Posted on Dec 1, 2012 in Conference |
GailL. Rose1
1University of Vermont
Journal MTM 1:4S:5, 2012
DOI:10.7309/jmtm.29
Abstract
Alcohol screening and brief intervention (SBI) is a clinical approach to reducing alcohol consumption and harms whose efficacy is well established. In spite of empirical support for the intervention, and its endorsement by entities such as the National Institutes of Health (NIH) and the US Preventive Services Task Force, implementation in clinical settings is limited. Delivery of SBI to heavy drinkers may be expanded with technology.
We developed an Interactive Voice Response (IVR) system that delivers Brief Intervention (BI) according to NIH clinician’s guidelines. Pilot studies supported feasibility, and now we are evaluating efficacy with a randomized, controlled trial. Objectives are threefold: evaluate the efficacy of IVR-BI for reducing drinking; determine the impact of IVR-BI on patient-physician interaction; and determine patient characteristics associated with treatment effect.
Patients presenting to primary care clinics are called by research staff three days before their appointment and asked to participate. Consenting patients are transferred to IVR for a brief behavioralhealth screening questionnaire (IVR-Screen), the results of which are automatically routed to their electronic medical record (EMR). Participants drinking above NIH guidelines for low-risk drinking qualify for the IVR-BI; consenting patients are randomized immediately and either complete or do not complete the IVR-BI. Participants are interviewed by research staff after their health care visit and again 3- and 6-months later.
To date, 21 have been randomized to IVR-BI vs. usual care, with follow-up interviews pending. Interviews will assess participants’ alcohol-related conversations with their primary care providers, their drinking behavior, and any treatment experiences they have had. Results of 3-month interview data on an anticipated 300 participants will be available for presentation at the time of the mHealth summit. The future potential of this IVR-EMR integrated system for delivering health screening and education relates not only to alcohol but to other behavioral problems as well.
Posted on Dec 1, 2012 in Conference |
R.Whittaker, S.Merry, K.Stasiak, H.Mc-Dowell, I.Doherty, M.Shepherd, E.Dorey, S.Ameratunga, A.Rodgers,
Journal MTM 1:4S:4, 2012
DOI:10.7309/jmtm.28
Abstract
Depressive disorder in adolescence is common, disabling, and heightens the risk of suicide. Universal depression prevention programmes can be effective but are resource intensive and difficult to scale up.
We developed a universal depression prevention programme for adolescents (MEMO) that is delivered solely via their mobile phones.The messages were developed from cognitive behavioural therapy (CBT) by experts in adolescent psychiatry and psychology, delivered within video diary style messages from teenagers, video messages from celebrities, mobisodes (30 second cartoon episodes), text messages and a simple mobile website. Coherence and memorability were provided by a logo, music, and three key words in every message.
We conducted a prospective double-blind randomized controlled trial in adolescents aged 13-17 years from 15 high schools across Auckland, New Zealand. Interested students (n=1348) consented to receive a mobile phone programme about living positively and were randomised (n=855) to either MEMO or a full attention control programme with the same frequency and types of messages. Trained researchers conducted individual interviews with participants at baseline, 9 weeks (post-programme) and 12 months. Students identified with high risk of depression or self-harm at baseline were excluded.
The Child Depression Rating Scale (CDRS-R) mean scores initially improved post-programme (mean change 0.61[SD 6.29]) then worsened by 12 months. There were no significant differences between MEMO and control groups (mean change from baseline to 12 months -1.18 [SD6.76] MEMO and -0.92 [SD 6.67] control), even when adjusted for multiple factors and in sensitivity analyses. There were also no differences between groups in self-rated scores of depressive symptoms and general functioning, or in the diagnosis of depression during the study period.
We were unable to demonstrate a significant benefit in depression scores in those receiving our intervention compared with a control mobile programme. There are several potential explanations that will be discussed.
Posted on Dec 1, 2012 in Conference |
BarbaraL Massoudi1, StephenRothemich2
1Center for the Advancement of Health IT, RTI International2Department of Family Medicine, Virginia Commonwealth University
Journal MTM 1:4S:3, 2012
DOI:10.7309/jmtm.27
Abstract
Asthma is a common, chronic illness, affecting over 23 million U.S. adults who face daunting challenges in managing their disease conditions on a daily basis. RTI and the Virginia Commonwealth University developed and piloted a smartphone app, built on the latest clinical guidelines for treatment and self-monitoring of individuals with asthma, to assist adults with asthma to better manage their care and disease condition.
BreathEasy, part of RWJF’s Project HealthDesign, was developed through a user-centered design approach with iterative development and feedback cycles. Patients used an Android-based smartphone to record their observations of daily living (ODLs), including asthma and mental health symptoms, medication use, symptom triggers, physical activity, and activity limitations, among others. Clinicians (physician/nurse pairs) used a Web-based dashboard to review patient data and visualize trends and patterns in the ODL data on a regular basis, in accordance with a disease management approach.
Six months of fielding with 30 patients in two urban practices has shown the app to be generally well accepted by both patients and clinicians, and findings indicate that collection and review of ODL data has resulted in positive changes in communication and care management. Changes in medication compliance and management, referrals to specialists, and diagnoses of comorbid conditions were attributed to use of the app. Patients reported using the ODL information in many ways, including recognizing when symptoms had become problematic, being more aware of symptom triggers, and better following recommendations made by their doctor.
These findings indicate early success of this smartphone and dashboard app to manage asthma. Further studies should focus on an evaluation including a control group and more closely approaching a controlled clinical trial. By providing a novel method of reporting patient-generated data to clinicians between office visits, this app shows promise for improving the quality of care of asthma patients.
Posted on Dec 1, 2012 in Conference |
Marcos Reyes-Estrada1, MarinildaRivera-Diaz2,NelsonVaras-Diaz2
1Ponce School of Medicine and Health Science, Pontifical Catholic University of Puerto Rico, Puerto Rico2University of Puerto Rico, Puerto Rico
Journal MTM 1:4S:2, 2012
DOI:10.7309/jmtm.26
Abstract
Background: Mobile technology has revolutionized the way that behavioral scientists collect, store, and analyze data (Press, 2011). Recent literature has begun to point out the effectiveness of this technology for research in health scenarios (Miller, 2011). Therefore, researchers need to continue exploring the use of specific mobile technology and its relevance to the study of health related issues, particularly physician/patient interactions.
Purpose: The purpose of our study was to document the behavioral manifestations of HIV/AIDS-related stigma in physician/patient interactions.
Methods: In order to achieve the aims of this study, a sequential mix method approach using focus groups and standardized patient technology was implemented. The qualitative phase included 9-focus group composed of 66 participants with an HIV/AIDS diagnosis. A qualitative analysis using iAnnotate-application on the iPad allowed the development of a behavioral manifestation of HIV/AIDS-related Stigma Inventory (BMHASI). The quantitative phase was based on three HIV/AIDS case simulations, which generated 91 video recordings of patient/physician interactions, and the administration of a previously validated scale to assess HIV/AIDS-related stigma attitudes. The stigma scales were completed in vivo by medical students using the iSurvey application on the iPad. Standardized patients also completed the BMHASI. In the third phase, six researchers use the BMHASI developed on iSurvey to evaluate the 91 medical interactions between the medical students and standardized patients.
Results: The preliminary analysis identified eight stigmatizing behaviors manifested by medical students during simulated interactions including: avoid shaking hands to the patient, avoid physical contact needed to perform physical examination required by medical protocol, and excessive physical distance.
Conclusions: The iPad is an emergent and valuable research tool for the behavioral sciences field with great potential for documenting socially stigmatized interactions in the health scenario.
Posted on Nov 30, 2012 in Conference |
Mia Van Der Kop1, DavidOjakaa2,Lennie Bazira2, LehanaThabane3,LilianMbau2,HelenGakuruh2 Koki Kinagwi2, Edward Mills4, Carlo Marra5, Richard Lester5,
1University of British Columbia Centre for Disease Control, Vancouver, Canada, 2 African Medical and Research Foundation, Nairobi, Kenya 3McMaster University, Hamilton,Canada4University of Ottawa, Ottawa, Canada5University of British Columbia, Vancouver, Canada
Journal MTM 1:4S:1, 2012
DOI:10.7309/jmtm.25
Abstract
High levels of patient retention after first clinical contact contribute to the timely initiation of antiretroviral therapy (ART) and better health outcomes. In Kenya (WelTel Kenya1), a weekly short message service (SMS) text message led to improved ART adherence and viral load suppression.
The objectives of this study are to: 1) determine if the WelTel intervention improves retention in Stage 1 HIV care (patient receives CD4 count results); 2) determine whether the WelTel intervention improves 12-month retention; and 3) evaluate the cost-effectiveness of the WelTel intervention.
A randomized controlled trial will be conducted at the Kibera Community Health Centre in Nairobi, Kenya. Over one year, HIV positive individuals newly enrolling at the clinic will be recruited and randomly allocated to an intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive a weekly SMS ‘check-in’ to which they will be required to respond within 48 hours. An HIV clinician will follow-up and triage any problems that are identified. Patients will be followed for one year, with a primary endpoint of retention in care at 12 months.
This study is in a pre-enrolment phase; a recruitment target of 686 participants provides 80% power to detect a proportionate difference of 15% in the primary outcome (alpha=0.05). Data will be analyzed according to intention to treat principles. Chi-squared tests will be used for categorical outcomes; and t-tests or Mann-Whitney U tests for continuous outcomes.
The WelTel Retain trial will contribute important information on the effectiveness of an established mHealth intervention to engage patients in care during the first year of HIV care, before initiating ART. Trial results and cost-effectiveness evaluation will inform how WelTel might contribute to the long-term success of PEPFAR-funded programs and towards a sustainable global HIV/AIDS response
Posted on Sep 26, 2012 in News |
Move over iPhone 5 – And make way for the Remotoscope- an iPhone otoscope that will be patient- worthy in the near future.
Georgia Institute of Technology announced in a press release recently, that they are currently developing the ‘Remotoscope’ as an iphone app in combination with a clip-on attachment which instantly transforms a regular iphone into a powerful diagnostic tool, through which physicians can remotely diagnose a large number of ear diseases. Georgia Tech is in the process of improving its software and hardware to make it more user-friendly which will allow parents to just insert the device into their child’s ear canal, make a small video and then directly upload it to the child’s physician who will be able to make the diagnosis.
The technology involved is based on the Cellscope, a mobile microscope developed by the University of California, Berkeley in 2008. Cellscope technology, a small wonder in its own right, has the potential to be used in many different fields like Dermatology, Oncology and now thanks to the Remotoscope, even ENT practice. This microscope technology coupled with the camera and flash of the iphone is what makes the Remotoscope possible.
So how can we put the Remotoscope to work, you may ask? Well, the possibilities are endless really. Parents who live in remote areas all over the world, without ready access to prompt medical care, can use this nifty device to be the eyes of the physician and catch nasty ear infections early before they cause much damage. Physicians can use it to keep an eye on their patients and monitor the efficacy of their treatment. That’s not all. As former medical students we all know how difficult it was to figure out what the doctor had actually wanted us to look at. Well, thanks to the Remotoscope the students can now be shown exactly what the doctor sees and how to diagnose certain diseases based on what they see, in real time. The possibilities are endless.
The remotoscope was no small task to complete. Dr. Wilbur Lam and his colleague Erik Douglas created the start-up Cellscope Inc., starting the project while they were still doctoral students at UC Berkeley. Dr. Lam then brought the project over to Atlanta when he joined the faculty at Georgia Tech and Emory University, and now receives resources from both institutions as well as Children’s Healthcare of Atlanta and the Atlanta Clinical & Translational Science Institute. He hopes to commercialize the device once the FDA trials comparing the Remotoscope’s diagnostic quality to that of the traditional otoscope are complete and it receives FDA approval. The trial is partly being funded by the FDA, through the Atlanta Pediatric Device Consortium.
So the question is when will you see the Remotoscope in stores near you? The trial data will be published at the end of this year and Dr. Lam hopes FDA approval will also follow, allowing the Remotoscope to be a on quite a few Christmas Wishlists soon.
Press Release: Georgia Tech
