Phases in development of an interactive mobile phone-based system to support self-management of hypertension

BackgroundIn cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects.ObjectiveTo explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects.MethodsEleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis.ResultsThe patients' experiences of using a mobile phone-based system were identified and constructed as: “being involved,” “pacing oneself,” and “managing the questions.” “Being involved” refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. “Pacing oneself” describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. “Managing the questions” pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment.ConclusionsThis mobile phone-based system reinforced the patients’ feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming.

Background. Tongue diagnosis is one of the main diagnostic methods in Chinese Medicine (CM). In addition to being used with other techniques to generate a CM diagnosis, methods derived from CM tongue diagnosis may have new applications, especially in early detection of certain diseases. Therefore, we believe that automating the collection and analysis of tongue images is of great benefit. While several methods for capturing images, extracting features and analyzing the data have been proposed over the years, most have limitations in reliability, accuracy, cost and usability. Nonetheless, recent advances in the field of image processing and machine learning (ML), together with improved hardware capabilities are rapidly enabling novel solutions to the problem. This paper describes a new mobile phone-based image acquisition method and reports our assessment of image quality from a clinical perspective. Methodology. A mobile phone-based system that uses a phone's flash and back camera to collect images with automatic white balance was developed. The usability and image quality were tested on forty (40) volunteers. Information pertaining to CM diagnosis of the tongue was collected through direct visual inspection, and by inspecting images produced by a commercially available tongue image diagnostic instrument, and by our newly developed system. The data collected amongst the three methods were compared using Cohen's kappa coefficient to evaluate the practical value of the images collected by the new system. Result. Our system is able to collect good quality tongue images and in general provides information comparable to those obtained through direct visual inspection or by the commercial instrument. Compared with the commercial instrument, our system has better inter-rater agreement with direct visual inspection in detecting the presence of tooth marks (kappa value: 0.633 vs 0.259), but inferior in detecting tongue coating greasiness (kappa value: 0.217 vs 0.739). Main contributions of this paper. We have presented a new mobile phone-based tongue image acquisition system that is low cost and convenient to use. Because of these desirable features, the system has the potential for mass public use to collect big data, paving the way for development of automatic tongue analysis using deep learning techniques.

A mobile phone-based system has been developed to detect and transmit notification of elderly person daily-life emergency situations. The system employs a dual axis accelerometer, two low-power active filters, a low-power 8-bit single chip microcomputer, two mobile phones and a personal computer. The dual axis accelerometer measures body movements produced by respiration, posture changing, falling and activities. If the person's respiration is paused for 3 minutes, or if they are in an inactive state for 1 minute after falling, or for 64 minutes without previously falling, then the system automatically sends the person's location by e-mail. It also informs the patient's family by voice, via the mobile phone, of the emergency situation.

Percutaneous Closure of the Patent Ductus Arteriosus in Very Low Weight Infants: Considerations Following US Food and Drug Administration Approval of a Novel Device

BackgroundGhana introduced a mobile phone-based contribution payment system in its national health insurance scheme (NHIS) in December 2018 to improve the process of enrolment. We evaluated the effect of this digital health intervention on retention of coverage in the Scheme, one year after its implementation.MethodsWe used NHIS enrolment data for the period, 1 December 2018–31 December 2019. Descriptive statistics and propensity-score matching method were performed to examine a sample of 57,993 members’ data.ResultsProportion of members who renewed their membership in the NHIS via the mobile phone-based contribution payment system increased from 0% to 8.5% whilst those who did so through the office-based system only grew from 4.7% to 6.4% over the study period. The chance of renewing membership was higher by 17.4 percentage points for users of the mobile phone-based contribution payment system, compared to those who used the office-based contribution payment system. The effect was greater for the informal sector workers, males and the unmarried.ConclusionsThe mobile phone-based health insurance renewal system is improving coverage in the NHIS particularly for members who hitherto were less likely to renew their membership. Policy makers need to devise an innovative way for new members and all member categories to enrol using this payment system to accelerate progress towards attainment of universal health coverage. Further study needs to be conducted using mixed-method design with inclusion of more variables.

The prominence of mobile devices and recent breakthroughs in machine learning have enabled an emerging class of new mobile health systems which hold the promise of transforming today's reactive healthcare practice to proactive, individualized care and wellbeing. However, the current mainstream machine learning approaches are largely supervised and must be trained by a large amount of labelled high-quality data. In contrast, due to small form factor and limited sensing capability, today's off-the-shelf mobile devices can only collect noisy and sporadic samples from users. Moreover, personal health data collected by on-device sensors cannot be uploaded or shared with other devices due to privacy concerns. These challenges have significantly hindered the performance and utility of mobile health systems in real-world settings. In this talk, I will first discuss new mobile systems that exploit human physiological models and innovative use of sensing modalities to achieve highly robust sensing performance without requiring extensive training. I will describe RunBuddy - the first smartphone-based system for monitoring continuous running rhythm and improving exercise efficiency. To mitigate significant environmental noise during running, RunBuddy integrates novel ambient sensing algorithms and a physiological model called Locomotor Respiratory Coupling (LRC). Based on this result, we also develop BreathCoach, a smart and unobtrusive system using smartwatch and smartphone-based VR for in-home RSA-BT (Respiratory Sinus Arrhythmia biofeedback-based Breathing Training), which is a common cardiorespiratory intervention to diseases such as asthma and an effective exercise to reduce anxiety. BreathCoach continuously monitors key bio-signals such as breathing pattern and inter-beat interval, and then recommends breathing patterns in the form of an intuitive VR game to provide an immersive training experience. In the second part of this talk, I will discuss a new approach for home activity recognition via federated learning. People spend significant portion of time in home. Characterizing home activities including both individual and family activities is important for studies of health, sociology, and home economics. For instance, risk factors of dementia and childhood obesity are strongly associated with a family's daily activities, and activity logging is proved a very effective approach to improve the self-awareness and motivate people to modify their behaviors toward a healthy lifestyle. Unfortunately, to date, there has been no unobtrusive and convenient methods to log family activities. I will present several new sensing and federated learning algorithms that enable mobile devices to collaboratively improve the accuracy of home activity sensing without sharing any sensor data, preserving user privacy.

The worldwide adoption of mobile devices presents an opportunity to build mobile systems to support health workers in low-resource settings. This paper presents an in-depth field evaluation of a mobile system that uses a smartphone's built-in camera and computer vision to capture and analyze diagnostic tests for infectious diseases. We describe how health workers integrate the system into their daily clinical workflow and detail important differences in system usage between small clinics and large hospitals that could inform the design of future mobile health systems. We also describe a variety of strategies that health workers developed to overcome poor network connectivity and transmit data to a central database. Finally, we show strong agreement between our system's computed diagnoses and trained health workers' visual diagnoses, which suggests that our system could aid disease diagnosis in a variety of scenarios. Our findings will help to guide ministries of health and other stakeholders working to deploy mobile health systems in similar environments.

In this paper, we introduce a new concept, Physical-Social Location (PSL), and propose MPSL, a mobile phone-based system to verify users’ self-report location claims for mobile social network service (MSNS). Unlike instant discrete location points, PSLs are geographic regions obtained over longer timescales and center around regularly visited locations of social significance, e.g., workplaces or neighborhoods. PSL verification can prevent the user from reporting fake locations, e.g. GPS coordinate, trajectory or geographic profile, to location-sensitive applications as well as aid online credibility in MSNS. In our MPSL system, a user’s location claim is proved by a set of selective co-located people serving as ”witnesses”. It is composed of two parts, i.e., proof generation and verification. The former leverages a certain number of co-located people to generate co-location certificates as location proofs during their physical encounters via Bluetooth. An efficient verification scheme is proposed to make our system accurate and adaptive. Besides, incentive are taken into account to keep our distributed system applicable. We have implemented the MPSL system using real-world Nokia N82 phones. Our experimental results show that our mobile phone based system can achieve high verification accuracy and good privacy protection.

BackgroundPrevious trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined.ObjectiveThe objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes.MethodsOne hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients’ mobile phones and alerts to a cardiologist’s mobile phone as required.ResultsBaseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics.ConclusionsOur findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones.Trial RegistrationClinicalTrials.gov NCT00778986

Self-management support tools using technology may improve adherence to hypertension treatment. There is a need for user-friendly tools facilitating patients’ understanding of the interconnections between blood pressure, wellbeing and lifestyle. This study aimed to examine comprehension, comprehensiveness and relevance of items, and further to evaluate the usability and reliability of an interactive hypertension-specific mobile phone self-report system. Areas important in supporting self-management and candidate items were derived from five focus group interviews with patients and healthcare professionals (n = 27), supplemented by a literature review. Items and response formats were drafted to meet specifications for mobile phone administration and were integrated into a mobile phone data-capture system. Content validity and usability were assessed iteratively in four rounds of cognitive interviews with patients (n = 21) and healthcare professionals (n = 4). Reliability was examined using a test–retest. Focus group analyses yielded six areas covered by 16 items. The cognitive interviews showed satisfactory item comprehension, relevance and coverage; however, one item was added. The mobile phone self-report system was reliable and perceived easy to use. The mobile phone self-report system appears efficiently to capture information relevant in patients’ self-management of hypertension. Future studies need to evaluate the effectiveness of this tool in improving self-management of hypertension in clinical practice.

To describe the design and application of an emergency response mobile phone-based information system for infectious disease reporting. Software engineering and business modeling were used to design and develop the emergency response mobile phone-based information system for infectious disease reporting. Seven days after the initiation of the reporting system, the reporting rate in the earthquake zone reached the level of the same period in 2007, using the mobile phone-based information system. Surveillance of the weekly report on morbidity in the earthquake zone after the initiation of the mobile phone reporting system showed the same trend as the previous three years. The emergency response mobile phone-based information system for infectious disease reporting was an effective solution to transmit urgently needed reports and manage communicable disease surveillance information. This assured the consistency of disease surveillance and facilitated sensitive, accurate, and timely disease surveillance. It is an important backup for the internet-based direct reporting system for communicable disease.

The increased penetration of mobile devices has created opportunities in the health sector and led to emerging of mobile health systems. As much as the mobile health systems have registered tremendous progress, they have been faced with privacy and usability issues. Due to the sensitivity of health information, there is an ethical need to equip mobile health systems with adequate privacy measures. However, these systems should also be useable by the intended users. Even though many researchers are working on solutions, the issues still persist. External factors such as cultural differences have also contributed to the issues, yet they have been under researched. In this article, we conduct a systematic literature review of 22 articles, categorize and present privacy and usability issues and possible solutions. We then discuss the relevance and implications of external factors to the findings on privacy and usability. We end with recommendations to address these external factors.

This chapter reveals the overview of mobile health systems; the adoption of mobile health systems; mobile health systems and patient monitoring; the overview of mobile health technology; the advanced issues of Electronic Health Record (EHR); and the challenges of EHR in global health care. Mobile health helps deliver the health care services with quality care, improved workflow, and increased patient interaction while minimizing complexity and cost to achieve the desired goals in health care settings. EHR systems are the real-time and patient-centered records that make information available instantly and securely to authorized users. The chapter argues that applying mobile health systems and EHR has the potential to improve health care efficiency and gain sustainable competitive advantage in global health care.

This chapter reveals the overview of mobile health systems; the adoption of mobile health systems; mobile health systems and patient monitoring; the overview of mobile health technology; the advanced issues of Electronic Health Record (EHR); and the challenges of EHR in global health care. Mobile health helps deliver the health care services with quality care, improved workflow, and increased patient interaction while minimizing complexity and cost to achieve the desired goals in health care settings. EHR systems are the real-time and patient-centered records that make information available instantly and securely to authorized users. The chapter argues that applying mobile health systems and EHR has the potential to improve health care efficiency and gain sustainable competitive advantage in global health care.

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