Evaluating the Clinical Effectiveness and Patient Experience of a Large Language Model–Based Digital Tool for Home-Based Blood Pressure Management: Mixed Methods Study

The further development of out-of-office BP monitoring: Japan's ImPACT Program Project's achievements, impact, and direction.

The need for a new generation of digital mental health tools to support more accessible, effective and equitable care.

The renal nerves contribute to hypertension through effects in the kidney that enhance sodium retention and renin secretion, and by effects in the central nervous system that increase systemic sympathetic activity. Therefore, targeting the renal nerves provides a logical basis for treating hypertension. Several trials of renal denervation––achieved by applying radiofrequency energy through catheters placed in the renal arteries–– have been completed. Clinical results have been inconsistent, however, partly because of factors related to the ablation technique and partly because these studies have been performed in patients with the inadequately defined clinical condition of “treatment-resistant hypertension.” This statement now explains our conclusion that future studies of renal denervation should be guided by the established randomized, controlled clinical trial designs used for studying antihypertensive drugs and other treatments for hypertension. © 2015 Wiley Periodicals, Inc.

A New Era of Renal Denervation Trials for Patients With Hypertension?

Digital health tools such as mobile apps and patient portals continue to be embedded in clinical care pathways to enhance mental health care delivery and achieve the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. However, a key issue that has greatly hindered the value of these tools is the suboptimal user engagement by patients and families. With only a small fraction of users staying engaged over time, there is a great need to better understand the factors that influence user engagement with digital mental health tools in clinical care settings. This review aims to identify the factors relevant to user engagement with digital mental health tools in clinical care settings using a sociotechnical approach. A scoping review methodology was used to identify the relevant factors from the literature. Five academic databases (MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO) were searched to identify pertinent articles using key terms related to user engagement, mental health, and digital health tools. The abstracts were screened independently by 2 reviewers, and data were extracted using a standardized data extraction form. Articles were included if the digital mental health tool had at least 1 patient-facing component and 1 clinician-facing component, and at least one of the objectives of the article was to examine user engagement with the tool. An established sociotechnical framework developed by Sittig and Singh was used to inform the mapping and analysis of the factors. The database search identified 136 articles for inclusion in the analysis. Of these 136 articles, 84 (61.8%) were published in the last 5 years, 47 (34.6%) were from the United States, and 23 (16.9%) were from the United Kingdom. With regard to examining user engagement, the majority of the articles (95/136, 69.9%) used a qualitative approach to understand engagement. From these articles, 26 factors were identified across 7 categories of the established sociotechnical framework. These ranged from technology-focused factors (eg, the modality of the tool) and the clinical environment (eg, alignment with clinical workflows) to system-level issues (eg, reimbursement for physician use of the digital tool with patients). On the basis of the factors identified in this review, we have uncovered how the tool, individuals, the clinical environment, and the health system may influence user engagement with digital mental health tools for clinical care. Future work should focus on validating and identifying a core set of essential factors for user engagement with digital mental health tools in clinical care environments. Moreover, exploring strategies for improving user engagement through these factors would be useful for health care leaders and clinicians interested in using digital health tools in care.

Delays in diagnosis and detection of skin neglected tropical diseases (NTDs) pose obstacles to prompt treatment, which is crucial in preventing disability. Recent developments in digital health have given rise to approaches that could increase access to diagnosis in resource-poor areas affected by skin NTDs. This scoping review provides an overview of current digital health approaches that aim to aid in the diagnosis of skin NTDs and provides an insight into the diverse functionalities of current digital health tools, their feasibility, usability, and the current gaps in research around these digital health approaches. This scoping review included a comprehensive literature search on PubMed, EMBASE and SCOPUS, following the PRISMA guidelines. Eleven studies were included in the review and were analysed using a descriptive thematic approach. Most digital tools were found to be mobile-phone based, such as mobile Health (mHealth) apps, store-and-forward tele-dermatology, and Short Messaging Service (SMS) text-messaging. Other digital approaches were based on computer software, such as tele-dermatopathology, computer-based telemedicine, and real-time tele-dermatology. Digital health tools commonly facilitated provider-provider interactions, which helped support diagnoses of skin NTDs at the community level. Articles which focused on end-user user experience reported that users appreciated the usefulness and convenience of these digital tools. However, the results emphasized the existing lack of data regarding the diagnostic precision of these tools, and highlighted various hurdles to their effective implementation, including insufficient infrastructure, data security issues and low adherence to the routine use of digital health tools. Digital health tools can help ascertain diagnosis of skin NTDs through remote review or consultations with patients, and support health providers in the diagnostic process. However, further research is required to address the data security issues associated with digital health tools. Developers should consider adapting digital health tools to diverse socio-cultural and technical environments, where skin NTDs are endemic. Researchers are encouraged to assess the diagnostic accuracy of digital health tools and conduct further qualitative studies to inform end-user experience. Overall, future studies should consider expanding the geographical and disease scope of research on digital health tools which aid the diagnosis of skin NTDs.

BackgroundDigital health tools (WeChat or mobile health apps) provide opportunities for new methods of hypertension management for hypertensive patients. However, the willingness of these patients to use social media and mobile health apps for hypertension management remains unclear. This study explored the characteristics and requirements of patients willing to use digital health (WDH) tools to manage hypertension.MethodsFrom February to March 2018, we administered questionnaires to 1089 patients with hypertension at eight Chinese primary medical units. We assessed independent risk factors of WDH and requirement among WDH patients.ResultsOverall, 43% (465/1089) of participants were WDH patients, who were younger (58 ± 12 vs 61 ± 13 years) and had a greater proportion of employed individuals (31% vs 14%) and higher education levels (65% vs 52%) than the non-WDH patients (all P < 0.0001). After adjusting for other risk factors, higher education (OR: 0.52; 95% CI: 0.34–0.79), good medicine adherence (OR: 1.5; 95% CI: 1.0–2.3) and blood pressure self-monitoring (OR: 1.6; 95% CI: 1.2–2.3) remained significantly associated with WDH (all P < 0.05). WDH patients responded that digital health tools should try to provide a platform for blood pressure monitoring (42%), medication reminders (41%), hypertension knowledge (39%) and doctor-patient communication (32%).ConclusionOur survey suggested that among hypertensive patients, willingness to use digital health tools was significantly associated with education, medicine adherence and blood pressure self-monitoring. Digital health tool developers and researchers should pay particular attention to recruiting older, less educated and unemployed patients with less willingness and who are less technologically savvy and research the requirements of WDH patients (blood pressure monitoring, medication reminders, and knowledge education) in the future.

Self blood pressure monitoring at home by wrist devices: a reliable approach?

ABSTRACTBackground or ContextStudies reporting the use of digital tools to promote the prevention and treatment of sexually transmitted and blood borne infections (STBBIs) have proliferated in recent years. Previous reviews highlight variability in the input sought from users in tool development, and its contribution to impact.ObjectiveThis scoping review sought to describe approaches to seeking and utilising user input, with the goal of providing guidance for developers.Search StrategySearches were conducted in MEDLINE, PsycInfo, and the Social Science Citation Index and results screened by two reviewers. The reference lists of included studies and review papers were also checked.Inclusion CriteriaPeer reviewed qualitative and mixed methods studies seeking user input on digital tools promoting the prevention and treatment of STBBIs, from prototyping onwards, published from after 2014 in English, were included.Data Extraction and SynthesisReported methods and findings were charted in Excel and synthesised using content analysis to provide an overview of methods and domains of user input and utilisation of this input.Main ResultsA total of 1838 unique titles and abstracts and the full text of 50 publications were screened. Data was charted from 37 eligible studies reporting findings from 34 projects developing digital health tools, including smartphone/tablet applications, websites/web‐based applications, chatbots, interactive automated SMS, and purpose‐built tools within dating and social media applications. Studies reported on tools developed for use by diverse target populations. The most common domain of input reported was usability (n = 31), while others—namely, satisfaction (n = 27), acceptability (n = 25), formative (n = 24), impact (n = 22), accessibility (n = 17), and engagement (n = 11)—were reported less consistently. User views were sought using qualitative methods such as interviews, focus groups and open‐ended survey questions, more often in combination with quantitative measures such as participant‐rated measures and engagement analytics. User suggestions for changes were reported in relation to three in four projects studied but incorporation of changes in less than half of projects.Discussion and ConclusionsThis review demonstrates considerable homogeneity in reported user input in the development of digital health tools. Input from users as co‐designers may improve the impact of tools on their intended outcomes.Patient and Public ContributionThis literature review brought together a group of researchers who have sought user input in the development of digital sexual health tools, but, due to resource limitations, did not involve potential users themselves, who are of diverse and disparate groups.

BACKGROUND Mental health disorders pose a significant challenge in low- and middle-income countries (LMICs), contributing substantially to the global disease burden. Despite the high prevalence of these disorders, LMICs allocate less than 1% of health budgets to mental health, resulting in inadequate care and a severe shortage of professionals. Stigma and cultural misconceptions further hinder access to mental health services. These challenges are present in Bangladesh, with high prevalence rates of depression and anxiety, a centralized and under-resourced mental health care system. Digital tools, such as smartphone applications and online platforms, offer innovative solutions to these challenges by increasing accessibility, cost-effectiveness, and scalability of mental health interventions. OBJECTIVE This study aims to characterise the views around digital tools for mental health among residents of Korail, a major slum in Dhaka, Bangladesh, including the use of smartphones and investigate acceptable digital tools, and barriers and facilitators for digital mental health tools. METHODS Eight focus groups (FGs) were conducted with 38 participants, including individuals with serious mental disorders and their caregivers. The FGs were transcribed, translated, and analysed using thematic analysis with NVivo 14 software. RESULTS The findings revealed a general lack of awareness and understanding of digital mental health tools among slum residents. However, there was a notable appetite in these tools, recognising their potential to provide timely and cost-effective support, reduce hospital visits, and make healthcare more accessible. Participants highlighted the convenience and communication benefits of smartphones but expressed concerns about misuse such as excessive use, particularly among adolescents. Barriers to the utilisation of digital mental health tools included limited technological literacy and accessibility issues. Despite these challenges, participants acknowledged the potential of these tools to bridge the gap in mental health services, especially for those unable to travel. The importance of providing proper guidance and education to maximize the effectiveness of digital tools was emphasized. CONCLUSIONS Digital mental health tools hold promises for improving mental health care in underserved slum communities. This study underscores the need for further research and investment in tailored digital mental health solutions to address the unique needs of slum populations in LMICs.

Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.

Cardiovascular (CV) diseases remain a leading global cause of death. Lowering blood pressure (BP) reduces the risk of CV complications, especially stroke and acute coronary events, and it delays the progression of kidney disease. Adequate non-pharmacological treatment improves the effectiveness of the antihypertensive therapy. A Mediterranean diet with high content of vegetables (rich in tomatoes) is associated with a reduced CV risk. The main objective of the present study was to assess whether the addition of standardised tomato extract (STE) or acetylsalicylic acid (ASA) to standard antihypertensive therapy can improve BP control in patients with arterial hypertension (HT). The study involved 82 high-risk hypertensive patients. Patients with primary HT at high to a very high total CV risk were randomised in a blinded fashion to one of two groups, i.e. the ASA and STE group. The patients had two visits, a baseline visit and one after four weeks of treatment. In all the patients, during each visit, clinical BP and ambulatory BP measurements (ABPM) were performed. Platelet aggregation was determined using the VerifyNow analyser. After four weeks of treatment in the STE group, there was a statistically significant reduction in 24-h systolic BP, diastolic BP, and mean arterial pressure values measured in ABPM (p < 0.001). After four weeks of treatment in the STE group there was a statistically significant reduction in pulse pressure (PP) during the daytime and during 24 h (p < 0.05). Interestingly, it was found that the use of STE in obese patients significantly decreased the day PP (p < 0.05). After four weeks of treatment in the ASA group there was no statistically significant reduction in BP values measured in ABPM. The results of this study show that the addition of STE to standard antihypertensive therapy improves BP control in hypertensive patients with high CV risk. This effect, together with the anti-aggregatory effect, may indicate the pleiotropic effect of tomato extract. This fact justifies further research into functional foods and gives new insights into STE as a food supplement that could have new therapeutic and prophylactic uses for the treatment of hypertensive patients with high CV risk and especially with obesity.

[corrected] Increased values of thyroid hormones in the clinical syndrome of hyperthyreosis affect blood pres sure values and its circadial variation. The aim of this study was to define the influence of hyperthyreosis on the values and circadial variations of arterial blood pressure, as well as to investigate the effect of thyroid surgery on blood pressure values. We compared the 24-hour averages of systolic and diastolic blood pressure, their variations and their reduction during the night between 20 female patients with hyperthyroidism and hypertension de novo and 20 healthy females. We compared the values of 24-hour ambulatory monitoring performed before the surgery with the values gathered two weeks after the surgery. The 24-hour average systolic and diastolic blood pressure values were higher in the patients with hyperthyroidism than in the control group (p < 0.001). In the group of patients, the variations in blood pressure were significantly higher than they were in the group of healthy people (p < 0.001). The amplitude of the nocturnal reduction of blood pressure was also significantly lower in the patients with hyperthyroid status and hypertension, in comparison to the healthy persons (p < 0.001). Two weeks after the surgery, a significant reduction of blood pressure values (both for systolic and diastolic) appeared. The patients with hyperthyroidism caused hypertension had higher systolic and dia stolic blood pressure, higher variations in blood pressure and lower nocturnal reduction of blood pressure than healthy subjects. Thyroid surgery, as a control of thyroid function, optimised blood pressure very rapidly.

Continuous blood pressure monitoring is essential in the management of patients in critical conditions, as well as those under anesthesia. However, continuous blood pressure monitoring requires insertion of a catheter into the radial artery. Thus, continuous noninvasive arterial blood pressure monitoring would be ideal. We designed and built a continuous noninvasive arterial blood pressure monitoring device with a pressure sensor diaphragm using microelectromechanical system technology, a square with 4 mm sides that were 0.4 mm thick. Comparisons between a continuous noninvasive arterial blood pressure monitoring device and a sphygmomanometer were carried out on 92 volunteers, and comparisons between noninvasive and invasive blood pressure monitoring were performed on three patients perioperatively at Fukushima Medical University Hospital. In the comparisons of arterial blood pressure measurements between a sphygmomanometer and our device, the differences became gradually greater over time after starting continuous monitoring in conscious participants. In the comparisons of arterial blood pressure measurements between the invasive and noninvasive methods in unconscious subjects under general anesthesia, the results of noninvasive monitoring were consistent with those of invasive arterial blood pressure monitoring. Continuous noninvasive arterial monitoring with a pressure sensor diaphragm using microelectromechanical system technology is a possible alternative to conventional invasive arterial pressure monitoring by an arterial catheter.

Background: The co-creation of integrated care delivery models and digital health tools with clinicians, patients, and their families is needed to address gaps in trajectories and transitions of rehabilitation care. Clients often refer to transitions as the in-betweens where they feel alone to rebuild your [their] day-to-day activities, to restore your [their] routine, to maintain your [their] physical activity level. Integrated practice units (IPU) can help during transitions by improving communication, coordination, and continuity of care. Digital health tools and evaluation protocols support IPUs by providing opportunities to increase efficiencies in care, application of stroke best practices, and activating patient and family involvement while optimizing costs. Approach: The CCOMTL health region in 209 created the Neurosciences IPU to ensure a smoother transition for clients from inpatient care to outpatient services and improve links with community partners and home-care services. The IPU includes a client and caregiver focus, integrated comprehensive care paths, with smooth transfer across a fixed or virtual team of providers, ongoing performance management and improvement cycles with input from patient experience measures and outcomes, and value-based healthcare (VBHC) evaluations. In collaboration with BRILLIANT, an academic and clinical partnership, an integrated knowledge translation and qualitative methodology was used to identify needs and gaps in rehabilitation trajectories and co-create digital health tools. Forty-five clinicians and 25 patients/caregivers across the CCOMTL and three other health regions participated in focus groups or interviews for the co-creation of digital health solutions. Two digital tools were developed that will form part of a trajectory platform: the electronic Mayo-Portland Assessment Inventory (e-MPAI), and the clinical information system for the Early Supported Discharge (ESD) program. Results: Data from the VBHC business intelligence system of the CCOMTL showed that, between 209 and 2022, on average the length of stay in acute care decreased by 2 days and the time to initiate in-patient rehabilitation decreased from 20 days to 4.4 days. The cost per episode decreased on average by $000. The needs and gaps across trajectories of care that digital health tools can help address were classified under five themes: ) Enabling continuity of care (e.g. standardized assessments), 2) System design (e.g. information services), 3) Community service accessibility, 4) Transportation services, 5) Individuals uncertainty during transitions. The development of the eMPAI occurred over four meetings within each health setting and two inter-site meetings. The main gaps addressed by the e-MPAI were to provide a standardized metric to the clinical team to evaluate patient activity limitations and participation restrictions when they transition from in-patient to community care, and a dashboard to support decision-making at the individual patient level and program level. The eMPAI has been used for 5 clients, with scores of 45% being shared across transitions of care between health regions.The co-creation of the ESD clinical information system occurred over year with the coordinator, clinicians, and a patient partner. The system includes the following modules: Standardized measures; Communication and information exchange; Shared intervention plan and goals; Client self-management support; and Quality improvement dashboard. Implementation of the platform is starting and indicators of adoption, impact on efficiencies of care, clinician best practice and experience, and client outcomes and experience will be evaluated.Implications: The development of the Neuroscience IPU and the co-creation of digital health tools represents a path to improving stroke care by providing the right intervention to the right person at the right time, accounting for long-term functional potential and meaningful participation in the community. The IPU aims to improve VBHC by integrating digital health into workflows, including standardized assessments with decision support, to optimize the organization of care across the continuum and during transitions.