Apps In Clinical Practice Research Articles

Clinical Usage and Potential Benefits of a Continuous Glucose Monitoring Predict App.

Continuous glucose monitoring (CGM) has become an increasingly important tool for self-management in people with diabetes mellitus (DM). In this paper, we discuss recommendations on how to implement predictive features provided by the Accu-Chek SmartGuide Predict app in clinical practice. The Predict app's features are aimed at ultimately reducing diabetes stress and fear of hypoglycemia in people with DM. Furthermore, we explore the use cases and potential benefits of continuous glucose prediction, predictions of low glucose, and nocturnal hypoglycemia.

Validated mobile applications in otolaryngology head and neck surgery for patient and physicians: A systematic literature review

ImportanceMobile apps in the field of ORL-HNS, are widely used by patients and physicians, but neither necessarily developed in collaboration with healthcare professionals nor subjected to regulations by the United States Food and Drug Administration guidelines, with a resultant potential of risk for its users. ObjectiveTo provide the ORL-HNS physician with an updated list of scientific peer review literature- validated mobile apps for safe use for both the clinician and the patients, for screening, diagnosis, therapy and follow up for various ORL-HNS pathologies. Evidence reviewA comprehensive systematic review of the scientific literature was conducted in “PubMed,” “EMBASE,” and “Web of Science” without limitation of publication date up to January 1st, 2023. The included papers validated mobile apps in the ORL-HNS discipline. Each study was evaluated using the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) tool. FindingsFrom the thousands of unregulated ORL-HNS mobile apps available for download and use in the various app stores, only 17 apps were validated for safe use by the clinician and/or patient. Their information is listed. Conclusions and relevanceThe limited number of validated mobile apps highlights the importance to use validated apps in clinical practice, to improve evidence-based medicine and patient safety. Physician are encouraged to use and recommend their patients to use validated mobile apps only, like any other tool in clinical practice in the evidence-based era.

The application of artificial intelligence in diabetic retinopathy screening: a Saudi Arabian perspective

IntroductionDiabetic retinopathy (DR) is the leading cause of preventable blindness in Saudi Arabia. With a prevalence of up to 40% of patients with diabetes, DR constitutes a significant public health burden on the country. Saudi Arabia has not yet established a national screening program for DR. Mounting evidence shows that Artificial intelligence (AI)-based DR screening programs are slowly becoming superior to traditional screening, with the COVID-19 pandemic accelerating research into this topic as well as changing the outlook of the public toward it. The main objective of this study is to evaluate the perception and acceptance of AI in DR screening among eye care professionals in Saudi Arabia.MethodsA cross-sectional study using a self-administered online-based questionnaire was distributed by email through the registry of the Saudi Commission For Health Specialties (SCFHS). 309 ophthalmologists and physicians involved in diabetic eye care in Saudi Arabia participated in the study. Data analysis was done by SPSS, and a value of p < 0.05 was considered significant for statistical purposes.Results54% of participants rated their level of AI knowledge as above average and 63% believed that AI and telemedicine are interchangeable. 66% believed that AI would decrease the workforce of physicians. 79% expected clinical efficiency to increase with AI. Around 50% of participants expected AI to be implemented in the next 5 years.DiscussionMost participants reported good knowledge about AI. Physicians with more clinical experience and those who used e-health apps in clinical practice regarded their AI knowledge as higher than their peers. Perceived knowledge was strongly related to acceptance of the benefits of AI-based DR screening. In general, there was a positive attitude toward AI-based DR screening. However, concerns related to the labor market and data confidentiality were evident. There should be further education and awareness about the topic.

Perspective of patients with first-episode psychosis, their relatives, and mental health professionals on the design and usability of an app in clinical practice.

Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups. An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.

Apps in Clinical Practice: Usage Behaviour of Trauma Surgeons and Radiologists in Northern Germany.

Apps, in general, are an integral part of our daily lives. To investigate the current usage behaviour of trauma surgeons and radiologists regarding medical apps in clinical practice and to find out if and how the current range of medical apps can be improved, we surveyed trauma surgeons and radiologists in northern Germany. Material and Methods. An online questionnaire was sent to 100 trauma surgeons and 100 radiologists in northern Germany. Participants were asked about the frequency of their use of medical apps in clinical practice, which apps were used most often, how useful participants thought apps were, and in which area they would like to see improvements. The most frequently mentioned apps were finally analyzed. The survey study showed that 87.4% of the trauma surgeons and 67.4% of the radiologists use medical apps on a regular basis at work. It also revealed that trauma surgeons used medical apps much more often than radiologists and that young doctors were more likely to rely on medical apps than chief physicians. 80.0% of the participants would pay at least 5 euros for a medical app. Trauma surgeons see the greatest need for support in their daily work from medical apps in the area of treatment, while radiologists seek more support in the area of classification. The study underscored the broad acceptance of medical apps in everyday clinical practice. As the physicians are willing to spend money and stated a general interest and need for further developments, there is high potential for the future. This trial is registered with DRKS00026766.

Using apps in clinical practice: 8 studies

Using apps in clinical practice: 8 studies

Emotion detection for supporting depression screening.

Depression is the most prevalent mental disorder in the world. One of the most adopted tools for depression screening is the Beck Depression Inventory-II (BDI-II) questionnaire. Patients may minimize or exaggerate their answers. Thus, to further examine the patient's mood while filling in the questionnaire, we propose a mobile application that captures the BDI-II patient's responses together with their images and speech. Deep learning techniques such as Convolutional Neural Networks analyze the patient's audio and image data. The application displays the correlation between the patient's emotional scores and DBI-II scores to the clinician at the end of the questionnaire, indicating the relationship between the patient's emotional state and the depression screening score. We conducted a preliminary evaluation involving clinicians and patients to assess (i) the acceptability of proposed application for use in clinics and (ii) the patient user experience. The participants were eight clinicians who tried the tool with 21 of their patients. The results seem to confirm the acceptability of the app in clinical practice.

Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study.

Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs' perspectives on the use of mobile apps to support HF management. The aim of this study is to determine HCPs' perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. The 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption-these include patient age, technology savviness, technology access, and ease of use; improved delivery of care-apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care-apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education-apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients-HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice.

Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise During Physical Therapy Treatment: Qualitative Study.

BackgroundHome-based exercise is an important part of physical therapy treatment for patients with low back pain. However, treatment effectiveness depends heavily on patient adherence to home-based exercise recommendations. Smartphone apps designed to support home-based exercise have the potential to support adherence to exercise recommendations and possibly improve treatment effects. A better understanding of patient perspectives regarding the use of smartphone apps to support home-based exercise during physical therapy treatment can assist physical therapists with optimal use and implementation of these apps in clinical practice.ObjectiveThe aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of a smartphone app to support home-based exercise following recommendations from a physical therapist.MethodsUsing an interpretivist phenomenology approach, 9 patients (4 males and 5 females; aged 20-71 years) with nonspecific low back pain recruited from 2 primary care physical therapy practices were interviewed within 2 weeks after treatment ended. An interview guide was used for the interviews to ensure that different aspects of the patients’ perspectives were discussed. The Physitrack smartphone app was used to support home-based exercise as part of treatment for all patients. Data were analyzed using the “Framework Method” to assist with interpretation of the data.ResultsData analysis revealed 11 categories distributed among the 3 themes “acceptability,” “satisfaction,” and “performance.” Patients were willing to accept the app as part of treatment when it was easy to use, when it benefited the patient, and when the physical therapist instructed the patient in its use. Satisfaction with the app was determined by users’ perceived support from the app when exercising at home and the perceived increase in adherence. The video and text instructions, reminder functions, and self-monitor functions were considered the most important aspects for performance during treatment. The patients did not view the Physitrack app as a replacement for the physical therapist and relied on their therapist for instructions and support when needed.ConclusionsPatients who use an app to support home-based exercise as part of treatment are accepting of the app when it is easy to use, when it benefits the patient, and when the therapist instructs the patient in its use. Physical therapists using an app to support home-based exercise can use the findings from this study to effectively support their patients when exercising at home during treatment.

251 The mendelian calculator

Monogenetic disorders are a common differential in Neurological clinical practice. While it is relatively easy to counsel patients with a known genetic disease on the probability of passing the condition to their offspring, calculating the probability of disease of an as yet unknown inheritance pattern from a known family history is much less straightforward.The Mendelian Calculator is a freely-available Web-based application that uses the input family history and estimated penetrance and relative population frequencies of inheritance patterns to calculate the probability that a patient’s clinical presentation is sporadic or inherited in a particular Mendelian fashion.The App also provides predictive values, sensitivities, specificities, likelihood ratios, and Matthews cor- relation coefficients to help the user determine the likelihood of finding inherited disease of a particular pattern when the family history of affected members is as yet unestablished. This can be especially helpful when there are both sporadic and genetic variants of a certain disease phenotype in deciding on the utility of further genetic investigation.In a short survey scoring the usefulness of the App in clinical practice, most Neurologists felt it was very useful. Comments included the suggestion to provide baseline data on relative frequencies and pen- etrances for common neurological phenotypes.john_m_30@hotmail.com

The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health careO aplicativo HEARTS: uma ferramenta clínica para o gerenciamento de risco cardiovascular e hipertensão na atenção primária à saúde

RESUMENHEARTS en las Américas es la adaptación regional de la iniciativa Global HEARTS de la Organización Mundial de la Salud, que será el modelo para el manejo del riesgo de las enfermedades cardiovasculares (ECV) en la atención primaria de salud en la Región de las Américas para el año 2025. Ya se ha implementado en 21 países y 1045 centros de atención primaria de salud en toda América Latina y el Caribe. Se ha adoptado un enfoque de salud pública y de sistemas de salud para introducir sistemáticamente intervenciones simplificadas en el nivel de la atención primaria de salud que se centran en el control de la hipertensión como punto de entrada clínico. En este artículo se presenta una aplicación nueva y mejorada cuyo componente principal es la calculadora de riesgo de ECV y de manejo de la hipertensión. Se resume el enfoque de evaluación del riesgo y la metodología utilizada por la Organización Mundial de la Salud para actualizar sus tablas de riesgo cardiovascular del 2019; se describe la aplicación, su uso, su funcionalidad y su proceso de validación; y se presenta un conjunto de recomendaciones prácticas para optimizar el manejo del riesgo de ECV y de la hipertensión, mediante el uso de la aplicación en la práctica clínica. La aplicación HEARTS es una herramienta sólida para mejorar la calidad de la atención prestada en los centros de atención primaria. La creación y difusión de la aplicación HEARTS es un paso esencial en el camino hacia la eliminación de las ECV prevenibles en la Región de las Américas.

The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care.

ABSTRACTHEARTS in the Americas is the regional adaptation of the World Health Organization’s Global Hearts Initiative, which will be the model for risk management for cardiovascular disease (CVD) in primary health care in the Region of the Americas by 2025. It has already been implemented in 21 countries and 1045 primary health care centers throughout Latin America and the Caribbean. It takes a public health and health systems approach to systematically introduce simplified interventions at the primary health care level and focuses on hypertension as a clinical entry point. This paper introduces a new, improved application (app), the main component of which is the calculator for CVD risk and hypertension management. The paper summarizes the risk assessment approach and the methodology used by the World Health Organization to update its cardiovascular risk charts in 2019; describes the app, its use, functionality and validation process; and provides a set of practical recommendations for optimizing CVD risk and hypertension management by using the app in clinical practice. The HEARTS app is a powerful tool to improve the quality of care provided in primary health settings. The creation and dissemination of the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas.

Using apps for bipolar disorder – An online survey of healthcare provider perspectives and practices

BackgroundSmartphone apps have recognized potential for improving access to evidence-based care in the treatment of bipolar disorder (BD). Healthcare providers are well-positioned to play a role in guiding patients to access safe, evidence-supported, and trustworthy apps. However, little is known about whether and how clinicians use apps with people with BD: understanding practices and attitudes of healthcare providers is essential to support the implementation of mHealth interventions in a real-world context. MethodsA web-based survey was used to explore clinicians’ attitudes towards, and use of apps when working with people with BD. Descriptive statistics were used to summarize quantitative findings. Free text responses were investigated using qualitative content analysis. ResultsEighty healthcare providers completed the survey. Approximately half of the respondents reported discussing or recommending apps in clinical practice with BD populations. Recommended apps were most commonly related to mood, sleep, and exercise. Barriers to discussing apps included a lack of healthcare provider knowledge/confidence, concerns about patients’ ability to access apps, and beliefs that patients lacked interest in apps. ConclusionAlthough research suggests that people with BD are interested in using apps, uptake of such technology among clinicians is more limited. A lack of clinician knowledge regarding apps, combined with concerns about the digital divide and patient interest, may account for this relatively limited integration of apps into the management of BD. These findings emphasise the importance of considering the information needs of healthcare providers when planning dissemination strategies for app-based interventions for BD.

Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study.

BackgroundMobile health and self-management interventions may positively affect behavioral change and reduce hospital admissions for patients with chronic obstructive pulmonary disease (COPD). However, not all patients qualify for these interventions, and systematic, comprehensive information on implementation- and compliance-related aspects of mobile self-management apps is lacking. Due to the tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on the use of these services in broad clinical practice for patients recently discharged from hospital.ObjectiveThis study aims to evaluate the effects of a mobile health and self-management app in clinical practice for recently discharged patients with COPD on use of the app, self-management, expectations, and experiences (technology acceptance); patients’ and nurses’ satisfaction; and hospital readmissions.MethodsA prototype of the app was pilot tested with 6 patients with COPD. The COPD app consisted of an 8-week program including the Lung Attack Action Plan, education, medication overview, video consultation, and questionnaires (monitored by nurses). In the feasibility study, adult patients with physician-diagnosed COPD, access to a mobile device, and proficiency of the Dutch language were included from a large teaching hospital during hospital admission. Self-management (Partners in Health Scale), technology acceptance (Unified Theory Acceptance and Use of Technology model), and satisfaction were assessed using questionnaires at baseline, after 8 weeks, and 20 weeks. Use was assessed with log data, and readmission rates were extracted from the electronic medical record.ResultsA total of 39 patients were included; 76.4% (133/174) of patients had to be excluded from participation, and 48.9% of those patients (65/133) were excluded because of lack of digital skills, access to a mobile device, or access to the internet. The COPD app was opened most often in the first week (median 6.0; IQR 3.5-10.0), but its use decreased over time. The self-management element knowledge and coping increased significantly over time (P=.04). The COPD app was rated on a scale of 1-10, with an average score by patients of 7.7 (SD 1.7) and by nurses of 6.3 (SD 1.2). Preliminary evidence about the readmission rate showed that 13% (5/39) of patients were readmitted within 30 days; 31% (12/39) of patients were readmitted within 20 weeks, compared with 14.1% (48/340) and 21.8% (74/340) in a preresearch cohort, respectively.ConclusionsThe use of a mobile self-management app after hospital discharge seems to be feasible only for a small number of patients with COPD. Patients were satisfied with the service; however, use decreased over time, and only knowledge and coping changed significantly over time. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, a multidisciplinary approach, technology-related aspects (such as acceptability), and fine-tuning its adoption in clinical pathways.Trial RegistrationClinicaltrials.gov NCT04540562; https://clinicaltrials.gov/ct2/show/NCT04540562.

Blending Cognitive Analytic Therapy With a Digital Support Tool: Mixed Methods Study Involving a User-Centered Design of a Prototype App.

BackgroundPatients can struggle to make good use of psychotherapy owing to deficits in awareness, and digital technologies that support awareness are at a premium. Currently, when patients participate in cognitive analytic therapy (CAT), the technology supporting relational awareness work involves completion of paper-based worksheets as between-session tasks.ObjectiveWe aimed to design, with therapists and patients, a prototype digital mobile app. This was to help patients better engage in the “recognition” phase of the CAT treatment model by providing an unobtrusive means for practicing relational awareness with dynamic feedback on progress.MethodsA national online survey was conducted with CAT therapists (n=50) to determine readiness for adoption of a mobile app in clinical practice and to identify core content, functionality, and potential barriers to adoption. A prototype mobile app based on data and existing paper-based worksheets was built. Initial face-to-face user testing of the prototype system was completed with three therapists and three CAT expatients.ResultsAmong the therapists surveyed, 72% (36/50) reported not currently using any digital tools during CAT. However, the potential value of a mobile app to support patient awareness was widely endorsed. Areas of therapist concern were data security, data governance, and equality of access. These concerns were mirrored during subsequent user testing by CAT therapists. Expatients generated additional user specifications on the design, functionality, and usability of the app. Results from both streams were integrated to produce five key changes for the reiteration of the app.ConclusionsThe user-centered design process has enabled a prototype CAT-App to be developed to enhance the relational awareness work of CAT. This means that patients can now practice relational awareness in a much more unobtrusive manner and with ongoing dynamic feedback of progress. Testing the acceptability and feasibility of this technological innovation in clinical practice is the next stage in the research process, which has since been conducted and has been submitted. The important challenges of data protection and governance must be navigated in order to ensure implementation and adoption if the CAT-App is found to be acceptable and clinically effective.

Mobile Clinical Decision Support System for the Management of Diabetic Patients With Kidney Complications in UK Primary Care Settings: Mixed Methods Feasibility Study.

BackgroundAttempts to utilize eHealth in diabetes mellitus (DM) management have shown promising outcomes, mostly targeted at patients; however, few solutions have been designed for health care providers.ObjectiveThe purpose of this study was to conduct a feasibility project developing and evaluating a mobile clinical decision support system (CDSS) tool exclusively for health care providers to manage chronic kidney disease (CKD) in patients with DM.MethodsThe design process was based on the 3 key stages of the user-centered design framework. First, an exploratory qualitative study collected the experiences and views of DM specialist nurses regarding the use of mobile apps in clinical practice. Second, a CDSS tool was developed for the management of patients with DM and CKD. Finally, a randomized controlled trial examined the acceptability and impact of the tool.ResultsWe interviewed 15 DM specialist nurses. DM specialist nurses were not currently using eHealth solutions in their clinical practice, while most nurses were not even aware of existing medical apps. However, they appreciated the potential benefits that apps may bring to their clinical practice. Taking into consideration the needs and preferences of end users, a new mobile CDSS app, “Diabetes & CKD,” was developed based on guidelines. We recruited 39 junior foundation year 1 doctors (44% male) to evaluate the app. Of them, 44% (17/39) were allocated to the intervention group, and 56% (22/39) were allocated to the control group. There was no significant difference in scores (maximum score=13) assessing the management decisions between the app and paper-based version of the app’s algorithm (intervention group: mean 7.24 points, SD 2.46 points; control group: mean 7.39, SD 2.56; t37=–0.19, P=.85). However, 82% (14/17) of the participants were satisfied with using the app.ConclusionsThe findings will guide the design of future CDSS apps for the management of DM, aiming to help health care providers with a personalized approach depending on patients’ comorbidities, specifically CKD, in accordance with guidelines.

Comparing a clinician-assisted and app-supported behavioral activation intervention to promote brain health and well-being in frontline care.

Positive psychiatry offers an unique approach to promote brain health and well-being in aging populations. Minimal interventions through behavioral activation to promote wellness are increasingly available using self-guided apps, yet little is known about the effectiveness of app technology or the difference between clinician-supported behavioral activation versus self-guided app methodologies. Investigate the difference in users and outcomes between two methods of the Fountain of Health (FoH) positive psychiatry intervention for behavioral activation to promote brain health and well-being: (1) clinician-assisted and (2) independent app use for behavioral self-management. As part of a larger knowledge translation intervention in positive psychiatry, two specific methods of a behavioral activation intervention were retrospectively compared. Two subsets of patients were compared; 254 clinician-assisted patients; 333 independent app users. A minimal positive psychiatry intervention in frontline care using the FoH health and behavior change clinical tools. Main outcomes were changes in psychological (health and resilience, well-being scores) and behavioral indices (goal attainment, items of goal SMART-ness). User profiles (age, sex and completion rates) were also compared. Clinician-assisted patients were more likely to be male, older, and have lower health and resilience scores at baseline. Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes (improved health and resilience, and well-being) were similar regardless of intervention method for those who completed the intervention. Behavioral outcomes revealed clinician-assisted patients set goals that better adhered to key goal-setting items. Clinician-patient relationships appear to be an important factor for intervention completion and behavioral outcomes, while further exploration of best practices for intervention completion using health apps in clinical practice is needed. A preliminary goal-setting methodology for effective behavioral activation, to promote brain health and wellness, is given.

The impact of the Trauma Triage App on pre-hospital trauma triage: design and protocol of the stepped-wedge, cluster-randomized TESLA trial

BackgroundField triage of trauma patients is crucial to get the right patient to the right hospital within a particular time frame. Minimization of undertriage, overtriage, and interhospital transfer rates could substantially reduce mortality rates, life-long disabilities, and costs. Identification of patients in need of specialized trauma care is predominantly based on the judgment of Emergency Medical Services professionals and a pre-hospital triage protocol. The Trauma Triage App is a smartphone application that includes a prediction model to aid Emergency Medical Services professionals in the identification of patients in need of specialized trauma care. The aim of this trial is to assess the impact of this new digital approach to field triage on the primary endpoint undertriage.MethodsThe Trauma triage using Supervised Learning Algorithms (TESLA) trial is a stepped-wedge cluster-randomized controlled trial with eight clusters defined as Emergency Medical Services regions. These clusters are an integral part of five inclusive trauma regions. Injured patients, evaluated on-scene by an Emergency Medical Services professional, suspected of moderate to severe injuries, will be assessed for eligibility. This unidirectional crossover trial will start with a baseline period in which the default pre-hospital triage protocol is used, after which all clusters gradually implement the Trauma Triage App as an add-on to the existing triage protocol. The primary endpoint is undertriage on patient and cluster level and is defined as the transportation of a severely injured patient (Injury Severity Score ≥ 16) to a lower-level trauma center. Secondary endpoints include overtriage, hospital resource use, and a cost-utility analysis.DiscussionThe TESLA trial will assess the impact of the Trauma Triage App in clinical practice. This novel approach to field triage will give new and previously undiscovered insights into several isolated components of the diagnostic strategy to get the right trauma patient to the right hospital. The stepped-wedge design allows for within and between cluster comparisons.Trial registrationNetherlands Trial Register, NTR7243. Registered 30 May 2018, https://www.trialregister.nl/trial/7038.

The use of smartphone apps in clinical practice: A survey of South African physiotherapists.

BackgroundThere is anecdotal evidence that physiotherapy clinicians increasingly are using medical apps and health-related apps as part of their clinical practice, and in some cases, even ‘prescribing apps’ to patients. However, there is limited information on how South African physiotherapists use, and what they think about, the integration of mobile apps in their practice.ObjectivesThis study aimed to describe the use of smartphone apps as part of clinical practice in a small group of South African physiotherapists.MethodThis study made use of a cross-sectional, descriptive design and a self-administered questionnaire to survey practitioners. The population included all 1300 physiotherapists who were registered with the Orthopaedic Manipulative Physiotherapists Group (OMPTG) of the special interest group of the South African Society of Physiotherapists (SASP), with a sample of 270 out of 1300 who responded (response rate = 21%). Descriptive data are presented using graphs, figures and percentages, and responses to open-ended questions are included in support of the themes.ResultsThe majority of the participants used apps as part of their practice (60%) but did not prescribe apps to patients. Most apps are used for administrative and communication purposes. Even clinicians who used apps themselves expressed concerns about prescribing them to patients, and there were clear misconceptions about the use of apps.ConclusionMany clinicians in this study reported that there were real benefits to the use of smartphone apps as part of their practice. However, they raised concerns about the more general prescription of apps for clients.Clinical implicationsFurther research, education and collaboration amongst all stakeholders is necessary to produce guidelines for the use of apps in clinical practice

Reduced symptom burden with the support of an interactive app during neoadjuvant chemotherapy for breast cancer – A randomized controlled trial

ObjectivesNeoadjuvant chemotherapy causes distressing symptoms, which have to be managed by patients at home. Assessing and acting upon relevant patient-reported symptoms regularly with the support of mHealth such as apps, has shown to decrease symptom burden and improve health-related quality of life (HRQoL). There is a lack of apps for patients with breast cancer which are tested in rigorous trials and only a few include interactive components for immediate clinical management. The aim of this study was to evaluate whether the use of the interactive app Interaktor improves patients’ levels of symptom burden and HRQoL during neoadjuvant chemotherapy for breast cancer. Materials and methodsThis randomized controlled trial included patients in an intervention group (n = 74) and a control group (n = 75), recruited at two university hospitals in Stockholm, Sweden. The intervention group used Interaktor for symptom reporting, self-care advice and support from health-care professionals during treatment, and the control group received standard care alone. Self-reported symptoms and HRQoL were assessed at two time points to determine differences between the groups. ResultsThe intervention group rated statistically significant less symptom prevalence in nausea, vomiting, feeling sad, appetite loss and constipation. Overall symptom distress and physical symptom distress were rated statistically significant lower in the intervention group. Further, emotional functioning was rated statistically significant higher in the intervention group. ConclusionsBy using the Interaktor app in clinical practice, patients get individual support when managing treatment-related symptoms during neoadjuvant chemotherapy for breast cancer, leading to decreased symptom burden and improved emotional functioning.