brian RM, Ben-Zeev D. Mobile health (mHealth) for mental health in Asia: objectives, strategies, and limitations. Asian J Psychiatr 2014; 10:96-100. [PMID: 25042960 DOI: 10.1016/j.ajp.2014.04.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/15/2022]
Abstract
Mobile technologies are transforming the way in which we interact with one another, access resources, find information, and conduct business around the world. Harnessing the capabilities of mobile technologies to support health care initiatives worldwide has developed into a new interdisciplinary field called mobile health (mHealth). In the current paper, we review the penetration of mobile technology in Asia, and consider the integration of mobile technologies into the study, diagnoses, and treatment of mental disorders in the region. We outline how mHealth programs could improve mental health literacy, provide greater access to mental health services, extend community-based outreach and engagement, support self-management of illness, and regulate medication distribution. We end with a consideration of the potential barriers and limitations of mHealth for mental health, including funding, language and literacy barriers, power supply considerations, data security, and privacy issues.
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Affiliation(s)
- Rachel M Brian
- Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Dror Ben-Zeev
- Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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23
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Misra SC, Bisui S. Critical Challenges for Adopting Personalized Medicine System in Healthcare Management. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2014. [DOI: 10.4018/ijehmc.2014040104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Personalized Medicine is an emerging approach in today's healthcare management. It bears a very strong potential to consolidate modern e-health systems fundamentally. Scientists have already discovered some of the personalized drugs that can shift the whole medicare process into a new dimension. However, bringing the change in healthcare management is an easy task. There are several critical challenges in the implementation of Personalized Medicine systems. This paper aims at identifying some of these critical challenges through a survey with medical doctors and patients. Challenges involved in implementing Personalized Medicine are listed. A questionnaire was distributed amongst a set of medical doctors, medical researchers, practitioners in pharmaceutical industries, regulatory board members, and a larger section of patients. The response data collected thereby were analysed statistically by using t-test. Summary of the descriptive statistical results of the responses received from medical doctors and patients are presented in tabular form. Based upon the statistical analysis, an attempt has been made in the paper to make a ranking of the challenges. A comparison of the perspectives of the doctors and patients has been made by using bar diagrams. The observations have been discussed in detail and some specific conclusions have been made. To the best of the author's knowledge and belief, this is the first academic paper in which an attempt has been made to suggest the crucial challenges for the implementation of Personalized Medicine. The study shows that both the medical doctors and patients perceive that genomic analysis of all the individuals is the most critical challenge.
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Affiliation(s)
- Subhas Chandra Misra
- Department of Industrial and Management Engineering, Indian Institute of Technology Kanpur, Kanpur, India
| | - Sandip Bisui
- Department of Mathematics and Statistics Engineering, Indian Institute of Technology Kanpur, Kanpur, India
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Yetisen AK, Martinez-Hurtado JL, da Cruz Vasconcellos F, Simsekler MCE, Akram MS, Lowe CR. The regulation of mobile medical applications. LAB ON A CHIP 2014; 14:833-840. [PMID: 24425070 DOI: 10.1039/c3lc51235e] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The rapidly expanding number of mobile medical applications have the potential to transform the patient-healthcare provider relationship by improving the turnaround time and reducing costs. In September 2013, the U.S. Food and Drug Administration (FDA) issued guidance to regulate these applications and protect consumers by minimising the risks associated with their unintended use. This guidance distinguishes between the subset of mobile medical apps which may be subject to regulation and those that are not. The marketing claims of the application determine the intent. Areas of concern include compliance with regular updates of the operating systems and of the mobile medical apps themselves. In this article, we explain the essence of this FDA guidance by providing examples and evaluating the impact on academia, industry and other key stakeholders, such as patients and clinicians. Our assessment indicates that awareness and incorporation of the guidelines into product development can hasten the commercialisation and market entry process. Furthermore, potential obstacles have been discussed and directions for future development suggested.
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Affiliation(s)
- Ali Kemal Yetisen
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QT, UK.
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Charani E, Castro-Sánchez E, Moore LSP, Holmes A. Do smartphone applications in healthcare require a governance and legal framework? It depends on the application! BMC Med 2014; 12:29. [PMID: 24524344 PMCID: PMC3929845 DOI: 10.1186/1741-7015-12-29] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/14/2014] [Indexed: 11/19/2022] Open
Abstract
The fast pace of technological improvement and the rapid development and adoption of healthcare applications present crucial challenges for clinicians, users and policy makers. Some of the most pressing dilemmas include the need to ensure the safety of applications and establish their cost-effectiveness while engaging patients and users to optimize their integration into health decision-making. Healthcare organizations need to consider the risk of fragmenting clinical practice within the organization as a result of too many apps being developed or used, as well as mechanisms for app integration into the wider electronic health records through development of governance framework for their use. The impact of app use on the interactions between clinicians and patients needs to be explored, together with the skills required for both groups to benefit from the use of apps. Although healthcare and academic institutions should support the improvements offered by technological advances, they must strive to do so within robust governance frameworks, after sound evaluation of clinical outcomes and examination of potential unintended consequences.
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Affiliation(s)
- Esmita Charani
- Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 0NN, USA.
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26
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Martínez-Pérez B, de la Torre-Díez I, López-Coronado M, Sainz-De-Abajo B. Comparison of mobile apps for the leading causes of death among different income zones: a review of the literature and app stores. JMIR Mhealth Uhealth 2014; 2:e1. [PMID: 25099695 PMCID: PMC4114467 DOI: 10.2196/mhealth.2779] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/07/2013] [Accepted: 12/03/2013] [Indexed: 12/11/2022] Open
Abstract
Background The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide. Objective The main aim of this paper was to compare the amount of research and the number of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. These diseases and conditions were ischemic heart disease; stroke and other cerebrovascular diseases; lower respiratory infections; chronic obstructive pulmonary disease; diarrheal diseases; HIV/AIDS; trachea, bronchus, and lung cancers; malaria; and Alzheimer disease and other dementias. Methods Two reviews were conducted. In the first, the systems IEEE Xplore, Scopus, Web of Knowledge, and PubMed were used to perform a literature review of applications related to the mentioned diseases. The second was developed in the currently most important mobile phone apps stores: Google play, iTunes, BlackBerry World, and Windows Phone Apps+Games. Results Search queries up to June 2013 located 371 papers and 557 apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps. Two diseases that are the first and second of low-income countries (lower respiratory infections and diarrheal diseases) have very little research and few commercial applications. HIV/AIDS, in the top 6 of low-income and middle-income zones, is one of the diseases with more research and applications, although it is not in the top 10 in high-income countries. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps. Conclusions Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. Nevertheless, there are some exceptions such as HIV/AIDS, due to its important social conscience; and trachea, bronchus and lung cancers, which was totally unexpected.
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Affiliation(s)
- Borja Martínez-Pérez
- University of Valladolid, Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain.
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Martínez-Pérez B, de la Torre-Díez I, López-Coronado M, Herreros-González J. Mobile apps in cardiology: review. JMIR Mhealth Uhealth 2013; 1:e15. [PMID: 25098320 PMCID: PMC4114428 DOI: 10.2196/mhealth.2737] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 06/26/2013] [Accepted: 06/30/2013] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates. Objective The aim of this paper is to study the literature on mobile systems and applications currently available, as well as the existing apps related to cardiology from the leading app stores and to then classify the results to see what is available and what is missing, focusing particularly on commercial apps. Methods Two reviews have been developed. One is a literature review of mobile systems and applications, retrieved from several databases and systems such as Scopus, PubMed, IEEE Xplore, and Web of Knowledge. The other is a review of mobile apps in the leading app stores, Google play for Android and Apple’s App Store for iOS. Results Search queries up to May 2013 located 406 papers and 710 apps related to cardiology and heart disease. The most researched section in the literature associated with cardiology is related to mobile heart (and vital signs) monitoring systems and the methods involved in the classification of heart signs in order to detect abnormal functions. Other systems with a significant number of papers are mobile cardiac rehabilitation systems, blood pressure measurement, and systems for the detection of heart failure. The majority of apps for cardiology are heart monitors and medical calculators. Other categories with a high number of apps are those for ECG education and interpretation, cardiology news and journals, blood pressure tracking, heart rate monitoring using an external device, and CPR instruction. There are very few guides on cardiac rehabilitation and apps for the management of the cardiac condition, and there were no apps that assist people who have undergone a heart transplant. Conclusions The distribution of work in the field of cardiology apps is considerably disproportionate. Whereas some systems have significant research and apps are available, other important systems lack such research and lack apps, even though the contribution they could provide is significant.
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Affiliation(s)
- Borja Martínez-Pérez
- University of Valladolid, Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain.
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Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev 2009; 2009:CD001096. [PMID: 19588323 PMCID: PMC4171964 DOI: 10.1002/14651858.cd001096.pub2] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering 'computer reminders'. OBJECTIVES To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. SEARCH STRATEGY We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. SELECTION CRITERIA Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. DATA COLLECTION AND ANALYSIS Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. MAIN RESULTS Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). AUTHORS' CONCLUSIONS Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.
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Affiliation(s)
- Kaveh G Shojania
- Director, University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Room D474, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5
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