Tablet-based Application Research Articles

Innovative infusion center assessments of chemotherapy-induced neurotoxicities: A pilot study supporting early and routine screenings as part of survivorship programs.

e24102 Background: More than 50% of patients treated with taxane and platinum chemotherapy experience neurotoxic adverse events due to treatment, including neuropathy, hearing loss or cognitive impairment. However, because risk factors and clinical trajectory of these toxicities remain poorly understood, it is not yet clear how or when patients should be screened. Innovative technology, such as tablet-based screening tools, create unique opportunities to capture patient symptoms, better understand potentially long-lasting side effects, and determine when to start either preventive or treatment/rehabilitation options. Methods: We assembled a multidisciplinary team from oncology, nursing, and audiology. IRB permission was obtained to perform a longitudinal observational pilot to assess the feasibility of performing chair-side neurotoxicity screenings in the infusion center of an urban safety net health system. Five infusion center nurses were recruited to collect data using a tablet-based application on 55 patients who met the inclusion criteria including chemotherapy-naive patients and fluent in English. Neuropathy and cognitive impairment were measured by validated standardized subjective scales (the Chemotherapy Induced Peripheral Neuropathy Assessment Tool, and the Attentional Function Index, respectively) and objective pure-tone audiometry (SHOEBOX Audiometry). Descriptive statistics were used to summarize outcome data. Results: Baseline assessments were completed on 48/55 patients with 37 completing at least one or up to 6 repeated assessments. All participants had baseline assessments before their first cycle by a chemo-certified RN in the infusion chair. Our sample included 55 adults aged 29 to 81 years, of whom 75% were females. 61% of participants were diagnosed with a gynecologic cancer, and 51% consented to receive Paclitaxel and Carboplatin chemotherapy regimen, 29% consented to receive Cisplatin chemotherapy, the remaining 20% consented to receive Oxaliplatin, Docetaxel, or Carboplatin alone. Significant changes occurred in all 3 symptoms by cycle 6 of chemotherapy with 45% of participants experiencing neuropathy, 13% experiencing a clinically significant change in hearing, and 30% experiencing self-reported cognitive concern by the 6th cycle. Ototoxicity and neurotoxicity scores followed the same trajectory of an increase or worsening in scores over time from cycle 1 to cycle 6. Conclusions: Use of innovative, portable tablet-based screening tool can be effectively used to capture symptoms of neuropathy chair-side as patients undergo chemotherapy. These observations support the need to better assess these approaches so that they can be used to optimize clinical outcomes and patient quality of life.

A Tablet-Based Application to Enhance Social Connectedness for Individuals With a Cognitive Impairment: Results From the PRISM-CI Pilot Study.

Social engagement is fundamental to successful aging and linked to better emotional, physical, and cognitive health. Maintaining social engagement is challenging for many older adults but especially for those with a cognitive impairment (CI). Information and communication technologies (ICT) can provide enhanced opportunities for social and cognitive engagement for older adults with a CI via increased information, education, and social connectivity access. This study used a pre-test post-test design to evaluate the feasibility, acceptability, and preliminary efficacy of the PRISM-CI software system, a tablet-based application designed to enhance access to resources, information, and social engagement, in 52 individuals with a CI between the ages of 65-88 years who had access to PRISM-CI for five months. Findings show that social isolation, loneliness, and depressive symptoms significantly decreased, and mobile device proficiency significantly increased, from baseline to follow-up. Results highlight ICTs potential to foster social engagement among older adults with a CI.

Co-ML: Collaborative Machine Learning Model Building for Developing Dataset Design Practices

Machine learning (ML) models are fundamentally shaped by data, and building inclusive ML systems requires significant considerations around how to design representative datasets. Yet, few novice-oriented ML modeling tools are designed to foster hands-on learning of dataset design practices, including how to design for data diversity and inspect for data quality. To this end, we outline a set of four data design practices (DDPs) for designing inclusive ML models and share how we designed a tablet-based application called Co-ML to foster learning of DDPs through a collaborative ML model building experience. With Co-ML, beginners can build image classifiers through a distributed experience where data is synchronized across multiple devices, enabling multiple users to iteratively refine ML datasets in discussion and coordination with their peers. We deployed Co-ML in a 2-week-long educational AIML Summer Camp, where youth ages 13–18 worked in groups to build custom ML-powered mobile applications. Our analysis reveals how multi-user model building with Co-ML, in the context of student-driven projects created during the summer camp, supported development of DDPs including incorporating data diversity, evaluating model performance, and inspecting for data quality. Additionally, we found that students’ attempts to improve model performance often prioritized learnability over class balance. Through this work, we highlight how the combination of collaboration, model testing interfaces, and student-driven projects can empower learners to actively engage in exploring the role of data in ML systems.

Effects of acute cannabis inhalation on reaction time, decision-making, and memory using a tablet-based application

BackgroundAcute cannabis use has been demonstrated to slow reaction time and affect decision-making and short-term memory. These effects may have utility in identifying impairment associated with recent use. However, these effects have not been widely investigated among individuals with a pattern of daily use, who may have acquired tolerance. The purpose of this study was to examine the impact of tolerance to cannabis on the acute effects as measured by reaction time, decision-making (gap acceptance), and short-term memory.MethodsParticipants (ages 25–45) completed a tablet-based (iPad) test battery before and approximately 60 min after smoking cannabis flower. The change in performance from before to after cannabis use was compared across three groups of cannabis users: (1) occasional use (n = 23); (2) daily use (n = 31); or (3) no current use (n = 32). Participants in the occasional and daily use group self-administered ad libitum, by smoking or vaping, self-supplied cannabis flower with a high concentration of total THC (15–30%).ResultsThe occasional use group exhibited decrements in reaction time (slowed) and short-term memory (replicated fewer shapes) from before to after cannabis use, as compared to the no-use group. In the gap acceptance task, daily use participants took more time to complete the task post-smoking cannabis as compared to those with no use or occasional use; however, the level of accuracy did not significantly change.ConclusionsThe findings are consistent with acquired tolerance to certain acute psychomotor effects with daily cannabis use. The finding from the gap acceptance task which showed a decline in speed but not accuracy may indicate a prioritization of accuracy over response time. Cognitive and psychomotor assessments may have utility for identifying impairment associated with recent cannabis use.

Optimizing radiological diagnostic management via mobile devices in trauma surgery

Time is ascarce resource for physicians. One medical task is the request for radiological diagnostics. This process is characterized by high administrative complexity and sometimes considerable time consumption. Measures that lead to an administrative relief in favor of patient care have so far been lacking. Process optimization of the request for radiological diagnostics. As aproof of concept the request for radiological diagnostics was conducted using amobile, smartphone and tablet-based application with dedicated voice recognition software in the Department of Trauma Surgery at the University Hospital of Würzburg (UKW). In aprospective study, time differences and efficiency of the mobile app-based method (ukw.mobile based Application = UMBA) compared to the PC-based method (PC-based application = PCBA) for requesting radiological services were analyzed. The time from the indications to the completed request and the time required to create the request on the device were documented and assessed. Due to the non-normal distribution of the data, aMann-Whitney Utest was performed. The time from the indications to the completed request was significantly (p < 0.05) reduced using UMBA compared to PCBA (PCBA: mean ± standard difference [SD] 19.57 ± 33.24 min, median 3.00 min, interquartile range [IQR] 1.00-30.00 min vs. UMBA: 9.33 ± 13.94 min, median 1.00 min, IQR 0.00-20.00 min). The time to complete the request on the device was also significantly reduced using UMBA (PCBA: mean ± SD 63.77 ± 37.98 s, median 51.96 s, IQR 41.68-68.93 s vs. UMBA: 25.21 ± 11.18 s, median 20.00 s, IQR 17.27-29.00 s). The mobile, voice-assisted request process leads to aconsiderable time reduction in daily clinical routine and illustrates the potential of user-oriented, targeted digitalization in healthcare. In future, the process will be supported by artificial intelligence.

The Effects of Artificial Intelligence on Implementors’ Fidelity of Instructional Strategies During Handwashing Acquisition in Children with Autism

Handwashing is a vital skill for maintaining health and hygiene. For individuals with intellectual and developmental disabilities (IDD), such as autism spectrum disorder, evidence-based strategies, such as prompting and task analysis, may be effective in teaching these skills. Due to the shortage of experts who teach individuals with IDD skills such as handwashing, staff working with children need a means of ensuring these instructional strategies are implemented with fidelity. This study examined the effects of a tablet-based application that used artificial intelligence (GAINS®) on four behavior technicians’ implementation of least-to-most prompting, total task chaining, and time delay during an acquisition of handwashing program with young children with autism. All four technicians increased fidelity immediately upon using GAINS and all four technicians reached mastery criteria within the shortest number of sessions possible. One child participant met mastery criteria, two showed some gains, and one demonstrated a high degree of variability across sessions. Limitations of the least-to-most prompting procedure, user design, considerations and directions for future research and practice are discussed.

Validation of a tablet-based application for hearing self-screening in an adult population

Objective This study evaluated the diagnostic performances of a tablet-based hearing screening test by assisted-test and self-test modes. Design/method Measurements were performed with the SoTone tests in normal hearing and hearing-impaired adult participants using an Android tablet and calibrated Bluetooth headphones. The duration of assisted- and self-test modes were compared. Receiver operating characteristic (ROC) curves were plotted after calculations of sensitivity and specificity at 20, 30, and 35 dB HL cut-off values. Study sample 217 participants performed the tests. The effect of test mode (assisted versus self) was compared in a sample of 103 participants. Results Self-test duration (89 s) was significantly longer than the assisted-test duration (75 s) (p = 0.003, Wilcoxon test). For the 20, 30, and 35 dB HL cut-off values, sensitivity was between 92% and 96%, and specificity was between 79 and 90%. Concordance of results between assisted-test and self-test modes was excellent (Cohen’s kappa = 0.81, p < 0.001). Conclusions The SoTone hearing screening test is accurate for identifying the presence of a suspected hearing loss at 20 dB HL or more in adults. It can be used either in assisted-test or self-test modes.

Using Goldmann Visual Field Volume to Track Disease Progression in Choroideremia

Choroideremia is an X-linked choroidopathy caused by pathogenic variants in the CHM gene. It is characterized by the early appearance of multiple scotomas in the peripheral visual field that spread and coalesce, usually sparing central vision until late in the disease. These features make quantitative monitoring of visual decline particularly challenging. Here, we describe a novel computational approach to convert Goldmann visual field (GVF) data into quantitative volumetric measurements. With this approach, we analyzed visual field loss in a longitudinal, retrospective cohort of patients with choroideremia. Single-center, retrospective, cohort study. We analyzed data from 238 clinic visits of 56 molecularly-confirmed male patients with choroideremia from 41 families (range, 1-27 visits per patient). Patients had a median follow up of 4 years (range, 0-56 years) with an age range of 5 to 76 years at the time of their visits. Clinical data from molecularly-confirmed patients with choroideremia, including GVF data, were included for analysis. Goldmann visual fieldrecords were traced using a tablet-based application, and the 3-dimensional hill of vision was interpolated for each trace. This procedure allowed quantification of visual field loss from data collected over decades with differing protocols, including different or incomplete isopters. Visual acuity (VA) data were collected and converted to logarithm of the minimum angle of resolution values. A delayed exponential mixed-effects model was used to evaluate the loss of visual field volume over time. Visual acuity and GVF volume. The estimated mean age at disease onset was 12.6 years (standard deviation, 9.1 years; 95% quantile interval, 6.5-36.4 years). The mean field volume loss was 6.8% per year (standard deviation, 4.5%; 95% quantile interval, 1.9%-18.8%) based on exponential modeling. Field volume was more strongly correlated between eyes (r2=0.935) than best-corrected VA (r2=0.285). Volumetric analysis of GVF data enabled quantification of peripheral visual function in patients with choroideremia and evaluation of disease progression. The methods presented here may facilitate the analysis of historical GVF data from patients with inherited retinal disease and other diseases associated with visual field loss. This work informs the creation of appropriate outcome measures in choroideremia therapeutic trials, particularly in trial designs. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Validating the measurement of upper limb sensorimotor behavior utilizing a tablet in neurologically intact controls and individuals with chronic stroke

BackgroundIntact sensorimotor function of the upper extremity is essential for successfully performing activities of daily living. After a stroke, upper limb function is often compromised and requires rehabilitation. To develop appropriate rehabilitation interventions, sensitive and objective assessments are required. Current clinical measures often lack precision and technological devices (e.g. robotics) that are objective and sensitive to small changes in sensorimotor function are often unsuitable and impractical for performing home-based assessments. Here we developed a portable, tablet-based application capable of quantifying upper limb sensorimotor function after stroke. Our goal was to validate the developed application and accompanying data analysis against previously validated robotic measures of upper limb function in stroke.MethodsTwenty individuals with stroke, twenty age-matched older controls, and twenty younger controls completed an eight-target Visually Guided Reaching (VGR) task using a Kinarm Robotic Exoskeleton and a Samsung Galaxy Tablet. Participants completed eighty trials of the VGR task on each device, where each trial consisted of making a reaching movement to one of eight pseudorandomly appearing targets. We calculated several outcome parameters capturing various aspects of sensorimotor behavior (e.g., Reaction Time, Initial Direction Error, Max Speed, and Movement Time) from each reaching movement, and our analyses compared metric consistency between devices. We used the previously validated Kinarm Standard Analysis (KSA) and a custom in-house analysis to calculate each outcome parameter.ResultsWe observed strong correlations between the KSA and our custom analysis for all outcome parameters within each participant group, indicating our custom analysis accurately replicates the KSA. Minimal differences were observed for between-device comparisons (tablet vs. robot) in our outcome parameters. Additionally, we observed similar correlations for each device when comparing the Fugl-Meyer Assessment (FMA) scores of individuals with stroke to tablet-derived metrics, demonstrating that the tablet can capture clinically-based elements of upper limb impairment.ConclusionsTablet devices can accurately assess upper limb sensorimotor function in neurologically intact individuals and individuals with stroke. Our findings validate the use of tablets as a cost-effective and efficient assessment tool for upper-limb function after stroke.

Engaging Nigerian Older Persons in Neighborhood Environment Assessment for Physical Activity Participation: A Citizen Science Project.

Global organizations are advocating that older persons' voices should guide communities in age-friendly design. An important aspect of age friendliness to enable daily function and health is ensuring that physical activity can occur, regardless of age, within local neighborhoods. This study used a specific citizen science approach, Our Voice, to engage a sample (N = 13) of older adults (60 or older) in Festac Town, Nigeria. The citizen scientists' roles were to assess and identify how different aspects of the neighborhood environment act as supports or barriers to their physical activity participation. They were individually enabled using a tablet-based mobile application called the Stanford Healthy Neighborhood Discovery Tool to record a total of 156 geocoded photos and 151 commentaries of neighborhood environmental features that facilitate or hinder physical activity in and around their neighborhoods. In a guided process, the following occurred: collaborative discussions of findings with other citizen scientists to determine common targets, setting of priority targets for change, and brainstorming strategies and solutions. Facilitators of physical activity included: pedestrian and traffic facilities (e.g., traffic lights, walkways); green areas and parks; multigenerational community features (e.g., programs/facilities); opportunities for social connection (e.g., neighborhood associations, churches); safety of destinations and services; and public toilets. Barriers to physical activity included: hazardous walkways/traffic; noise pollution; refuse, selling of public parks; crime (e.g., kidnapping, criminal hideouts); no safe drinking water; and ageism. The priorities for changes were social connectivity; improved pedestrian and traffic facilities; and green and beautiful environments. In this study, both physical and social aspects of the environment were deemed important for older Nigerians to enable physical activity in their local community. This approach has a promise for age-friendly initiatives seeking local changes by meaningfully engaging older adults.

Influences of a Virtual Manipulatives Context on Argumentation About Integers

This article presents a case study of two Grade 5 boys’ argumentation concerning addition and subtraction of negative numbers while using an interactive tablet-based application simulating positive and negative tiles. We examine the properties of integers they conjectured, and the kinds of evidence and arguments they used to support their conjectures. The proof-based teaching theory used to develop the tasks, and the features of the virtual manipulative environment, are described. The results show that the tasks, in combination with the virtual manipulative environment, allowed the boys to perform calculations that they had not been able to perform previously, that in one instance one boy used a deductive argument to explain a conjecture they had made, and that a known weakness of the counterbalance model of integers that was used was not a problem in this case.

Pattern of Road Traffic Injuries and Their Pre-hospitalization Factors Reported at a Public Tertiary Healthcare Facility and Rural Private Healthcare Facility in Rajasthan, India.

We aimed to report the pattern of road traffic injuries (RTIs) and pre-hospitalization factors of road traffic injuries among the accident victims reported at an urban and arural healthcare facility in the Jaipur district, Rajasthan. This cross-sectional study was conducted in a tertiary-level, urban public healthcare facility in Jaipur city and a secondary-level, rural private facility in nearby Chomu town. The study participants were all those who encountered road traffic injury and visited any of these healthcare facilities to seek care. The study tool included information on demographics, type of road user, vehicles, accidents, roads, environment, and other pre-hospitalization factors. Data collectors were nurses trained to collect data using the tablet-based application. Data were analyzed using proportions/percentages. Bivariate analysis was done to assess the significance of differences between categories of factors and between rural and urban facilities. Among 4,642 cases, 93.8% were enrolled in the urban facility, and the remaining were enrolled in the rural facility. Predominantly, males (83.9%) and young adults 18-34 years (58.9%) were reported in both study facilities. Among the accident victims reported at the urban facility, major groups were educated up to the primary level (25.1%) or graduate level (21.9%). About 60% of them were drivers. Most of these injuries occurred on urban roads (50.2%) or two-lane roads (42%). About three-fourths of the injured were using two-wheeler geared vehicles, and 46.7% were overtaking or turning the vehicle when the accident happened. The majority of cases (61.6%) did not require hospitalization. Among the rural facility participants, 27.2% were graduates, and 24.7% were below primary education. Most of these injuries happened on the national highway (35.8%) or rural roads (33.3%). Most of them used two-wheeler geared (80.1%) at the time of the accident. Most were injured while doing normal straight driving (80.5%). Most participants (80.1%)in the rural facility did not follow the traffic rules, and 43.9% required hospitalization. Young males were the most affected age group by road traffic injuries. Differential patterns of road traffic injuries and pre-hospital factors were observed in urban and rural areas.

A Case Study in Tablet-Based Augmented Reality Vocabulary Acquisition

Augmented Reality (AR) is a novel technology capable of embedding digital objects a user's experience of reality via a smartphone, tablet, or head-mounted display. AR offers interesting pedagogical applications and research possibilities in the field of SLA, particularly in the deliberate study of vocabulary. Such applications also offer implications for distance learning. This case study examined a 25-year-old Japanese language teacher in her deliberate acquisition of three sets of 15 vocabulary items selected from the first 1,000 most frequent words of Basque. A word card study method was compared with two AR vocabulary study methods. One AR study method involved the study of physical objects and their signifying Basque vocabulary items within a context-independent scene which was unknown to the participant. The second AR study method similarly involved the study of physical objects and their signifying Basque vocabulary items within a context-dependent scene which was known to the learner. In terms of vocabulary retention as measured with meaning recognition, form recognition, and form recall tests, both AR methods of study appeared to be as effective if not more so than word cards. The study of vocabulary items represented by physical objects in a contextualized environment with the use of a tablet-based AR application was beneficial in leveraging the recall of meaning and form of those items. During reflective interviews regarding the use of AR the participant indicated that she found the novel method of vocabulary study to be engaging and motivating. The findings of this study also indicate that mobile AR applications have potential pedagogical uses relevant to distance education practices.

Supervised, Self-Administered Tablet-Based Cognitive Assessment in Neurodegenerative Disorders and Stroke

Introduction: As the population ages, the prevalence of cognitive impairment is expanding. Given the recent pandemic, there is a need for remote testing modalities to assess cognitive deficits in individuals with neurological disorders. Self-administered, remote, tablet-based cognitive assessments would be clinically valuable if they can detect and classify cognitive deficits as effectively as traditional in-person neuropsychological testing. Methods: We tested whether the Miro application, a tablet-based neurocognitive platform, measured the same cognitive domains as traditional pencil-and-paper neuropsychological tests. Seventy-nine patients were recruited and then randomized to either undergo pencil-and-paper or tablet testing first. Twenty-nine age-matched healthy controls completed the tablet-based assessments. We identified Pearson correlations between Miro tablet-based modules and corresponding neuropsychological tests in patients and compared scores of patients with neurological disorders with those of healthy controls using t tests. Results: Statistically significant Pearson correlations between the neuropsychological tests and their tablet equivalents were found for all domains with moderate (r > 0.3) or strong (r > 0.7) correlations in 16 of 17 tests (p < 0.05). All tablet-based subtests differentiated healthy controls from neurologically impaired patients by t tests except for the spatial span forward and finger tapping modules. Participants reported enjoyment of the tablet-based testing, denied that it provoked anxiety, and noted no preference between modalities. Conclusions: This tablet-based application was found to be widely acceptable to participants. This study supports the validity of these tablet-based assessments in the differentiation of healthy controls from patients with neurocognitive deficits in a variety of cognitive domains and across multiple neurological disease etiologies.

Studying cognitive-motor interactions using a tablet-based application of the Color Trails Test.

The Color Trails Test (CTT) is a pen and paper (P&P) test designed to measure cognitive function. The test consists of two parts that evaluate primarily sustained visual attention (Trails A) and divided attention (Trails B). Based on clinical interest in converting neuropsychological testing from P&P to computerized testing, we developed a digital version of the CTT ('Tablet-CTT'). Twenty-four young, healthy participants performed Trails A and B of both the original P&P and the Tablet-CTT. Hand kinematics were calculated using the continuous location of an electronic pen on the tablet touch screen. To compare motor control aspects, we differentiated for each test session the 'movement planning' and 'movement execution' times (accumulated across all single target-to-target trajectories). Concurrent validity was demonstrated by the high correlation between completion times of the P&P and Tablet-CTT, in both Trails A (r = 0.6; p < 0.005) and Trails B (r = 0.8; p < 0.001). Trails B yielded significantly longer completion times in both formats (p < 0.001). Examining hand kinematics in Tablet-CTT revealed that the difference in durations was mostly due to prolonged planning time, but also due to significantly lower execution velocity in Trails B (p < 0.001). Lastly, we found increased hand velocity during the planning phase in Trails B compared to Trails A (p < 0.001). This study demonstrates how transforming the CTT to a digital platform could be useful for studying cognitive-motor interactions in healthy individuals. Moreover, it could potentially serve as a diagnosis tool by introducing a more comprehensive testing method that incorporates online recordings of hand movements.

Effectiveness of a Telerehabilitation Evidence-Based Tablet App for Rehabilitation in Traumatic Bone and Soft Tissue Injuries of the Hand, Wrist, and Fingers

ObjectiveTo assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services. DesignA multicenter assessor-blinded, parallel, 2-group controlled trial. SettingTrauma and rehabilitation services of 4 hospitals. ParticipantsSix hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663). InterventionsThe experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper. Main Outcome MeasuresThe primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments). ResultsThe experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η2=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=−1.64; 95% confidence interval, −2.64 to −0.65) and physiotherapy sessions (mean difference=−8.52, 95% confidence interval, −16.92 to −0.65) compared to the control group. ConclusionsIn patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients’ functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.

Neurocognitive monitoring in patients undergoing opioid pain medication after spinal surgery: a feasibility study of a new monitoring method

PurposePatients undergoing spinal surgery require postoperative pain management to alleviate wound pain. Pain medication includes WHO grade 1 analgesic as well as potent opioids, potentially leading to cognitive decline. Up until now, the cognitive impairment is only poorly studied and difficult to monitor. We hereby investigate the feasibility of a digital monitoring method for neurocognitive function under opioid medication after spinal instrumentation.MethodsProspective monocenter feasibility study enrolling patients before undergoing spinal surgery. We performed cognitive testing using a tablet-based application before (baseline), as well as on day 2 after surgery (intravenous opioids), before discharge (oral opioids), and at follow-up. We recorded the exact pain medication and its other side effects. Potential risk factors for the postoperative decline in cognition included age, high-dose opioid application, and length of surgery.ResultsWe included 20 patients in our study. The baseline assessment revealed no cognitive impairment before surgery. All patients underwent dorsal instrumentation for degenerative (60%), osteoporotic fracture (15%), or spinal tumor (25%) indications. Cognitive testing after surgery showed a significant decline under intravenous opioid therapy including short time and delayed verbal recall (p < 0.001) as well as arithmetic fluency. Cognitive performance significantly improved with partial recovery until follow-up and opioid discontinuation.ConclusionCognition testing and monitoring of neurocognitive decline under high-dose opioid medication were feasible using the digital tablet-based application. The cognition app helps to identify difficulties in cognitive function as a side effect of overdosage in opioid medication, and care givers should evaluate the risk of non-comprehension and impaired informed consent appropriately.

A PILOT ASSESSMENT OF A TABLET-BASED INTERVENTION FOR HOMEBOUND OR SOCIALLY ISOLATED OLDER ADULTS WITH DEPRESSION

Abstract Older adults who are homebound or socially isolated have high rates of loneliness and depression with fewer opportunities for treatment. Our team extended an existing psychotherapy intervention (Engage &amp; Connect) to improve access to mental health care for older adults who are homebound. We iteratively created a tablet-based application (Engage PRISM) leveraging a user-centered design approach to provide older adults, particularly those with limited technology experience, an easy-to-use application to support social reward. Engage PRISM connects clients with the psychotherapy intervention and additional features to increase social reward exposure virtually. All eligible participants received a K92 ZTE tablet, equipped with the Engage PRISM application, internet service, Zoom, and access to Selfhelp’s Virtual Senior Center. Participants were then enrolled in the 9-week Engage &amp; Connect intervention delivered by a licensed mental health counselor via Zoom on the tablet each week. We evaluated feasibility of the intervention and preliminary effect on depressive symptoms through a weekly PHQ-9. Feasibility was assessed through participants’ ability to use the tablet to access mental health treatment. We provided tablets to eight participants ages 67 to 84; participants demonstrated 100% feasibility of use of the tablet intervention. We dropped two participants from the study due to a greater level of care needed. All participants were provided with referrals prior to ending the study. Preliminary evidence indicates that four of the six remaining participants had experienced a reduction in depressive symptoms (i.e., had lower PHQ-9 scores) three weeks into the study reporting over a 30% reduction on average.

Utility of VestAid to Detect Eye-Gaze Accuracy in a Participant Exposed to Directed Energy.

The VestAid is a tablet-based application that provides feedback about a patient's eye/head movements during exercise after concussion. The goal of this case series was to determine if VestAid could be used to detect eye-gaze accuracy in a participant exposed to directed energy (DE). The VestAid results of a participant with DE were compared to an age- and gender-matched healthy control, a participant post-concussion, and a participant with vestibular neuritis. A tablet with VestAid software was utilized to record eye-gaze accuracy and head speed during VORx1 exercises using eye and facial recognition as participants were exposed to 12 visual scenes. The participant with DE consistently had difficulty with eye-gaze accuracy when the head was rotated towards the right for all trials. The participant with DE had poor eye-gaze accuracy during all phases of the head turn cycle compared to the control participant (mean 47.91%, [SD = 7.32%] for the DE participant versus mean 94.28%, [SD = 5.87%] for the control participant). Post-exercise dizziness and perceived difficulty in the 12 exercises completed by the participant with DE were strongly related (Spearman's rho = 0.7372, P = .0062). The participant with DE had the lowest scores on 10 of the 12 head movement trials. VestAid provided unique information about eye-gaze accuracy that detected eye movement abnormalities in the participants with DE exposure, concussion, and vestibular neuritis. The objective metrics of eye-gaze stability correlate with participants' symptoms and perceived difficulty of the eye/head movements.

Usability and acceptability of the software ‘Arogya Sahyog’ to assess non-communicable diseases in rural India

BackgroundIn rural regions with few doctors to manage non-communicable diseases (NCDs), people rely on community health workers (CHWs). We developed a tablet-based decision support application (app), called ‘Arogya Sahyog’, to support CHWs in the field. ObjectiveTo assess usability of the app for screening, providing lifestyle advice, and referring patients with NCDs to health centers. MethodsSixteen CHWs in the Tehri Garhwal district of India underwent a five-day training program in November 2019. We assessed: (i) acceptability: through a self-administered questionnaire; (ii) fidelity: by comparing the app data with ‘pre-set’ responses, and (iii) usability: through the validated system usability scale (SUS). The ‘Strengths, Weaknesses, Opportunities and Threats (SWOT)’ framework was used to identify enablers of, and barriers to, use of the app. ResultsUsability on the SUS was 88.3% (95% confidence interval 85.6-92.0%), with ratings between ‘excellent’ and ‘best imaginable’. Most CHWs (87-93%) reported that the app was user-friendly, had a pleasing color scheme, and was entertaining to use. Human error on data entry was < 4%, with most errors being in free-text fields. Four main themes were identified in using the app: ‘strengths’ (clear instructions), ‘weaknesses’ (difficulty in using the inbuilt keyboard), opportunities’ (high motivation), and ‘threats’ (increased workload and interference with their routine work). ConclusionArogya Sahyog was well accepted and achieved an excellent usability rating, supporting its use by CHWs. The next step is to test whether CHWs can use the app to identify and manage people with NCDs in the community.