Patient-centered Applications Research Articles

Orthopedic Research Funding: Assessing the Relationship between Investments and Breakthroughs.

Orthopedic research plays a crucial role in improving patient outcomes for musculoskeletal disorders. This narrative review explores the intricate interplay between funding patterns and the trajectory of breakthroughs achieved in this dynamic field. A meticulous search strategy identified studies illuminating the diverse sources of orthopedic research funding, including public funding (government agencies), philanthropic organizations, private sector investment, and international funding bodies. The review further delved into the spectrum of breakthroughs, encompassing fundamental scientific discoveries, technological advancements, and personalized medicine approaches. Public funding emerged as a significant pillar, supporting foundational research that lays the groundwork for future advancements. Philanthropic organizations addressed specific musculoskeletal disorders, often focusing on patient-centric applications. International funding bodies played a role in supporting research in low- and middle-income countries. Breakthroughs extended beyond cutting-edge prosthetics and minimally invasive surgeries, encompassing fundamental discoveries in areas like gene therapy and biomaterials science. Technological advancements included brain-computer interface prosthetics and 3D-printed implants. Personalized medicine offered the potential for tailored treatments based on individual needs and genetic profiles. This review underscores the complex interplay between funding patterns and breakthroughs in orthopedic research. A multifaceted approach is essential for continued progress. Fostering collaboration, optimizing funding models, and prioritizing both foundational and translational research hold the key to unlocking the true potential of orthopedic research and transforming the lives of patients suffering from musculoskeletal disorders.

Orthopedic Research Funding: Assessing the Relationship between Investments and Breakthroughs.

Orthopedic research plays a crucial role in improving patient outcomes for musculoskeletal disorders. This narrative review explores the intricate interplay between funding patterns and the trajectory of breakthroughs achieved in this dynamic field. A meticulous search strategy identified studies illuminating the diverse sources of orthopedic research funding, including public funding (government agencies), philanthropic organizations, private sector investment, and international funding bodies. The review further delved into the spectrum of breakthroughs, encompassing fundamental scientific discoveries, technological advancements, and personalized medicine approaches. Public funding emerged as a significant pillar, supporting foundational research that lays the groundwork for future advancements. Philanthropic organizations addressed specific musculoskeletal disorders, often focusing on patient-centric applications. International funding bodies played a role in supporting research in low- and middle-income countries. Breakthroughs extended beyond cutting-edge prosthetics and minimally invasive surgeries, encompassing fundamental discoveries in areas like gene therapy and biomaterials science. Technological advancements included brain-computer interface prosthetics and 3D-printed implants. Personalized medicine offered the potential for tailored treatments based on individual needs and genetic profiles. This review underscores the complex interplay between funding patterns and breakthroughs in orthopedic research. A multifaceted approach is essential for continued progress. Fostering collaboration, optimizing funding models, and prioritizing both foundational and translational research hold the key to unlocking the true potential of orthopedic research and transforming the lives of patients suffering from musculoskeletal disorders.

BEHeDaS: A Blockchain Electronic Health Data System for Secure Medical Records Exchange

Blockchain platforms propagate into every facet, including managing medical services with professional and patient-centered applications. With its sensitive nature, record privacy has become imminent with medical services for patient diagnosis and treatments. The nature of medical records has continued to necessitate their availability, reachability, accessibility, security, mobility, and confidentiality. Challenges to these include authorized transfer of patient records on referral, security across platforms, content diversity, platform interoperability, etc. These, are today – demystified with blockchain-based apps, which proffers platform/application services to achieve data features associated with the nature of the records. We use a permissioned-blockchain for healthcare record management. Our choice of permission mode with a hyper-fabric ledger that uses a world-state on a peer-to-peer chain – is that its smart contracts do not require a complex algorithm to yield controlled transparency for users. Its actors include patients, practitioners, and health-related officers as users to create, retrieve, and store patient medical records and aid interoperability. With a population of 500, the system yields a transaction (query and https) response time of 0.56 seconds and 0.42 seconds, respectively. To cater to platform scalability and accessibility, the system yielded 0.78 seconds and 063 seconds, respectively, for 2500 users.

Genetics Adviser: The development and usability testing of a new patient digital health application to support clinical genomic testing

PurposeIncreasing demand for genomic testing coupled with genetics workforce shortages has placed unsustainable pressure on standard models of care. Digital tools can offer improved access, efficiency, and cost savings. We created a patient-facing digital health application to support genomic testing. MethodsWe developed the digital application through user-centered design, guided by an advisory board. We tested its usability and acceptability with patients, practitioners, and members of the general public using mixed methods; data were analyzed using qualitative description and descriptive statistics. ResultsThe “Genetics Adviser” delivers pre-test education, counseling, and post-test return of results adaptable to any population, test platform, and setting. Usability testing with 25 patients, the general public, and genetics practitioners (15/25 female; mean age range 40-49 years) demonstrated enthusiasm about the application; users found it easy to navigate and comprehend. Acceptance testing with 19 patients and the public (13/19 female; mean age range 40-49 years) indicated high acceptability of the application and moderate knowledge of genomic sequencing after use. ConclusionThe Genetics Adviser is a comprehensive, interactive, patient-centered application found to have high acceptability and usability for pre- and post-test genomic testing, counseling, and return of results adaptable for multiple testing platforms, populations, and settings.

From patient generated data to precision medicine: An example of a patient-centered application in oncology.

e13559 Background: To practice precision medicine, the inclusion of patients in therapy is becoming increasingly important. Terms such as ‘patient empowerment’ (PE), ‘patient reported outcome’, and ‘patient generated data’ (PGD) are becoming quite present in current research. In order to implement PE consistently and integrate PGD in therapy, it is necessary to provide patients with specific tools. Methods: In order to develop such a corresponding system, challenges for implementation were identified as well as the current state of PGD in oncology. The aim was to design a system suitable for everyday use that allows the measurement of individual effects like quality of life (QoL) directly at the patient. Based on the positive experience of a previous developed questionnaire tool (EQU) to support physician-patient communication and the findings of the methodology a new patient-centered system was conceptualized with an automated data collection using sensor systems. A decisive factor was to support patients in self-management between treatment periods. This solution was then discussed extensively with stakeholders in order to identify and prioritize functionality and therefore incorporate specific user needs of oncological patients. Results: A great acceptance and need for tools to support patients especially between appointments was identified. In order to enable the recognition of individual characteristics, a continuous survey is essential. Based thereon an application called Lion-App for longitudinal QoL assessment in oncology was developed. A user-centered development aligns the app with the needs of the patients while HL7 FHIR provides the framework for an interoperable exchange. To reduce the burden of continuous interaction, sensors are used for data collection. With an interpretation of this data in the context of QoL, patients are able to visualize their personal course to gain an even better understanding of their disease. With the possibility to perform self-management between appointments, patients are lifted to another level of empowerment. In addition, the gained knowledge may then be used to focus on the effects of the disease in the next appointment and thus take a self-determined role in treatment. First evaluations of the app have been started. Conclusions: There are many ways to use PGD in the manner of precision medicine. The main factor is to create awareness among patients, collect data in an exchangeable way and involve end users early into development. A great opportunity to reduce user interactions and therefore enable long-term usage is the integration of sensor technologies. As a secondary use, algorithms can be extended via the expanded data base to become even more individualized to the patient. Thus, in the long run, such a system may help to further strengthen the cooperation between patient and physician and thus to enable a personalized, QoL-based treatment in oncology.

Review of Innovative Immersive Technologies for Healthcare Applications

ABSTRACTImmersive technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), can connect people using enhanced data visualizations to better involve stakeholders as integral members of the process. Immersive technologies have started to change the research on multidimensional genomic data analysis for disease diagnostics and treatments. Immersive technologies are highlighted in some research for health and clinical needs, especially for precision medicine innovation. The use of immersive technology for genomic data analysis has recently received attention from the research community. Genomic data analytics research seeks to integrate immersive technologies to build more natural human-computer interactions that allow better perception engagements. Immersive technologies, especially VR, help humans perceive the digital world as real and give learning output with lower performance errors and higher accuracy. However, there are limited reviews about immersive technologies used in healthcare and genomic data analysis with specific digital health applications. This paper contributes a comprehensive review of using immersive technologies for digital health applications, including patient-centric applications, medical domain education, and data analysis, especially genomic data visual analytics. We highlight the evolution of a visual analysis using VR as a case study for how immersive technologies step, can by step, move into the genomic data analysis domain. The discussion and conclusion summarize the current immersive technology applications' usability, innovation, and future work in the healthcare domain, and digital health data visual analytics.

Blockchain-Enabled iWellChain Framework Integration With the National Medical Referral System: Development and Usability Study.

BackgroundMedical referral is the transfer of a patient’s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA’s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists.ObjectiveTo eliminate the existing restrictions of the NHIA’s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA’s NMR referral data to build an alliance-based medical referral service connecting health care facilities.MethodsWe developed a blockchain-enabled framework that can integrate patient referral data from the NHIA’s NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients’ behavior and investigate the acceptance of our personal authorization-controlled framework.ResultsThe constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports.ConclusionsThis study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption.

The Moderating Role Of Top Executives' Sex, Level Of Education And Knowledge On Adoption Of Mobile Health Applications By Hospitals In Kenya.

BackgroundKenya lags behind other countries in adoption of mobile health (m-health) applications. Understanding factors affecting adoption of m-health by hospitals is required to inform strategic scale up and leverage m-health for sustainable development goals. This study investigated the moderating effects of Top Executives’ (TEs) traits, namely sex, level of education and knowledge of m-health, on adoption of Patient Centered (PC) and Facility-Centered (FC) m-health applications.MethodsThis study applied the Technological, Organizational and Environmental (TOE) framework and the Diffusion of Innovation (DOI) theory to test hypotheses that TEs' traits individually or combined had no statistically significant moderating effect on adoption of PC and FC m-health applications. Primary data were collected through a self-administered questionnaire from a representative sample size of 211 TEs from level 4 to 6 hospitals. The Logit Regression Model was used to determine the significance of each predictor.ResultsMost TEs of hospitals are predominantly male (75.3%). Most TEs (65%) rated their knowledge of m-health at medium level. Most TEs reported having completed undergraduate (46%) or post-graduate (38.4%) degrees. At 5% level of significance, the study found that being a male TE (p=0.041) and having higher level of knowledge of m-health (p=0.009) were statistically significant moderators of adoption of PC m-health applications by hospitals in Kenya. However, all TEs' traits combined or individually were not statistically significant moderators of FC m-health applications. The moderating effect of TEs' traits is thus affected by the focus, level of complexity of the technology, and by the required organizational change management. For PC scale-up, there is an urgent need to integrate digital health training in the medical education curricula and in the professional development programs and to develop policy incentives that remove any gender-related barriers to adoption of m-health. However, scale up of FC m-health may require other strategies such as pre-existence of systems and infrastructure and a cohesive change management strategy.ConclusionThis study recommends a differentiated approach to introduction, scale up, and investigation of PC and FC m-health applications.

Moderating role of transformational leadership styles of hospital management boards on adoption of mobile health innovations by hospitals in Kenya

Sub-Saharan Africa lags other regions in the adoption of both Patient-Centered (PC) and Facility Centered (FC) mobile health (m-health) applications. Transformational Leadership Style (TLS) of Hospital Management Boards (HMBs) is catalytic for the adoption of disruptive technologies such as m-health by hospitals. There is limited evidence on the effect of TLS of HMBs in the adoption of innovations in Low- and Middle-Income Countries (LMICS). This study investigated the moderating role of TLS of HMBs on the adoption of PC and FC m-health by hospitals in Kenya. It used the Logit Regression Model to test null hypotheses that the four constructs of TLS (Idealized Influence (II), Individualized Consideration (IC), Inspirational Motivation (IM), Intellectual Stimulation (IS)) individually or combined had no significant moderating effect on adoption of PC and FC m-health applications. Primary data was collected from a representative sample size of 211 Top Executives (TEs) of level 4 to 6 hospitals who evaluated the TLS of their HMBs on m-health adoption. At a 5% level of significance, the study found that only the combined application of the four constructs (II, IC, IM, IS) significantly moderated the adoption of PC m-health (p=0.046) but did not moderate FC m-health (p=0.345). Each incremental application of TLS would increase the odds of adopting PC m-health by 1.002 but not for FC. Therefore, this study recommends the capacity strengthening of HMBs in TLS to scale up PC m-health adoption in Kenya and other LMICs. It also recommends a differentiated approach to policies, practices, and theories of adoption of innovations using the PC-FC models.

Factors associated with combined do-not-resuscitate and do-not-intubate orders: A retrospective chart review at an urban tertiary care center

BackgroundIn clinical practice, do-not-intubate (DNI) orders are generally accompanied by do-not-resuscitate (DNR) orders. Use of do-not-resuscitate (DNR) orders is associated with older patient age, more comorbid conditions, and the withholding of treatments outside of the cardiac arrest setting. Previous studies have not unpacked the factors independently associated with DNI orders. ObjectiveTo compare factors associated with combined DNR/DNI orders versus isolated DNR orders, as a means of elucidating factors associated with the addition of DNI orders. DesignRetrospective chart review. Setting/subjectsPatients who died on a General Medicine or MICU service (n = 197) at an urban public hospital over a 2-year period. MeasurementsLogistic regression was used to identify demographic and medical data associated with code status. ResultsCompared with DNR orders alone, DNR/DNI orders were associated with a higher median Charlson Comorbidity Index (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.13–1.43); older age (OR 1.02, 95% CI 1.01–1.04); malignancy (OR 2.27, 95% CI 1.18–4.37); and female sex (OR 1.98, 95% CI 1.02–3.87). In the last 3 days of life, they were associated with morphine administration (OR 2.76, 95% CI 1.43–5.33); and negatively associated with use of vasopressors/inotropes (OR 10.99, 95% CI 4.83–25.00). ConclusionsCompared with DNR orders alone, combined DNR/DNI orders are more strongly associated with many of the same factors that have been linked to DNR orders. Awareness of the extent to which the two directives may be conflated during code status discussions is needed to promote patient-centered application of these interventions.

Innovation Challenges and Opportunities in Biopharma, MedTech, Digital Medicine, and Their Emerging Convergence: User & Patient Centric Applications in the “Pharma 3.0 Business Model Paradigm”

In the first section of this monograph, titled “Bridging Theory and Practice for Commercialization and Innovation – a market-centered perspective for cross-industry applications”, we outlined a number of overlapping theories or models dealing with innovation. Theories, when well stated and proven, are basically statements of causality. Scientists and technologists use them all the time to predict physical or chemical phenomenon for example. However, whether or not we explicitly recognize them as such, theories also exist in the business world and can be useful as guides to behavior and decision making. These models serve as lenses through which “the world” is viewed and that enable predictions, or forecasts to be made. However, they may also act as “blinders”, limiting our ability to see that which may not fit into our existing models. As the famous statistician, George Box said in an often-repeated quote, “essentially, all models (theories) are wrong, but some are useful.”

Improving patient outcomes through multidisciplinary treatment planning conference.

The purpose of this study was for us to determine National Comprehensive Cancer Network (NCCN) guideline-compliance of multidisciplinary conference (MDC) recommendations and actual treatment received, and to determine this impact on patient outcomes. We conducted a retrospective review of patients presented at MDC between January 1, 2006, and December 31, 2006, with previously untreated incident cancers. We identified 232 patients, for whom MDC recommendations were NCCN guideline-compliant in 201 (86.6%). Actual treatment was NCCN guideline-compliant in 170 of 197 patients (86.3%). Adherence of MDC recommendations to NCCN guidelines was associated with superior overall survival (hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.33-1.39; p = .3), as was guideline-compliance of actual treatment (HR = 0.6; 95% CI = 0.64-1.07; p = .07); congruence between MDC recommendations and actual treatment conferred a statistically significant overall survival benefit (HR = 0.49; 95% CI = 0.27-0.89; p = .02). Our findings argue for patient-centered application of NCCN guidelines. Prospective evaluation will enable more timely identification of systematic NCCN guideline deviations that quality improvement interventions may address. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1820-E1825, 2016.

Recent Directions in Telemedicine: Review of Trends in Research and Practice.

ObjectivesHealthcare is now routinely delivered by telecommunications-based services in all developed countries and an increasing number of developing countries. Telemedicine is used in many clinical specialities and across numerous healthcare settings, which range from mobile patient-centric applications to complex interactions amongst clinicians in tertiary referral hospital settings. This paper discusses some recent areas of significant development and progress in the field with the purpose of identifying strong trends in both research and practice activities.MethodsTo establish the breadth of new ideas and directions in the field, a review of literature was made by searching PubMed for recent publications including terms (telemedicine OR telehealth) AND (challenge OR direction OR innovation OR new OR novel OR trend), for all searchable categories. 3,433 publications were identified that have appeared since January 1, 2005 (2,172 of these since January 1, 2010), based on a search conducted on June 1, 2015.ResultsThe current interest areas in these papers span both synchronous telemedicine, including intensive care, emergency medicine, and mental health, and asynchronous telemedicine, including wound and burns care, dermatology and ophthalmology.ConclusionsIt is concluded that two major drivers of contemporary tele medicine development are a high volume demand for a particular clinical service, and/or a high criticality of need for clinical exper tise to deliver the service. These areas offer promise for further study and enhancement of applicable telemedicine methods and have the potential for large-scale deployments internationally, which would contribute significantly to the advancement of healthcare.

Patient-centered Applications: Use of Information Technology to Promote Disease Management and Wellness. A White Paper by the AMIA Knowledge in Motion Working Group

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Religion and medicine IV: religion, physical health, and clinical implications.

In the fourth and final article of this religion and medicine series, I summarize the results of a comprehensive and systematic review of research examining religion's relationship to physical health and mortality. This review focuses on pain and disability, cardiovascular disease, immune and neuroendocrine function, susceptibility to infection, cancer, and overall mortality. I also explore what these research findings mean for medical practice and suggest patient-centered applications that are sensitive to ethical concerns.