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Posted on Sep 16, 2012 in Editorial | 0 comments

Principles of m-Health survey design


Dr Rahul Chakrabarti MBBS1,2
1 Editor-In-Chief, Journal of Mobile Technology in Medicine, 2Centre for Eye Research Australia
Corresponding Author:
Journal MTM 1:3:1-5, 2012

Before you start

The first step is to conduct a critical appraisal of existing literature relevant to the research question. Before proceeding further, it is then necessary to consider whether a survey is the most appropriate method to collect the data required to answer the research question.  Appropriate alternatives to surveys include a systematic review or meta-analysis, case-studies, or studies with focus groups. It is beyond the scope of this article to discuss these alternate forms in depth, however, the researcher should be guided by published literature in their topic.  The key steps for survey design will now be discussed. (Refer to figure 1).

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Posted on Sep 16, 2012 in Original Article | 2 comments

Validation of Near Eye Tool for Refractive Assessment (NETRA) – Pilot Study

Dr Andrew Bastawrous1,2, Dr Christopher Leak2, Frederick Howard3, Mr B Vineeth Kumar1
1Wirral University Teaching Hospitals NHS Foundation Trust, UK,  2International Centre for Eye Health, Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, UK, 3Independant Optometrist, UK
Corresponding Author:
Journal MTM 1:3:6-16, 2012

Background: Uncorrected-refractive-error (URE) is the leading cause of global visionimpairment (VI); 122.5 million people are estimated VI from URE. NETRA is a $30USD clip-on application for smartphones.

Purpose: To validate the NETRA as an alternative to subjective refraction for potential use in resource-poor countries.

Methods: NETRA uses a pinhole mask attached to a smartphone displaying a spatially resolved pattern to the subject. Refractive error is estimated by the patient subjectively aligning patterns by a touchscreen interface on the smartphone. NETRA was compared to subjective refraction in 34 eyes.

Results: The mean Subjective Spherical Equivalent (SSE) was -0.65D (std 2.79, 95%CI ±0.97) Two-sided T-test showed that mean SSE is not statistically significantly different (two sided t-test; t=1.6742 p=0.1036, 95% CI±0.29) from the mean NETRA Spherical Equivalent (NSE) .  Mean difference of Spherical Equivalents (NSE – SSE) was 0.24D (Std 0.84, 95%CI ±0.29). And NETRA produced a mean VA improvement of 0.44LogMAR (Std 0.52, 95%CI±0.18), or four Snellen lines.

Conclusion:In settings where access to a trained refractionist is not possible, NETRA has the potential to estimate refractive error closely enough to render an individual no longer VI from URE. NETRA is potentially a cost-effective tool in meeting the VISION2020 goals to eradicate avoidable blindness and warrants further testing in resource-poor settings.

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Posted on Sep 16, 2012 in Original Article | 0 comments

A Meta-Analysis of Mobile Health and Risk Reduction in Patients with Diabetes Mellitus: Challenge and Opportunity


Dr Longjian Liu PHD1, Stella-Maris Ogwu MPH1,2
1Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, USA, 2Opening Doors for Health Disparity Training Porgram, Drexel University School of Public Health, Philadelphia, USA Corresponding Author:
Journal MTM 1:3:17-24, 2012

Purpose: To examine scientific evidence on the effectiveness of mobile phone technology in Diabetes Mellitus (DM) care management.

Methods: A systematic review was conducted through literature searches from three electronic databases and was restricted to English-language articles published between January 2002 and March 2012. Studies that used mobile phone intervention and reported changes in diet, physical activity, and blood glucose and /or glycosylated hemoglobin (HbA1c) levels were retrieved. A meta-analysis was conducted for studies with HbA1c measures.

Results: More than 50 articles were screened. Of them, 15 met the review criteria. Of the 15, study sample sizes ranged from 12 to 130 participants aged 8 to 70 years old. Duration of intervention ranged from 1 to 12 months. Overall, significant improvements were observed in blood glucose and/or HbA1c concentration, adherence to medication, healthy lifestyle, and self-efficacy. Twelve of 15 trials, which had serum HbA1c measures, showed an average 0.39% (95%CI: -0.067, -0.721) HbA1c reduction from studies with pre- to post-tests (p=0.018).

Conclusion: Findings from the study provide the evidence that health reminders, disease monitoring and management, and education through mobile phone technology may significantly help improve glycaemic control patients with DM.

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Posted on Sep 16, 2012 in Original Article | 0 comments

Ambulatory Autonomic Activity Monitoring Among At-Risk Adolescent Mothers

Dr Sonali Rajan EdD1, Dr Noelle Leonard PhD1,2, Dr Richard Fletcher PhD3 Dr Beth Casarjian PhD4, Robin Casarjian MA4, Cathleen Cisse MPH24, Dr MaryaGwadz PhD2

1Teachers College, Columbia University, New York, USA,2New York University, College of Nursing, New York, USA,3Massachusetts Institute of Technology, Cambridge, USA, 4Lionheart Foundation, Boston, USA

Corresponding Author:
Journal MTM 1:3:25-31, 2012

Background: Many adolescent mothers experience significant challenges in regulating emotions due to adverse life experiences, which can place adolescent mothers and their children at risk for poor developmental outcomes.  Ambulatory monitoring of stress that also provides immediate feedback using wearable biosensors has the potential to enhance clinician-delivered parenting interventions and help young mothers develop emotion regulatory skills.

Methods: We conducted a pilot study to assess the acceptability, ease of use, and preliminary efficacy of a wearable biosensor, the iCalm sensor band, among a sample of four mothers, ages 15-18 years.  Mothers wore the biosensor for a period of 24-36 hours while engaging in normal, daily tasks (e.g. caring for their child, attending school).  Both quantitative electrodermal activity (EDA) data (via the iCalm sensor band) and qualitative data (via individual semi-structured interviews) were collected.

Results: The adolescent mothers were able to comfortably use and wear the iCalm sensor band.  EDA data were collected and corresponded with stressful daily life events described by the mothers during qualitative interviews.

Conclusion: The iCalm biosensor is acceptable to use among high-risk adolescent mothers and appears to help mothers with the development of emotion regulatory skills.

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Posted on Sep 16, 2012 in Original Article | 0 comments

A Preliminary Investigation of the Benefits and Barriers to Implementing Health Information Technology in Medical Clinics

Dr Amy Chesser PhD1, Dr Nikki Woods PhD2, Dr Traci Hart PhD2, Dr Jennifer Wipperman MD1
1University of Kansas School of Medicine, Wichita, USA. 2Wichita State University, Wichita, USA
Corresponding Author:
Journal MTM 1:3:32-39, 2012

Background: The successful integration of mobile information technology (IT) and existing health information technology (HIT) requires a critical evaluation of factors that may impede implementation and end-user perceptions of new technology.

Purpose: Using a mixed-method approach researchers interviewed and issued questionnaires to a family medicine faculty and residents to ascertain: 1) usability of iPad features and functions in a practice setting, and 2) perceptions of barriers to and support for implementation of HIT in a clinical setting.

Methods: Two faculty physicians and one resident were interviewed to discuss the HIT infrastructure for the clinical site, as well as attitudes and preferences about iPad usability. Qualitative data was transcribed and analyzed. Resident and faculty physicians (n=42) from a family medicine residency completed an American Medical Association survey on HIT readiness. Descriptive and non-parametric statistics were tabulated.

Results: Both interview and survey participants reported individual readiness for HIT adoption, while listing environmental barriers. Interview participants also described physical and software features of the iPad they would find useful in practice. Survey respondents reported clinical staff readiness as a strength for adoption of HIT.

Conclusion: Participants reported readiness to integrate HIT into clinical practice and have a clear idea of useful device features. HIT adoption may be hampered by environmental factors, and future research should focus in this area.

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Posted on Sep 16, 2012 in Original Article | 0 comments

Using Mobile Tethering for sharing data across devices: application in rural eye screening

Dr George Kong PhD1, Dr Jonathan Kam MBBS1
1Royal Victorian Eye and Ear Hospital, Melbourne, Australia
Corresponding Author:
Journal MTM 1:3:40-45, 2012

Background: Eye screening programs have been effective in reducing the burden of eye diseases in the developing world.  Most use paper recording systems which are prone to misplacement and are inefficient for auditing purposes.  Digital data collection via mobile devices may prove more efficient, but reliable strategies information sharing between devices in rural settings remain an issue. This paper examines the speed and range of use of Mobile Tethering technology to synchronize data across devices, and hence the suitability of such devices in the eye screening setting.

Methods: The data synchronization feature of eyePatients software for iPhone and iPad was tested using an Apple iPhone 4 as the central router, with Mobile Tethering activated. Apple iPad 2 devices were connected to the wireless local area networks (WiFi) generated by the iPhone 4. The linear range of data synchronization and the effect of corners and barriers on synchronization were tested.

Results: Synchronization was rapid, taking between 1.0-1.5 seconds to complete when linear distance was within 30 meters.  Beyond 34 meters considerable slowing was noted and no successful connections were able to be established beyond 40 meters. A single corner had no statistically significant effect on the maximum range of a single tether connection, but two corners or a door barrier had a small but statistically significant reduction on range.

Conclusion: Mobile Tethering provides a reliable and fast connection between multiple devices that can be used for the synchronization of large amounts of data required for eye screening purposes.

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Posted on Sep 16, 2012 in Case report | 0 comments

Application of self-recorded photos using mobile phones in maxillofacial surgery

Prof Fereydoun Pourdanesh DDS1, A/Prof Ashraf Sayyedi DDS2, Prof Abdolreza Jamilian DDS3, Prof Masoud Yaghmaei1
1Department of Oral and Maxillofacial Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Dental Research Center, Research Insitiute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 3Department of Orthodontics, Center for craniofacial research, Islamic Azad University, Tehran, Iran
Corresponding Author:
Journal MTM 1:3:46-49, 2012

Nowadays, there is an increasing use of mobile phones as a part of telemedicine to aid in the management of various health conditions. There are numerous reports of using mobile phones as a tool for sending and receiving short text message (SMS) in medicine. Aside from keeping patients continuously in touch with their health care providers, mobile phones can also be a useful tool for providing doctors with valuable information. A useful adjunct of many mobile phones is its ability to take clinical pictures.

In this study we present a case series where mobile phone photos taken by the patient were later used to aid in the diagnosis and management of various maxillofacial conditions.

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Posted on Sep 16, 2012 in Letters | 0 comments

Ethical Considerations Related to Mobile Technology Use in Medical Research

A/Prof Melissa Parker MD1,2
1Pediatric Critical Care Medicine and Pediatric Emergency Medicine, McMaster Children’s Hospital,2Pediatric Emergency Medicine, The Hospital for Sick Children, Adjunct Clinical Assistant Professor of Pediatrics, University of Toronto in Medicine.
Corresponding Author:
Journal MTM 1:3:50-52, 2012

Mobile technology has become increasingly prevalent in the workplace.  Smart phones, tablets, and other forms of personal digital assistant have particular appeal for professionals seeking tools to enhance productivity.  Research in particular requires the capacity to collect and process data in an efficient and cost effective manner.  Investigators are increasingly turning to mobile devices for solutions as programs and data handling capabilities become more sophisticated.  With these developments, however, arises the need to contemplate and address ethical considerations relevant to mobile technology use in the research context.

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Posted on Sep 16, 2012 in Letters | 1 comment

The use of short message service (SMS) for patient appointment reminders

Susan McClean1, Dr Mahendra Perera MBBS1
1Albert Road Clinic, Melbourne, Australia
Corresponding Author:
Journal MTM 1:3:53-55, 2012

Albert Road Clinic is an acute care private psychiatric hospital with active and committed Psychiatrists who work with us. The Albert Road Clinic Consulting Suites is based within the hospital and this space is tenanted by approximately 40 consultant psychiatrists who work either full time or on a sessional basis in their private practice.  Several psychiatrists approached me to try and resolve the issue of their patients not attending for scheduled appointments; the non- attendance has potential detrimental effects for the patient (who may have forgotten the appointment) leading to possible clinical risk. The other consequences have been an adverse effect on the consultant psychiatrists’ business and the inability to back fill the appointment for which the patient has not attended.

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