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

A Smartphone App to Screen for HIV-Related Neurocognitive Impairment

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

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

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?

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 Dec 12, 2013 in Conference | 0 comments

A Feasibility Study of Smart-Phone Application on Breast Self-Examination in Korea


Jaesung Heo, MD1, Mison Chun, MD, PhD1, Ki Young Lee, PhD2, Young-Taek Oh, MD, PhD1, O kyu Noh, MD, PhD1, Rae Woong Park, MD, PhD2,3,4

1Department of Radiation Oncology, Ajou University School of Medicine, Republic of Korea; 2Department of BiomedicalInformatics, Ajou University School of Medicine, Republic of Korea; 3Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; 4Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

Journal MTM 2:4S:19, 2013

DOI: 10.7309/jmtm.2.4S.16

Abstract


Background Breast cancer patients who founded in early stage have a good prognosis. Females who practice breast self-examination (BSE) are usually diagnosed at an earlier stage than those who do not.

Aims The purpose of this study was to develop a smart-phone application to encourage BSE, and to evaluate the effects of mobile intervention in terms of improving breast self-examination behavior.

Methods A developed smart-phone application had several functions including a BSE date alarm, a reminder to encourage mother and daughter to practice BSE together, BSE record, and educational video clips. Females aged 19 and over were enrolled and two series of questionnaires were carried out (before and after using the application) between July and September 2012.

Results Forty five subjects (age 29.5 ± 5.9 years) were enrolled in the study. Of 45 participants, 28 (62.2%) had practiced BSE, and only one of these was carried out at the appropriate time, based on the results of the baseline survey. After using the application, the number of participants practicing BSE increased from 28 to 32 (62.2% to 71.1%; p = 0.503). In subgroup analysis (age <30 years), the number of participants using BSE increased from 8 to 18 (36.4% to 81.8%; p = 0.002), and the number of those using it at the appropriate time improved from 1 to 15 (2.2% to 33.3%, p <0.001).

Conclusions In female younger than 30 years, the developed smart-phone application increased BSE practice. To confirm the long-term effect of the mobile application and overcome difference in smart phone usage, further studies must be carried out.

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Posted on Dec 5, 2013 in Conference | 0 comments

Feasibility of Text Messaging to Improve Oral Anti-Cancer Adherence in older Cancer Patients


Sandra Spoelstra,PhD, RN1, Barbara Given,PhD, RN, FAAN1, Alla Sikorskii,PhD3,

Constantinos Coursaris,PhD4, Atreyee Majumder,MD3, Monica Schueller,BA1,

Kimberly Ridenour,Nurse Scholar1, Michele Wormser,Nurse Scholar1, Charles W. Given,PhD2

1College of Nursing; 2Family Medicine; 3Department of Probability and Statistics; 4Department of Communication at

Michigan State University, East Lansing, MI

Journal MTM 2:4S:1, 2013

DOI: 10.7309/jmtm.2.4S.1

Abstract


Background More than 50 oral chemotherapy agents in pill form are on the market, with projections that in 3 years, 25% of cancer treatment will be in pill form. For oral agents to achieve a therapeutically effective level for cancer treatment, patients must strictly adhere to the regimen. However, adherence is often less than 80%, which may be inadequate for treating the cancer. There are more than 285 million wireless subscribers in the US with an estimated 67.5% of adults owning cell phones and 98% of those phones having text messaging capability. A recent review of 12 trials on interventions for disease prevention or management found that text messaging improved health behaviors.

Purpose There are multiple mobile applications and smart phone products to prompt medication adherence, however, few have examined if these prompts improve medication adherence. Adherence is critical among cancer patients who are older and less likely to text message. The cancer medications can be costly, as much as $800 per pill, and only effective if taken as prescribed. Adherence is complicated by complexity of the dosing and the duration of the prescriptions. Therefore, the purpose of this study is to test the feasibility, usability, and satisfaction with text messages to improve symptoms from side effects of treatment and adherence to oral chemotherapy agents.

Methods A 10-week, 2-group, prospective trial will enroll 76 patients from cancer centers to examine a 3-week text message intervention to promote oral agent adherence and management of symptoms from side effects of treatment. Descriptive statistics, generalized linear modeling, and generalized estimating equations will be used for analysis.

Results Enrollment is underway and preliminary findings on characteristics, feasibility of text message intervention and its influence on adherence rates will be presented.

Conclusion Text messages can easily be tailored to a specific oral agent regimen, making this intervention usable for simple or more complex dosing. Further, delivering the text messages on cell phones makes this intervention readily accessible. Likewise, it is the first study to enroll a cohort of patients who are newly prescribed oral agents. Past research has demonstrated that adherence levels begin to decline 2 months after the initiation of therapy. Therefore, this research could inform initiation of care, where patterns of behavior could be established and carried out through the entire treatment regimen. This type of novel intervention also has the potential to transform and impact other ill populations that require adherence to a medication regimen.

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