Symptom clusters in chronic obstructive pulmonary disease: A systematic review.

AIM: To conduct a comprehensive literature review to identify symptom clusters commonly present in Chronic obstructive pulmonary disease (COPD) patients. BACKGROUND: COPD is the fourth leading cause of death worldwide. Substantial research has been studied regarding single symptoms that burden patients with this disease and the profound impacts that these symptoms can have on physical and psychological health. However, these symptoms rarely occur in isolation and limited research has been conducted identifying clinically significant relationships or clusters of symptoms associated with COPD afflicted patients. METHODS: PubMed, Web of Science, and Embase databases were used to identify potential articles limited to records published between 2005 and 2018 with human-conducted trials on adults with COPD, examining symptom clusters in this population. Only 5 studies met inclusion criteria. RESULTS: Across the five studies, 596 participants were included with a mean age of 70.49. Two themes emerged including psychological symptom clusters and respiratory-related symptom clusters. Anxiety-related symptoms appeared to be a common theme among psychological symptom clusters and varied greatly based on instrument selection. Inconsistent results were found in respiratory-related symptom clusters, but included difficulty breathing as a common symptom component. Only one study examined for stability of symptoms over time. CONCLUSION: There were inconsistent results across all studies which may be contributed to the heterogeneity amongst patients, instruments administered, and statistical approach. Future research should be conducted to further elucidate COPD related symptom clusters, their effects on somatic and cognitive health, and the stability of these symptom clusters over time.

"Mobile technology to improve heart failure outcomes: A proof of concept paper".

BACKGROUND: Heart failure (HF) causes significant symptom burden and human suffering with considerable economic burden due to hospital readmissions. Targeted interventions to encourage and support self-management behavior is warranted. AIM: To test the proof of concept of a mobile application (HeartMapp) in improving self-care management of patients with heart failure. METHOD: An exploratory inquiry used a field study strategy with purposeful sampling and constant comparative analysis to test the proof of concept of HeartMapp using The Business Model Canvas framework. RESULTS: A total of 125 individuals, who were identified as potential candidates to use the HeartMapp completed the interview over a seven-week period in 2016. Constant comparative analysis indicated themes that Skilled Nursing Facilities had increased readmissions. Participants from Skilled Nursing Facilities reported concern on lack of staffing, star rating, and malpractice claims. Two types of patients were identified as early adapters of technology and those in denial. Health care facilities reported challenges on transitional care, nurses struggle with engagement of patients on self-care management. To avoid readmission penalty, hospitals task home care agencies to keep the patients home for 30-days. While home care agencies rely on remote telemonitoring reported that current telemonitoring devices are costly to maintain, thus exploring novel technology. CONCLUSION: The Business Model Canvas provided directions for future testing of HeartMapp for its usability as an adjunct device in home health setting to improve self-management and enhance communication with providers, and ultimately reduce readmissions.

Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study.

BACKGROUND: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. OBJECTIVE: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. METHODS: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. RESULTS: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77%, indicating superior suitability. CONCLUSIONS: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge.

TussisWatch: A Smart-Phone System to Identify Cough Episodes as Early Symptoms of Chronic Obstructive Pulmonary Disease and Congestive Heart Failure.

Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are leading chronic health concerns among the aging population today. They are both typically characterized by episodes of cough that share similarities. In this paper, we design TussisWatch, a smart-phone-based system to record and process cough episodes for early identification of COPD or CHF. In our technique, for each cough episode, we do the following: 1) filter noise; 2) use domain expertise to partition each cough episode into multiple segments, indicative of disease or otherwise; 3) identify a limited number of audio features for each cough segment; 4) remove inherent biases as a result of sample size differences; and 5) design a two-level classification scheme, based on the idea of Random Forests, to process a recorded cough segment. Our classifier, at the first-level, identifies whether or not a given cough segment indicates a disease. If yes, the second-level classifier identifies the cough segment as symptomatic of COPD or CHF. Testing with a cohort of 9 COPD, 9 CHF, and 18 CONTROLS subjects spread across both the genders, races, and ages, our system achieves good performance in terms of Sensitivity, Specificity, Accuracy, and Area under ROC curve. The proposed system has the potential to aid early access to healthcare, and may be also used to educate patients on self-care at home.

Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review.

BACKGROUND: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. OBJECTIVE: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. METHODS: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. RESULTS: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration's tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. CONCLUSIONS: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure-related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care.

A Mobile Health Intervention to Improve Self-Care in Patients With Heart Failure: Pilot Randomized Control Trial.

BACKGROUND: Heart failure (HF) is a progressive chronic disease affecting 6.5 million Americans and over 15 million individuals globally. Patients with HF are required to engage in complex self-care behaviors. Although the advancements in medicine have enabled people with HF to live longer, they often have poor health-related quality of life and experience severe and frequent symptoms that limit several aspects of their lives. Mobile phone apps have not only created new and interactive ways of communication between patients and health care providers but also provide a platform to enhance adherence to self-care management. OBJECTIVE: The aim of this pilot study was to test the feasibility of a newly developed mobile app (HeartMapp) in improving self-care behaviors and quality of life of patients with HF and to calculate effect sizes for sample size calculation for a larger study. METHODS: This was a pilot feasibility randomized controlled trial. Participants were enrolled in the hospital before discharge and followed at home for 30 days. The intervention group used HeartMapp (n=9), whereas the control group (n=9) received HF education. These apps were downloaded onto their mobile phones for daily use. RESULTS: A total of 72% (13/18) participants completed the study; the mean age of the participants was 53 (SD 4.02) years, 56% (10/18) were females, 61% (11/18) lived alone, 33% (6/18) were African Americans, and 61% (11/18) used mobile phone to get health information. The mean engagement with HeartMapp was 78%. Results were promising with a trend that participants in the HeartMapp group had a significant mean score change on self-care management (8.7 vs 2.3; t3.38=11, P=.01), self-care confidence (6.7 vs 1.8; t2.53=11, P=.28), and HF knowledge (3 vs -0.66; t2.37=11, P=.04. Depression improved among both groups, more so in the control group (-1.14 vs -5.17; t1.97=11, P=.07). Quality of life declined among both groups, more so in the control group (2.14 vs 9.0; t-1.43=11, P=.18). CONCLUSIONS: The trends demonstrated in this pilot feasibility study warrant further exploration on the use of HeartMapp to improve HF outcomes. TRIAL REGISTRATION: Pilot study, no funding from National agencies, hence not registered.