Building Bridges for "Palliative Care-in-Place": Development of a mHealth Intervention for Informal Home Care

Intelligent Care Management for Diabetic Foot Ulcers: A Scoping Review of Computer Vision and Machine Learning Techniques and Applications

Ten percent of adults in the United States have a diagnosis of diabetes and up to a third of these individuals will develop a diabetic foot ulcer (DFU) in their lifetime. Of those who develop a DFU, a fifth will ultimately require amputation with a mortality rate of up to 70% within five years. The human suffering, economic burden, and disproportionate impact of diabetes on communities of color has led to increasing interest in the use of computer vision (CV) and machine learning (ML) techniques to aid the detection, characterization, monitoring, and even prediction of DFUs. Remote monitoring and automated classification are expected to revolutionize wound care by allowing patients to self-monitor their wound pathology, assist in the remote triaging of patients by clinicians, and allow for more immediate interventions when necessary. This scoping review provides an overview of applicable CV and ML techniques. This includes automated CV methods developed for remote assessment of wound photographs, as well as predictive ML algorithms that leverage heterogeneous data streams. We discuss the benefits of such applications and the role they may play in diabetic foot care moving forward. We highlight both the need for, and possibilities of, computational sensing systems to improve diabetic foot care and bring greater knowledge to patients in need.

A scoping review of mobile apps for use with palliative patients in the context of home care

CONTEXT

Progress in mobile technology, especially the use of applications for mobile devices, can support the process of monitoring patients in palliative care (therapeutics), controlling symptoms, or providing self-care guidelines for the user, namely patients or caregivers.

OBJECTIVES

To map the available knowledge regarding the use of applications for mobile devices to support adult patients in palliative care at home.

METHODS

Literature review, based on the Joanna Briggs Institute model(s) for Scoping Review. All articles published until October 27, 2022, were identified in the electronic databases MEDLINE®, CINAHL®, Psychology and Behavioral Sciences Collection, Cochrane Library, and Scopus using the respective Boolean logical operators and key terms.

RESULTS

A total of 634 articles were identified, and a final 24 studies were included. Eleven mobile device applications were identified, demonstrating different aspects of design, use, and technological development. These have incorporated the most recent technology in their functionalities.

CONCLUSION

Mobile applications can be considered a viable and effective means of monitoring patients in palliative care. However, these applications must go beyond the academic scenario in which they were developed and move toward widespread use in practice, allowing the evaluation of the impact of this "new" intervention modality to understand their effectiveness and the application of best practices.

Who cares for the carers? carerhelp: development and evaluation of an online resource to support the wellbeing of those caring for family members at the end of their life

BACKGROUND

Most people living with a terminal illness and approaching death will need the assistance of a non-professional carer such as a family member, friend, or neighbour to provide physical, emotional, and practical caring supports. A significant portion of these carers can feel overwhelmed, isolated and experience psychological and/or financial distress. Carers can have unmet information needs and information needs can change across the caring period.

METHODS

Guided by an Australian National Reference Group, this project undertook a multiphase set of activities to enable the development of an online carer resource. These activities included a literature review of key issues and considerations for family carers supporting someone with a terminal illness, a scoping scan of existing online resources, and interviews and focus groups with eighteen carers to understand their needs and context of caring. This information formed the basis for potential digital content. A web project team was established to create the information architecture and content pathways. User testing survey and usability assessment of the CarerHelp Website was undertaken to assess/optimise functionality prior to release. An evaluation process was also devised.

RESULTS

The literature review identified carer needs for practical and psychological support along with better education and strategies to improve communication. The scoping scan of available online resources suggested that while information available to carers is plentiful, much of that which is provided is general, disparately located, inadequately detailed, and disease specific. The eighteen carers who were interviewed highlighted the need for helpful information on: services, symptom management, relationships, preparation for death, managing the emotional and psychological burden that often accompanies caring, and support during bereavement. User testing and usability assessment of the prototype resource led to changes to enhance the user experience and effectiveness of navigation. It also highlighted a lack of awareness of existing resources and the needs of marketing and communication to address this problem.

CONCLUSIONS

The project led to the development of an open access online resource, CarerHelp ( www.carerhelp.com.au ), for use by carers and families caring for a person who has palliative care needs. The web metrics demonstrate substantial use of the resources.

Exploring the Potential Use of Wearable Devices as a Prognostic Tool among Patients in Hospice Care

Background: Smartphones and wearable devices have become a part and parcel of the healthcare industry. The use of wearable technology has already proved its potentials in improving healthcare research, clinical work, and patient care. The real time data allows the care providers to monitor the patients' symptoms remotely, prioritize the patients' visits, assist in decision-making, and carry out advanced care planning. Objectives: The primary objective of our study was to investigate the potential use of wearable devices as a prognosis tool among patients in hospice care and palliative care, and the secondary objective was to examine the association between wearable devices and clinical data in the context of patient outcomes, such as discharge and deceased at various time intervals. Methods: We employed a prospective observational research approach to continuously monitor the hand movements of the selected 68 patients between December 2019 and June 2022 via an actigraphy device at hospice or palliative care ward of Taipei Medical University Hospital (TMUH) in Taiwan. Results: The results revealed that the patients with higher scores in the Karnofsky Performance Status (KPS), and Palliative Performance Scale (PPS) tended to live at discharge, while Palliative Prognostic Score (PaP) and Palliative prognostic Index (PPI) also shared the similar trend. In addition, the results also confirmed that all these evaluating tools only suggested rough rather than accurate and definite prediction. The outcomes (May be Discharge (MBD) or expired) were positively correlated with accumulated angle and spin values, i.e., the patients who survived had higher angle and spin values as compared to those who died/expired. Conclusion: The outcomes had higher correlation with angle value compared to spin and ACT. The correlation value increased within the first 48 h and then began to decline. We recommend rigorous prospective observational studies/randomized control trials with many participants for the investigations in the future.

Determinants of the Mobile Health Continuance Intention of Elders with Chronic Diseases: An Integrated Framework of ECM-ISC and UTAUT

With the deepening of population aging in China, chronic diseases are a major public health concern that threatens the life and health of nationals. Mobile health or mHealth can effectively monitor chronic diseases, which holds vital significance to the alleviation of social pressure caused by aging. To patients with chronic diseases, mHealth cannot give full play to its value, only when it is used in the long term. However, there is not yet research exploring mHealth continuance intention from the perspective of elders with chronic diseases. So, this research represents the first attempt to empirically analyze mHealth continuance intention from the perspective of elders with chronic diseases. The purpose of this research is to make up the research gap of the mHealth field and to put forward theoretical and practical implications based on research results. To obtain research data, a questionnaire was conducted. A total of 926 copies were collected online and 527 copies were collected offline. The structural equation model (SEM) was used for data analysis. Research results suggest that confirmation can significantly influence satisfaction, performance expectancy and effort expectancy. Meanwhile, confirmation and performance expectancy can significantly influence satisfaction. Additionally, effort expectancy, performance expectancy, social influence and facilitating conditions can directly and significantly influence continuance intention. Among them, performance expectancy can directly influence continuance intention in the most significant way. This research provides solid evidence for the validity of the integrated model of ECM-ISC and UTAUT in the mHealth field, which can be a theoretical basis for mHealth operators' product R&D.