Background: Patients requiring daily intravenous (IV) home parenteral nutrition (HPN) would benefit from in-home professional observation to improve self-care, to assess, detect and prevent serious complications.

Aims: The study aims are to assess the viability and utility of conducting mobile healthcare (mHealth) videoconference assessments with patients managing lifelong daily 12-hour IV nutrition infusions in their homes. The challenges and solutions to implementing mobile personal computer (PC) tablet based clinic appointments are described.

Methods: A wireless Apple iPad Mini™ mobile touch-screen tablet computer with 5 mega-pixel camera was loaned to patients. Each tablet had Polycom RealPresence software and a fourth generation (4G) mobile telecommunications data plan. These supported audio-visual mobile videoconferencing encrypted connections between health professionals in their offices and HPN patients and their family members in their homes. Patients’ and professionals’ evaluations of their mHealth clinic experiences are collected.

Results: Patients (mean age = 41.9, SD = 2.8 years) had been prescribed 12-hour home parenteral nutrition (HPN) infusions daily due short bowel disorders. Patients had been on HPN from 1 to 10 years (M = 4, SD = 3.6). Evaluation of clinic appointments revealed that 100% of the patients (n = 45) and the professionals (n = 6) indicated that they can clearly hear and easily see one another. The mHealth audio-visual interactions were highly rated by patients and family members. Professionals highly rated their ability to obtain a medical history and visual inspection of patients. Several challenges were identified and recommendations for resolutions are described.

Discussion: All patients and professionals highly rated the iPad mHealth clinic appointments for convenience and ease of communicating between homes and offices. An important challenge for all mHealth visits is the clinical professional’s ability to make clinically accurate judgments about what they observed and heard from the patients. Following our solutions for obtaining clear visuals with the iPad can improve ability to make clinical assessments.

Background: Smartphone technology is the fastest growing in U.S. populations particularly in African -American community. Smartphone technology, therefore, may hold promise for improving health communication and accuracy of dietary intake assessment in this population. There is no information about maternal perceptions of using smartphone for dietary assessment. This paper reports the perceptions of low-income African -American mothers of children aged four to five years towards the use of smartphone for their children’s dietary intake assessment and as a means of receiving nutritional feedback.

Methods: A total of 17 low-income African -American mothers, who attended a large food pantry community center in Wisconsin and were eligible to participate in the study, completed either focus group discussions or individual interviews. The mothers also completed a self-administered demographic and smartphone activity patterns survey. The mothers who were interested in taking a photograph of a meal of their child were provided a private email address for sending the photographs to the researcher using their smartphones.

Results: The focus group and interview data were analyzed using thematic and structural analysis techniques. Mothers’ mean age was 37 years (range 23-48 years) with mean BMI at 33 (range 23-40). Children’s mean age was 4.8 years (range 4-5.6 years). Children’s mean BMI percentile was at the 92nd percentile (range 82nd – 96th percentile). These mothers seemed to have favorable attitudes towards the use of smartphones to take photographs of their children’s diets and receive nutritional feedback for their children.

Conclusion: The mothers in this study have a strong interest in using their smartphones to assess their children’s diets and download mobile health apps i.e. healthy recipes, and receive nutritional feedback for their children’s diets via SMS. Smartphone technology appears to hold great potential in terms of accurate, efficient, user-friendly, and flexible features in helping these low-income African-American mothers and health care providers to assess children’s dietary intake. Further studies testing the acceptability of mobile-based health apps in low-income African-American mothers and its effects on their children’s healthy body weight and nutritional well-being are warranted.

Background: Due to changes in treatment guidelines, traditional pharmacokinetic based dosing and existing vancomycin nomograms may not predict doses adequate for reaching the increased trough concentration goals. A novel nomogram was created to achieve the updated goals, and the nomogram was previously validated at our institution. For this study, the nomogram was converted into an iOS vancomycin clinical decision support software (CDSS) application.

Aims: This study was designed to determine if the use of the iOS vancomycin CDSS application decreases the time pharmacists spend dosing vancomycin thus resulting in a cost savings to the health-system.

Methods: Enrolled patients’ dosing regimens were determined using the newly developed iOS vancomycin CDSS application. Survey data was used to assess pharmacists’ impressions of the iOS vancomycin CDSS application and the time required to determine a personalized vancomycin dosing regimen among several different dosing methods. The accuracy of the iOS vancomycin CDSS application was also evaluated and compared to data from the original paper version of the dosing nomogram.

Results: A total of 367 patients were dosed using the iOS vancomycin CDSS application, and 146 of these patients met all inclusion criteria for accuracy analysis. The mean time savings of using the iOS vancomycin CDSS application versus traditional pharmacokinetic calculations was 10.3 minutes per consult (p = 0.014). The iOS vancomycin CDSS application was estimated to save a total $13,617 per year compared to using traditional vancomycin pharmacokinetic calculations at our institution. There was no statistical difference in therapeutic trough concentration frequencies between the paper nomogram and the iOS vancomycin CDSS application (p =0.877).

Conclusion: An iOS vancomycin CDSS application saved pharmacist’s time, established a moderate cost-savings, was well accepted, and accurately predicted appropriate vancomycin dosing regimens. This iOS CDSS drug dosing application was only used for vancomycin, and therefore the time and costs savings could increase substantially as more drugs are incorporated into the CDSS application.