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.

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.].

Mental Health Care for Service Members and Their Families Across the Globe.

The U.S. Defense Department partnered with the International Initiative for Mental Health Leadership on effective leadership and operational practices for delivery of mental health (MH) as well as addiction services throughout the world for Service Members (SM) and beneficiaries. A Military Issues Work Group (MIWG) was established in 2011 to focus on challenges experienced by military SM and beneficiaries among countries. The MIWG found common concerns related to MH care delivery to rural and remote beneficiaries. Gaps in access to care were identified and prioritized to explore. This led to better collaboration and understanding of telemental health (TMH) practices and technology applications (apps) which increase access to care for rural and remote SMs and beneficiaries. An assessment of the number of SMs and dependents distant from MH care services in the USA was conducted, as well as an environmental scan for psychological health-focused mobile apps and TMH services geared toward SM, veterans, and beneficiaries. The MIWG is developing a compendium of existing military TMH programs and apps that address MH concerns and extant literature on use of technology to extend global access to care for military members and their families across the world.

¿Cuál es el efecto de la utilización de aplicaciones móviles en la adherencia farmacológica de pacientes con patologías crónicas? / What is the effect of the use of mobile applications on the pharmacological adherence of patients with chronic diseases?

INTRODUCCIÓN: Las enfermedades crónicas no transmisibles (ECNT) constituyen la principal causa de muerte a nivel global, afectando a todos los grupos de edad y poblaciones, y con una mayor proporción en países de mediano y bajo ingreso (más del 73% de las muertes por ECNT(1)). La Organización Mundial de la Salud (OMS) ha hecho un llamado urgente para luchar contra las enfermedades crónicas y los trastornos mentales, destacando la responsabilidad de los Jefes de Estado y Gobierno en el control de las ECNT, y la importancia de lograr cobertura universal, incluyendo la prevención y control de ECNT(2). Más aún, una de las metas de los Objetivos de Desarrollo Sostenible (ODS) para el 2030 es reducir las muertes prematuras por ECNT en un 33% (meta 3.4)(3). En Chile, las muertes por ECNT han aumentado en un 30% en los últimos años, siendo la principal causa de muerte, y el principal factor de años de vida perdidos ajustados por discapacidad (DALYs)(4). La OMS el año 2017 publicó una lista de las "mejores inversiones" para abordar las ECNT, dentro de las que se establece como objetivo reducir los factores de riesgo modificables de las ECNT, y que el tratamiento farmacológico y asesoramiento de éste, es una de las mejores inversiones para enfrentarlas(5). Sin embargo, un elemento importante para el manejo de estos pacientes es asegurar la adherencia a los tratamientos farmacológicos, dado que de lo contrario se aumenta el riesgo de hospitalizaciones, muertes prematuras, además de aumentar el costo en salud(6,7). Con el objetivo de hacer frente a este escenario, el Ministerio de Salud a través del Programa "Hospital Digital" ha impulsado una serie de medidas que a través de la telemedicina y digitalización de procesos logren mejorar la situación de salud de la población en Chile. Dentro de las tecnologías contempladas en este programa se encuentra el uso de aplicaciones móviles para mejorar el manejo de pacientes con enfermedades crónicas. Esta síntesis rápida de evidencia evalúa el uso de aplicaciones móviles como intervención para mejorar la adherencia de pacientes con enfermedades crónicas en Chile. OBJETIVO: Esta síntesis busca aportar evidencia sobre el efecto que tendrían los recordatorios, a través de aplicaciones móviles, para mejorar la adherencia a los tratamientos de pacientes con enfermedades crónicas no transmisibles (ECNT). METODOLOGÍA: Se incluyeron todos los tipos de intervenciones realizadas a través de aplicaciones móviles, en adultos con diagnóstico de ECNT, que buscaran la compensación y adherencia al tratamiento. Se excluyeron intervenciones que combinaran el uso de aplicaciones móviles con otras intervenciones que en su escenario habitual no se realizaran (por ej, aumento en el número de sesiones educativas al paciente). Se utilizó como comparador las intervenciones habituales para este tipo de población. Al realizar la búsqueda, los títulos y resúmenes fueron seleccionados por dos revisores independientes, discutiendo cada uno de los disensos encontrados. Se encontraron inicialmente 192 revisiones sistemáticas. De éstas, se excluyeron 109 por disenso o duplicados y 65 por no ser la población e intervención abordada en este resumen. RESULTADOS: De esta forma, se utilizaron 18 revisiones sistemáticas (8,9,18­25,10­17) publicadas entre 2007 y 2018. Sobre estas revisiones, se excluyeron estudios primarios que evaluaban la intervención en niños y adolescentes, utilización de recordatorios a través de mensajes de texto o llamadas telefónicas, y mensajes motivacionales que no incluían recordatorios. El solicitante decidió no incluir poblaciones con diagnóstico de VIH, diabetes tipo I y salud mental, por ser pacientes con características y complejidad diferente a la población de interés para la revisión. Además, se excluyeron intervenciones con una duración menor a 6 meses y que midieran adherencia a través del auto reporte. Con estos criterios, se consideraron finalmente 9 estudios primarios(26­34), de los cuales 5 fueron Ensayos Controlados Aleatorizados (ECAs)(27,28,32­34). De los 4 estudios observacionales incluidos, uno utilizó un diseño de cohorte prospectivo(30) y tres control antes-después(29,31,35). Los resultados registron una mejora en la adherencia al utilizar recordatorios con aplicaciones móviles en pacientes hipertensos(29­31), mientras que en uno de ellos se observó que los pacientes mantenían su adherencia en el tiempo(30). Por últino, otro estudio evaluó la intervención en pacientes con patología crónica respiratoria, informando mejoras en la compensación de esta patología(35). CONCLUSIÓN: Los hallazgos aquí presentados se han separado de acuerdo a la condición de salud (enfermedades cardiovasculares, o respiratorias). En cada una de ellas se reporta por separado las intervenciones de acuerdo a su duración (≥6meses y ≥12 meses). Cada hallazgo contiene además una tabla resumen con los resultados, mostrando la certeza en la evidencia de cada uno de los desenlaces encontrados.

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

Near patient CD4 count in a hospitalized HIV patient population.

BACKGROUND: Point-of-care (POC) CD4 T-cell counting is increasingly recognized as providing improved linkage-to-care during management of HIV infection, particularly in resource-limited settings where disease burden is highest. This study evaluated prototype POC CD4 T-cell counters from MBio Diagnostics in the context of low CD4 count, hospitalized patients in Mozambique. This study measured system performance when presented with challenging, low count samples from HIV/AIDS patients with acute illnesses resulting in hospitalization. METHODS: Forty whole blood samples were collected from donors on the medical service at Maputo Central Hospital and absolute CD4 counts were generated on the MBio CD4 system and a reference laboratory using flow cytometry. RESULTS: The mean and median CD4 counts by the flow cytometry reference were 173 and 80 cells/µL, respectively. Correlation between the MBio CD4 System and the reference was good. Bland-Altman analysis showed a mean bias of +15 cells/µL (+9 to +21 cells/µL, 95% CI), and limits of agreement of -47 to 77 cells/µL. For samples with counts >100 cells/µL (N = 14), the mean coefficient of variation was 7.3%. For samples with counts <50 cells/µL, mean absolute bias of replicate samples was 4.8 cells/µL. When two MBio readers were compared, Bland-Altman bias was -4 cells/µL (-13 to +6 cells/µL, 95% CI), and limits of agreement of -63 and +55 cells/µL. CONCLUSIONS: The MBio System holds promise as a POC system for quantitation of CD4 T cells in resource-limited settings given system throughput (80-100 cartridges/day), design simplicity, and ease-of-use. © 2015 International Clinical Cytometry Society.

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.

Diabetes Applications for Arabic Speakers: A Critical Review of Available Apps for Android and iOS Operated Smartphones.

Today, 415 million adults have diabetes; more than 35 million of diabetic adults live in the Middle East and North Africa region. Smartphone penetration in the region is high and applications, or apps, for diabetics have shown promising results in recent years. This study took place between September and December 2015 and reviewed all currently available smartphone diabetes apps for Arabic speakers in both the Apple App and Google Play stores. There were only few diabetes apps for Arabic speakers; only eighteen apps were discovered and considered for this study. Most apps were informational. Only three apps offered utilities such as glucose reading conversion. The apps had issues related to information quality and adherence to latest evidence-based medical advice. There is a need for more evidence-based Arabic diabetes apps with improved functionality. Future research of Arabic diabetes apps should also focus on the involvement and engagement of the patients in the design of these apps.

An investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal.

BACKGROUND: We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa. MATERIALS AND METHODS: We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access to manage chronic disease, local support and management of patients (to reduce unnecessary travel to the hospital), emergency care (up to 8 h for an ambulance to arrive), e-mail, access to up-to-date information (Web), and teleclinics. We made site measurements at a representative set of health clinics to determine the type of coverage (general packet radio service [GPRS]/3G), its capabilities to support videoconferencing (H323 and Skype™ [Microsoft, Redmond, WA]) and audio (Skype), and throughput for transmission control protocol (TCP) to gain a measure of application performance. RESULTS: We found that none of the remote health clinics had 3G service. The GPRS service provided typical upload speed of 44 kilobits per second (Kbps) and download speed of 64 Kbps. This was not sufficient to support any form of videoconferencing. We also observed that GPRS had significant round trip time (RTT), in some cases in excess of 750 ms, and this led to slow start-up for TCP applications. CONCLUSIONS: We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT. We found some health clinics were so remote that they had no mobile service. 3G, where available, had measured upload speed of 331 Kbps and download speed of 446 Kbps and supported videoconferencing and audio at all sites, but we frequently experienced 3G changing to GPRS. We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable communication is essential and use of store and forward for mobile applications.