Developing a smartphone application to support social connectedness and wellbeing in young people with cystic fibrosis.

BACKGROUND: Young people with cystic fibrosis (CF) may be at increased risk of social isolation and mental illness. This study aimed to design and evaluate the usability and acceptability of a smartphone application (app) to support the social connectedness and wellbeing of young people living with CF. METHODS: Young people with CF aged 12-17 years (N = 22) were recruited from two paediatric hospitals in Australia. Study participants tested the CF app for six weeks before responding to an online survey about the app's usability and acceptability. A subsample of participants (n = 20) discussed the app's strengths and weaknesses during 11 online group interviews. RESULTS: During the six-week testing period, 77% of participants used the app at least once a week and 82% accessed the app from a smartphone. Usability of the CF app was rated high. Most participants agreed the app was easy to use (86%) and felt comfortable using it (96%). Acceptability of the app was moderate. 77% of participants agreed they would recommend the app to others. Recommendations to improve the app's functionality and acceptability included locating the chatroom within the app rather than redirecting users to a web browser and allowing users to personalise images, wellness tips and videos. CONCLUSIONS: This study developed and tested a highly usable, and moderately acceptable, smartphone app to improve the psychosocial health of young people living with CF. Future research will test the efficacy of the CF app on users' social connectedness and wellbeing.

Evaluating a digital tool for supporting breast cancer patients: a randomized controlled trial protocol (ADAPT).

BACKGROUND: There are a growing number of mHealth tools for breast cancer patients but a lack of scientific evidence for their effects. Recent studies have shown a mix of positive and negative impacts on users. Here we will assess the impact of OWise Breast Cancer, a mobile application for self-monitoring symptoms and managing care, on the process of self-management. METHODS: This randomized controlled trial with early stage breast cancer patients will assess the effect of OWise use on patient activation at 3 months from diagnosis measured by the PAM-13 questionnaire. We will also assess differences in changes in health-related quality of life, psychological distress, health status, and National Health Service (NHS) health resource utilization over the first year from diagnosis. Participants will be randomly allocated (1:1) to standard care or standard care plus OWise. Participants will complete questionnaires before starting anti-cancer treatment and at 3, 6, and 12 months from diagnosis. Clinical and patient-reported outcome data will be linked to health resource utilization data from Discover, an integrated care record of primary, secondary, and social care in North West London. We will measure contamination in the control group and adjust the sample size to mitigate the dilution of effect estimates. A per-protocol analysis will be conducted as a sensitivity analysis to assess robustness of the primary results. DISCUSSION: This study aims to generate evidence for the effectiveness of OWise at improving patient activation for women with early-stage breast cancer. The results will show the impact of using the tool at the patient level and the NHS health system level. The outcomes of the study will have implications for the application of OWise across the NHS for breast cancer patients and expansion into other tumor types. Assessing publicly available mHealth tools poses a challenge to trialists due to the risk of contamination. Here we apply various methods to measure, mitigate, and assess the effects of contamination. TRIAL REGISTRATION: The study was registered at clincaltrials.gov (NCT03866655) on 7 March 2019.

Cancer specialist nurses' perspectives of physical activity promotion and the potential role of physical activity apps in cancer care.

PURPOSE: The purpose of this study was to understand breast, prostate and colorectal cancer clinical nurse specialists' (CNSs) perspectives on physical activity (PA) promotion and the role of smartphone apps to support PA promotion in cancer care. METHODS: CNSs working in breast, prostate or colorectal cancer were recruited via advertisements distributed by professional organizations. In-depth semi-structured telephone interviews were conducted and analysed using thematic analysis. RESULTS: Nineteen CNSs participated. The analysis resulted in 4 themes regarding CNSs' perspectives of PA promotion within cancer care: (i) policy changes in survivorship care have influenced CNSs' promotion of PA; (ii) CNSs recognize their role in supporting PA but sit within a wider system necessary for effective PA promotion; (iii) CNSs use several techniques to promote PA within their consultations; (iv) remaining challenges in PA promotion. The analysis resulted in 3 themes regarding CNSs' perspectives on the use of apps to promote PA within cancer care: (i) the influence of apps on access to PA support; (ii) the role of apps in self-directed PA; (iii) implementing apps in cancer care. CONCLUSIONS: The results of this study provide valuable insight into the CNS role and provide a number of important considerations for the development and implementation of PA interventions within cancer care, with a specific focus on smartphone-based interventions. IMPLICATIONS FOR CANCER SURVIVORS: CNSs play an important role in PA promotion in cancer care and this research can inform the development of PA interventions delivered via smartphone app for people affected by cancer.

Behavior Change Content, Understandability, and Actionability of Chronic Condition Self-Management Apps Available in France: Systematic Search and Evaluation.

BACKGROUND: The quality of life of people living with chronic conditions is highly dependent on self-management behaviors. Mobile health (mHealth) apps could facilitate self-management and thus help improve population health. To achieve their potential, apps need to target specific behaviors with appropriate techniques that support change and do so in a way that allows users to understand and act upon the content with which they interact. OBJECTIVE: Our objective was to identify apps targeted toward the self-management of chronic conditions and that are available in France. We aimed to examine what target behaviors and behavior change techniques (BCTs) they include, their level of understandability and actionability, and the associations between these characteristics. METHODS: We extracted data from the Google Play store on apps labelled as Top in the Medicine category. We also extracted data on apps that were found through 12 popular terms (ie, keywords) for the four most common chronic condition groups-cardiovascular diseases, cancers, respiratory diseases, and diabetes-along with apps identified through a literature search. We selected and downloaded native Android apps available in French for the self-management of any chronic condition in one of the four groups and extracted background characteristics (eg, stars and number of ratings), coded the presence of target behaviors and BCTs using the BCT taxonomy, and coded the understandability and actionability of apps using the Patient Education Material Assessment Tool for audiovisual materials (PEMAT-A/V). We performed descriptive statistics and bivariate statistical tests. RESULTS: A total of 44 distinct native apps were available for download in France and in French: 39 (89%) were found via the Google Play store and 5 (11%) were found via literature search. A total of 19 (43%) apps were for diabetes, 10 for cardiovascular diseases (23%), 8 for more than one condition in the four groups (18%), 6 for respiratory diseases (14%), and 1 for cancer (2%). The median number of target behaviors per app was 2 (range 0-7) and of BCTs per app was 3 (range 0-12). The most common BCT was self-monitoring of outcome(s) of behavior (31 apps), while the most common target behavior was tracking symptoms (30 apps). The median level of understandability was 42% and of actionability was 0%. Apps with more target behaviors and more BCTs were also more understandable (ρ=.31, P=.04 and ρ=.35, P=.02, respectively), but were not significantly more actionable (ρ=.24, P=.12 and ρ=.29, P=.054, respectively). CONCLUSIONS: These apps target few behaviors and include few BCTs, limiting their potential for behavior change. While content is moderately understandable, clear instructions on when and how to act are uncommon. Developers need to work closely with health professionals, users, and behavior change experts to improve content and format so apps can better support patients in coping with chronic conditions. Developers may use these criteria for assessing content and format to guide app development and evaluation of app performance. TRIAL REGISTRATION: PROSPERO CRD42018094012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94012.

The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study.

BACKGROUND: The shift from inpatient to outpatient and community cancer care means that more patients with cancer need to manage their condition at home, without the direct supervision of their clinician. Subsequently, research has reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. Before designing an app intervention to help patients with cancer to meet their information needs, in-depth qualitative research is required to gain an understanding of the views of the target users. OBJECTIVE: We aimed to develop an app intervention to help patients meet their illness-related information needs in noninpatient settings. This study explored the information needs of patients with cancer and their preferences for an app and desired app features. Specifically, the perceived acceptability of an app, desired app features, and the potential benefits and disadvantages of, and barriers to, an app were explored. METHODS: Qualitative, one-on-one semistructured interviews were conducted with patients with urological, colorectal, breast, or gynecological cancers (N=23) across two hospitals in South Wales. Interviews were audio-taped, transcribed, and analyzed using a thematic analysis. RESULTS: Findings indicated that barriers to information exchange and understanding in consultations, and identification of reliable information sources between consultations, appeared to contribute to patients' unmet information needs. Consequently, app feature suggestions included a question prompt list, a glossary of cancer terms, a resources feature, and a contacts feature. Anticipated benefits of this type of app included a more informed patient, improved quality of life, decreased anxiety, and increased confidence to participate in their care. The anticipated barriers to app use are likely to be temporary or can be minimized with regard to these findings during app development and implementation. CONCLUSIONS: This study highlights the desire of patients with cancer for an app intervention to help them meet their information needs during and between consultations with their clinicians. This study also highlights the anticipated acceptability and benefits of this type of intervention; however, further research is warranted.

Evaluation of a Free Public Smartphone Application to Detect Leukocoria in High-Risk Children Aged 1 to 6 Years.

PURPOSE: To determine whether a white-eye detector smartphone application (app) can be used as a screening tool to detect early signs of leukocoria in a clinical practice. METHODS: A prospective, single-visit study of children aged 1 to 6 years presenting to the University Eye Clinic of Genova for a complete pediatric ophthalmologic examination was conducted. All children who met the enrollment criteria were screened by an orthoptist with the CRADLE (Computer Assisted Detector of Leukocoria) smartphone app for an iPhone operating system (iOS) (iPhone 7; Apple, Cupertino, CA). Cycloplegic retinoscopy and fundus examination were performed 30 minutes after one to two drops of a pediatric combination drop, comprising tropicamide 1% and phenylephrine 2.5%, were instilled. A comparison between the two methods yielded sensitivity, specificity, and negative likelihood ratio values. RESULTS: A total of 244 eyes of 122 children were included in the study. Nine eyes of 244 (3.6%) had leukocoria evaluable by penlight caused by amblyogenic cataract, 1 (0.4%) patient had retinopathy of prematurity stage 5, and 3 (1.2%) patients had retinoblastoma. The sensitivity of the white-eye detector app was 15.38% (95% confidence interval [CI]: 1.92% to 45.45%), the specificity was 100% (95% CI: 98.48% to 100.00%), and the negative likelihood ratio was 0.85 (95% CI: 0.67 to 1.07). CONCLUSIONS: A smartphone photoscreening app able to detect leukocoria may provide valuable support for children's parents. However, it cannot be considered an alternative to the ophthalmoscope for children. [J Pediatr Ophthalmol Strabismus. 2019;56(4):229-232.].

Patient-oriented mobile applications in ophthalmology.

BACKGROUND: Mobile solutions will improve patient care only if they are equally valued by physicians and their patients. Although mobile applications are gaining acceptance among ophthalmologists and optometrists, little is known about their adoption among patients. Therefore, this study was designed to analyse the market for patient-oriented mobile applications in ophthalmology. METHODS: Search engines of Google Play and App Store were utilised to find patient-oriented mobile applications. All applications were divided into seven subspecialties; dry eye, strabismus and amblyopia, macular degeneration, cataract, glaucoma, diabetic retinopathy and general ophthalmology. Subsequently, number of downloads, average patient rating, year of release and source of clinical information provided in the application were collected. Furthermore, in order to evaluate whether development of software responds to epidemiological demand, number of applications in each subspecialty was correlated with the prevalence of particular diseases. RESULTS: Fifty-six applications that met established criteria were found. The overall number of downloads was estimated at the level of 1.5 million, whereas the weighted average rating for all applications was 4.21/5. The number of applications by subspecialty did not correlate with the prevalence of particular eye disorder. The dry eye was the most frequently downloaded and best rated subspecialty. CONCLUSIONS: The overall number of patient-oriented applications in ophthalmology is low. Subspecialties are not equally equipped with patient-oriented mobile solutions. Furthermore, the number of applications or downloads in each subspecialty does not correlate with the number of potential users such as patients with particular eye disorders. Finally, ophthalmologists should encourage software developers to meet future demand for mobile solutions in eye disorders.

Feasibility of a Smartphone-based pilot intervention for Hispanic breast cancer survivors: a brief report.

Hispanic breast cancer survivors (BCS) are at high risk for experiencing poor health-related quality of life (HRQoL) after completion of active breast cancer treatment. Therefore, there is a need to develop culturally tailored interventions for Hispanic BCS. To date, there have been limited interventions that have demonstrated that increasing cancer-related knowledge, self-efficacy in communication, and self-management skills can improve HRQoL among Hispanic BCS. These interventions have been delivered in person or by phone, which may be burdensome for Hispanic BCS. To facilitate intervention delivery, we developed My Guide, a Smartphone application aimed at improving HRQoL among Hispanic BCS. The purpose of the current study is to describe the feasibility results of a 4-week pilot trial testing My Guide among Hispanic BCS. Twenty-five women enrolled in the study (75% recruitment rate) and 22 women were retained (91.6% retention rate). Mean time spent using My Guide across the 4 weeks was 9.25 hr, and mean score on the satisfaction survey was 65.91 (range 42-70), in which higher scores reflect greater satisfaction. Participants' scores on the Breast Cancer Knowledge Questionnaire significantly improved from study baseline (M = 9.50, SD = 2.92) to the postintervention assessment (M = 11.14, SD = 2.66), d = 0.59. Participants' HRQoL scores improved over the course of 4 weeks, but these improvements were not statistically significant. Overall, My Guide was feasible and acceptable. Future studies will assess the preliminary efficacy of My Guide in improving HRQoL in a larger, randomized trial of Hispanic BCS.

[Medicine 4.0: examples of applications of electronics, information technology and microsystems in modern medicine]. / « Médecine 4.0 ¼ - Exemples d'application de l'électronique, de la technologie de l'information et des microsystèmes dans la médecine moderne.

The electronic advances of the last hundred years have made enormous contributions to medical research and the development of new therapeutic methods. In recent years in particular, it has been demonstrated that intelligent sensors, with appropriate radio interfaces, will soon allow diagnostic and therapeutic processes in medicine to be linked to one another - this will enable the development of completely new forms of therapy [1]. This new "Medicine 4.0" was the subject of a first article in the series, which presented the progress achieved through the merging of microsensor technology, microelectronics, information and communication technologies, with a particular focus on the case of personalized chemotherapy. The purpose of this new article is to present more practical applications of these new therapeutic methods.

'Prostate Cancer Risk Calculator' mobile applications (Apps): a systematic review and scoring using the validated user version of the Mobile Application Rating Scale (uMARS).

PURPOSE: The use of mobile phone applications (Apps) has modernised the conventional practice of medicine. The diagnostic ability of the current Apps in prostate specific antigen monitoring, and its diagnostic ability within prostate cancer (PCa) risk calculators have not yet been appraised. We aimed to review, rate and assess the everyday functionality, and utility of all the currently available PCa risk calculator Apps. METHODS: A systematic search on iTunes, Google Play Store, Blackberry World and Windows Apps Store, was performed on 23/11/2017, using the search term 'prostate cancer risk calculator'. After applying the exclusion criteria, each App was individually assessed and rated using pre-set criteria and grading was performed using the validated uMARS scale. RESULTS: In total, 83 Apps were retrieved. After applying our exclusion criteria, only 9 Apps were relevant, with 2 duplicated, and the remaining 7 were suitable for critical review. Data sizes ranged from 414 kb to 10.1 Mb. The cost of the Apps ranged from South African rand (ZAR) 0.00 to ZAR 29.99. The overall mean category uMARS scores ranged from 2.8/5 to 4.5/5. Apps such as Rotterdam Prostate Cancer Risk Calculator, Coral-Prostate Cancer Nomogram Calculator and CPC Risk Calculator, performed the best. CONCLUSIONS: The current PCa risk calculator mobile Apps available may be beneficial in counselling the concerned at risk patient. These Apps have potential to assist both the patient and the urologist alike. The PCa risk calculator App 'predictability' may be further enhanced by the incorporation of newly validated risk factors and predictors for PCa.

Planejamento e Gestão da atenção a pessoas com "Pé Diabético" através de um Sistema de Informações Geográficas e de um aplicativo para dispositivos móveis em uma Unidade de Saúde da Família de Manaus, Amazonas / Planning and management of care for people with "Diabetic Foot" through a Geographic Information System and an application for the use of mobile devices in a Family Health Unit in Manaus, Amazonas

O objetivo desse estudo foi desenvolver uma proposta para o planejamento e gestão da atenção ao Pé Diabético através de um Sistema de Gerenciamento de Informações Geográficas, em Manaus, Amazonas. Realizou-se estudo descritivo que teve como propósito o desenvolvimento experimental de um aplicativo, com a finalidade de gerir a atenção a pessoas com diabetes e pé diabético. Foram formuladas perguntas prévias para embasar o trabalho com o Sistema de Informações Geográficas. O desenvolvimento ocorreu em 4 fases: georreferenciamento do bairro, elaboração de banco de dados para avaliação e estratificação de risco de pessoas com diabetes e pé diabético, construção de mapas dinâmicos da área de cobertura das equipes de saúde da família e desenvolvimento de um protótipo de aplicativo para gerenciamento das informações desses pacientes. O estudo estimou uma população de 11.041 pessoas distribuídas em 3.135 famílias para o bairro estudado. Foram identificadas 374 pessoas com diagnóstico de diabetes sob a responsabilidade do Módulo de Saúde da Família Vila da Prata: 3,98% das pessoas com idades a partir de 15 anos. O bairro foi georreferenciado com base nas três áreas de cobertura das equipes de saúde da família, que totalizam 21 microáreas. Foram georreferenciadas todas as unidades de Saúde que realizam atendimentos a pessoas com diabetes em nível ambulatorial e hospitalar na cidade de Manaus. O banco de dados está constituído pelos módulos de cadastramento do domicílio, cadastramento individual, avaliação clínica geral, classificação de risco, exame físico, avaliação neurológica, avaliação vascular, índice tornozelo-braço, classificação do pé diabético, medicações em uso, avaliação laboratorial, exames complementares, avaliação de feridas, classificação do Texas e gravidade da infecção e quadro de condutas. O aplicativo foi desenvolvido a partir dos módulos do banco de dados da plataforma PowerApps. O estudo concluiu que o Diabetic Foot System combinado a um GIS tem potencial para se tornar uma eficiente ferramenta de planejamento e gestão da atenção a pessoas com diabetes e pé diabético

The objective of this study was to develop a proposal for Planning and Management of Attention to Diabetic Foot through a Geographic Information Management System, in Manaus, Amazonas. A descriptive study was carried out, whose purpose was the experimental development of an application, to manage the attention of people with diabetes and diabetic foot. Previous questions were asked to support the work with the Geographic Information System. The development took place in four phases: geo-referencing of the neighborhood, elaboration of the database for evaluation and risk stratification of people with diabetes and diabetic foot, construction of dynamic maps of the coverage area of the family health teams and development of a prototype of an application for managing the information of these patients. The study estimated a population of 11,041 people distributed in 3,135 families to the studied neighborhood. A total of 374 people diagnosed with diabetes under the responsibility of the Vila da Prata Family Health Module were 3.98% of those aged 15 and over. The neighborhood was georeferenced based on the three coverage areas of the family health teams, which total 21 micro areas. All the health units that provide care for people with diabetes at an outpatient and hospital level in the city of Manaus were geo-referenced. The database is composed of the modules of household registration, individual registration, general clinical evaluation, risk classification, physical examination, neurological evaluation, vascular evaluation, ankle-brachial index, diabetic foot classification, medications in use, laboratory evaluation, complementary exams, wound evaluation, Texas classification and severity of infection and conduction framework. The application was developed from the database modules on the PowerApps platform. The study concluded that the Diabetic Foot System combined with ArcGIS has the potential to become an effective tool for planning and managing care for people with diabetes and diabetic foot

Thirty-five years of CD4 T-cell counting in HIV infection: From flow cytometry in the lab to point-of-care testing in the field.

CD4 T-cell counting was introduced in clinical laboratories shortly after the discovery of the human immune deficiency virus (HIV) in the early eighties. In western clinical laboratories, improvements in the CD4 T-cell counting methods were mainly driven by progress in the field of flow cytometry and immunology. In contrast, the development of dedicated CD4 T-cell counting technologies were needs driven. When antiretroviral treatment (ART) was made available on a large scale by international Acquired Immune Deficiency Syndrome (AIDS) relief programs to HIV+ patients living in low income countries in 2003, there was a distinct need for simplified and affordable CD4 T-cell counting technologies. The first decade of 2000, several compact flow cytometers appeared on the market, mainly to the benefit of low income countries with limited resources. More recently, however, portable point-of-care (POC) CD4 T-cell counting devices have been developed especially to improve access to affordable monitoring of HIV+ patients in low income countries. The accuracy of these POC instruments is not yet very well documented as many are still under development and clinical validation but preliminary evidence is encouraging. The new HIV treatment guidelines released by the World Health Organization in 2016 give CD4 T-cell counting a less central role in the management of HIV infection. It is, therefore, to be expected that CD4 T-cell counting will be phased out as a tool to assess eligibility of HIV+ patients for ART in the future. However, CD4 T-cell counting will remain a valuable tool for directing treatment against opportunistic infections. © 2016 International Clinical Cytometry Society.

Characterising smoking cessation smartphone applications in terms of behaviour change techniques, engagement and ease-of-use features.

The aim of this study was to assess whether or not behaviour change techniques (BCTs) as well as engagement and ease-of-use features used in smartphone applications (apps) to aid smoking cessation can be identified reliably. Apps were coded for presence of potentially effective BCTs, and engagement and ease-of-use features. Inter-rater reliability for this coding was assessed. Inter-rater agreement for identifying presence of potentially effective BCTs ranged from 66.8 to 95.1 % with 'prevalence and bias adjusted kappas' (PABAK) ranging from 0.35 to 0.90 (p < 0.001). The intra-class correlation coefficients between the two coders for scores denoting the proportions of (a) a set of engagement features and (b) a set of ease-of-use features, which were included, were 0.77 and 0.75, respectively (p < 0.001). Prevalence estimates for BCTs ranged from <10 % for medication advice to >50 % for rewarding abstinence. The average proportions of specified engagement and ease-of-use features included in the apps were 69 and 83 %, respectively. The study found that it is possible to identify potentially effective BCTs, and engagement and ease-of-use features in smoking cessation apps with fair to high inter-rater reliability.