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Posted on Feb 28, 2014 in Original Article | 0 comments

A Smartphone App to Screen for HIV-Related Neurocognitive Impairment

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Reuben N. Robbins, PhD1, Henry Brown, BSc2, Andries Ehlers, BTech2, John A. Joska, MBChB, PhD3, Kevin G.F. Thomas, PhD4, Rhonda Burgess, MBA5, Desiree Byrd, PhD, ABPP-CN5, Susan Morgello, MD5

1HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York; 2Envisage IT, Cape Town, South Africa; 3The Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; 4ASCENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa; 5The Icahn School of Medicine at Mount Sinai, New York, New York

Corresponding author: rnr2110@columbia.edu

Journal MTM 3:1:23–36, 2014

doi:10.7309/jmtm.3.1.5

Background: Neurocognitive Impairment (NCI) is one of the most common complications of HIV-infection, and has serious medical and functional consequences. However, screening for it is not routine and NCI often goes undiagnosed. Screening for NCI in HIV disease faces numerous challenges, such as limited screening tests, the need for specialized equipment and apparatuses, and highly trained personnel to administer, score and interpret screening tests. To address these challenges, we developed a novel smartphone-based screening tool, NeuroScreen, to detect HIV-related NCI that includes an easy-to-use graphical user interface with ten highly automated neuropsychological tests.

Aims: To examine NeuroScreen’s: 1) acceptability among patients and different potential users; 2) test construct and criterion validity; and 3) sensitivity and specificity to detect NCI.

Methods: Fifty HIV+ individuals were administered a gold-standard neuropsychological test battery, designed to detect HIV-related NCI, and NeuroScreen. HIV+ test participants and eight potential provider-users of NeuroScreen were asked about its acceptability.

Results: There was a high level of acceptability of NeuroScreen by patients and potential provider-users. Moderate to high correlations between individual NeuroScreen tests and paper-and-pencil tests assessing the same cognitive domains were observed. NeuroScreen also demonstrated high sensitivity to detect NCI.

Conclusion: NeuroScreen, a highly automated, easy-to-use smartphone-based screening test to detect NCI among HIV patients and usable by a range of healthcare personnel could help make routine screening for HIV-related NCI feasible. While NeuroScreen demonstrated robust psychometric properties and acceptability, further testing with larger and less neurocognitively impaired samples is warranted.

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Posted on Feb 28, 2014 in Original Article | 0 comments

Medical students’ perceptions regarding the impact of mobile medical applications on their clinical practice

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Kwee Choy Koh, MMed, MBBS1, Jun Kit Wan2, Sivasanggari Selvanathan2, Chithralekha Vivekananda2, Gan Yi Lee2, Chun Tau Ng2

1Senior lecturer, Department of Medicine, International Medical University, Seremban, Negeri Sembilan, Malaysia, and consultant infectious disease physician, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia; 23rd year undergraduate medical student, International Medical University, Seremban, Negeri Sembilan, Malaysia

Corresponding Author: kweechoy_koh@imu.edu.my

Journal MTM 3:1:46–53, 2014

doi:10.7309/jmtm.3.1.7

Background; Medical apps on smart devices are popular among medical students. However, the impact of medical apps on clinical practice is relatively less known.

Aims: To study the prevalence of medical app usage among medical students and assess its impact on clinical practice.

Method: One hundred fifty-five first year medical students of the International Medical University, Malaysia completed an anonymous questionnaire designed to explore demographic parameters, types of smart devices owned and the medical apps installed on the smart devices; and the frequency and purpose of usage of the apps. The students’ perception regarding medical apps, the impact of medical apps on clinical practice and the characteristics of an ideal medical app were explored.

Results: About 88% of medical students reported owning a smart device and 87.5% had medical apps installed on their smart devices. Most students reported positive perceptions towards medical apps and agreed they have positive impact on their studies and clinical practice. However, the medical students reported little awareness about the potential breach of patient confidentiality with the use of these apps.

Conclusion: There is high prevalence of smart devices and medical apps usage among first year clinical medical students with positive perception regarding its usage and impact on their clinical practice. Medical schools should encourage the use of medical apps among medical students with strategies put in place to safeguard patient confidentiality.

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Posted on Feb 28, 2014 in Original Article | 1 comment

Fitness apps, a Valid Alternative to the Gym: a pilot study

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Dr Gayan Padmasekara 1

1Monash Medical Centre, Melbourne, Australia

Journal MTM 3:1:37–45, 2014

doi:10.7309/jmtm.3.1.6

Background: Physical activity is an integral part of a healthy lifestyle. There are multiple barriers to exercise in the modern world. This combined with poor dietary behavior is a principle driver of obesity. Given the prevalence of mobile technology, especially among young adults, public health initiatives utilising fitness applications on smartphones offer an exciting new frontier in tackling this problem. However, there is a lack of evidence regarding the effectiveness of this mobile technology as a substitute to other exercise modalities.

Methods: In this pilot study, a search was performed using the Apple 4S smartphone’s “App Store” for relevant fitness applications (‘apps’). Three apps were found to fulfill the inclusion and exclusion criteria of the study: Nike Training Club, Instant Fitness and Gorilla Workout Free. Exercise was then performed as per each app’s guidance, and caloric expenditure was measured using a validated device. This caloric expenditure was then compared with the control exercises, which included slow-speed jogging, WiiFit Plus exercises, and RPM, an indoor gym cycling program. One subject performed three trials of each exercise modality.

Results: Jogging was the best form of exercise in regards to caloric expenditure (mean 7.9 calories/min), and was superior to all other groups. Nike Training Club was superior to Gorilla Workout Free app, however, there were no other significant differences between the apps. Nike Training Club and Instant Fitness apps were as effective as RPM and WiiFit Plus groups.

Conclusion: This pilot study showed that fitness apps are as effective as a gym cycling group class with regards to caloric expenditure per unit of time. They offer a new paradigm for exercise for individuals with barriers to participating in organised fitness activity. Smartphone technology has the potential to be utilised as a new tool for public health initiatives to tackle the growing obesity epidemic.

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Posted on Feb 28, 2014 in Letter to the Editor | 0 comments

Skin Health Applications: Blessing or Misdiagnosis?

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Anum Wasim1, Madiha Hassan Rizvi1, Ayisha Farooq Khan1

15th year Medical Student, Dow Medical College, Karachi, Pakistan

Corresponding Author: anum.wasim5@gmail.com

doi:10.7309/jmtm.3.1.8

There has been a global rise in skin cancer over the last few years with the rising diagnosis of 2–3 million non-melanoma and 132,000 melanoma skin cancer cases each year1. This growing prevalence is not only attributed to the increasing ultraviolet radiation by ozone depletion but also by other major predisposing factors centred to an individual’s own responsibility controls like recreational sun exposure and sunburn1. However despite the escalating figures, low skin screening rates and awareness levels among the general population are highly disconcerting2.

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Posted on Feb 11, 2014 in News | 2 comments

The Unrealized Potential of mHealth

The Unrealized Potential of mHealth

Predictions about the rapid growth of the mobile healthcare market in the future are paired with great optimism about what this technology can achieve, but despite the progress that has been made, there are still some significant limitations and concerns that might restrict the uptake of this type of technology. Until these issues can be addressed, the potential of mHealth may remain unrealized.

The Year’s Top Inventions

The growing importance of mHealth and healthcare technology in general is reflected by the inclusion of four healthcare related creations on the list of the 25 best inventions of 2013 produced by Time magazine. The selected healthcare inventions included an artificial pancreas, which can monitor blood glucose levels and control insulin release in response to them to treat type 1 diabetes, and the Rewalk bionic suit, which can translate the user’s shifts in balance and body weight into the movements of powered braceson the limbs and torso, enabling them to stand and walk. Two other healthcare inventions on the list were of more relevance to mobile healthcare. The Argus II combines an artificial retina with a video sensor mounted on a pair of glasses to improve the vision of people affected by retinitis pigmentosa, while the Edible Password Pill created by Motorola demonstrates how technology is being created that can allow communication between the body and mobile devices. The pill is currently being developed simply as a tiny chip that can be swallowed and powered by stomach acid, emitting a password signal so the user can be recognized by asmartphone or computer, but this technology might go on to have application in mHealth and other fields.

Market Growth

These developments in mHealth technology are matched by rapid growth in the value of the mHealth market. Its estimated value in 2012 was $6.7 billion, but it is expected to reach $8.3 billion by the end of 2013. Over the remainder of the decade, increasing investment in healthcare around the world, together with the development of better mHealth applications, is likely to result in even stronger growth. The global mHealth market has been projected to grow to $58.8 billion by the year 2020, which would reflect an annual compound growth rate of 32.3%.

Limitations for mHealth

Despite these signals of a positive future for mHealth, there are still some doubts about how useful the technology may be, at least in its current state. Although many of these doubts are likely to be removed as the technology develops further and as people become more comfortable with using mHealth technologies, they are still significant limiting factors that the industry needs to take account of as they create and promote their products.

The technology itself can be limiting, since mHealth apps will need to be both functional and meaningful if they are to play a significant role in healthcare, rather than simply being novelties. A recent survey of approximately 43,000 mHealth apps available from iTunes found that there were serious limitations in functionality. Only 10% of the apps scored above 40 out of 100 when rated for 25 clinical functionalities, and there were significant gaps in the types of conditions and populations being catered for, with those in greatest need, such as the elderly and people in developing countries, rarely being targeted. Popular mHealth apps were more likely to be used for monitoring diet and weight loss than for serious health conditions. The limited functionality of mHealth apps limited their use, with just five apps representing 15% of all mHealth downloads from the store, and half of the apps having been downloaded fewer than 500 times. The technology on which the apps can be used might also limit the uptake of mHealth products, since consumers are likely to have concerns about relying on mobile devices that could be damaged, run out of power, or lose their signal, for important healthcare services such as monitoring and reminders to take medication. The technology needs to be more reliable if people are to depend on it for their health.

Other significant limiting factors relate to the patient populations who mHealth has the potential to help. Although access to mobile devices capable of supporting mHealth applications is widespread in many parts of the world, there are still gaps in access in poorer populations and in the elderly, whose great need for healthcare services is often matched by a reluctance to adopt new technologies, which can make providing these services through mHealth more difficult. The willingness and ability of target populations to use mHealth products will be a serious limiting factor in the future, and it must be addressed if these technologies are to reach the people who can benefit from them. Mobile healthcare may remain an unrealized technology of the future for some time, before both medical professionals and consumers are willing to adopt and rely on it for their healthcare.

by Evelyn Dunne

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