Apple iTunes Research Articles

A Systematic Review of Cervical Cancer Mobile Applications and a Future Directions for Developers.

The objective of this study is to evaluate the quality of mobile health (mHealth) applications that promote cervical cancer awareness and provide screening assistance, with an emphasis on apps available on the Google Play Store and iOS. From December 2023 to February 2024, we assessed mobile applications focused on cervical cancer screening that are available on Google Play and Apple iTunes. The "Cervical Cancer," "Mobile Application," "Pap Test," "Cervical Cancer Guide," "Human Papillomavirus," plus "Cervical Screening are the keywords used to search the applications." Data collection includes features such as application name, pricing, download metrics, invention date, last update, affiliation, online access, login requirements, and notification functionality, which were gathered in Excel. Interrater reliability based on four reviewers' independent judgments, varied from 0.75 to 0.83. In our research, we found 25 apps (16 on the Google Play Store and 9 on iOS). After a thorough review, only 14 relevant apps were included. According to the MARS rating, Rise Against Cancer received the highest score (3.9), followed by FightHPV and Cervical Cancer Forum (3.8). Rise Against Cancer (29), HPV Vaccine (28), and CDC STI Tx Guidelines (28) scored highest in the APPLICATIONS rating system. Hope 4 All and OCI Cervibreast closely matched the statements, meeting seven of the thirteen requirements each. Future app developers should produce user-friendly, often updated mHealth applications that include high-quality cervical cancer awareness and screening content. These apps should provide validated information and pleasant graphic effects.

Digital Apps to Improve Mobility in Adults with Neurological Conditions: A Health App-Focused Systematic Review.

The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps are suitable for prescribing mobility exercises for adults with neurological health conditions, (2) how well these apps incorporate telehealth strategies, and (3) how well these apps rate in terms of quality and capacity for behaviour change. The Australian Apple iTunes Store was systematically searched, by using a search code and manually, for apps suitable for training mobility in neurological rehabilitation. Additional searches were conducted in known app repositories and for web-based apps. Trained reviewers extracted data from the included apps, including population-specific characteristics; quality, by using the Mobile App Rating Scale (MARS); and behaviour change potential, by using the App Behaviour Change Scale (ABACUS). The included apps (n = 18) provided <50 to >10,000 exercises, many incurred a subscription fee (n = 13), and half included telehealth features. App quality was moderate (mean MARS score of 3.2/5 and SD of 0.5), and potential for behaviour change was poor (mean ABACUS score of 5.7/21 and SD of 2.1). A limited number of high-quality apps are available for the prescription of mobility exercises in people with neurological conditions.

Mobile Apps for Patients with Peritoneal Dialysis: Systematic App Search and Evaluation.

Peritoneal dialysis (PD) is one type of renal replacement therapy. If patients have problems during the dialysis process, healthcare providers may not be able assist the patients immediately. mHealth can provide patients with information and help them to solve problems in real-time, potentially increasing their willingness to choose PD. The objectives of this study were to conduct a comprehensive review of free mobile applications for patients with PD on the Internet and to recommend suitable mobile applications to facilitate patient self-management and health. We conducted a systematic search for PD mobile applications on Google Play and the Apple iTunes Store from 3 to 16 June 2023. A total of 828 identifiable mobile applications were initially identified, and ultimately, 21 met the inclusion criteria. The Mobile App Rating Scale (MARS) assessment of the applications revealed the highest score in the functionality domain, followed by the aesthetics, information, app-specific, subjective quality, and engagement domains, respectively. In the comprehensive self-management of PD, the highest percentage was related to disease-related information. The findings of this study suggest that some applications, with the highest quality, can be recommended to patients for use in English or traditional Chinese.

Assessing the Quality and Behavior Change Potential of Vaping Cessation Apps: Systematic Search and Assessment.

An increasing number of people are using vapes (e-cigarettes), and with growing evidence of associated harms, there is a need for acceptable cessation support and interventions. Smartphone apps for health and well-being have increased in popularity and use. Limited published literature assesses the potential of apps to support vaping cessation. A systematic search of vaping cessation apps currently available in Australia for iOS and Android platforms was conducted. Apps were assessed against established health app assessment tools for quality and behavior change potential. A systematic search through the Australian Apple iTunes and Google Play stores was conducted using the search terms "vape"; "vaping"; "e-cigarette"; and "cessation," "quit," or "quitting" in May 2023. Only apps that encouraged the cessation of vaping were included. App descriptions were reviewed to determine if they were relevant for inclusion in this study, and relevant apps were downloaded onto the appropriate mobile device for review. The Mobile App Rating Scale (MARS) was used to rate the quality (engagement, functionality, aesthetics, and information) of the apps using an overall score out of 5. The App Behavior Change Scale (ABACUS) was used to assess the behavior change potential of each app using a score out of 21. An initial search of the app stores yielded 220 Android apps and 124 iOS apps. Screening against the inclusion criteria left 20 iOS apps and 10 Android apps for review. Six apps were available on both operating systems, and these were downloaded, reviewed, and reported separately for each operating system. The average MARS score for all apps assessed in this review was 3.1 (SD 0.41) out of 5. The reviewed apps overall performed well for the MARS elements relating to functionality, such as ease of use and navigation, but had the lowest scores for information-related elements, such as credibility. The number of ABACUS behavior change features per app ranged from 0 to 19 out of 21, with a mean of 8.9 (SD 4.51). The apps commonly included information-related features, such as requesting baseline information. The least common behavior change features were those relating to goal-setting, such as asking about the user's willingness for behavior change and providing feedback on current actions in comparison to future goals. The identified vaping cessation apps had moderate levels of quality and some behavior change components. Future vaping cessation apps could benefit from including more features that are known to support behavior change, such as goal-setting, to improve the potential benefit of these apps to support people to stop vaping. As guidelines for vaping cessation continue to be established, future apps need to reference these in their development.

Road rule enforcement and where to find it: An investigation of applications used to avoid detection when violating traffic rules

Introduction: One of the primary countermeasures in place to prevent road rule violations is legal enforcement, yet there are numerous applications that can undermine such efforts by notifying drivers of enforcement locations. However, the capabilities of these applications and how they can impact offending behavior is currently unknown. Method: Two studies were conducted to understand which of these applications are being used by drivers and how these applications are impacting road rule violations. Study 1 consisted of a content analysis that involved searching the Google Play Store and Apple iTunes Store for applications that could be used to avoid road rule violations using pre-determined keywords. Meanwhile, Study 2 consisted of 468 licensed Australian drivers (54.5% males) over the age of 17 years (Mage = 35 years) who completed a survey. Results: A total of 73 applications were identified for Study 1, with most of the applications displaying speed camera locations. It was found that applications that notify drivers of traffic enforcement locations are widely prevalent, can be used on a variety of interfaces and include numerous additional features. Study 2 found that those who use the applications were more willing to speed than those who do not use the applications, while there was no difference in phone use while driving between those who do and do not use the applications. Practical Applications: The findings have important implications for stakeholders, policy, and future research. For example, it is suggested that specific functions of these applications need to be regulated to reduce road rule violations and crash risk. Meanwhile, enforcement initiatives need to evolve at a faster rate to keep up to date with the changing technology that can undermine them.

Value Capture in the Face of Known and Unknown Unknowns

A large theoretical literature on value capture uses cooperative games under complete information to study how and why firms earn supernormal profits. However, firms often have different information, beliefs, or creative foresight. We extend value capture theory to incomplete information (“known unknowns”) or unawareness (“unknown unknowns”) and illustrate some conceptual issues with that extension. Using the case study of Cirque du Soleil, we show how an entrepreneurial firm can profit even when it does not contribute materially to value creation. In a case study of Apple iTunes, we show how value capture depends quantitatively on the beliefs of other firms.

Monitoring Symptoms of COVID-19: Review of Mobile Apps.

BackgroundMobile health (mHealth) apps have facilitated symptom monitoring of COVID-19 symptoms globally and have been used to share data with health care professionals and support disease prediction, prevention, management, diagnostics, and improvements in treatments and patient education.ObjectiveThe aim of this review is to evaluate the quality and functionality of COVID-19 mHealth apps that support tracking acute and long-term symptoms of COVID-19.MethodsWe systematically reviewed commercially available mHealth apps for COVID-19 symptom monitoring by searching Google Play and Apple iTunes using search terms such as “COVID-19,” “Coronavirus,” and “COVID-19 and symptoms.” All apps underwent three rounds of screening. The final apps were independently assessed using the Mobile Application Rating Scale (MARS), an informatics functionality scoring system, and the Center for Disease Control and World Health Organization symptom guidelines. The MARS is a 19-item standardized tool to evaluate the quality of mHealth apps on engagement, functionality, aesthetics, and information quality. Functionality was quantified across the following criteria: inform, instruct, record (collect, share, evaluate, and intervene), display, guide, remind or alert, and communicate. Interrater reliability between the reviewers was calculated.ResultsA total of 1017 mobile apps were reviewed, and 20 (2%) met the inclusion criteria. The majority of the 20 included apps (n=18, 90%) were designed to track acute COVID-19 symptoms, and only 2 (10%) addressed long-term symptoms. Overall, the apps scored high on quality, with an overall MARS rating of 3.89 out of 5, and the highest domain score for functionality (4.2). The most common functionality among all apps was the instruct function (n=19, 95%). The most common symptoms included in the apps for tracking were fever and dry cough (n=18, 90%), aches and pains (n=17, 85%), difficulty breathing (n=17, 85%), tiredness, sore throat, headache, loss of taste or smell (n=16, 80%), and diarrhea (n=15, 75%). Only 2 (10%) apps specifically tracked long-term symptoms of COVID-19. The top 4 rated apps overall were state-specific apps developed and deployed for public use.ConclusionsOverall, mHealth apps designed to monitor symptoms of COVID-19 were of high quality, but the majority of apps focused almost exclusively on acute symptoms. Future apps should also incorporate monitoring long-term symptoms of COVID-19 and evidence-based educational materials; they should also include a feature that would allow patients to communicate their symptoms to specific caregivers or their own health care team. App developers should also follow updated technical and clinical guidelines from the Center for Disease Control and the World Health Organization.

The Validity of Mobile Applications to Facilitate Patient Care Provided to Cancer Patients: Opportunities and Limitations.

The use of health-related applications (apps) on smartphones has become widespread. This is especially of value during the ongoing SAR-COV-2 pandemic, where accessibility to health care services has been greatly limited. Patients with free access to apps can obtain information to improve their understanding and management of health issues. Currently, there are cancer-related apps available on iPhones and androids. However, there are no guidelines to control these apps and ensure their quality. Furthermore, these apps may significantly modify the patients' perception and knowledge about drug-related health services. The aim of this study was to assess the convenience, quality, safety and efficacy of apps for cancer patient care. The study was conducted by searching all apps related to cancer care on both Google Play Store and Apple iTunes Store. A detailed assessment was then performed using the mobile application rating scale (MARS) and risk assessment tools. The results indicated that on a scale from 1-5, 47% of the apps were rated ≥ 4. The MARS assessment of the apps yielded an overall quality rating of 3.38 ± 0.9 (mean ± SD). The visual appeal of the app was found to have a significant effect on app functionality and user engagement. The potential benefits of these apps come with challenges and limitations. Patents related to smartphone applications targeting patients were also discussed. We recommend a greater emphasis toward producing evidence-based apps. These apps should be rigorously tested, evaluated and updated by experts, particularly clinical pharmacists. Also, these apps may alter patient attitudes toward services provided by physicians and pharmacists. Finally, these apps should not replace in-person interactive health services.

Systematic Review of Pelvic Anatomy iOS and Android Applications for Obstetricians and Gynecologists

Resources for learning and enhancing knowledge in medicine, such as mobile applications (apps), have dramatically increased in recent years; however, there is lack of a valid source for identifying the best and most reliable mobile apps. The goal of this study was to identify the highest scoring available pelvic anatomy apps based on quality, content, and functionality for obstetrician-gynecologists using a validated tool. This was a systematic evaluation of anatomy apps in the Apple iTunes (iOS) and Google Play (Android) stores. Exclusions included apps that had nonhuman, nonanatomy content, did not include female pelvic anatomy or were deemed inappropriate for postgraduate level. The validated Mobile App Rating Scale (MARS), a mobile-health (mHealth) app scoring system was used to evaluate apps based on both objective and subjective quality. The authors' MARS scores for each variable were compiled, and the objective, subjective, and overall scores were calculated. The search criteria yielded 2,432 apps: 952 (39%) Apple iTunes store and 1,480 (60.8%) Google Play Store apps. After applying the exclusion criteria, 35 (14 iOS, 8 Android, and 13 iOS/Android) apps were included for evaluation using the MARS system. "Complete Anatomy" app, available for both iOS and Android systems, obtained the highest objective, subjective, and overall MARS score. Although there are numerous anatomy apps available, only a few meet prespecified criteria for functionality, content, quality, and are appropriate for obstetrician-gynecologists. Using a validated scoring system, we present a scored list of female pelvic anatomy apps most appropriate for obstetrician-gynecologists.

Evaluation of mobile health applications for cervical cancer in the digital marketplace.

ObjectiveTo assess the quality of mobile health (mHealth) applications (apps) for cervical cancer using the mobile app rating scale (MARS), APPLICATIONS scoring system, and app rating using specific statements.MethodsWe searched for cervical cancer apps on two major mobile operating systems (Google Play Store and Apple iTunes Store) in March 2021. Eligible apps were downloaded and assessed for quality by two independent reviewers using multimodal assessment tools.ResultsThe overall quality of the MARS score was 2.61±0.795. The highest scoring app was “The American Society for Colposcopy and Cervical Pathology (ASCCP) Management Guidelines” (3.98). Overall, apps scored highest in the functionality domain, followed by information, engagement, and aesthetics domains. The mean±standard deviation of the APPLICATIONS scoring system was 8.50±1.712. The highest-rated apps were “ASCCP Management Guidelines,” “The British Society for Colposcopy and Cervical Pathology (BSCCP),” and “Cervical Cancer Guide.” Apps scored the highest in the paid subscription and price domains. By contrast, apps scored poorly in the text search, literature, and subjective presentation domains. Concerning app content, many apps infrequently provided misconceptions regarding cervical cancer. The apps’ rating using specific statements was 7.81±4.562.ConclusionOverall, the apps analyzed using the MARS and APPLICATIONS scoring systems demonstrated above-average quality. However, there is a need to improve the essential information conveyed by these applications. Moreover, the assessment tools have influenced different app quality rating results, confirming the lack of standardized quality assessment tools for mHealth apps.

Evidence-Based Behavioral Strategies in Smartphone Apps for Children's Sleep: Content Analysis.

BackgroundEmpirically supported treatments for pediatric sleep problems exist, but many families turn to other sources for help with their children’s sleep, such as smartphone apps. Sleep apps are easy for families to access, but little evidence exists regarding the validity of the services and information provided in the developer descriptions of the apps.ObjectiveThe goal of this study was to examine the features and claims of developer descriptions of sleep apps for children.MethodsA search of the Apple iTunes store and Google Play was conducted using the terms “kids sleep,” “child sleep,” and “baby sleep.” Data on the type of app, price, user rating, and number of users were collected. Apps were analyzed in comparison with evidence-based behavioral strategies and were thematically coded on the basis of claims provided in developer descriptions.ResultsA total of 83 app descriptions were examined, of which only 2 (2.4%) offered sleep improvement strategies. The majority were sound and light apps (78%) and 19% were bedtime games or stories. Only 18 of 83 (21.6%) apps were identified as containing empirically supported behavioral sleep strategies. Despite this, many apps asserted claims that they will help children “fall asleep instantly,” “cry less and sleep better,” or improve child development.ConclusionsA large variety of sleep apps exist for use among children, but few include evidence-based behavioral strategies according to the developer descriptions of the apps. Addressing sleep difficulties in children is important to promote physical, cognitive, and emotional development. Collaboration between sleep researchers and technology developers may be beneficial for creating evidence-supported apps to help with children’s sleep in the future.

A Structured Review of Commercially Available Cardiac Rehabilitation mHealth Applications Using the Mobile Application Rating Scale.

This study systematically evaluated the quality and functionalities of patient-facing, commercially available mobile health (mHealth) apps for cardiac rehabilitation (CR). We performed our search in two of the most widely used commercial mobile app stores: Apple iTunes Appstore and Google Play Store (Android apps). Six search terms were used to query relevant CR apps: "cardiac rehabilitation," "heart disease and remote therapy," "heart failure exercise," "heart therapy and cardiac recovery," "cardiac recovery," and "heart therapy." App quality was evaluated using the Mobile Application Rating Scale (MARS). App functionality was evaluated using the IQVIA functionality scale, and app content was evaluated against the American Heart Association guidelines for CR. Apps meeting our inclusion criteria were downloaded and evaluated by two to three reviewers, and interclass correlations between reviewers were calculated. We reviewed 3121 apps and nine apps met our inclusion criteria. On average, the apps scored a 3.0 on the MARS (5-point Likert scale) for overall quality. The two top-ranking mHealth apps for CR for all three quality, functionality, and consistency with evidence-based guidelines were My Cardiac Coach and Love My Heart for Women, both of which scored ≥4.0 for behavior change. Overall, the quality and functionality of free apps for mobile CR was high, with two apps performing the best across all three quality categories. High-quality CR apps are available that can expand access to CR for patients with cardiovascular disease.

Evaluation of Mobile Apps for Food Allergy

Digital technology has great potential for helping patients prevent and manage food allergies. The goal of this study is to examine the content and accuracy free food allergy apps that are available in the Apple iTunes App Store.

Emergency Preparedness and Disaster Response: There's an App for That 2.0.

In disaster response, smartphone applications (or apps) are being used by the layperson, emergency first responders, and health care providers to aid in everything from incident reporting to clinical decision making. However, quality apps are often diluted by the overwhelming number of apps that exist for both the lay public and first responders in the Apple iTunes (Apple Inc.; Cupertino, California USA) and Google Play (Google LLC; Mountain View, California USA) stores. A systematic review of disaster response apps was originally completed in 2015; a follow-up review was completed here to evaluate trends and explore novel apps. A search of the Apple iTunes and Google Play stores was performed using the following terms obtained from PubMed (National Center for Biotechnology Information; Bethesda, Maryland USA) Medical Subject Headings Database: Emergency Preparedness; Emergency Responders; Disaster; Disaster Planning; Disaster Medicine; Bioterrorism; Chemical Terrorism; Hazardous Materials; and the Federal Emergency Management Agency (FEMA [Washington, DC USA]). After excluding any unrelated apps, a working list of apps was formed and categorized based on topics. Apps were categorized by intended user (first responders or the public) and sub-categorized by topic for discussion. Sub-categories included News/Information, Reference/Education, Weather/Natural Disasters, Travel/Navigation, and Communication/Reunification. A search of the Apple iTunes store revealed 394 unique apps and was narrowed to 342 based on relevance to the field and availability on the iPhone. A search of the Google Play store yielded 645 unique applications and was narrowed to 634 based on relevance. Of note, 49 apps appeared in both app stores using the search terms. An aggregate 927 apps from the Apple iTunes and Google Play stores were then critically reviewed by the authors. Apps were sub-categorized based on intended audience, layperson or first responder, and sorted into one of five disaster response categories. Two apps were chosen for discussion from each of the five sub-categories. The highest quality apps were determined from each group based on relevance to emergency preparedness and disaster response, rating, and number of reviews. After comparisons with the 2015 article, many new apps have been developed and previously described apps have been updated, highlighting that this is a constantly changing field deserving of continued analysis and research.

A Content Analysis of Free, Popular Plant-Based Mobile Health Apps

ObjectivesThere has been an increased emphasis on plant-based foods and diets in numerous dietary guidelines worldwide. Although mobile technology has the potential to be a convenient and cost-effective tool to aid adherence to dietary guidelines, little is known about the content and the quality of available mobile Apps on plant-based diets. Therefore, the objective of the study was to assess free, popular mobile health (mHealth) Apps supporting plant-based diets for Canadians. MethodsUsing pre-defined search terms, Apple iTunes and GooglePlay App stores were searched on December 22, 2020; the top 100 returns for each search term were screened for eligibility. Free and popular (≥3 out of 5 ratings; ≥100 total reviews) mHealth Apps available in English, primarily marketed to help users follow plant-based diets were included. Included Apps were downloaded and assessed for quality by three research assistants/dietitians using the Mobile App Rating Scale (MARS) and the App Quality Evaluation (AQEL) tool. ResultsOf the 998 Apps screened, 16 Apps (mean ratings ± SEM = 4.5 ± 0.08) met the eligibility criteria for assessment, comprising 10 recipe manager and meal planners, 2 food scanners, 2 vegan community builders, 1 restaurant identifier, and 1 sustainability-focused App. All included Apps targeted the general population and focused on changing behaviours using education (14 Apps), skills training (14 Apps), and/or goal setting (5 Apps). Vegan, vegetarian or other plant-based (e.g., pescatarian, flexitarian) settings were available in 13 Apps, while 3 Apps offered no plant-based diet settings. The MARS (rated out of 5) revealed a high overall App quality score (3.84 ± 0.66) and subjective quality score (3.63 ± 0.62), but low credibility score (2.09 ± 0.36). The AQEL (rated out of 10) revealed high scores in App function (8.29 ± 0.47), purpose (8.11 ± 0.39), and behavioral change potential (8.35 ± 0.45), but a low score in support of knowledge acquisition (4.82 ± 0.43). ConclusionsAlthough a variety of free plant-based Apps with different focuses and behavioural change techniques are available to help Canadians follow plant-based diets, our findings suggest a need for credible Apps and other resources to complement the low support of knowledge acquisition in plant-based Apps. Funding SourcesBanting & Best Diabetes Centre.

An Overview of Commercially Available Apps in the Initial Months of the COVID-19 Pandemic

Introduction: It has been 4 months since the discovery of COVID-19, and there have been many measures introduced to curb movements of individuals to stem the spread. There has been an increase in the utilization of web-based technologies for counseling, and for supervision and training, and this has been carefully described in China. Several telehealth initiatives have been highlighted for Australian residents. Smartphone applications have previously been shown to be helpful in times of a crisis. Whilst there have been some examples of how web-based technologies have been used to support individuals who are concerned about or living with COVID-19, we know of no studies or review that have specifically looked at how M-Health technologies have been utilized for COVID-19.Objectives: There might be existing commercially available applications on the commercial stores, or in the published literature. There remains a lack of understanding of the resources that are available, the functionality of these applications, and the evidence base of these applications. Given this, the objective of this content analytical review is in identifying the commercial applications that are available currently for COVID-19, and in exploring their functionalities.Methods: A mobile application search application was used. The search terminologies used were “COVID” and “COVID-19.” Keyword search was performed based on the titles of the commercial applications. The search through the database was conducted from the 27th March through to the 18th of April 2020 by two independent authors.Results: A total of 103 applications were identified from the Apple iTunes and Google Play store, respectively; 32 were available on both Apple and Google Play stores. The majority appeared on the commercial stores between March and April 2020, more than 2 months after the first discovery of COVID-19. Some of the common functionalities include the provision of news and information, contact tracking, and self-assessment or diagnosis.Conclusions: This is the first review that has characterized the smartphone applications 4 months after the first discovery of COVID-19.

Assessing the Food and Drug Administration's Risk-Based Framework for Software Precertification With Top Health Apps in the United States: Quality Improvement Study.

BackgroundAs the development of mobile health apps continues to accelerate, the need to implement a framework that can standardize the categorization of these apps to allow for efficient yet robust regulation is growing. However, regulators and researchers are faced with numerous challenges, as apps have a wide variety of features, constant updates, and fluid use cases for consumers. As past regulatory efforts have failed to match the rapid innovation of these apps, the US Food and Drug Administration (FDA) has proposed that the Software Precertification (Pre-Cert) Program and a new risk-based framework could be the solution.ObjectiveThis study aims to determine whether the risk-based framework proposed by the FDA’s Pre-Cert Program could standardize categorization of top health apps in the United States.MethodsIn this quality improvement study during summer 2019, the top 10 apps for 6 disease conditions (addiction, anxiety, depression, diabetes, high blood pressure, and schizophrenia) in Apple iTunes and Android Google Play Store in the United States were classified using the FDA’s risk-based framework. Data on the presence of well-defined app features, user engagement methods, popularity metrics, medical claims, and scientific backing were collected.ResultsThe FDA’s risk-based framework classifies an app’s risk by the disease condition it targets and what information that app provides. Of the 120 apps tested, 95 apps were categorized as targeting a nonserious health condition, whereas only 7 were categorized as targeting a serious condition and 18 were categorized as targeting a critical condition. As the majority of apps targeted a nonserious condition, their risk categorization was largely determined by the information they provided. The apps that were assessed as not requiring FDA review were more likely to be associated with the integration of external devices than those assessed as requiring FDA review (15/58, 26% vs 5/62, 8%; P=.03) and health information collection (24/58, 41% vs 9/62, 15%; P=.008). Apps exempt from the review were less likely to offer health information (25/58, 43% vs 45/62, 72%; P<.001), to connect users with professional care (7/58, 12% vs 14/62, 23%; P=.04), and to include an intervention (8/58, 14% vs 35/62, 55%; P<.001).ConclusionsThe FDA’s risk-based framework has the potential to improve the efficiency of the regulatory review process for health apps. However, we were unable to identify a standard measure that differentiated apps requiring regulatory review from those that would not. Apps exempt from the review also carried concerns regarding privacy and data security. Before the framework is used to assess the need for a formal review of digital health tools, further research and regulatory guidance are needed to ensure that the Pre-Cert Program operates in the greatest interest of public health.

Harmful smartphone applications promoting alcohol and illicit substance use: a review and content analysis in the United States.

Few studies have conducted analysis of commercially available smartphone applications designed to promote alcohol and illicit substance use. The aim of this review is to determine harmful themes of content in applications promoting alcohol and illicit substance use found using recovery app search terms. A systematic search, via Apple iTunes and Google Play stores, was conducted of applications targeting abstinence or reduced substance use in online app stores (n = 1,074 apps) in March 2018. We conducted a secondary analysis of apps encouraging alcohol and illicit substance use in July 2018. Our initial search yielded 904 apps pertaining to alcohol and illicit substance use. Four reviewers conducted a content analysis of 102 apps meeting inclusion criteria and assessed app design, delivery features, text, and multimedia content pertaining to substance use. The initial coding scheme was refined using a data-driven, iterative method grouping in thematic categories. The number of apps coded to a specific substance include: alcohol (n = 74), methamphetamine (n =13), cocaine (n = 15), heroin (n = 12), and marijuana (n = 15), with nine apps overlapping more than one substance. Key themes identified among apps included: (i) tangibility (alcohol home delivery services); (ii) social networks (builtin social media platforms promoting substance use); (iii) software design (gamification or simulation of substance use); and (iv) aesthetics (sexual or violent imagery). Despite claims of restricting apps promoting substance use, further efforts are needed by online app stores to reduce the availability of harmful content.

Eyes for Ears—A Medical Education Podcast Feasibility Study

Downloadable audio files called podcasts have become popular within many areas of medical education. They can be a valuable supplement to traditional teaching methods. Medical educators may wish to incorporate podcasts into their curriculum and disseminate their work to a larger audience, but may not know how. We aim to describe the implementation of a novel medical education podcast series for ophthalmology medical student and resident education, and demonstrate feasibility, sustainability, and acceptance of this learning platform. The Basic and Clinical Science Course (BCSC) textbooks and supplementary texts, were used to create a weekly series of ophthalmology review podcasts. Feasibility markers include time and cost of production. Sustainability measures included download markers over time. Acceptance was measured by reviews on Apple iTunes and Twitter followers. Forty-eight episodes were released from January 10, 2019 to March 31, 2020. Costs included $212.18 startup, and $29 monthly. The podcast has had 122,709 downloads to date (466/month January 2019, increased to 17,500/month February 2020). It obtained 331 Twitter followers, and 114 ratings on iTunes, with an average of 5.0 stars. Medical education podcasts are a feasible way of disseminating educational materials to learners. We demonstrate sustainability and acceptance of this learning platform.

CREOGs Over Coffee: Feasibility of an Ob-Gyn Medical Education Podcast by Residents.

Podcasts and other digital resources are increasingly popular among medical learners and allow the dissemination of research to larger audiences. Little is known about the feasibility of graduate medical education trainees developing podcasts for their own and others' learning. We described the development and implementation of a medical education podcast series by residents for obstetrics and gynecology (Ob-Gyn) resident learning, and demonstrated feasibility, sustainability, and acceptance of this series. We used the Council on Resident Education in Obstetrics and Gynecology (CREOG) educational guidelines to create a weekly study podcast for Ob-Gyn residents over 10 months. Costs and donations (for feasibility), downloads over time (for sustainability), and number of reviews on Apple iTunes and followers on Twitter (for acceptability) were measured. Sixty episodes were released from September 30, 2018, to July 28, 2019 (43 weeks). Initial costs included $3,150 startup and $29 monthly. Online donations through Patreon amounted to $200 a month, which covered 58% of startup costs at 10 months and are projected to cover full costs by 1.5 years. The podcast had 173 995 downloads as recorded through Podbean (39 a month in September, increased to 31 206 a month in July). It gained 644 followers on Twitter and 147 ratings on iTunes, with an average of 4.86 out of 5 stars. Medical podcasts created by Ob-Gyn residents during their training appear feasible and highly acceptable over a sustained period.