Digital Apps to Improve Mobility in Adults with Neurological Conditions: A Health App-Focused Systematic Review

The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps are suitable for prescribing mobility exercises for adults with neurological health conditions, (2) how well these apps incorporate telehealth strategies, and (3) how well these apps rate in terms of quality and capacity for behaviour change. The Australian Apple iTunes Store was systematically searched, by using a search code and manually, for apps suitable for training mobility in neurological rehabilitation. Additional searches were conducted in known app repositories and for web-based apps. Trained reviewers extracted data from the included apps, including population-specific characteristics; quality, by using the Mobile App Rating Scale (MARS); and behaviour change potential, by using the App Behaviour Change Scale (ABACUS). The included apps (n = 18) provided <50 to >10,000 exercises, many incurred a subscription fee (n = 13), and half included telehealth features. App quality was moderate (mean MARS score of 3.2/5 and SD of 0.5), and potential for behaviour change was poor (mean ABACUS score of 5.7/21 and SD of 2.1). A limited number of high-quality apps are available for the prescription of mobility exercises in people with neurological conditions.

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

BACKGROUND

The use of large quantities of antimicrobial drugs for human health and agriculture is advancing the predominance of drug resistant pathogens in the environment. Antimicrobial resistance is now a major public health threat posing significant challenges for achieving the Sustainable Development Goals. In Bangladesh, where over one third of the population is below the poverty line, the achievement of safe and effective antibiotic medication use for human health is challenging.

OBJECTIVE

To explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective.

METHODS

This qualitative study comprises the second phase of the multi-country ABACUS (Antibiotic Access and Use) project in Matlab, Bangladesh. Information was collected through six focus group discussions and 16 in-depth interviews. Informants were selected from ten villages in four geographic locations using the Health and Demographic Surveillance System database. The Access to Healthcare Framework guided the interpretation and framing of the findings in terms of individuals' abilities to: perceive, seek, reach, pay and engage with healthcare.

RESULTS

Village pharmacies were the preferred and trusted source of antibiotics for self-treatment. Cultural and religious beliefs informed the use of herbal and other complementary medicines. Advice on antibiotic use was also sourced from trusted friends and family members. Access to government-run facilities required travel on poorly maintained roads. Reports of structural corruption, stock-outs and patient safety risks eroded trust in the public sector. Some expressed a willingness to learn about antibiotic resistance.

CONCLUSION

Antimicrobial resistance is both a health and development issue. Social and economic contexts shape medicine seeking, use and behaviours. Multi-sectoral action is needed to confront the underlying social, economic, cultural and political drivers that impact on the access and use of antibiotic medicines in Bangladesh.

Deployment and performance of model-based dose calculation algorithm in 192Ir shielded cylinder brachytherapy

PURPOSE

The purpose of the study was to integrate model-based dose calculation algorithm (MBDCA) and 3-D planning into our institutional capabilities for clinical cases with inherent heterogeneities, namely shielded cylinder cases, which were previously performed using templates.

METHODS AND MATERIALS

AcurosBV (Varian Medical Systems) was selected as MBDCA, and we compared results against the American Association of Physicists in Medicine working group (WG) reference Test Case #4, which contains a 36-mm-diameter 180-degree shielded cylinder. The last five clinically used template plans, as generated with ABACUS (Varian Medical Systems), were compared against MBDCA results. Clinical plans used 20-, 23-, and 26-mm-diameter cylinders, prescribed from 5 to 7 Gy, 50- to 110-mm active length, 7 to 21 dwell positions, with 5- or 10-mm spacing.

RESULTS

Compared with the WG reference plan, AcurosBV produced excellent agreement, within 1% at reference points. Larger deviations arose only within the applicator itself. Historical plans generated using ABACUS had higher point dose than AcurosBV by 3-4% or 2-3% using transport within medium at prescription points, with dose to medium or water, respectively.

CONCLUSIONS

To verify the accuracy of our MBDCA algorithm, we benchmarked against the WG data set available for shielded cylinders. We discovered a 3-4% difference in dose from our established historical templates, which is easily outweighed by daily positioning uncertainties. Dose distributions from MBDCA were used to assess and validate existing historical templates.

Safe and Efficacious Use of Automated Bolus Advisors in Individuals Treated With Multiple Daily Insulin Injection (MDI) Therapy: Lessons Learned From the Automated Bolus Advisor Control and Usability Study (ABACUS)

Numerous studies have shown that use of integrated automated bolus advisors (BAs) provides significant benefits to individuals using insulin pump devices, including improved glycemic control and greater treatment satisfaction. Within the past few years, BA devices have been developed specifically for individuals treated with multiple daily insulin injection (MDI) therapy; however, many clinicians who treat these individuals may be unfamiliar with insulin pump therapy and, thus, BA use. Findings from the Automated Bolus Advisor Control and Usability Study (ABACUS) revealed that BA use can be efficacious and clinically meaningful in MDI therapy, and that most patients are willing and able to use this technology appropriately when adequate clinical support is provided. The purpose of this article is to review key learnings from ABACUS and provide practical advice for initiating BA use and monitoring therapy.