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Reinders EFH, de Vries R, Wouters-van Poppel PCM, Van Riel NAW, Haak HR. Serious digital games for diabetes Mellitus: A scoping review of its current State, Accessibility, and functionality for patients and healthcare providers. Diabetes Res Clin Pract 2024; 216:111833. [PMID: 39179114 DOI: 10.1016/j.diabres.2024.111833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024]
Abstract
The global rise in diabetes prevalence poses a significant challenge to healthcare providers, stimulating interest in digital interventions such as educational games. However, the impact and availability of research-developed diabetes games remain uncertain. This scoping review aimed to provide a comprehensive overview of serious games for diabetes, encompassing their availability, characteristics and health effects. Through an electronic search in multiple databases, a total of 21 articles addressing 23 games were included in the literature review. The majority of these games were inaccessible outside of research settings, despite demonstrating positive effects on various aspects of diabetes management, including knowledge, physical activity, self-management, mental well-being, and HbA1c levels. Most games were designed for mobile phones, targeting both children and adults. A subsequent app store search revealed 13 additional diabetes games, however nearly none (7.7%) of these underwent research scrutiny, leaving their expected effects uncertain. The disparity between evidence-based games and those available in app stores underscores the need for bridging this gap to ensure the availability of effective digital games for diabetes management worldwide.
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Affiliation(s)
- Edouard F H Reinders
- Máxima MC, Department of Internal Medicine, Eindhoven/Veldhoven, the Netherlands; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Ryan de Vries
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Natal A W Van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Harm R Haak
- Máxima MC, Department of Internal Medicine, Eindhoven/Veldhoven, the Netherlands; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Bouchi R, Izumi K, Ishizuka N, Uemura Y, Ohtsu H, Miyo K, Tanaka S, Satoh‐Asahara N, Hara K, Odawara M, Kusunoki Y, Koyama H, Onoue T, Arima H, Tsushita K, Watada H, Kadowaki T, Ueki K. Internet of things-based approach for glycemic control in people with type 2 diabetes: A randomized controlled trial. J Diabetes Investig 2024; 15:1287-1296. [PMID: 38712947 PMCID: PMC11363111 DOI: 10.1111/jdi.14227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024] Open
Abstract
AIMS The utilization of long-term effect of internet of things (IoT) on glycemic control is controversial. This trial aimed to examine the effect of an IoT-based approach for type 2 diabetes. MATERIALS AND METHODS This randomized controlled trial enrolled 1,159 adults aged 20-74 years with type 2 diabetes with a HbA1c of 6.0-8.9% (42-74 mmol/mol), who were using a smartphone on a daily basis were randomly assigned to either the IoT-based approach group (ITG) or the control group (CTG). The ITG were supervised to utilize an IoT automated system that demonstrates a summary of lifelogging data (weight, blood pressure, and physical activities) and provides feedback messages that promote behavioral changes in both diet and exercise. The primary end point was a HbA1c change over 52 weeks. RESULTS Among the patients, 581 were assigned to the ITG and 578 were in the CTG. The changes in HbA1c from baseline to the final measurement at 52 weeks [mean (standard deviation)] were -0.000 (0.6225)% in ITG and - 0.006 (0.6449)% in CTG, respectively (P = 0.8766). In the per protocol set, including ITG using the IoT system almost daily and CTG, excluding those using the application almost daily, the difference in HbA1c from baseline to 52 weeks were -0.098 (0.579)% and 0.027 (0.571)%, respectively (P = 0.0201). We observed no significant difference in the adverse event profile between the groups. CONCLUSIONS The IoT-based approach did not reduce HbA1c in patients with type 2 diabetes. IoT-based intervention using data on the daily glycemic control and HbA1c level may be required to improve glycemic control.
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Affiliation(s)
- Ryotaro Bouchi
- Diabetes and Metabolism Information CenterResearch Institute, National Center for Global Health and MedicineTokyoJapan
- Department of Diabetes and Endocrinology and MetabolismCenter Hospital, National Center for Global Health and MedicineTokyoJapan
| | - Kazuo Izumi
- Center for Clinical SciencesNational Center for Global Health and MedicineTokyoJapan
| | - Naoki Ishizuka
- Center for Clinical SciencesNational Center for Global Health and MedicineTokyoJapan
- Center for Digital Transformation of Healthcare, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Yukari Uemura
- Center for Clinical SciencesNational Center for Global Health and MedicineTokyoJapan
| | - Hiroshi Ohtsu
- Clinical Research and Trial CenterJuntendo UniversityTokyoJapan
| | - Kengo Miyo
- Center for Medical Informatics IntelligenceNational Center for Global Health and MedicineTokyoJapan
| | - Shigeho Tanaka
- Faculty of NutritionKagawa Nutrition UniversitySaitamaJapan
- Department of Nutrition and MetabolismNational Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and NutritionTokyoJapan
| | - Noriko Satoh‐Asahara
- Department of Endocrinology, Metabolism and Hypertension ResearchClinical Research Institute, National Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kazuo Hara
- Department of Endocrinology and Metabolism, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Masato Odawara
- Department of Diabetology, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Yoshiki Kusunoki
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityHyogoJapan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, School of MedicineHyogo Medical UniversityHyogoJapan
| | - Takeshi Onoue
- Departments of Endocrinology and DiabetesNagoya University Graduate School of MedicineNagoyaJapan
| | - Hiroshi Arima
- Departments of Endocrinology and DiabetesNagoya University Graduate School of MedicineNagoyaJapan
| | - Kazuyo Tsushita
- Faculty of NutritionKagawa Nutrition UniversitySaitamaJapan
- Comprehensive Health Science CenterAichi Health Promotion FoundationHigashiura‐choAichiJapan
| | - Hirotaka Watada
- Department of Metabolism and EndocrinologyJuntendo University Graduate School of MedicineTokyoJapan
| | | | - Kohjiro Ueki
- Department of Diabetes and Endocrinology and MetabolismCenter Hospital, National Center for Global Health and MedicineTokyoJapan
- Diabetes Research CenterResearch Institute, National Center for Global Health and MedicineTokyoJapan
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Zhao J, Zhu H, Zhu D, Chang F, Liu C, Yang Y, Han T. Effectiveness of identity-building interventions on recovery identity and patient-reported health outcomes in chronic diseases: A meta-analysis. J Health Psychol 2024:13591053241249636. [PMID: 38819962 DOI: 10.1177/13591053241249636] [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: 06/02/2024] Open
Abstract
This meta-analysis aimed to assess the impact of identity-building interventions on recovery identity and patient-reported health outcomes in chronic disease patients. We identified 15 relevant empirical studies (comprising 2261 patients) from 989 records through extensive keyword searches and manual screening conducted between March 2nd and March 13th, 2023. Utilizing the Cochrane tool, meta-regression, and the GRADE approach, we evaluated these studies for their characteristics, findings, and quality. The analysis revealed that identity-building interventions, encompassing recovery-oriented group, interest group, and linguistic approaches, positively influenced identity synthesis and had varying effects on health outcomes. Notably, multiple regression analysis demonstrated that identity synthesis significantly predicted health outcomes. However, the study identified mild heterogeneity, a high attrition bias risk, and insufficient data on selection and detection bias as limitations. Overall, identity-building interventions proved influential in enhancing recovery identity, a vital predictor of patient-reported health outcomes in chronic disease patients.
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Affiliation(s)
| | | | - Dian Zhu
- Shanghai Jiao Tong University, China
| | | | | | - Yan Yang
- Shanghai Jiao Tong University, China
| | - Ting Han
- Shanghai Jiao Tong University, China
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Yao W, Han Y, Yang L, Chen Y, Yan S, Cheng Y. Electronic Interactive Games for Glycemic Control in Individuals With Diabetes: Systematic Review and Meta-Analysis. JMIR Serious Games 2024; 12:e43574. [PMID: 38345856 PMCID: PMC10897792 DOI: 10.2196/43574] [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: 10/16/2022] [Revised: 05/05/2023] [Accepted: 10/24/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Several electronic interventions have been used to improve glycemic control in patients with diabetes. Electronic interactive games specific to physical activity are available, but it is unclear if these are effective at improving glycemic control in patients with diabetes. OBJECTIVE This study aimed to determine the effects of electronic game-based interventions on glycemic control in patients with diabetes. METHODS Relevant studies that were published before April 1, 2023, were searched from 5 databases: PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Eligibility criteria included prospective studies examining the relationship between electronic games with physical activities or diet education and glycemic control as the outcome. The risk of bias was assessed using the Cochrane risk-of-bias tool. All analyses were conducted using RevMan5.4.1. Depending on the heterogeneity across studies, the pooled effects were calculated using fixed-effects or random-effects models. RESULTS Participants from 9 studies were included and assessed. Glycated hemoglobin (HbA1c) and fasting blood glucose improved in the intervention group, although the analysis revealed no significant reduction in HbA1c (-0.09%, 95% CI -0.29% to 0.10%) or fasting blood glucose (-0.94 mg/dL, 95% CI -9.34 to 7.46 mg/dL). However, the physical activity of individuals in the intervention group was significantly higher than that of those in the control group (standardized mean difference=0.84, 95% CI 0.30 to 1.38; P=.002). Other outcomes, such as weight and blood lipids, exhibited no significant improvement (all P>.05). CONCLUSIONS Electronic games had a good impact on participants' physical activity and offered an advantage in glycemic control without reaching statistical significance. Electronic games are convenient for reminders and education. Low-intensity exercise games may not be considered a better adjuvant intervention to improve diabetes self-management care.
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Affiliation(s)
- WenQi Yao
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - YiBing Han
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Li Yang
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
- Department of Nutrition, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ying Chen
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - ShengZhe Yan
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - YanZhen Cheng
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Brady VJ, Mathew Joseph N, Ju HH. Impact of Gaming (Gamification) on Diabetes Self-Care Behaviors and Glycemic Outcomes Among Adults With Type 2 Diabetes. Sci Diabetes Self Manag Care 2023; 49:493-511. [PMID: 37927059 PMCID: PMC10666525 DOI: 10.1177/26350106231208153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE The purpose of this systematic review was to determine if the use of gaming (gamification) among persons with type 2 diabetes improves diabetes self-management behaviors and diabetes outcomes. METHODS A systematic review was conducted using electronic databases including MEDLINE, Embase, Web of Science, and CINAHL. Studies reporting on the impact of gaming on at least 1 of the Association of Diabetes Care and Education Specialists self-care behaviors (ADCES7) were included. RESULTS The review included 9 studies, 8 of which were of strong/high quality. Five of the self-care behaviors were addressed in at least 1 of the included studies. However, taking medications and problem solving were not reported in any of the studies. Physical activity and self-efficacy or quality of life (healthy coping) were the most frequently reported ADCES7 behaviors. Six of the studies used A1C as an outcome measure, with a reduction reported in all the studies except 1. CONCLUSION Type 2 diabetes affects a person holistically, necessitating a range of self-care behaviors to effectively manage the chronic condition. Novel gaming interventions may improve coping mechanisms, lifestyle behaviors, medication engagement, and monitoring of risks and problems, all of which are essential in facilitating optimal diabetes self-management.
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Affiliation(s)
- Veronica Joyce Brady
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Nitha Mathew Joseph
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Hsiao-Hui Ju
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas
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Bakema R, Smirnova D, Biri D, Kocks JWH, Postma MJ, de Jong LA. The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review. J Med Internet Res 2023; 25:e42474. [PMID: 37751232 PMCID: PMC10565624 DOI: 10.2196/42474] [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] [Received: 09/05/2022] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. METHODS We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. RESULTS Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ≥3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains.
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Affiliation(s)
- Robbert Bakema
- Nederlandse Service Apotheek Beheer BV, 's-Hertogenbosch, Netherlands
| | - Daria Smirnova
- Asc Academics, Groningen, Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Despina Biri
- Asc Academics, Groningen, Netherlands
- Victoria Hospital, Kirkcaldy, United Kingdom
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, Netherlands
- Groningen Research Institute Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia
| | - Lisa A de Jong
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Zhang X, Zhang L, Lin Y, Liu Y, Yang X, Cao W, Ji Y, Chang C. Effects of E-health-based interventions on glycemic control for patients with type 2 diabetes: a Bayesian network meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1068254. [PMID: 37214251 PMCID: PMC10196691 DOI: 10.3389/fendo.2023.1068254] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/22/2023] [Indexed: 05/24/2023] Open
Abstract
The high disease burden of type 2 diabetes seriously affects the quality of life of patients, and with the deep integration of the Internet and healthcare, the application of electronic tools and information technology to has become a trend for disease management. The aim of this study was to evaluate the effectiveness of different forms and durations of E-health interventions in achieving glycemic control in type 2 diabetes patients. PubMed, Embase, Cochrane, and Clinical Trials.gov were searched for randomized controlled trials reporting different forms of E-health intervention for glycemic control in type 2 diabetes patients, including comprehensive measures (CM), smartphone applications (SA), phone calls (PC), short message service (SMS), websites (W), wearable devices (WD), and usual care. The inclusion criteria were as follows: (1) adults (age≥18) with type 2 diabetes mellitus; (2) intervention period ≥1 month; (3) outcome HbA1c (%); and (4) randomized control of E-health based approaches. Cochrane tools were used to assess the risk of bias. R 4.1.2 was used to conduct the Bayesian network meta-analysis. A total of 88 studies with 13,972 type 2 diabetes patients were included. Compared to the usual care group, the SMS-based intervention was superior in reducing HbA1c levels (mean difference (MD)-0.56, 95% confidence interval (CI): -0.82 to -0.31), followed by SA (MD-0.45, 95% CI: -0.61 to -0.30), CM (MD-0.41, 95% CI: -0.57 to -0.25), W (MD-0.39, 95% CI: -0.60 to -0.18) and PC (MD-0.32, 95% CI: -0.50 to -0.14) (p < 0.05). Subgroup analysis revealed that intervention durations of ≤6 months were most effective. All type of E-health based approaches can improve glycemic control in patients with type 2 diabetes. SMS is a high-frequency, low-barrier technology that achieves the best effect in lowering HbA1c, with ≤6 months being the optimal intervention duration. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42022299896.
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Buis L, Park MK, Kim Y, Kim YH. The Treatment Outcome of Smart Device-Based Tinnitus Retraining Therapy: Prospective Cohort Study. JMIR Mhealth Uhealth 2023; 11:e38986. [PMID: 36633890 PMCID: PMC9880806 DOI: 10.2196/38986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/28/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Tinnitus retraining therapy (TRT) is a standard treatment for tinnitus that consists of directive counseling and sound therapy. However, it is based on face-to-face education and a time-consuming protocol. Smart device-based TRT (smart-TRT) seems to have many advantages, but the efficacy of this new treatment has been questioned. OBJECTIVE The aim of this study was to compare the efficacy between smart-TRT and conventional TRT (conv-TRT). METHODS We recruited 84 patients with tinnitus. Results were compared between 42 patients who received smart-TRT and 42 control participants who received conv-TRT. An interactive smart pad application was used for directive counseling in the smart-TRT group. The smart pad application included detailed education on ear anatomy, the neurophysiological model of tinnitus, concept of habituation, and sound therapy. The smart-TRT was bidirectional: There were 17 multiple choice questions between each lesson as an interim check. The conv-TRT group underwent traditional person-to-person counseling. The primary outcome measure was the Tinnitus Handicap Inventory (THI), and the secondary outcome measure was assessed using a visual analogue scale (VAS). RESULTS Both treatments had a significant treatment effect, which comparably improved during the first 2 months. The best improvements in THI were -23.3 (95% CI -33.1 to -13.4) points at 3 months and -16.8 (95% CI -30.8 to -2.8) points at 2 months in the smart-TRT group and conv-TRT group, respectively. The improvements on the VAS were also comparable: smart-TRT group: -1.2 to -3.3; conv-TRT: -0.7 to -1.7. CONCLUSIONS TRT based on smart devices can be an effective alternative for tinnitus patients. Considering the amount of time needed for person-to-person counseling, smart-TRT can be a cost-effective solution with similar treatment outcomes as conv-TRT.
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Affiliation(s)
| | - Moo Kyun Park
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yoonjoong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Young Ho Kim
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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Stevens S, Gallagher S, Andrews T, Ashall-Payne L, Humphreys L, Leigh S. The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:936752. [PMID: 36992773 PMCID: PMC10012107 DOI: 10.3389/fcdhc.2022.936752] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
Introduction Diabetes mellitus (DM) is a leading cause of morbidity and mortality worldwide. At the same time, digital health technologies (DHTs), which include mobile health apps (mHealth) have been rapidly gaining popularity in the self-management of chronic diseases, particularly following the COVID-19 pandemic. However, while a great variety of DM-specific mHealth apps exist on the market, the evidence supporting their clinical effectiveness is still limited. Methods A systematic review was performed. A systematic search was conducted in a major electronic database to identify randomized controlled trials (RCTs) of mHealth interventions in DM published between June 2010 and June 2020. The studies were categorized by the type of DM and impact of DM-specific mHealth apps on the management of glycated haemoglobin (HbA1c) was analysed. Results In total, 25 studies comprising 3,360 patients were included. The methodological quality of included trials was mixed. Overall, participants diagnosed with T1DM, T2DM and Prediabetes all demonstrated greater improvements in HbA1c as a result of using a DHT compared with those who experienced usual care. The analysis revealed an overall improvement in HbA1c compared with usual care, with a mean difference of -0.56% for T1DM, -0.90% for T2DM and -0.26% for Prediabetes. Conclusion DM-specific mHealth apps may reduce HbA1c levels in patients with T1DM, T2DM and Prediabetes. The review highlights a need for further research on the wider clinical effectiveness of diabetes-specific mHealth specifically within T1DM and Prediabetes. These should include measures which go beyond HbA1c, capturing outcomes including short-term glycemic variability or hypoglycemic events.
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Affiliation(s)
- Sebastian Stevens
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Susan Gallagher
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
| | - Tim Andrews
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Warwick Medical School (WMS), The University of Warwick, Coventry, United Kingdom
| | - Liz Ashall-Payne
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Warwick Medical School (WMS), The University of Warwick, Coventry, United Kingdom
| | - Lloyd Humphreys
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
| | - Simon Leigh
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Warwick Medical School (WMS), The University of Warwick, Coventry, United Kingdom
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Ferguson C, Hickman LD, Lombardo L, Downie A, Bajorek B, Ivynian S, Inglis SC, Wynne R. Educational Needs of People Living with Atrial Fibrillation: A Qualitative Study. J Am Heart Assoc 2022; 11:e025293. [PMID: 35876410 PMCID: PMC9375481 DOI: 10.1161/jaha.122.025293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/16/2022] [Indexed: 12/01/2022]
Abstract
Background This study explored the educational and self-management needs of adults living with atrial fibrillation (AF). Methods and Results This is a qualitative study of adults living with AF, clinicians, and expert key stakeholders. Interviews were conducted via a one-to-one semistructured videoconference or phone and transcribed verbatim for thematic analysis. A total of 34 participants were recruited and included in analyses (clinicians n=13; experts n=13, patients n=8). Interviews were on average 40 (range 20-70) minutes in duration. Three key themes were identified: (1) "Patient-centered AF education"; (2) "Prioritizing AF education"; and (3) "Timing AF education." The availability of credible information was perceived as highly variable. Information primarily focused on anticoagulation, or procedural information, as opposed to other aspects of management, such as risk factor reduction. Factors to optimize learning, such as multimedia, apps, case studies, or the use of visuals were perceived as important. Continuity of care, including engagement of caregivers, was important to help develop relationships, and facilitate understanding, while concurrently creating opportunities for timely targeted education. Clinicians described acute care as a suboptimal setting to deliver education. Competing interests aligned with the time-pressured context of acute care were prioritized over patient education. In contrast, patients valued continuity of care. AF education strategies need to pivot from a "one size fits all" approach and modernize to implement a range of approaches. Conclusions There remain many unmet needs in the provision of quality AF education to support self-management. Multimodal offerings and the ability to tailor to individual patient needs are important design considerations for new education programs.
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Affiliation(s)
- Caleb Ferguson
- Western Sydney Nursing & Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown HospitalBlacktownNew South WalesAustralia
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Louise D. Hickman
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Lien Lombardo
- Western Sydney Nursing & Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown HospitalBlacktownNew South WalesAustralia
| | - Annie Downie
- Department of CardiologyThe Sutherland HospitalCaringbahAustralia
| | - Beata Bajorek
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Serra Ivynian
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Sally C. Inglis
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Rochelle Wynne
- Western Sydney Nursing & Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown HospitalBlacktownNew South WalesAustralia
- School of Nursing & MidwiferyDeakin UniversityGeelongAustralia
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11
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Baradez C, Liska J, Brulle-Wohlhueter C, Pushkarna D, Baxter M, Piette J. Brief Digital Solutions in Behavior Change Interventions for Type 2 Diabetes Mellitus: A Literature Review. Diabetes Ther 2022; 13:635-649. [PMID: 35279813 PMCID: PMC8917814 DOI: 10.1007/s13300-022-01244-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION With the advent of the COVID-19 pandemic, health systems increasingly look to digital health solutions to provide support for self-management to people with type 2 diabetes (T2D). This review aimed to assess brief digital behavior change solutions (i.e., solutions that require limited engagement or contact) for T2D, including use of behavior change techniques (BCTs) and their impact on self-care and glycemic control. METHODS A review was conducted by searching Embase and gray literature using a predefined search strategy to identify randomized controlled trials (RCT) published between January 1, 2015, and March 21, 2021. BCTs were coded using an internationally established BCT taxonomy v1 (BCTTv1). RESULTS Out of 1426 articles identified, 10 RCTs were included in qualitative synthesis. Of these, six reported significant improvements in primary outcome(s), including improved patient engagement, glycemic control, self-efficacy, and physical activity. Interventions as short as 12 min were found to be effective, and users' ability to control their preferences was noted as conducive to engagement. Almost three quarters of BCTs targeted by interventions were under the hierarchical clusters of "Feedback and monitoring," "Goals and planning," and "Shaping knowledge." Interventions that targeted fewer BCTs were at least as effective as interventions that were more comprehensive in their goals. DISCUSSION Digital behavior change solutions can successfully improve T2D self-care support and outcomes in a variety of populations including patients with low incomes, limited educational attainment, or living in rural areas. Easy-to-use interventions tailored to patient needs may be as effective as lengthy, complex, and more generalized interventions. CONCLUSIONS Brief digital solutions can improve clinical and behavioral outcomes while reducing patient burden, fitting more easily in patients' lives and potentially improving usability. As T2D patients increasingly expect access to self-care assistance between face-to-face encounters, digital support tools will play a greater role in effective diabetes management programs.
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Affiliation(s)
| | | | | | | | - Mike Baxter
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, England, UK
| | - John Piette
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2705 Ember Way, Ann Arbor, MI, 48104, USA.
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12
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Su J, Dugas M, Guo X, Gao G. Building social identity-based groups to enhance online peer support for patients with chronic disease: a pilot study using mixed-methods evaluation. Transl Behav Med 2022; 12:702-712. [DOI: 10.1093/tbm/ibac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Online peer support is increasingly important to encourage patients with chronic diseases to engage in successful self-management. However, studies mainly focus on individual-level participation and have not fully explored how to maximize the impact of online peer support through group identification. In this study, we aim to build an online social identity-based group to examine the impact of group identity on peer support. Twenty-five participants who completed the first phase of a larger study were randomly assigned either to the treatment group (identity-based group level, n = 15, three subgroups, five members in each subgroup) or to the control group (individual-level, n = 10). All participants in both treatment and control groups received the same tasks and incentives. Peer support behavior (informational support and emotional support), task completion (knowledge learning, self-tracking behavior), and health-related outcomes (self-efficacy [SE] and HbA1c) were collected for qualitative and quantitative analysis. Results from a 3-month pilot experiment showed that the treatment group offered substantial enhancement in peer support compared to the control group. It also significantly promoted improvement in SE. However, there was no significant difference in task completion or changes in HbA1c between the two groups. The results of the content analysis suggest that having a team leader, timely responsiveness, and intergroup competition played important roles in building social identity-based online groups and subsequently generating peer support. We provide some encouraging results that indicate how online groups may be effectively designed to promote peer support.
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Affiliation(s)
- Jingyuan Su
- eHealth Research Institute, School of Management, Harbin Institute of Technology, Harbin 150001, China
| | - Michelle Dugas
- Center for Health Information and Decision Systems, Department of Decision, Operations, and Information Technologies, Robert H. Smith School of Business, University of Maryland, College Park, MD 20742, USA
| | - Xitong Guo
- eHealth Research Institute, School of Management, Harbin Institute of Technology, Harbin 150001, China
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13
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Shiau CWC, Lim SM, Cheng LJ, Lau Y. Effectiveness of Game-Based Self-Management Interventions for Individuals with Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Games Health J 2021; 10:371-382. [PMID: 34860133 DOI: 10.1089/g4h.2020.0203] [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: 11/13/2022] Open
Abstract
Objective: Self-management is essential for individuals with diabetes. However, traditional self-management interventions may be hard to follow for other patients. Although games can stimulate extrinsic motivations, its application on self-management remains unclear. This review aims to evaluate the effects of game-based self-management interventions on health outcomes. Materials and Methods: We utilize PubMed, CINAHL, Cochrane Central, EMBASE, ProQuest Dissertation and Theses, PsycINFO, and Scopus from their inception until January 20, 2020. Meta-analyses are performed using Comprehensive Meta-analysis 3.0 software. The overall effect is measured using Hedges' g and determined using Z-statistics at significance level of P < 0.05. Heterogeneity is assessed using χ2 and I2 statistics. The risk of bias tool and the grades of recommendation, assessment, development, and evaluation system are used to assess individual and overall quality of evidence, respectively. Results: A total of 2150 records are identified, and 13 randomized controlled trials are selected. Meta-analyses revealed that game-based self-management interventions significantly improved patients' change in glycated hemoglobin (HbA1c) level (g = 0.18, P = 0.02), adherence to physical activities (g = 0.59, P < 0.001), balance (g = 0.94-1.14, P < 0.001), and fall efficacy (g = 1.01, P < 0.001). Significant results were only found for the three-trial meta-analysis for HbA1c changes, but not for the two other HbA1c meta-analyses that included more trials. Furthermore, negligible improvements were observed in glycated hemoglobin at postintervention and follow-up assessments, diabetes knowledge, and self-efficacy. Conclusion: Game-based self-management can consider a supplementary intervention. Overall evidence is ranging from very low to low. Future studies can consider a large sample size with high-quality design according to the Consolidated Standards of Reporting Trials statement criteria.
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Affiliation(s)
| | - Shi Min Lim
- Department of Nursing, National University Hospital, National University Health System, Singapore
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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14
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Kaihara T, Intan-Goey V, Scherrenberg M, Falter M, Frederix I, Akashi Y, Dendale P. Impact of gamification on glycaemic control among patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab030. [PMID: 35919887 PMCID: PMC9242065 DOI: 10.1093/ehjopen/oeab030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/16/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022]
Abstract
Aims The prevalence of type 2 diabetes mellitus (T2DM) is very high and still rising. Optimal medical therapy and lifestyle management are essential in reducing the long-term complications of T2DM. Gamification, which is the use of design elements, and characteristics of games in a non-gaming context, is an innovative approach to improve healthy behaviour. It thereby could be able to improve glycaemic control in T2DM. The aim of this systematic review and meta-analysis is to evaluate the effect of gamification on glycaemic control expressed by haemoglobin A1c (HbA1c) levels in T2DM patients. Methods and results All articles from 2000 to 2021 were searched in electronic databases (PubMed, Cochrane Library, Embase). The total number of patients was 704. The rate of male participants and their mean ages ranged, respectively, from 46% to 94% and 60 to 63 years. Inclusion criteria were randomized controlled trials of T2DM management using gamification which included HbA1c as an outcome measure. A meta-analysis was performed. After removing duplicates, 129 articles were screened and a total of 3 articles corresponding to the inclusion criteria were identified. Haemoglobin A1c was significantly reduced [mean difference −0.21; 95% confidence interval (−0.37 to −0.05); P = 0.01; I2 = 0%] in the intervention group using gamification as compared to the control group. Conclusion Gamification has a positive effect on glycaemic control expressed by HbA1c changes in patients with T2DM. However, only three studies were included in this review. More research is needed to confirm the effectiveness of gamification in T2DM.
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Affiliation(s)
- Toshiki Kaihara
- Heart Centre Hasselt, Jessa Hospital , Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University , Agoralaan gebouw D, 3590 Diepenbeek, Belgium
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine , 2-16-1 Sugao, Miyamae Ward, 216-8511 Kawasaki, Japan
| | - Valent Intan-Goey
- Heart Centre Hasselt, Jessa Hospital , Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital , Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University , Agoralaan gebouw D, 3590 Diepenbeek, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken Building S, Universiteitsplein 1 , 2610 Wilrijk, Belgium
| | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital , Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University , Agoralaan gebouw D, 3590 Diepenbeek, Belgium
- KULeuven, Faculty of Medicine, Department of Cardiology , Herestraat 49, 3000 Leuven, Belgium
| | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital , Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University , Agoralaan gebouw D, 3590 Diepenbeek, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken Building S, Universiteitsplein 1 , 2610 Wilrijk, Belgium
- Department of Cardiology, Antwerp University Hospital , Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Yoshihiro Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine , 2-16-1 Sugao, Miyamae Ward, 216-8511 Kawasaki, Japan
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital , Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University , Agoralaan gebouw D, 3590 Diepenbeek, Belgium
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15
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Wong CA, Hakimi S, Santanam TS, Madanay F, Fridman I, Ford C, Patel M, Ubel PA. Applying Behavioral Economics to Improve Adolescent and Young Adult Health: A Developmentally-Sensitive Approach. J Adolesc Health 2021; 69:17-25. [PMID: 33288458 PMCID: PMC8175460 DOI: 10.1016/j.jadohealth.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022]
Abstract
Each day, adolescents and young adults (AYAs) choose to engage in behaviors that impact their current and future health. Behavioral economics represents an innovative lens through which to explore decision-making among AYAs. Behavioral economics outlines a diverse set of phenomena that influence decision-making and can be leveraged to develop interventions that may support behavior change. Up to this point, behavioral economic interventions have predominantly been studied in adults. This article provides an integrative review of how behavioral economic phenomena can be leveraged to motivate health-related behavior change among AYAs. We contextualize these phenomena in the physical and social environments unique to AYAs and the neurodevelopmental changes they undergo, highlighting opportunities to intervene in AYA-specific contexts. Our review of the literature suggests behavioral economic phenomena leveraging social choice are particularly promising for AYA health. Behavioral economic interventions that take advantage of AYA learning and development have the potential to positively impact youth health and well-being over the lifespan.
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Affiliation(s)
- Charlene A Wong
- Division of Primary Care, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Duke Sanford School of Public Policy, Durham, North Carolina
| | - Shabnam Hakimi
- Center for Cognitive Neuroscience, Duke University, Levine Science Research Center, Durham, North Carolina.
| | - Taruni S Santanam
- Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina
| | - Farrah Madanay
- Duke Sanford School of Public Policy, Durham, North Carolina
| | - Ilona Fridman
- Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina
| | - Carol Ford
- Division of Adolescent Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mitesh Patel
- Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter A Ubel
- Duke Sanford School of Public Policy, Durham, North Carolina; Fuqua School of Business, Durham North Carolina
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16
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Koohmareh Z, Karandish M, Hadianfard AM. Effect of implementing a mobile game on improving dietary information in diabetic patients. Med J Islam Repub Iran 2021; 35:68. [PMID: 34277505 PMCID: PMC8278028 DOI: 10.47176/mjiri.35.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Nowadays, digital games are not just entertainment, but beside routine treatments, they are used in patient care, especially in patients with diabetes. Application of digital games in patient's education can improve self-management of diabetes. The aim of the present study was to evaluate the effect of a mobile game (Amoo) implementation on enhancing dietary information in patients with type 2 diabetes. Methods: A mobile game (called Amoo), which was developed by researchers of this study, was applied to assess the self-education of patients with diabetes. Sixty patients with type 2 diabetes participated in the study. The participants took part in a pre-intervention test to determine their dietary information. The participants were randomly divided into one of two groups, including the intervention group: played the game for 15 minutes daily for 6 weeks, and the control group: did not involve in the game. A post-intervention test was run to show a possible improvement in dietary information. Data were analyzed using paired t test and suitable non-parametric testes including Mann-Whitney and Wilcoxon signed rank tests as well as Spearman and Pearson correlation coefficients via IBM SPSS statistics version 21 (SPSS, v 21.0, IBM, Armonk, NY, USA). A P-value less than 0.05 was considered as a significant level. Results: The results indicated a statistically significant difference between the pre and post test scores in the intervention group (p<0.001). However, there was no significant difference in fasting blood sugar (p=0.125). Conclusion: The mobile game (Amoo) could enhance the knowledge of patients with type 2 diabetes about food calories and glycemic index. This means that mobile games may serve as an educational aid to these patients.
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Affiliation(s)
- Zahra Koohmareh
- Depatment of Health Information Technology, School of Allied Medical Science,Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Karandish
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Mohammad Hadianfard
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
PURPOSE OF REVIEW To review existing mHealth-based interventions and examine their efficacy in reducing cardiovascular disease (CVD) risk factors. RECENT FINDINGS A total of 50 articles are included in this review. The majority of the mHealth interventions targeted a specific CVD risk factor, while 4 addressed 2 or more CVD risk factors. Of the 9 mHealth-supported weight loss intervention trials, 4 resulted in significant weight loss. Four out of 7 RCTs targeting improvement in physical activity reported significant improvement, while 4 of the 8 mHealth-supported smoking cessation intervention trials resulted in smoking abstinence. Of the 10 mHealth-based diabetes intervention trials, 5 reported significant reductions in HbA1c; however, only 3 out of the 9 antihypertension interventions resulted in significant reductions in blood pressure. There is a growing body of literature focused on mHealth interventions that address CVD risk factors. Despite the immense potential of mHealth interventions, evidence of their efficacy in mitigating cardiovascular risk is heterogeneous.
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18
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Davis AJ, Parker HM, Gallagher R. Gamified applications for secondary prevention in patients with high cardiovascular disease risk: A systematic review of effectiveness and acceptability. J Clin Nurs 2021; 30:3001-3010. [PMID: 33872436 DOI: 10.1111/jocn.15808] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Gamified health mobile applications (apps) are promoted as innovative approaches to self-management and risk factor reduction. However, information is lacking on effectiveness or feasibility in older patients at high risk for cardiovascular diseases (CVD), which limits uptake and recommendations by nurses. This study aimed to evaluate the effectiveness and acceptability of gamified apps for CVD secondary prevention. METHODS EQUATOR PRISMA checklist was used to guide the systematic review. PubMed, Embase and SCOPUS were searched from inception to January 2020 for studies evaluating app interventions incorporating ≥2 game tactics and targeting secondary prevention in patients diagnosed with heart disease, hypertension, stroke or type 2 diabetes. Narrative summaries of results were used as meta-analysis were not possible. The PROSPERO ID number was CRD42020209791. RESULTS Seven studies involving 657 patients were included. Gamified apps resulted in more improvement in physical activity, HbA1C and diabetes self-management empowerment compared to multiple different comparators, and more physical activity motivation compared to a neutral content control app. Heart failure knowledge also improved significantly. However, no benefits above usual care were evident for blood pressure or body mass index, or from app use for heart failure self-management, medication adherence or atrial fibrillation knowledge. App acceptability in terms of usage declined with time but was high for the game components of challenges, medication monitoring, viewing of leader boards and badges and walking training participation. Enjoyment was highest for elements that featured surprise/novelty, having teammates, challenges, good graphic design and clarity. CONCLUSIONS Gamified mobile apps show the potential to improve secondary prevention in high CVD risk patients. Indications for acceptability were evident, with higher adherence than clinic-based secondary prevention programmes. However, further well-designed randomised controlled trials, which track app usage are needed to confirm this potential and encourage nurses to recommend these types of apps.
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Affiliation(s)
- Angus J Davis
- Sydney School of Nursing, University of Sydney, Sydney, Australia
| | - Helen M Parker
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Robyn Gallagher
- Sydney School of Nursing, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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19
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Abstract
Gamified applications are regarded as useful for patients in facilitating daily self-care management and the personalization of health monitoring. This paper reports the development of a gamified application by considering a design that had previously been investigated and reported. Numerous game elements were installed in the application, which covered several tasks aimed at managing diabetes mellitus. The development process utilized the Rapid Application Development (RAD) methodology in terms of system requirements, user design, construction, and cutover; this paper refers to the user design and cutover processes. The developed application was tested through system testing and usability testing. The usability testing adopted the Software Usability Scale (SUS) to assess the usability of the application. Twenty participants were involved in the testing. The result showed that the gamified application is easy and practical to use for an individual with or without diabetes. All the provided functions worked as designed and planned, and the participants accepted their usability. Overall, this study offers a promising result that could lead to real-life implementation.
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20
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Chanes DC, Piza FMDT, San Martin G, Leão ER, Dos Santos OFP. Fall prevention education for people with multiple sclerosis: a randomized clinical trial. Int J Qual Health Care 2021; 33:6151771. [PMID: 33638988 DOI: 10.1093/intqhc/mzab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/01/2021] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Online spaced education (OSE) is a method recognized for promoting long-term knowledge retention, changing behaviors and improving outcomes for students and healthcare professionals. However, there is little evidence about its impacts on patient education. OBJECTIVES The aim of this research was to compare knowledge retention using educational brochure and OSE on individuals with multiple sclerosis (MS) and to verify the impact of educational methods on fall outcome. METHODS Individuals with MS (n = 230) were randomly assigned to two types of patient education-educational brochure (control) and OSE (intervention). During 12 weeks, the intervention group received multiple-choice tests on fall prevention. Knowledge retention, behavior change and fall incidence were assessed before intervention and after 3 and 6 months. The participants' satisfaction with the education method was also evaluated. RESULTS Knowledge retention was similar between groups, and behavior change was observed in both groups. There was a significant reduction in fall rate in the intervention group, from 0.60 to 0.27 at 6 months (P < 0.001). Participants' satisfaction achieved an average of 8.75, with no differences between groups. CONCLUSION Individuals demonstrated significant improvement in fall rate outcome in both groups with no significant difference. In regard to test scores and satisfaction, results were similar between groups.
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Affiliation(s)
- Daniella Cristina Chanes
- Learning and Research Center, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, Sao Paulo 05652-900, Brazil
| | - Felipe Maia de Toledo Piza
- Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, Sao Paulo 05652-900, Brazil
| | - Gustavo San Martin
- Amigos Múltiplos pela Esclerose, Av, R. São João D'Aliança, 282 - Vila Rosalia, Guarulhos 07064-130, Brazil
| | - Eliseth Ribeiro Leão
- Learning and Research Center, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, Sao Paulo 05652-900, Brazil
| | - Oscar Fernando Pavão Dos Santos
- Learning and Research Center, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, Sao Paulo 05652-900, Brazil
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Martos-Cabrera MB, Membrive-Jiménez MJ, Suleiman-Martos N, Mota-Romero E, Cañadas-De la Fuente GA, Gómez-Urquiza JL, Albendín-García L. Games and Health Education for Diabetes Control: A Systematic Review with Meta-Analysis. Healthcare (Basel) 2020; 8:E399. [PMID: 33066372 PMCID: PMC7712293 DOI: 10.3390/healthcare8040399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
Finding methods to improve people's diabetes control and management is important to prevent its complications and maintain the quality of life. The aim of this review was to assess the effect of games on the blood glucose level (glycated hemoglobin (HbA1c)). A systematic review and meta-analysis were made. Pubmed, Scopus, and CINAHL databases were consulted in July of 2020. Ten studies were selected as a final sample, most of them being clinical trials using games to improve diabetes control. Half of the studies had samples between 8 and 14.9 years old and the other half between 57 and 65 years old. The studies informed about using applications/games for mobile phones, game consoles, and board games for diabetes education and management. The meta-analysis was performed with 4 studies showing a mean difference of 0.12 (CI 95% 0.57, 0.33) of HbA1c in favor of the intervention group with p > 0.05. Games are positive for diabetes health education and promoting healthier lifestyle, but their impact on HbA1c is low.
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Affiliation(s)
- María Begoña Martos-Cabrera
- San Cecilio Clinical University Hospital, Andalusian Health Service, Avenida del Conocimiento s/n, 18016 Granada, Spain;
| | - María José Membrive-Jiménez
- Ceuta University Hospital, National Institute of Health Management, Loma del Colmenar s/n, 51003 Ceuta, Spain;
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, Ceuta University Campus, University of Granada, C/Cortadura del Valle SN, 51001 Ceuta, Spain;
| | - Emilio Mota-Romero
- Assitance Unit Doctores Dr. Salvador Caballero García, Granada-Metropolitano Health District, Andalusian Health Service, C/Joaquina Eguaras, n° 2, Edificio 2, 1ᵃ planta, 18013 Granada, Spain;
| | | | - José L. Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain;
| | - Luis Albendín-García
- Assitance Unit La Chana, Granada-Metropolitano Health District, Andalusian Health Service, C/Joaquina Eguaras, n° 2, Edificio 2, 1ᵃ planta, 18013 Granada, Spain;
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Xie LF, Itzkovitz A, Roy-Fleming A, Da Costa D, Brazeau AS. Understanding Self-Guided Web-Based Educational Interventions for Patients With Chronic Health Conditions: Systematic Review of Intervention Features and Adherence. J Med Internet Res 2020; 22:e18355. [PMID: 32788152 PMCID: PMC7473470 DOI: 10.2196/18355] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic diseases contribute to 71% of deaths worldwide every year, and an estimated 15 million people between the ages of 30 and 69 years die mainly because of cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Web-based educational interventions may facilitate disease management. These are also considered to be a flexible and low-cost method to deliver tailored information to patients. Previous studies concluded that the implementation of different features and the degree of adherence to the intervention are key factors in determining the success of the intervention. However, limited research has been conducted to understand the acceptability of specific features and user adherence to self-guided web interventions. Objective This systematic review aims to understand how web-based intervention features are evaluated, to investigate their acceptability, and to describe how adherence to web-based self-guided interventions is defined and measured. Methods Studies published on self-guided web-based educational interventions for people (≥14 years old) with chronic health conditions published between January 2005 and June 2020 were reviewed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement protocol. The search was performed using the PubMed, Cochrane Library, and EMBASE (Excerpta Medica dataBASE) databases; the reference lists of the selected articles were also reviewed. The comparison of the interventions and analysis of the features were based on the published content from the selected articles. Results A total of 20 studies were included. Seven principal features were identified, with goal setting, self-monitoring, and feedback being the most frequently used. The acceptability of the features was measured based on the comments collected from users, their association with clinical outcomes, or device adherence. The use of quizzes was positively reported by participants. Self-monitoring, goal setting, feedback, and discussion forums yielded mixed results. The negative acceptability was related to the choice of the discussion topic, lack of face-to-face contact, and technical issues. This review shows that the evaluation of adherence to educational interventions was inconsistent among the studies, limiting comparisons. A clear definition of adherence to an intervention is lacking. Conclusions Although limited information was available, it appears that features related to interaction and personalization are important for improving clinical outcomes and users’ experience. When designing web-based interventions, the selection of features should be based on the targeted population’s needs, the balance between positive and negative impacts of having human involvement in the intervention, and the reduction of technical barriers. There is a lack of consensus on the method of evaluating adherence to an intervention. Both investigations of the acceptability features and adherence should be considered when designing and evaluating web-based interventions. A proof-of-concept or pilot study would be useful for establishing the required level of engagement needed to define adherence.
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Affiliation(s)
- Li Feng Xie
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Alexandra Itzkovitz
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Amelie Roy-Fleming
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | | | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada.,Montreal Diabetes Research Center, Montreal, QC, Canada
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Thomas TH, Sivakumar V, Babichenko D, Grieve VLB, Klem ML. Mapping Behavioral Health Serious Game Interventions for Adults With Chronic Illness: Scoping Review. JMIR Serious Games 2020; 8:e18687. [PMID: 32729836 PMCID: PMC7426803 DOI: 10.2196/18687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Serious games for health are increasingly being used to address health outcomes in patients with chronic illnesses. These studies vary in their study designs, patient populations, frameworks, outcome variables, and degree of specificity of the serious game intervention. OBJECTIVE This scoping review aims to clarify the conceptual features of the existing research related to serious games designed to improve cognitive and behavioral outcomes in adults with chronic illness. METHODS We applied the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for scoping reviews (PRISMA-ScR) methodology, including an a priori research question. We searched 4 electronic databases to identify articles published through November 2019. Inclusion criteria encompassed (1) adults 18 years or older; (2) patients with a diagnosis of chronic illness; (3) a serious game intervention; and (4) defined patient outcomes that assess patients' behavioral, cognitive, or health outcomes. RESULTS Of the 3305 articles identified, 38 were included in the review. We charted and analyzed the theoretical frameworks, key concepts, and outcome variables of these studies with summaries of features across articles. The majority of studies used a randomized controlled trial design (23/38, 61%), included a custom serious game intervention (22/38, 58%), and lacked a theoretical framework (25/38, 66%). Common outcome variables included quality of life (16/38, 42%), mood (15/38, 39%), cognitive function (13/38, 34%), symptoms (12/38, 32%), and physical activity (9/38, 24%). Key differences between studies included whether or not serious games aimed to train versus teach patients, be widely accessible versus tailored interventions, or replace versus complement current treatments. CONCLUSIONS This scoping review defines the current landscape of research in serious games for health research targeting behavioral and cognitive outcomes in adults with chronic disease. Studies have addressed a variety of patient populations and diverse patient outcomes. Researchers wanting to build on the current research should integrate theoretical frameworks into the design of the intervention and trial to more clearly articulate the active ingredients and mechanisms of serious games.
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Affiliation(s)
| | - Varshini Sivakumar
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dmitriy Babichenko
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Victoria L B Grieve
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mary Lou Klem
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, United States
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Menon V, Chubaty A, Clezy K, Su Y, Post JJ, Janssen A, Shaw T, Konecny P. Infectious diseases and antimicrobial prescribing: Online spaced education for junior doctors. J Glob Antimicrob Resist 2020; 22:226-230. [PMID: 32087310 DOI: 10.1016/j.jgar.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/01/2020] [Accepted: 02/10/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inappropriate antimicrobial prescribing may harm patients and drive antimicrobial resistance. Junior doctors' knowledge of infectious diseases and antimicrobial prescribing is inadequate. Online spaced case-based learning can improve knowledge. OBJECTIVE To develop infectious diseases and antimicrobial prescribing course content for online spaced education and assess its effectiveness and feasibility for junior doctors. METHODS Infectious diseases and antimicrobial course content was developed for an online spaced education platform (Qstream Inc., Burlington, MA). Junior doctors (postgraduate years 1-3) at two tertiary teaching hospitals in Sydney participated in the study. Course content was provided with Qstream at one hospital and at the other hospital via two face-to-face (FTF) tutorials from August to October 2017. Knowledge and self-confidence were compared before and after training within and between both cohorts. RESULTS Participation in the course was higher in the Qstream cohort with 48/127 (37.8%) completing the course compared with 44/110 (40%) attending one or both FTF sessions, of whom 22/110 (20%) attended both. Improvement in mean knowledge score from 69.7% to 81.5% in the Qstream cohort was significantly greater than the FTF cohort's minimal improvement from 67.6% to 67.9% (95% CI 2.79-20.33; P=0.01). In the Qstream cohort mean confidence rating (0-10) improvement from 5.14 to 6.55 was greater than the FTF group improvement from 5.37 to 5.85 (95% CI 0.132-1.171; P=0.02). Qstream feedback was very positive. CONCLUSIONS Online spaced education in infectious diseases and antimicrobial prescribing was feasible, acceptable and effective for junior doctors. It has potential to reduce inappropriate antimicrobial prescribing and warrants further investigation.
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Affiliation(s)
- V Menon
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - A Chubaty
- Pharmacy Department, Prince of Wales Hospital, Sydney, Australia
| | - K Clezy
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Y Su
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
| | - J J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - A Janssen
- Research in Implementation Science and eHealth Group, The University of Sydney, Sydney, Australia
| | - T Shaw
- Research in Implementation Science and eHealth Group, The University of Sydney, Sydney, Australia
| | - P Konecny
- Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Sydney, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia.
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Bramwell SE, Meyerowitz-Katz G, Ferguson C, Jayaballa R, McLean M, Maberly G. The effect of an mHealth intervention for titration of insulin for type 2 diabetes: A pilot study. Eur J Cardiovasc Nurs 2019; 19:386-392. [DOI: 10.1177/1474515119889764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Stabilising blood glucose levels (BGL) after starting or changing insulin and related therapies can be challenging for diabetes services and the patient with type 2 diabetes. Traditionally, a credentialled diabetes educator (CDE) would talk with the patient over the phone to obtain a history of their BGLs over the previous week and provide advice on the insulin dose adjustments as required. This study trialled a smartphone application for sharing BGLs, with the ability to digitally transmit advice back to patients compared with their usual care. Aims: The aim of this study was to compare desirability, efficiency and ease of use. Methods: Participants were enrolled in either the traditional ( n=50) or Health2Sync (H2S) ( n=42) treatment group by patient preference. All insulin stabilisations were conducted by the CDE. Descriptive statistics were used for analysis. Results: The average total time taken to titrate patients was similar in both groups ( p>0.05), however there were fewer failure of contacts reported with H2S ( p<0.01) and time per interaction was also lower ( p<0.01). Sensitivity analysis revealed that, excluding the influence of no contacts, H2S patients had a lower average time for titration ( p<0.01). There was no difference in clinical outcomes as measured by HbA1c between the two groups ( p=0.75). Conclusion: We demonstrated a high acceptance and clinical utility of the H2S application. Clinicians were happy to use H2S and found it easy and convenient for most patients. Importantly, this reduced frequency of contacts with patients, time per interaction and average time for titration ( p<0.01). Patient selection for this communication intervention is important.
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Affiliation(s)
- Siân E Bramwell
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
| | - Gideon Meyerowitz-Katz
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
- School of Health and Society, Population Wellbeing and Environment Research Lab, University of Wollongong, Australia
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District, Western Sydney University, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
| | - Mark McLean
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
- School of Medicine, University of Western Sydney, Australia
| | - Glen Maberly
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
- School of Medicine, University of Western Sydney, Australia
- School of Public Health, University of Sydney, Australia
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Höchsmann C, Müller O, Ambühl M, Klenk C, Königstein K, Infanger D, Walz SP, Schmidt-Trucksäss A. Novel Smartphone Game Improves Physical Activity Behavior in Type 2 Diabetes. Am J Prev Med 2019; 57:41-50. [PMID: 31128953 PMCID: PMC7719398 DOI: 10.1016/j.amepre.2019.02.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Many type 2 diabetes patients show insufficient levels of physical activity and are often unmotivated to change physical activity behaviors. This study investigated whether a newly developed smartphone game delivering individualized exercise and physical activity promotion through an elaborate storyline can generate sustained improvements in daily physical activity (steps/day). STUDY DESIGN Thirty-six participants were enrolled in this 24-week RCT between August 2016 and April 2018. After baseline assessment, participants were randomized in equal numbers to the intervention or control condition. Data analysis was performed in May-June 2018. SETTING/PARTICIPANTS Inactive, overweight type 2 diabetes patients, aged 45-70 years, were recruited through advertising and from hospitals and diabetes care centers in the Basel, Switzerland, metropolitan area. INTERVENTION Participants were instructed to play the innovative smartphone game (intervention group) or to implement the recommendations from the baseline lifestyle counseling (control group) autonomously during the 24-week intervention period. MAIN OUTCOME MEASURES Primary outcomes were changes in daily physical activity (steps/day); changes in aerobic capacity, measured as oxygen uptake at the first ventilatory threshold; and changes in glycemic control, measured as HbA1c. RESULTS Daily physical activity increased by an average of 3,998 (SD=1,293) steps/day in the intervention group and by an average of 939 (SD=1,156) steps/day in the control group. The adjusted difference between the two groups was 3,128 steps/day (95% CI=2,313, 3,943, p<0.001). The increase in daily physical activity was accompanied by an improved aerobic capacity (adjusted difference of oxygen uptake at the first ventilatory threshold of 1.9 mL/(kg·min), 95% CI=0.9, 2.9, p<0.001). Glycemic control (HbA1c) did not change over the course of the intervention. CONCLUSIONS A novel, self-developed smartphone game, delivering multidimensional home-based exercise and physical activity promotion, significantly increases daily physical activity (steps/day) and aerobic capacity in inactive type 2 diabetes patients after 24 weeks. The ability of the game to elicit a sustained physical activity motivation may be relevant for other inactive target groups with chronic diseases. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02657018.
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Affiliation(s)
- Christoph Höchsmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Olivia Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Muriel Ambühl
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christopher Klenk
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Karsten Königstein
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Steffen P Walz
- Centre for Design Innovation, Swinburne University of Technology, Melbourne, Australia
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Larentis AV, Barbosa DNF, da Silva CR, Barbosa JLV. Applied Computing to Education on Noncommunicable Chronic Diseases: A Systematic Mapping Study. Telemed J E Health 2019; 26:147-163. [PMID: 30807261 DOI: 10.1089/tmj.2018.0282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The number of deaths from noncommunicable chronic diseases (NCDs) has increased worldwide. These deaths would be partly avoidable if prevention and follow-up measures were applied to reduce risk factors. Computing can help educate individuals, improving their knowledge about NCDs. This article presents a systematic mapping of studies that apply computing to education on NCDs. The results allow a general view of the literature and the identification of research opportunities. Materials and Methods: The methodology followed three steps: (1) definition of search databases from computer science and health sciences, (2) selection of keywords for search string composition, and (3) application of inclusion and exclusion criteria to filter the results. The survey occurred from January 2008 to April 2018. Results: The initial search resulted in 19,675 papers, of which 38 were selected after applying the filter criteria. The use of mobile computing stood out in 25 papers. The education modalities were self-management and educational content for diabetes (10 papers), asthma (1), cardiovascular disease (1) and chronic diseases (1), self-management of diabetes and games (1), educational content (15), games (6), personalized content (2), and virtual community (1). The percentage of papers on diabetes was 65%. Most solutions (55%) do not use data from individuals to provide information considering their health condition. In addition, 19 papers produced outcome measures by means of experiments. Conclusions: Mobile computing was the most used technology in the papers. In addition, self-management, educational content, and games were the most used mechanisms. A research opportunity consists of personalized assistance. In this sense, ubiquitous learning can provide a continuous and contextualized education.
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Affiliation(s)
- Andrêsa Vargas Larentis
- Applied Computing Graduate Program, University of Vale do Rio dos Sinos, São Leopoldo, Brazil
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28
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Affiliation(s)
- Neal Kaufman
- 1 Fielding School of Public Health, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- 2 Canary Health, Inc, Los Angeles, CA
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Moonian O, Jodheea-Jutton A, Khedo KK, Baichoo S, Nagowah SD, Nagowah L, Mungloo-Dilmohamud Z, Cheerkoot-Jalim S. Recent advances in computational tools and resources for the self-management of type 2 diabetes. Inform Health Soc Care 2019; 45:77-95. [PMID: 30653364 DOI: 10.1080/17538157.2018.1559168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: While healthcare systems are investing resources on type 2 diabetes patients, self-management is becoming the new trend for these patients. Due to the pervasiveness of computing devices, a number of computerized systems are emerging to support the self-management of patients.Objective: The primary objective of this review is to identify and categorize the computational tools that exist for the self-management of type 2 diabetes, and to identify challenges that need to be addressed.Results: The tools have been categorized into web applications, mobile applications, games and ubiquitous diabetes management systems. We provide a detailed description of the salient features of each category along with a comparison of the various tools, listing their challenges and practical implications. A list of platforms that can be used to develop new tools for the self-management of type 2 diabetes, namely mobile applications development, sensor development, cloud computing, social media, and machine learning and predictive analysis platforms, are also provided.Discussions: This paper identifies a number of challenges in the existing categories of computational tools and consequently presents possible avenues for future research. Failure to address these issues will negatively impact on the adoption rate of the self-management tools and applications.
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Affiliation(s)
- Oveeyen Moonian
- Department of Digital Technologies, FoICDT, University of Mauritius
| | | | - Kavi Kumar Khedo
- Department of Digital Technologies, FoICDT, University of Mauritius
| | | | | | - Leckraj Nagowah
- Department of Software and Information Systems, FoICDT, University of Mauritius
| | | | - Sudha Cheerkoot-Jalim
- Department of Information and Communication Technologies, FoICDT, University of Mauritius
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30
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Ferguson C, Hickman LD, Phillips J, Newton PJ, Inglis SC, Lam L, Bajorek BV. An mHealth intervention to improve nurses’ atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study. Eur J Cardiovasc Nurs 2018; 18:7-15. [DOI: 10.1177/1474515118793051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There is a need to improve cardiovascular nurses’ knowledge and practices related to stroke prevention, atrial fibrillation and anticoagulation therapy. Aims: The aim of this study was to evaluate the efficacy of EVICOAG – a novel mHealth, smartphone-based, spaced-learning intervention on nurses’ knowledge of atrial fibrillation and anticoagulation. Methods: Nurses employed in four clinical specialties (neuroscience, stroke, rehabilitation, cardiology) across three hospitals were invited to participate. In this quasi-experimental study, 12 case-based atrial fibrillation and anticoagulation learning scenarios (hosted by an mHealth platform) were delivered to participants’ smartphones over a 6-week period (July–December 2016) using a spaced timing algorithm. Electronic surveys to assess awareness and knowledge were administered pre (T1) and post (T2) intervention. Results: From 74 participants recruited to T1, 40 completed T2. There was a 54% mean improvement in knowledge levels post-intervention. The largest improvement was achieved in domains related to medication interaction and stroke and bleeding risk assessment. Post-intervention, those who completed T2 were significantly more likely to use CHA2DS2-VASc (2.5% vs. 37.5%) and HAS-BLED (2.5% vs. 35%) tools to assess stroke and bleeding risk, respectively ( P<0.01). Conclusion: The EVICOAG intervention improved nurses’ knowledge of atrial fibrillation and anticoagulation, and influenced their uptake and use of stroke and bleeding risk assessment tools in clinical practice. Future research should focus on whether a similar intervention might improve patient-centred outcomes such as patients’ knowledge of their condition and therapies, medication adherence, time in the therapeutic range and quality of life.
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Affiliation(s)
- Caleb Ferguson
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney University, Australia
| | | | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Australia
| | - Phillip J Newton
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney University, Australia
| | - Sally C Inglis
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Australia
| | - Lawrence Lam
- Faculty of Health, University of Technology Sydney, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Australia
- Discipline of Pharmacy, University of Technology Sydney, Australia
- President’s Office, Tung Wah College, Hong Kong
| | - Beata V Bajorek
- Discipline of Pharmacy, University of Technology Sydney, Australia
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Hou C, Xu Q, Diao S, Hewitt J, Li J, Carter B. Mobile phone applications and self-management of diabetes: A systematic review with meta-analysis, meta-regression of 21 randomized trials and GRADE. Diabetes Obes Metab 2018; 20:2009-2013. [PMID: 29582538 DOI: 10.1111/dom.13307] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/10/2018] [Accepted: 03/23/2018] [Indexed: 01/09/2023]
Abstract
We conducted a systematic review with meta-analysis of randomized controlled trials that evaluated the effect of diabetes mobile phone applications. A total of 1550 participants from 21 studies were included. For type 1 diabetes, a significant 0.49% reduction in HbA1c was seen (95% CI, 0.04-0.94; I2 = 84%), with unexplained heterogeneity and a low GRADE of evidence. For type 2 diabetes, using diabetes apps was associated with a mean reduction of 0.57% (95% CI, 0.32-0.82; I2 = 77%). The results had severe heterogeneity that was explained by the frequency of HCP feedback. In studies with no HCP feedback, low frequency and high frequency HCP feedback, the mean reduction is 0.24% (95% CI, 0.02-0.49; I2 = 0%), 0.33% (95% CI, 0.07-0.59; I2 = 47%) and 1.12% (95% CI, 0.91-1.32; I2 = 0%), respectively, with a high GRADE of evidence. There is evidence that diabetes apps improve glycaemic control in type 1 diabetes patients. A reduction of 0.57% in HbA1c was found in type 2 diabetes patients. However, HCP functionality is important to achieve clinical effectiveness. Future studies are needed to explore the cost-effectiveness of diabetes apps and the optimal intensity of HCP feedback.
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Affiliation(s)
- Can Hou
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Qian Xu
- Department of Pathophysiology, West China School of Basic and Forensic Medicine, Sichuan University, Chengdu, China
| | - Sha Diao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Ben Carter
- Division of Population Medicine, Cardiff University, Cardiff, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Cochrane Skin Group, School of Medicine, Nottingham University, Nottingham, UK
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Ferguson C, Hickman L, Wright R, Davidson PM, Jackson D. Preparing nurses to be prescribers of digital therapeutics. Contemp Nurse 2018; 54:345-349. [DOI: 10.1080/10376178.2018.1486943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Australia
- Western Sydney University & Western Sydney Local Health District, Australia
| | - Louise Hickman
- Discipline of Nursing, Faculty of Health, University of Technology, Sydney, Australia
| | - Rebecca Wright
- School of Nursing, Johns Hopkins University, Baltimore, MA, USA
| | | | - Debra Jackson
- Discipline of Nursing, Faculty of Health, University of Technology, Sydney, Australia
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Abstract
PURPOSE OF REVIEW Telehealth has the potential to positively transform the quality and cost-effectiveness of complex diabetes management in adults. This review explores the landscape of telemedicine approaches and evidence for incorporation into general practice. RECENT FINDINGS Telemedicine for diabetes care is feasible based on over 100 randomized clinical trials. Evidence shows modest benefits in A1c lowering and other clinical outcomes that are better sustained over time vs. usual care. While telemedicine interventions are likely cost-effective in diabetes care, more research is needed using implementation science approaches. Telehealth platforms have been shown to be both feasible and effective for health care delivery in diabetes, although there are many caveats that require tailoring to the institution, clinician, and patient population. Research in diabetes telehealth should focus next on how to increase access to patients who are known to be marginalized from traditional models of health care.
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Affiliation(s)
- Marie E McDonnell
- Division of Endocrinology Diabetes and Hypertension, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 381, Boston, MA, 02115, USA.
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Wang C, Wang Q, Tan R. Preparation of enzyme-functionalized carbon nanotubes and their application in glucose and Fe2+ detection through “turn on” and “turn off” approaches. Analyst 2018; 143:4118-4127. [DOI: 10.1039/c8an00823j] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Herein, we report the preparation of enzyme-conjugated carbon nanotubes for the detection of Fe2+ and glucose with enhanced signal intensity.
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Affiliation(s)
- Chengke Wang
- College of Food and Biological Engineering
- Jiangsu University
- Zhenjiang 212013
- P. R. China
| | - Qingqing Wang
- College of Food and Biological Engineering
- Jiangsu University
- Zhenjiang 212013
- P. R. China
| | - Rong Tan
- College of Food and Biological Engineering
- Jiangsu University
- Zhenjiang 212013
- P. R. China
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Zhang Y, Chu L. Effectiveness of Systematic Health Education Model for Type 2 Diabetes Patients. Int J Endocrinol 2018; 2018:6530607. [PMID: 30147724 PMCID: PMC6083492 DOI: 10.1155/2018/6530607] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/27/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Health education is considered to be essential in the overall care of patients with type 2 diabetes mellitus (T2DM); systematic health education integrates individual education not only during hospitalization but also extended care outside of a hospital. To test effectiveness of the systematic health education model for T2DM, we conducted a randomized study with a control group among patients with T2DM living in Nanjing, China. METHODS 998 eligible patients completed the enrollment and were randomized to systematic health education model and conventional model groups (498 and 500 patients, resp.). The systematic health education model was based on the following aspects: image education, visitation of the exhibition hall, dissemination of educational materials, individualized medical nutrition therapy and exercise programs, WeChat group and regular health lectures, evaluation of complications, lifestyle modification, systematic treatment scheme, self-monitoring of glycemic control, monthly evaluation of the therapeutic effect, proposed improvement measures, and individualized follow-up scheme. The main outcome measures were glycated hemoglobin A1c (HbA1c), blood pressure, body mass index (BMI), and lipids during the 2-year follow-up. RESULTS The systematic health education model led to a favorable variation in HbA1c, LDL cholesterol, and systolic blood pressure (SBP) (P < 0.05). After adjusted analysis, the HbA1c decreased by 0.67% (P < 0.01) in the systematic health education model, SBP decreased by 10.83 mmHg (P < 0.01), and the level of diastolic blood pressure (DBP), HDL cholesterol, and total cholesterol decreased slightly and was not significant. The BMI did not change significantly during the study in either of the two groups. CONCLUSIONS The systematic health education model is a useful method in the treatment of T2DM because it contributes to decrease in HbA1c, LDL cholesterol, and SBP levels, as well as helps in increasing the compliance with the control criteria, except for DBP and BMI.
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Affiliation(s)
- Yongwen Zhang
- Department of Endocrinology, Nanjing Integrated Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210014, China
| | - Lanfang Chu
- Department of Integrated Traditional Chinese and Western Medicine, Nanjing General Hospital of Nanjing Military Command, Nanjing 210012, China
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