What makes a good health ‘app’? Identifying the strengths and limitations of existing mobile application evaluation tools

Research using mHealth apps has the potential to positively impact health care management and outcomes. However, choosing an appropriate mHealth app may be challenging for the health researcher. The author team used existing evaluation tools, checklists, and guidelines to assess selected mHealth apps to identify strengths, challenges, and potential gaps within existing evaluation tools. They identified specific evaluation tool components, questions, and items most effective in examining app content, usability, and features, including literacy demand and cultural appropriateness; technical information; practical aspects of app functionality; and evolving capabilities of mobile medical apps. Challenges included the subjective nature of the results, time required to complete the evaluation, lack of emphasis on evidence‐based content, and inadequate tool flexibility. Health researchers considering the integration of mobile apps into research will benefit from evaluation tools that assess both evidence‐based content and the ability of the mobile app to securely integrate with other digital technologies involved in patient care. Next steps will include the involvement of health care providers and professionals, including nurses a wide range of expertise, to develop an mHealth evaluation tool that focuses on identifying quality, evidence‐based mobile apps into patient outcomes research.     

State of the Science: Pacemaker and Defibrillator Interference from Wireless Communication Devices

The use of wireless communication devices has increased rapidly, with current industry estimates of 50,000,000 subscribers of cellular telephone services, a number that is expected to double by the year 2000. Because wireless communication devices emit RF signals, they have the potential to interfere with implantable devices. The mechanisms of interference and the magnitude of interference must be considered in terms of the type of wireless communication device being used and the characteristics of the individual implantable device that is exposed to the RF emission of the cellular phone. This article reviews the potential effects of wireless communication devices on implantable devices and makes initial recommendations for patients with implantable devices.     

医院机动护士的岗位设置与管理

目的:探讨机动护士的岗位设置与管理方法。方法:针对临床科室的特殊用人需求,如护士短缺、病人需要特护、执行应急任务等,护理部在每年新毕业的护士中选拔机动护士,制定机动护士工作要求和管理制度,对机动护士进行统一调配,支援护士紧缺的科室或完成医院的各项应急任务。结果:2003-2010年,先后有78名新毕业护士担任过机动护士的工作,2008年7月至2010年7月,外出参加保健26人次,支援护士紧缺科室117人次,参加特护11人次,H1N1甲型流感期间支援发热门诊23人次,有效地保障了临床科室在护士紧缺时能正常运转。结论:机动护士的设立有效支援了临床科室的工作,满足了医院各项应急任务对护理人力的需求,并圆满完成了一些特殊护理任务。     

Assessing the quality of mobile applications targeting postpartum depression in China

Postpartum depression is a serious mental illnessdisorder that occurs after delivery and is one of the most common post‐partum complications. With the increasing popularity and extensive use of smartphones worldwide and the fact that China has become the country with the largest number of smartphone users, it is necessary to have a deep understanding of the use and influence of smartphones and discuss the role of smartphone applications in postpartum depression. This study evaluated and analysed the contents of all postpartum depression applications available in China, applying the US Preventive Services Task Force Recommendation Statement (Interventions to Prevent Perinatal Depression) and expert consensus on the guidelines for the prevention and treatment of postpartum depression. We used the keywords ‘postpartum depression; and ‘PPD’ to search Android, iOS, and WeChat in the Chinese application market. Two reviewers agreed on the coding guidelines and coded the content and functionality of the application through content analysis to determine its intervention and adherence to the guidelines. In addition, we used the Mobile App Rating Scale (MARS) to evaluate the application for engagement, functionality, aesthetics, and information domains and recorded the features of the postpartum depression application. The current findings suggest that despite the recent expansion of smartphone platforms and increased availability of applications, existing Chinese apps for postpartum depression have low levels of adherence to clinical practice‐based guidelines. New apps need to be developed, and existing apps need to be revised following evidence‐based principles.     

IIAM (important information about me): a patient portability profile app for adults,children and families with neurodevelopmental disabilities

Purpose: To describe the development of important information about me (IIAM), an application (app) used to communicate and organize healthcare information for people with neurodevelopmental disabilities (NDD).

Methods: Prior to the development of IIAM version 1.0, households with NDD were selected to participate in a focus group. Respondents (n?=?7) were parents of children with NDD. Participants were asked to use a beta version for at least 2 months in day-to-day applications and to complete a questionnaire at the end of the trial.

Results: Over half (57%) of the participants found the beta version to be useful. The greatest limitation in usability was the child’s age and literacy level. All participants found the app to be visually appealing and easy to navigate. IIAM was commonly used to communicate information to caregivers, and to facilitate quality interactions between the child and others.

Conclusion: Mobile technology has become ubiquitous and has emerged as an important tool in healthcare. New applications could potentially promote accessible, cost-effective and self-managed interventions for the disability community. IIAM is a user-friendly, well-accepted and useful app for people with NDD. The focus group feedback elicited from the beta testing was used to develop the IIAM app version 1.0. However, the sample size in this initial feasibility study is small, and warrants a prospective study that evaluates the overall benefits of this app in improving quality of life and helping individuals with developmental disabilities manage their day-to-day activities.

• Implications for Rehabilitation

• Mobile technology has been more ubiquitous in health care and has emerged as a tool in communicating healthcare needs.

• New applications could potentially promote accessible, cost-effective and self-managed interventions for the disability community.

• IIAM (important information about me) is a new iOS application that enables adults and children with neurodevelopmental disabilities to organize their medical records, advocate for their healthcare needs, and help overcome communication and time limitations with health professionals and caregivers.

     

mHealth intervention to improve medication management in chronically ill patients: analysis of the recruitment process

Objectives: Mobile phones have been rapidly adopted by the general population and are now a promising technology with considerable potential in health care. However, refusal rates of 24%–75% have been reported in telemedicine studies. We aimed to report the challenges faced when recruiting patients to use Android and iOS smartphone applications aimed at improving medication management and communication between patients and healthcare professionals.

Methods: The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal.

Results: Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00).

Conclusion: We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology.     

The Safety of Digital Mobile Cellular Telephones with Minute Ventilation Rate Adaptive Pacemakers

In vitro tests suggest that rate adaptive pacemakers using changes in transthoracic impedance to vary pacing rate may be affected by digital mobile telephones. Electromagnetic fields generated by digital mobile telephones (Global System for Mobile [GSM]) represent a potential source of electromagnetic interference (EMI) for the Telectronics META rate adaptive pacemakers, which use transthoracic impedance as a sensor to determine changes in minute ventilation. Sixteen implanted Telectronics META pulse generators were exposed to 25-W simulated GSM transmissions (900-MHz carrier pulsed at 2, 8, and 217 Hz with a pulse width of 0.6 ms) and the antenna of a 2-W digital mobile telephone (900-MHz, 217-Hz pulse. 0.6-ms pulse width). The 12 dual and four single chamber devices were programmed to maximum sensitivity and assessed in unipolar and bipolar settings and rate adaptive and nonrate adaptive modes. In all cases of EMI, testing was repeated at lower, more routinely set bipolar sensitivity levels. At maximum sensitivity, 11 of 16 devices displayed no evidence of EMI. Brief ventricular triggering occurred in 2, a brief pause in 1, a combination of both in 1, and a brief episode of pacemaker-mediated tachycardia in 1. With pulse generators programmed to more routine sensitivities, only one device displayed rare single beat ventricular triggering. No changes in minute ventilation rate adaptive pacing were observed. At maximum unipolar sensitivities, the META series of rate adaptive pacemakers are resistant to clinically important EMI from digital mobile telephones. Set at routine sensitivities, these devices perform reliably in the presence of digital mobile telephones.     

Influence of D-Net (European GSM-Standard) Cellular Phones on Pacemaker Function in 50 Patients with Permanent Pacemakers

The widespread use of cellular phones in the last years has prompted some recant studies to suggest an interference of pacemaker function by cellular phone usage. To determine the risk of pacemaker patients using D-net cellular phones, we tested 50 patients with permanent pacemakers after routine pacemaker check by short phone calls using a cellular phone (Ericsson, D-net, frequency 890–915 MHz, digital information coding, equivalent to the European Croupe Systemes Mobiles standard). A six-channel surface ECG was continuously recorded from each patient to detect any interactions between pacemakers and cellular phones. Phone calls were repeated during the following pacemaker settings: (1) preexisting setting; (2) minimum ventricular rate of 90 beats/min and preexisting sensitivity; and (3) minimum ventricular rate of 90 beats/min and maximum sensitivity without T wave oversensing. Only 2 (4%) of 50 patients repeatedly showed intermittent pacemaker inhibition during calls with the cellular phone. Both pacemakers had unipolar sensing. Therefore, although interactions between cellular phone use and pacemaker function appear to be rare in our study, pacemaker dependent patients in particular should avoid the use of cellular phones.     

河北医科大学学生手机游戏使用现状与睡眠质量和情绪状况的关系

目的 探讨河北医科大学学生手机游戏使用现状与睡眠质量和情绪状况的关系,更有针对性地为医学生提出建议,引导医学生合理安排手机游戏使用时长与时间段。结论 选取河北医科大学精神医学、麻醉医学、中西医结合等专业423例学生作为研究对象,收集其社会学资料,包括性别、年龄、居住地、家庭收入、父母受教育程度等。手机游戏使用现状包括“每天花在手机游戏上的时间”和“每天最密集的手机游戏使用时间段”两个问题,前者包括“<2小时” “2~4小时” “>4~6小时” “>6小时”四个组,后者分成“早上”“上午”“中午”“下午”“晚上”五个组。采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、白天嗜睡量表(Epworth Sleeping Scale,ESS)、焦虑自评量表(Self-rating Anxiety Scale,SAS)评估其睡眠质量,流调中心用抑郁量表(Center for Epidemiological Studies-Depression,CES-D)评估其情绪状况,分析 “每天花在手机游戏上的时间”和“每天最密集的手机游戏使用时间段”对睡眠质量和情绪状况的影响。结果 376例调查者提供了有效数据,有效回收率为88.88%。“每天花在手机游戏上的时间”和“每天最密集的手机游戏使用时间段”对于睡眠质量和情绪状况无影响(均P>0.05);而性别、是否吸烟、学习兴趣、人际关系四项对睡眠质量和情绪状况有影响,差异有统计学意义(均P<0.05)。方法 “每天花在手机游戏上的时间”和“每天最密集的手机游戏使用时间段”与睡眠质量和情绪状况之间无关。男性、吸烟、学习兴趣低和人际关系较差的学生每天花在手机游戏上的时间更长。     

Providing Culturally Sensitive Palliative Care in the Desert—The Experience, the Need, the Challenges, and the Solution

The Bedouin population of the Negev region in Israel consists of 180,000 Muslims, half of whom live in six townships. The other half is dispersed in small temporary settlements (huts, tents) with no running water or electricity. Accessibility is quite difficult, with no paved roads or any form of motorized public transportation. For patients with advanced illnesses near the end of life, adequate palliative treatment is not available in their rural homestead. A mobile palliative care unit (MPCU) has been established, with the aims of delivering palliative care to terminal patients living in remote regions not easily accessible to the community health care teams and to provide palliative care consultation services to the local primary care teams. The mobile unit consists of a core team of a nurse, a social worker, a physician, and a Bedouin driver-interpreter/translator. The MPCU cares for about 30 patients at any given time, including four to six Bedouins living in rural homesteads, four to six Bedouins living in townships, and the remainder Jewish patients living in the surrounding settlements. One hundred patients were cared for and about 1800 home visits were conducted during the past year, including 15% by the whole mobile unit team, 15% by the physician alone, 25% by the nurse alone, and 25% by the unit's nurse together with the local primary clinic nurse. The average distance covered per home visit was around 70 km. Our experience in establishing a culturally sensitive MPCU can be a model to provide palliative care services in remote areas.     

新疆地区护士对移动护士工作站的使用意愿及其影响因素分析

目的 ：了解新疆地区护士移动护士工作站的使用意愿,并提出相应对策。方法 ：采用自行设计的移动护士工作站使用现状调查问卷,对新疆某三级甲等医院的1068名护士进行调查并分析。结果 ：护士对移动护士工作站的使用意愿总得分为16-80（65.86±9.21）分,处于中等偏上水平;单因素分析显示,不同年龄、性别、科室、职务、职称、岗位性质、工作年限、每天分管患者数、培训频次的护士使用意愿不同,差异有统计学意义（P〈0.05）;回归分析中,进入回归方程的因素为：性别、科室。结论 ：护士更愿意使用移动护士工作站优势明显的功能版块;护理管理人员应根据新疆少数民族地区特色,采取针对性措施提高新疆地区护士移动护士工作站的使用意愿。     

移动通讯干预提升NAFLD患者健康知识水平的对照研究

目的探讨移动通讯干预对提升NAFLD患者健康知识水平的效果。方法选取2013年7月至2014年6月住院的78例患者为对照组,选取2014年7月至2015年6月住院的80例患者为观察组,对照组患者出院后7d、1月、3月分别进行电话随访,并进行休息、饮食、运动及服药等方面的健康教育;观察组患者采用移动通讯干预;比较两组患者出院后6月健康知识问卷得分和临床观察指标情况。结果观察组患者健康知识问卷得分显著性高于对照组,临床观察指标改善情况优于对照组,比较差异均有统计学意义。结论采用移动通讯干预可提升NAFLD患者健康知识水平。     

TTAA serves as the target site for TFP3 lepidopteran transposon insertions in both nuclear polyhedrosis virus and Trichoplusia ni genomes

We have analysed TFP3 transposable elements from five independently isolated FP mutants of the Autographa californica nuclear polyhedrosis virus (AcMNPV). We also analysed genomic copies of TFP3 elements amplified from the DNAs of the Trichoplusia ni cell line (TN-368) and T. ni larvae using the polymerase chain reaction (PCR). The sequences of all the newly isolated TFP3 elements closely resemble the previously described TFP3/1 element. Each of the transposons isolated from the virus mutants duplicated a TTAA tetranucleotide target site upon insertion into the viral genome. Four of these TFP3 elements transposed into three different ‘TTAA’ target sites within the 25 K gene (FP locus, map units 36–37 of AcMNPV). The fifth TFP3 element inserted at a ’TTAA’ site within the AcMNPV Hin dlll-E fragment. One genomic TFP3 element, amplified from the TN-368 cell line DNA by an inverse PCR method, duplicated a ‘TTAA’ tetranucleotide target site that is present only once in the homologous larval DNA sequence. These data suggest that mobilization of TFP3 into both viral and cellular sites is identical in specificity and mechanism.     

移动医疗在妇科恶性肿瘤患者康复期支持性照护中的应用进展

妇科恶性肿瘤包括宫颈癌、卵巢癌、子宫内膜癌、外阴癌等[1 ].据W H O公布数据,2018年世界范围内妇科恶性肿瘤发病人数达124 .7万,中国发病人数约23 .3万[2 ].