Use of a mobile application for the control of anticoagulation with warfarin: a cluster randomized controlled clinical trial - Ijui/RS/Brazil

Abstract To evaluate the effectiveness of an anticoagulation protocol adapted in a mobile application (appG) for patients using warfarin. This was a cluster randomized controlled clinical trial carried out in basic health centers of Ijui, RS, Brazil, between April and October 2017. The appG was installed on the cell phones of all physicians belonging to the intervention group. Primary outcomes were bleeding and thrombosis, and secondary outcomes were changes in the dose of warfarin, use of new drugs, drug interactions, search for health services, and remaining on the target international normalized ratio. Thirty-three patients belonging to 11 basic health centers were included in this study. From these, 15 patients were in the intervention group which used the appG, and 18 were in the control group. After 6 months, patients in the appG group had fewer bleeding events (7% versus 50%, p-value=0.028) and a lower weekly dose of warfarin (29.3 ± 9.7 mg versus 41.7 ± 12.5 mg, p-value=0.030) when compared to the control group. The anticoagulation protocol adapted in a mobile app reduced bleeding in patients using warfarin.

Medical Mobile App Classification Using the National Institute for Health and Care Excellence Evidence Standards Framework for Digital Health Technologies: Interrater Reliability Study.

BACKGROUND: Clinical governance of medical mobile apps is challenging, and there is currently no standard method for assessing the quality of such apps. In 2018, the National Institute for Health and Care Excellence (NICE) developed a framework for assessing the required level of evidence for digital health technologies (DHTs), as determined by their clinical function. The framework can potentially be used to assess mobile apps, which are a subset of DHTs. To be used reliably in this context, the framework must allow unambiguous classification of an app's clinical function. OBJECTIVE: The objective of this study was to determine whether mobile health apps could be reliably classified using the NICE evidence standards framework for DHTs. METHODS: We manually extracted app titles, screenshots, and content descriptions for all apps listed on the National Health Service (NHS) Apps Library website on July 12, 2019; none of the apps were downloaded. Using this information, 2 mobile health (mHealth) researchers independently classified each app to one of the 4 functional tiers (ie, 1, 2, 3a, and 3b) described in the NICE digital technologies evaluation framework. Coders also answered contextual questions from the framework to identify whether apps were deemed to be higher risk. Agreement between coders was assessed using Cohen κ statistic. RESULTS: In total, we assessed 76 apps from the NHS Apps Library. There was classification agreement for 42 apps. Of these, 0 apps were unanimously classified into Tier 1; 24, into Tier 2; 15, into Tier 3a; and 3, into Tier 3b. There was disagreement between coders in 34/76 cases (45%); interrater agreement was poor (Cohen κ=0.32, 95% CI 0.16-0.47). Further investigation of disagreements highlighted 5 main explanatory themes: apps that did not correspond to any tier, apps that corresponded to multiple tiers, ambiguous tier descriptions, ambiguous app descriptions, and coder error. CONCLUSIONS: The current iteration of the NICE evidence standards framework for DHTs did not allow mHealth researchers to consistently and unambiguously classify digital health mobile apps listed on the NHS app library according to their functional tier.

The Utility of Smartphone Applications and Technology in Wound Healing.

Appropriate management of both acute and chronic wounds is a dynamic practice that consumes large amounts of time and financial resources within the health care system. Traditionally, wounds were measured clinically and subjectively, leading to inaccuracies in assessing wound progression and healing over time. The recent development of mobile applications and digital equipment in medicine provides an opportunity for significant improvement in wound care through the incorporation of "smart" technologies in clinical practice. The utility of these technologies has been assessed regarding the treatment of diabetic foot ulcers, burns, and general wounds. The focus of this review is to provide an update on the current status of mobile applications and digital technology in the management of wounds.

Assessment of mobile phone applications for care management in gynecology and obstetrics.

We identified mobile applications (apps) found on digital platforms (iTunes Store and Google Play) that addressed topics about gynecology and obstetrics.

The App Behavior Change Scale: Creation of a Scale to Assess the Potential of Apps to Promote Behavior Change.

BACKGROUND: Using mobile phone apps to promote behavior change is becoming increasingly common. However, there is no clear way to rate apps against their behavior change potential. OBJECTIVE: This study aimed to develop a reliable, theory-based scale that can be used to assess the behavior change potential of smartphone apps. METHODS: A systematic review of all studies purporting to investigate app's behavior change potential was conducted. All scales and measures from the identified studies were collected to create an item pool. From this item pool, 3 health promotion exerts created the App Behavior Change Scale (ABACUS). To test the scale, 70 physical activity apps were rated to provide information on reliability. RESULTS: The systematic review returned 593 papers, the abstracts and titles of all were reviewed, with the full text of 77 papers reviewed; 50 papers met the inclusion criteria. From these 50 papers, 1333 questions were identified. Removing duplicates and unnecessary questions left 130 individual questions, which were then refined into the 21-item scale. The ABACUS demonstrates high percentage agreement among reviewers (over 80%), with 3 questions scoring a Krippendorff alpha that would indicate agreement and a further 7 came close with alphas >.5. The scale overall reported high interrater reliability (2-way mixed interclass coefficient=.92, 95% CI 0.81-0.97) and high internal consistency (Cronbach alpha=.93). CONCLUSIONS: The ABACUS is a reliable tool that can be used to determine the behavior change potential of apps. This instrument fills a gap by allowing the evaluation of a large number of apps to be standardized across a range of health categories.

'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.

A review of smartphone apps for smoking cessation available in Portuguese. / Revisão dos aplicativos de smartphones para cessação do tabagismo disponíveis em língua portuguesa.

Smartphone apps are being developed as a complement to smoking cessation treatment. The current study aimed to analyze the content of available apps in Portuguese in two operational systems, Android and iOS. Fifty-one apps were found in iTunes and 600 in Google Play. Content evaluation included apps that focused on smoking cessation, with a total of 12 apps in iOS and 3 in Android. Each app was categorized according to its approach to smoking cessation and scored according to level of adherence to the Treating Tobacco Use and Dependence smoking cessation treatment guideline. Nine apps were classified as calendars, 8 as information tools, 6 as calculators, 3 as cigarette trackers, and 1 as hypnosis. The apps showed low level of adherence to the guideline, with a mean score of 12.8. We recommend that the available apps be revised and that future apps be developed using evidence-based practices for smoking cessation.

Revisão dos aplicativos de smartphones para cessação do tabagismo disponíveis em língua portuguesa / Revisión de aplicaciones de smartphones para dejar de fumar en portugués / A review of smartphone apps for smoking cessation available in Portuguese

Resumo: Aplicativos de smartphones estão sendo desenvolvidos como uma forma complementar ao tratamento do tabagismo. O presente estudo teve como objetivo analisar o conteúdo de aplicativos disponíveis na língua portuguesa em dois sistemas operacionais: Android e iOS. Cinquenta e um aplicativos foram encontrados no iTunes e 600 no Google Play. Foram incluídos na avaliação do conteúdo aqueles aplicativos que tivessem como foco a cessação do tabagismo, com um total de 12 no iOS e 3 no Android. Cada aplicativo foi categorizado por meio da sua abordagem na cessação de tabagismo e pontuado de acordo com o seu nível de aderência às diretrizes de tratamento de tabagismo do Treating Tobacco Use and Dependence. Em relação às categorias, 9 foram classificados como calendário, 8 como informativo, 6 como calculadora, 3 como medidor de cigarros fumados e 1 como hipnose. Os aplicativos apresentaram baixo nível de aderência às diretrizes, com uma média de 12,8. Recomenda-se que os aplicativos disponíveis sejam revisados e que futuros aplicativos sejam desenvolvidos utilizando práticas baseadas em evidência para a cessação do tabagismo.

Resumen: Aplicaciones para smartphones se están desarrollando como un complemento al tratamiento del tabaquismo. Este estudio tuvo como objetivo analizar el contenido de aplicaciones disponibles en el idioma portugués en dos sistemas operativos: Android y iOS. Cincuenta y un aplicaciones fueron encuentradas en iTunes y 600 en Google Play. Se incluyeron en la evaluación las aplicaciones que se han centrado en dejar de fumar, con un total de 12 en iOS y 3 en Android. Se clasificó cada aplicación de acuerdo a su enfoque para el abandono del hábito de fumar y se anotó de acuerdo con el nivel de adherencia a la guía de tratamiento del Treating Tobacco Use and Dependence. Nueve aplicaciones se clasificaron como calendarios, 8 como herramientas de información, 6 como calculadoras, 3 como seguidores de cigarrillos y 1 como hipnosis. Las aplicaciones mostraron un bajo nivel de adherencia a la guía de tratamiento, con una puntuación media de 12,8. Recomendamos que se revisen las aplicaciones disponibles y que las aplicaciones futuras se desarrollen utilizando prácticas basadas en la evidencia para dejar de fumar.

Abstract: Smartphone apps are being developed as a complement to smoking cessation treatment. The current study aimed to analyze the content of available apps in Portuguese in two operational systems, Android and iOS. Fifty-one apps were found in iTunes and 600 in Google Play. Content evaluation included apps that focused on smoking cessation, with a total of 12 apps in iOS and 3 in Android. Each app was categorized according to its approach to smoking cessation and scored according to level of adherence to the Treating Tobacco Use and Dependence smoking cessation treatment guideline. Nine apps were classified as calendars, 8 as information tools, 6 as calculators, 3 as cigarette trackers, and 1 as hypnosis. The apps showed low level of adherence to the guideline, with a mean score of 12.8. We recommend that the available apps be revised and that future apps be developed using evidence-based practices for smoking cessation.

Persian mHealth Apps: A Cross Sectional Study Based on Use Case Classification.

Mobile health apps play an important role in healthcare processes and health promotion. In recent years many Persian mhealth apps were developed and are available in various national app markets. Cafebazaar is the largest Persian app store that contains more than 3500 android apps in medical and health & fitness categories. In this study some characteristics of 200 top Persian medical apps of Cafebazaar were investigated and then categorized by their use cases. Results showed that only 6% of apps declare the involvement of at least one health professional in the conception or development of the apps. In 35% of studied apps, no contact information was provided for the users and 10.5% applied reliable sources for their content. 13 distinct use cases were found in all 200 apps of which two were new to an already published use-case model. This study shows that Persian mHealth apps, like other existing apps in the world, have a long way to improve and reach some basic standards. Lack of regulatory agencies and absence of a dynamic evaluation system for mHealth apps might be the main reason of these defects. This study also shows that 20 use cases existing in international health related apps are not yet used in Persian apps and therefore there is a reach potential of creating new apps in mHealth field.

Classification of Health Related Applications.

Although there is a large number of health related apps available in the stores of the major mobile platforms, the stores do not really offer clear definitions of what health related apps are and how they can be categorized. A similar picture is found in literature. Here, many proposals covering different app related aspects have been published, but often, these only cover a narrow field. There is no common terminology describing what health apps are and neither is there a common classification. In order to alleviate the situation, we developed a proposal for categorization that can be used as a basis for discussing aspects related to health applications and for describing the unclear situation on the market. In this paper, the function related aspects are covered, although the scheme itself covers many other aspects related to users of health apps, technical aspects and so on. This initial classification was applied to a sample of health apps available for iOS and Android.

Current Status and Quality Assessment of Cardiovascular Diseases Related Smartphone Apps in China.

To examine current status and quality of CVD related apps available for download in China, a total of 151 apps from the top popular six app stores were analyzed. Data analysis uncovered a range of issues including missing of key variables in the pre-formatted daily records, no platform for interaction with relevant healthcare professionals and undesirable user-interface design. More importantly, these apps had low levels of adherence to internationally recognized guidelines in CVD management. Overall quality score of these apps was below the average (8.08/20). This study identified areas for improvement concerning the existing CVD related apps. Information may guide the further advancement of CVD related apps and benefit CVD management in China.

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.

Digital disease detection and participatory surveillance: overview and perspectives for Brazil.

This study aimed to describe the digital disease detection and participatory surveillance in different countries. The systems or platforms consolidated in the scientific field were analyzed by describing the strategy, type of data source, main objectives, and manner of interaction with users. Eleven systems or platforms, developed from 1996 to 2016, were analyzed. There was a higher frequency of data mining on the web and active crowdsourcing as well as a trend in the use of mobile applications. It is important to provoke debate in the academia and health services for the evolution of methods and insights into participatory surveillance in the digital age.

Análisis de la calidad y seguridad de la información de aplicaciones móviles en prevención terciaria / Quality and security analysis of mobile applications in tertiary prevention

Objetivo: Analizar la calidad y seguridad de la información de las aplicaciones móviles en la App Store de Apple® destinadas a prevención terciaria. Material y métodos: Estudio observacional transversal de las aplicaciones móviles más populares en la categoría de medicina disponibles en Apple Store® a día de 21 de diciembre de 2014. Las aplicaciones fueron evaluadas con los criterios establecidos en el programa AppSaludable. Se seleccionaron aquellos criterios relacionados con la evaluación de la calidad y seguridad de la información. Resultados: De las 160 aplicaciones recogidas, sólo 12 aplicaciones estaban incluidas en la prevención terciaria. Todas las aplicaciones recuperadas estaban relacionadas con la adherencia, diabetes, hipertensión y alergia. Las aplicaciones desarrolladas por equipos multidisciplinares fueron las que presentaron mayor rigor en su información, Conclusiones: La presencia de un profesional sanitario como colaborador de la aplicación parece mejorar la calidad de la información (AU)

Objective: Analyze quality and information security of mobile applications in the Apple App Store® used for tertiary prevention. Methods: Cross-sectional study of the most popular mobile applications in the category of medicine available in Apple Store® to date of 21 December 2014. Criteria established in the AppSaludable program and related to quality and information security criteria were used for applications’ assessment. Results: Of the 160 applications found, only 12 applications were included in tertiary prevention. They were related to adherence, diabetes, hypertension and allergy. Applications developed by multidisciplinary teams showed more rigorous information. Conclusion: The presence of a health professional as a team member would improve information quality (AU)

Mobile Health Applications, in the Absence of an Authentic Regulation, Does the Usability Score Correlate with a Better Medical Reliability?

Health-related mobile applications (apps) have been shown to improve the quality of health and patient care. Their use in clinical and health-related environments is becoming more considerable. The number of health-related apps available for download has considerably increased, while the regulatory position of this new industry is not well known. Despite this lack of regulation, measuring the usability score of these apps is not difficult. We compared two samples of twenty health-related applications each. One of the samples contained the apps with top-rated usability scores, and the other contained the apps with lowest-rated usability scores. We found that a good usability score correlates with a better medical reliability of the app's content (p<0.005). In the period in which a valid regulation is still lacking, calculation and attribution of usability scores to mobile applications could be used to identify apps with better medical quality. However, the usability score method ought to be rigorous and should not be rounded off with a simple five stars rating (as is the case in the classic app stores).

Comparision and analysis of top 10 exercise android Apps in mainland China.

Medical guidelines highly recommend physical activity and aerobic exercise in the prevention of primary and secondary cardiovascular disease. The use of exercise-promoting application software may improve clinical outcomes for cardiovascular disease (CVD) patients. The study aimed to compare and analyze the functions of the top 10 exercise Android Apps which had more than 1,000,000 downloads from the main four Android App stores in mainland China. The results showed that most of these popular apps had pedometer, exercise plan preset, user data presentation, user encouragement and community sharing functions while a few of them had exercise video clips or animation support and wearable devices. Given these data, the conclusion is that these popular apps fulfill some of the functions recommended by medical guidelines, however, lack of some functions such as pre-exercise risk assessment, the exercise intensity recording, specific instructions by professionals, and monitoring functions for CVD patients.

Evaluating diabetes mobile applications for health literate designs and functionality, 2014.

INTRODUCTION: The expansion of mobile health technologies, particularly for diabetes-related applications (apps), grew exponentially in the past decade. This study sought to examine the extent to which current mobile apps for diabetes have health literate features recommended by participants in an Institute of Medicine Roundtable and compare the health literate features by app cost (free or not). METHODS: We used diabetes-related keywords to identify diabetes-related apps for iOS devices. A random sample of 110 apps (24% of total number of apps identified) was selected for coding. The coding scheme was adapted from the discussion paper produced by participants in the Institute of Medicine Roundtable. RESULTS: Most diabetes apps in this sample addressed diabetes management and therapeutics, and paid apps were more likely than free apps to use plain language strategies, to label links clearly, and to have at least 1 feature (a "back" button) that helps with the organization. CONCLUSION: Paid apps were more likely than free apps to use strategies that should be more useful and engaging for people with low health literacy. Future work can investigate ways to make free diabetes mobile apps more user-friendly and accessible.

Toward a use case based classification of mobile health applications.

Smartphones are growing in number and mobile health applications (apps) are becoming a commonly used way for improving the quality of health and healthcare delivery. Health related apps are mainly centralized in Medical and health&fitness categories in Google and Apple app stores. However, these apps are not easily accessible by the users. We decided to develop a system facilitating the access to these apps, to increase their visibility and usability. Various use cases for 567 health related apps in French were identified and listed incrementally. UML modeling was then used to represent these use cases and their relationships with each other and with the potential users of these apps. Thirty one different use cases were found that were then regrouped into six major categories: consulting medical information references, communicating and/or sharing the information, fulfilling a contextual need, educational tools, managing professional activities, health related management. A classification of this type would highlight the real purpose and functionalities of these apps and offers the user to search for the right app rapidly and to find it in a non-ambiguous context.