Effects of Healthcare Technologies on the Promotion of Physical Activities in Older Persons: A Systematic Review.

This study aimed to explore the effects of health technologies on the promotion of health through physical activities of older persons. Following PRISMA guidelines, a systematic review of relevant articles published prior to 2020 was conducted from selected indices such as COCHRANE, PubMed, Science Direct, Proquest, including the use of hand search procedure. Twenty-seven articles were analyzed with significant findings influential to older people nursing: types of health technologies used for promoting physical activity; effects of technology use in promoting physical activity of older person care; and aspects that need to be considered in technology use among older persons. Characteristics of technologies were accuracy, usefulness, reliability, comfort, safety, and relevancy. Most technologies promoting physical activities for older people were wearable technologies that use artificial intelligence. Altogether, these technologies influenced overall healthcare behaviors of older persons. With healthcare technology efficiencies, proficiencies, and dependencies, technology-based healthcare have served older people well. Most technologies for older people care, such as wearables, reliably produce characteristics enhancing dependency and accuracy of bio-behavioral information influencing physical activities of older persons. Health technologies foster the values of physical activities among older persons thereby promoting healthy living.

Tecnologia gerencial para mediar a consulta de enfermagem a pessoas vivendo com doença de chagas / Management technology to mediate nursing consultation for people living with chagas disease

Objetivo: Construir e validar uma tecnologia gerencial, baseada no referencial teórico de Dorothea Orem, para mediar à consulta de enfermagem ao paciente com doença de chagas no Ambulatório de Cardiopatia Chagásica de uma instituição de ensino no município de Belém/Pa. Método: Pesquisa metodológica do tipo exploratória com abordagem quantitativa, realizada no período de maio a novembro de 2019, constituída em duas fases: elaboração do instrumento; submissão, avaliação e validação do instrumento por juízes especialistas. Resultados: Com exceção de um único item do instrumento, todo este foi validado com concordância de 95,12%. Conclusão: O instrumento validado contribuirá para a implementação da assistência a população. Os princípios da teoria do autocuidado são aplicáveis e pertinentes para planejar e avaliar a assistência aos pacientes que, neste estudo, especificamente, são os que vivem com doença de chagas, assim, este estudo proporciona aos enfermeiros um instrumento baseado em evidências científicas e validado por profissionais qualificados.(AU)

Objective: To construct and validate a management technology, based on Dorothea Orem's theoretical framework, to mediate the nursing consultation with patients with chagas disease at the Chagas Heart Disease Outpatient Clinic of an educational institution in the city of Belém/Pa. Method: Exploratory methodological research with quantitative approach, carried out from May to November 2019, consisting of two phases: elaboration of the instrument; submission, evaluation and validation of the instrument by expert judges. Results: With the exception of a single item of the instrument, the whole of this was validated with agreement of 95.12%. Conclusion: The validated instrument will contribute to the implementation of assistance to the population. The principles of the theory of self-care are applicable and pertinent to plan and evaluate care for patients who, in this study, specifically, are those living with Chagas disease, thus, this study provides nurses with an instrument based on scientific evidence and validated by qualified professionals.(AU)

Objetivo: Construir y validar una tecnología de manejo, basada en el marco teórico de Dorothea Orem, para mediar la consulta de enfermería con pacientes con enfermedad de Chagas en el Ambulatorio de Cardiopatías de Chagas de una institución educativa de la ciudad de Belém/Pa. Método: Investigación metodológica exploratoria con enfoque cuantitativo, realizada de mayo a noviembre de 2019, constituida en dos fases: elaboración del instrumento; presentación, evaluación y validación del instrumento por jueces expertos. Resultados: Con la excepción de un solo ítem del instrumento, el conjunto de este fue validado con concordancia de 95,12%. Conclusión: El instrumento validado contribuirá a la implementación de la asistencia a la población. Los principios de la teoría del autocuidado son aplicables y pertinentes para planificar y evaluar la atención de los pacientes que, en este estudio, específicamente, son los que viven con la enfermedad de Chagas, por lo que este estudio brinda al enfermero un instrumento basado en evidencia científica y validada. por profesionales calificados.(AU)

How Academic Medical Centers Can Navigate the Pandemic and Its Aftermath: Solutions for 3 Major Issues.

The COVID-19 crisis has seriously affected academic medical centers (AMCs) on multiple levels. Combined with many trends that were already under way pre pandemic, the current situation has generated significant disruption and underscored the need for change within and across AMCs. In this article, the authors explore some of the major issues and propose actionable solutions in 3 areas of concentration. First, the impact on medical students is considered, particularly the trade-offs associated with online learning and the need to place greater pedagogical emphasis on virtual care delivery and other skills that will be increasingly in demand. Solutions described include greater utilization of technology, building more public health knowledge into the curriculum, and partnering with a wide range of academic disciplines. Second, leadership recruiting, vital to long-term success for AMCs, has been complicated by the crisis. Pressures discussed include adapting to the dynamics of competitive physician labor markets as well as attracting candidates with the skill sets to meet the requirements of a shifting AMC leadership landscape. Solutions proposed in this domain include making search processes more focused and streamlined, prioritizing creativity and flexibility as core management capabilities to be sought, and enhancing efforts with assistance from outside advisors. Finally, attention is devoted to the severe financial impact wrought by the pandemic, creating challenges whose resolution is central to planning future AMC directions. Specific challenges include recovery of lost clinical revenue and cash flow, determining how to deal with research funding, and the precarious economic balancing act engendered by the need to continue distance education. A full embrace of telehealth, collaborative policy-making among the many AMC constituencies, and committing fully to being in the vanguard of the transition to value-based care form the solution set offered.

The design and development of technology platforms in a developing country healthcare context from an ecosystem perspective.

BACKGROUND: Research on the development and functioning of technology platforms specifically for health applications in sub-Saharan Africa (SSA), is limited. The healthcare sector has also been resistant to platform adoption due to characteristics such as sensitive data and high cost of failure. A framework for the design, development and implementation of technology platforms in the South African health context could therefore contribute to the gap in research as well as provide a practical tool that platform owners could use to potentially increase the adoption of platforms in this context. METHODS: The research design for this study was based on the Grounded Theory Conceptual Framework Analysis process. The process focused on mapping and investigating data sources, categorising and integrating concepts, synthesising these concepts into a framework and iteratively evaluating the framework. The first stage of the evaluation process was a preliminary evaluation exploring an existing Health platform in South Africa (MomConnect). The second evaluation stage included local and international interviews with nine experts to identify any missing concepts in the framework. Stage three included a case study and case study interviews which led to the formulation of the final framework and management tool. RESULTS: The developed and evaluated framework comprised three components, namely the pre-use component, which includes considerations the platform owner should be aware of prior to using the framework. The framework comprises of two dimensions, 1) an ecosystem dimension to guide the platform owner to consider different ecosystem actors before embarking on designing a platform 2) a platform development dimension that include typical platform development components and presents an interpretation of the viewpoints included in the ecosystem levels. CONCLUSIONS: The final framework can be used by platform owners as a management tool. A unique contribution of this study is that the framework draws from two platform perspectives, namely the engineering and the economic perspectives to provide a holistic understanding of platforms. Finally, a contribution of this article is the tailoring of the framework for the South African health context.

A Prototype Framework Design for Assisting the Detection of Atrial Fibrillation Using a Generic Low-Cost Biomedical Sensor.

Cardiovascular diseases are the leading cause of death around the world. As a result, low-cost biomedical sensors have been gaining importance in business and research over the last few decades. Their main benefits include their small size, light weight, portability and low power consumption. Despite these advantages, they are not generally used for clinical monitoring mainly because of their low accuracy in data acquisition. In this emerging technological context, this paper contributes by discussing a methodology to help practitioners build a prototype framework based on a low-cost commercial sensor. The resulting application consists of four modules; namely, a digitalization module whose input is an electrocardiograph signal in portable document format (PDF) or joint photographic expert group format (JPEG), a module to further process and filter the digitalized signal, a selectable data calibration module and, finally, a module implementing a classification algorithm to distinguish between individuals with normal sinus rhythms and those with atrial fibrillation. This last module employs our recently published symbolic recurrence quantification analysis (SRQA) algorithm on a time series of RR intervals. Moreover, we show that the algorithm applies to any biomedical low-cost sensor, achieving good results without requiring.

Are cost-effective technologies feasible to measure gait in older adults? A systematic review of evidence-based literature.

BACKGROUND: Unrestricted by time and place, innovative technologies seem to provide cost-effective solutions for gait assessment in older adults. OBJECTIVE: The objective of this study is to provide an overview of gait assessment for older adults by investigating critical gait characteristics of older adults, discussing advantages and disadvantages of the current gait assessment technologies, as well as device applicability. METHODS: The Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed during the review. Inclusion criteria were: (1) Sample consisting of adults older than 60 years; (2) qualitative, quantitative, or mixed-method researches using one or more specific gait assessment technologies; and (3) publication in English between 2000 and 2018. RESULTS: In total, twenty-one studies were included. Gait speed, stride length, frequency, acceleration root mean square, step-to-step consistency, autocorrelation, harmonic ratio were reported in the existing literatures to be associated with falls. The enrolled studies address the use of pedometer, wearable accelerometer-based devices, Kinect, Nintendo Wii Balance Board as cost-effective gait assessment technologies. CONCLUSIONS: Gait parameters and assessment approaches for older adults are diverse. Cost-effective technologies such as a wearable accelerometer-based device, Kinect, and the Nintendo Wii Balance Board provide potential alternatives for gait assessment with acceptable validity and reliability compared with sophisticated devices. The popularity and development of cost-effective devices have made large-scale data collection for gait assessment possible in the daily environment. Further study could involve older adults and their family members/caregivers in use of these technologies to design elderly-friendly products.

Rise of cyborg microrobot: different story for different configuration.

By integrating organic parts achieved through evolution and inorganic parts developed by human civilisation, the cyborg microrobot is rising by taking advantage of the high flexibility, outstanding energy efficiency, extremely exquisite structure in the natural components and the fine upgradability, nice controllability in the artefact parts. Compared to the purely synthetic microrobots, the cyborg microrobots, due to the exceptional biocompatibility and biodegradability, have already been utilised in in situ diagnosis, precise therapy and other biomedical applications. In this review, through a thorough summary of recent advances of cyborg microrobots, the authors categorise the cyborg microrobots into four major classes according to the configuration between biomaterials and artefact materials, i.e. microrobots integrated inside living cell, microrobots modified with biological debris, microrobots integrated with single cell and microrobots incorporated with multiple cells. Cyborg microrobots with the four types of configurations are introduced and summarised with the combination approaches, actuation mechanisms, applications and challenges one by one. Moreover, they conduct a comparison among the four different cyborg microrobots to guide the actuation force promotion, locomotion control refinement and future applications. Finally, conclusions and future outlook of the development and potential applications of the cyborg microrobots are discussed.

Mothers' Voices Related to Caregiving: The Transition of a Technology-Dependent Infant from the NICU to Home.

PURPOSE: The transition from the NICU to home is a complicated, challenging process for mothers of infants dependent on lifesaving medical technology, such as feeding tubes, supplemental oxygen, tracheostomies, and mechanical ventilation. The study purpose was to explore how these mothers perceive their transition experiences just prior to and during the first three months after initial NICU discharge. DESIGN: A qualitative, descriptive, longitudinal design was employed. SAMPLE: Nineteen mothers of infants dependent on lifesaving technology were recruited from a large Midwest NICU. MAIN OUTCOME VARIABLE: Description of mothers' transition experience. RESULTS: Three themes were identified pretransition: negative emotions, positive cognitive-behavioral efforts, and preparation for life at home. Two posttransition themes were negative and positive transition experiences. Throughout the transition, the mothers expressed heightened anxiety, fear, and stress about life-threatening situations that did not abate over time despite the discharge education received.

Market and Patent Analyses of Wearables in Medicine.

Wearable medical devices (WMDs) will advance point-of-care diagnostics and therapeutics. This article analyses the market and patents for wearable devices. Activity monitors have the largest market share, and the intellectual property landscape is dominated by electronics corporations. However, the majority of these patents have not been realized in commercial products.

Very Preterm Infants with Technological Dependence at Home: Impact on Resource Use and Family.

OBJECTIVE: To examine the impact of medical complexity among very preterm infants on health care resource use, family, and neurodevelopmental outcomes at 18 months' corrected age. METHODS: This observational cohort study of Canadian infants born < 29 weeks' gestational age in 2009-2011 compared infants with and those without medical complexity defined as discharged home with assistive medical technology. Health care resource use and family outcomes were collected. Children were assessed for cerebral palsy, deafness, blindness, and developmental delay at 18 months. Logistic regression analysis was performed for group comparisons. RESULTS: Overall, 466/2,337 infants (20%) needed assistive medical technology at home including oxygen (79%), gavage feeding (21%), gastrostomy or ileostomy (20%), CPAP (5%), and tracheostomy (3%). Children with medical complexity were more likely to be re-hospitalized (OR 3.6, 95% CI 3.0-4.5) and to require ≥2 outpatient services (OR 4.4, 95% CI 3.5-5.6). Employment of both parents at 18 months was also less frequent in those with medical complexity compared to those without medical complexity (52 vs. 60%, p < 0.01). Thirty percent of children with medical complexity had significant neurodevelopmental impairment compared to 13% of those without medical complexity (p < 0.01). Lower gestational age, lower birth weight, bronchopulmonary dysplasia, sepsis, and surgical necrotizing enterocolitis were associated with a risk of medical complexity. CONCLUSION: Medical complexity is common following very preterm birth and has a significant impact on health care use as well as family employment and is more often associated with neurodevelopmental disabilities. Efforts should be deployed to facilitate care coordination upon hospital discharge and to support families of preterm children with medical complexity.

An Extended Hackathon Model for Collaborative Education in Medical Innovation.

To support the next generation of healthcare innovators - whether they be engineers, designers, clinicians, or business experts by training - education in the emerging field of medical innovation should be made easily and widely accessible to undergraduate students, graduate students, and young professionals, early in their careers. Currently, medical innovation curricula are taught through semester-long courses or year-long fellowships at a handful of universities, reaching only a limited demographic of participants. This study describes the structure and preliminary outcomes of a 1-2 week "extended hackathon" course that seeks to make medical innovation education and training more accessible and easily adoptable for academic medical centers. Eight extended hackathons were hosted in five international locations reaching 245 participants: Beijing (June 2015 and August 2016), Hong Kong (June 2016, 2017, and 2018), Curitiba (July 2016), Stanford (October 2017), and São Paulo (May 2018). Pre- and post-hackathon surveys asking respondents to self-assess their knowledge in ten categories of medical innovation were administered to quantify the perceived degree of learning. Participants hailed from a diverse range of educational backgrounds, domains of expertise, and academic institutions. On average, respondents (n = 161) saw a greater than twofold increase (114.1%, P < 0.001) from their pre- to post-hackathon scores. In this study, the extended hackathon is presented as a novel educational model to teach undergraduate and graduate students a foundational skillset for medical innovation. Participants reported gaining significant knowledge across all ten categories assessed. To more robustly assess the educational value of extended hackathons, a standardized assessment for medical innovation knowledge needs to be developed, and a larger sample size of participants surveyed.

[Who will kick off the digital transformation of health?] / Qui initiera la transformation digitale de la santé?

Over the past few years, numerous medical digital initiatives have blossomed, displaying tangible signs of efficacy in improving, for example, medication adherence or lifestyle. Such patient-centered solutions free themselves, at least conceptually, from the silos between the major players in healthcare (pharmaceutical industry, health authorities, hospitals, payers). The lack of a global rethinking of patient care has resulted in structural fragility. This could provide fertile ground for the arrival of players from the digital world, called "pure players", who could radically rethink and disrupt business models by proposing personalized digital solutions based on patients' needs. Thus, in the management of chronic disease, such as cardiovascular disease or type 2 diabetes, "pure players" could bring about a paradigm shift via a commitment to achieve results which are driven by real-world outcome assessment rather than being means-driven.

Digital technologies for the assessment of cognition: a clinical review.

Dementia is the most widespread form of neurodegenerative disorder and is associated with an immense societal and personal cost. Prevalence of this disorder is projected to triple worldwide by 2050 leading to an urgent need to make advances in the efficiency of both its care and therapy research. Digital technologies are a rapidly advancing field that provide a previously unavailable opportunity to alleviate challenges faced by clinicians and researchers working in this area. This clinical review aimed to summarise currently available evidence on digital technologies that can be used to monitor cognition. We identified a range of pervasive digital systems, such as smartphones, smartwatches and smart homes, to assess and assist elderly demented, prodromal and preclinical populations. Generally, the studies reported good level of agreement between the digital measures and the constructs they aimed to measure. However, most of the systems are still only in the initial stages of development with limited data on acceptability in patients. Although it is clear that the use of digital technology to monitor and support the cognitive domains affected by dementia is a promising area of development, additional research validating the efficacy, utility and cost-effectiveness of these systems in patient populations is needed.

New technologies improve adenoma detection rate, adenoma miss rate, and polyp detection rate: a systematic review and meta-analysis.

BACKGROUND AND AIMS: The need to increase the adenoma detection rate (ADR) for colorectal cancer screening has ushered in devices that mechanically or optically improve conventional colonoscopy. Recently, new technology devices (NTDs) have become available. We aimed to compare the ADR, polyp detection rate (PDR), and adenoma miss rate (AMR) between NTDs and conventional colonoscopy and between mechanical and optical NTDs. METHODS: MEDLINE and Embase databases were searched from inception through September 2017 for articles or abstracts reporting ADR, PDR, and AMR with NTDs. Randomized controlled trials and case-control studies with >10 subjects were included. Primary outcomes included ADR, PDR, and AMR odds ratio (OR) between conventional colonoscopy and NTDs. Secondary outcomes included cecal intubation rates, adverse events, cecal intubation time, and total colonoscopy time. RESULTS: From 141 citations, 45 studies with 20,887 subjects were eligible for ≥1 analyses. Overall, the ORs for ADR (1.35; 95% confidence interval [CI] 1.24-1.47; P < .01) and PDR (1.51; 95% CI, 1.37-1.67; P < .01) were higher with NTDs. Higher ADR (OR, 1.52 vs 1.25; P = .035) and PDR (OR, 1.63 vs 1.10; P ≤ .01) were observed with mechanical NTDs. The overall AMR with NTDs was lower compared with conventional colonoscopy (OR, .19; 95% CI, .14-.26; P < .01). Mechanical NTDs had lower AMRs compared with optical NTDs (OR, .10 vs .33; P < .01). No differences in cecal intubation rates, cecal intubation time, or total colonoscopy time were found. CONCLUSIONS: Newer endoscopic technologies are an effective option to improve ADR and PDR and decrease AMR, particularly with mechanical NTDs. No differences in operability and safety were found.

Remotely Piloted Life-Saving Effort vehicles and emergency management: An analysis on revolutionizing humanitarian assistance in Pakistan.

The majority of the Pakistani public has known little of the unmanned aerial vehicles, also known for their onomatopoeically inspired name "drones," except the fact that it regularly rains Hellfire missiles in Pakistan, claiming the lives of many innocent Pakistanis settled in the western provinces. In actuality, in addition to their destructive capacities, these remotely piloted vehicles have been used since the turn of the century in a variety of live-saving and risk-reducing roles. This research article primarily addresses the third stage of Emergency management-response, with Pakistan being the primary region of research. This research article will first begin by diagnosing and accurately delineating the types of humanitarian crisis that grip Pakistan, devastating its land, exhausting its limited resources in its weak, and now almost archaic, disaster response strategy that results in the prolongation of its citizens' plight. Subsequently, this article will describe the history of the usage of unmanned vehicles, its multi-functional capacities, and its relevance in aiding humanitarian response efforts in disaster-stricken areas. Finally, this article will propose the introduction of Remotely Piloted Life-Saving Effort (RELIEF) vehicles in performing analysis and surveillance roles in Pakistan's disaster-prone and disaster-struck areas and its capacity to dramatically improve and expedite the existing relief supply delivery systems in place.

Participatory design of healthcare technology with children.

Purpose There are many frameworks and methods for involving children in design research. Human-Computer Interaction provides rich methods for involving children when designing technologies. The paper aims to discuss these issues. Design/methodology/approach This paper examines various approaches to involving children in design, considering whether users view children as study objects or active participants. Findings The BRIDGE method is a sociocultural approach to product design that views children as active participants, enabling them to contribute to the design process as competent and resourceful partners. An example is provided, in which BRIDGE was successfully applied to developing upper limb prostheses with children. Originality/value Approaching design in this way can provide children with opportunities to develop social, academic and design skills and to develop autonomy.

Novel sensing technology in fall risk assessment in older adults: a systematic review.

BACKGROUND: Falls are a major health problem for older adults with significant physical and psychological consequences. A first step of successful fall prevention is to identify those at risk of falling. Recent advancement in sensing technology offers the possibility of objective, low-cost and easy-to-implement fall risk assessment. The objective of this systematic review is to assess the current state of sensing technology on providing objective fall risk assessment in older adults. METHODS: A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). RESULTS: Twenty-two studies out of 855 articles were systematically identified and included in this review. Pertinent methodological features (sensing technique, assessment activities, outcome variables, and fall discrimination/prediction models) were extracted from each article. Four major sensing technologies (inertial sensors, video/depth camera, pressure sensing platform and laser sensing) were reported to provide accurate fall risk diagnostic in older adults. Steady state walking, static/dynamic balance, and functional mobility were used as the assessment activity. A diverse range of diagnostic accuracy across studies (47.9% - 100%) were reported, due to variation in measured kinematic/kinetic parameters and modelling techniques. CONCLUSIONS: A wide range of sensor technologies have been utilized in fall risk assessment in older adults. Overall, these devices have the potential to provide an accurate, inexpensive, and easy-to-implement fall risk assessment. However, the variation in measured parameters, assessment tools, sensor sites, movement tasks, and modelling techniques, precludes a firm conclusion on their ability to predict future falls. Future work is needed to determine a clinical meaningful and easy to interpret fall risk diagnosis utilizing sensing technology. Additionally, the gap between functional evaluation and user experience to technology should be addressed.

Promise of Mobile Health Technology to Reduce Disparities in Patients With Cancer and Survivors.

Despite recent advances in cancer control, numerous disparities exist in the areas of patient access to care, self-management, and quality of life. However, mobile health technology shows promise as a tool to reduce disparities among patients with cancer and cancer survivors by overcoming such barriers as limited access to providers, difficulty communicating with providers, and inadequate communication between patients and providers regarding symptoms. This narrative review draws on the literature in cancer and noncancer populations to identify factors that create or maintain disparities and to describe opportunities for mobile health technology to reduce disparities.