mHealth Engineering: A Technology Review

In this paper, we review the technological bases of mobile health (mHealth). First, we derive a component-based mHealth architecture prototype from an Institute of Electrical and Electronics Engineers (IEEE)-based multistage research and filter process. Second, we analyze medical databases with regard to these prototypic mhealth system components.. We show the current state of research literature concerning portable devices with standard and additional equipment, data transmission technology, interface, operating systems and software embedment, internal and external memory, and power-supply issues. We also focus on synergy effects by combining different mHealth technologies (e.g., BT-LE combined with RFID link technology). Finally, we also make suggestions for future improvements in mHealth technology (e.g., data-protection issues, energy supply, data processing and storage)

Devices and Data Workflow in COPD Wearable Remote Patient Monitoring: A Systematic Review

Background: With global increase in Chronic Obstructive Pulmonary Disease (COPD) prevalence and mortality rates, and socioeconomical burden continuing to rise, current disease management strategies appear inadequate, paving the way for technological solutions, namely remote patient monitoring (RPM), adoption considering its acute disease events management benefit. One RPM’s category stands out, wearable devices, due to its availability and apparent ease of use. Objectives: To assess the current market and interventional solutions regarding wearable devices in the remote monitoring of COPD patients through a systematic review design from a device composition, data workflow, and collected parameters description standpoint. Methods: A systematic review was conducted to identify wearable device trends in this population through the development of a comprehensive search strategy, searching beyond the mainstream databases, and aggregating diverse information found regarding the same device. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and quality appraisal of identified studies was performed using the Critical Appraisal Skills Programme (CASP) quality appraisal checklists. Results: The review resulted on the identification of 1590 references, of which a final 79 were included. 56 wearable devices were analysed, with the slight majority belonging to the wellness devices class. Substantial device heterogeneity was identified regarding device composition type and wearing location, and data workflow regarding 4 considered components. Clinical monitoring devices are starting to gain relevance in the market and slightly over a third, aim to assist COPD patients and healthcare professionals in exacerbation prediction. Compliance with validated recommendations is still lacking, with no devices assessing the totality of recommended vital signs. Conclusions: The identified heterogeneity, despite expected considering the relative novelty of wearable devices, alerts for the need to regulate the development and research of these technologies, specially from a structural and data collection and transmission standpoints.Introdução: Com o aumento global das taxas de prevalência e mortalidade da Doença Pulmonar Obstrutiva Crónica (DPOC) e o seu impacto socioeconómico, as atuais estratégias de gestão da doença parecem inadequadas, abrindo caminho para soluções tecnológicas, nomeadamente para a adoção da monitorização remota, tendo em conta o seu benefício na gestão de exacerbações de doenças crónicas. Dentro destaca-se uma categoria, os dispositivos wearable, pela sua disponibilidade e aparente facilidade de uso. Objetivos: Avaliar as soluções existentes, tanto no mercado, como na área de investigação, relativas a dispositivos wearable utilizados na monitorização remota de pacientes com DPOC através de uma revisão sistemática, do ponto de vista da composição do dispositivo, fluxo de dados e descrição dos parâmetros coletados. Métodos: Uma revisão sistemática foi realizada para identificar tendências destes dispositivos, através do desenvolvimento de uma estratégia de pesquisa abrangente, procurando pesquisar para além das databases convencionais e agregar diversas informações encontradas sobre o mesmo dispositivo. Para tal, foram seguidas as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), e a avaliação da qualidade dos estudos identificados foi realizada utilizando a ferramenta CASP (Critical Appraisal Skills Programme). Resultados: A revisão resultou na identificação de 1590 referências, das quais 79 foram incluídas. Foram analisados 56 dispositivos wearable, com a ligeira maioria a pertencer à classe de dispositivos de wellness. Foi identificada heterogeneidade substancial nos dispositivos em relação à sua composição, local de uso e ao fluxo de dados em relação a 4 componentes considerados. Os dispositivos de monitorização clínica já evidenciam alguma relevância no mercado e, pouco mais de um terço, visam auxiliar pacientes com DPOC e profissionais de saúde na previsão de exacerbações. Ainda assim, é notória a falta do cumprimento das recomendações validadas, não estando disponíveis dispositivos que avaliem a totalidade dos sinais vitais recomendados. Conclusão: A heterogeneidade identificada, apesar de esperada face à relativa novidade dos dispositivos wearable, alerta para a necessidade de regulamentação do desenvolvimento e investigação destas tecnologias, especialmente do ponto de vista estrutural e de recolha e transmissão de dados

A systematic review of digital technology to evaluate motor function and disease progression in motor neuron disease

Amyotrophic lateral sclerosis (ALS) is the most common subtype of motor neuron disease (MND). The current gold-standard measure of progression is the ALS Functional Rating Scale—Revised (ALS-FRS(R)), a clinician-administered questionnaire providing a composite score on physical functioning. Technology offers a potential alternative for assessing motor progression in both a clinical and research capacity that is more sensitive to detecting smaller changes in function. We reviewed studies evaluating the utility and suitability of these devices to evaluate motor function and disease progression in people with MND (pwMND). We systematically searched Google Scholar, PubMed and EMBASE applying no language or date restrictions. We extracted information on devices used and additional assessments undertaken. Twenty studies, involving 1275 (median 28 and ranging 6–584) pwMND, were included. Sensor type included accelerometers (n = 9), activity monitors (n = 4), smartphone apps (n = 4), gait (n = 3), kinetic sensors (n = 3), electrical impedance myography (n = 1) and dynamometers (n = 2). Seventeen (85%) of studies used the ALS-FRS(R) to evaluate concurrent validity. Participant feedback on device utility was generally positive, where evaluated in 25% of studies. All studies showed initial feasibility, warranting larger longitudinal studies to compare device sensitivity and validity beyond ALS-FRS(R). Risk of bias in the included studies was high, with a large amount of information to determine study quality unclear. Measurement of motor pathology and progression using technology is an emerging, and promising, area of MND research. Further well-powered longitudinal validation studies are needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-022-11312-7

ADAPT: Approach to Develop context-Aware solutions for Personalised asthma managemenT

The creation of sensors allowing the collection of a high amount of data has been possible thanks to the evolution of information and communication technology. These data must be properly interpreted to deliver meaningful information and services. Context-aware reasoning plays an important role in this task, and it is considered as a hot topic to study in the development of solutions that can be categorised under the scope of Intelligent Environments. This research work studies the use of context-aware reasoning as a tool to provide support in the asthma management process. The contribution of this study is presented as the Approach to Develop context-Aware solutions for Personalised asthma managemenT (ADAPT), which can be used as a guideline to create solutions supporting asthma management in a personalised way. ADAPT proposes context-aware reasoning as an appropriate tool to achieve the personalisation that is required to address the heterogeneity of asthma. This heterogeneity makes people with asthma have different triggers provoking their exacerbations and to experience different symptoms when their exacerbations occur, which is considered as the most challenging characteristic of the condition when it comes to implementing asthma treatments. ADAPT context dimensions are the main contribution of the research work as they directly address the heterogeneity of asthma management by allowing the development of preventive and reactive features that can be customised depending on the characteristics of a person with asthma. The approach also provides support to people not knowing their triggers properly through case-based reasoning, and includes virtual assistant as a complementing technology supporting asthma management. The comprehensive nature of ADAPT motivates the study of the interaction between context-aware reasoning and case-based reasoning in Intelligent Environments, which is also reported as a key contribution of the research work. The inclusion of people with asthma, carers and experts in respiratory conditions in the experiments of the research project was possible to achieve thanks to the collaboration formed with Asthma UK

Novel electronic adherence monitoring devices in children with asthma: a mixed-methods study

Introduction: Adherence monitoring to inhaled corticosteroids is an essential component of asthma management. Electronic monitoring devices (EMD) provide objective data on date, time and number of actuations. However, most give no information on inhalation. Novel EMD (NEMD) platforms have the potential to monitor both activation and inhalation. Aim: To assess the feasibility of NEMDs, in terms of usability, acceptability to patients and healthcare professionals and accuracy. Methods: This was an open-label, prospective, mixedmethods, pragmatic randomised study. Children with asthma attending specialist tertiary care were randomised to one of four NEMD: Remote Directly Observed Therapy (R-DOT), Hailie Smartinhaler, INhaler Compliance Assessment device (INCA) and the Rafi-tone App. Following monitoring, participants were invited to focus groups or one-to-one interviews. Usability and acceptability were evaluated using themes identified from the focus groups and interviews. Adherence accuracy was determined using adherence data from each NEMD. Results: Thirty-five children were recruited; 18 (51%), (11 males, median age 13.5 (7–16) years) completed monitoring, 14 (78%) provided feedback. Participants identified various features such as ease of use and minimal effort as desirable criteria for an NEMD. The Hailie and INCA fulfilled these criteria and were able to record both actuation and inhalation. Negative themes included a ‘Big Brother’ effect and costs. Conclusion: There was no ‘one size fits all’, as participants identified advantages and disadvantages for each NEMD. Devices that can easily calculate adherence to activation and inhalation have the potential to have greatest utility in clinical practice. Each NEMD has different functionality and therefore choice of platform should be determined by the needs of the patient and healthcare professional

Domiciliary monitoring to predict exacerbations of COPD

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common, longterm condition that is usually caused by cigarette smoking. In addition to daily symptoms and limitation in activities, patients are prone to chest infections ('exacerbations'). These are a significant problem: unpleasant for patients, and sometimes severe enough to cause hospital admission and death. Reducing the impact of exacerbations is very important. Previous studies have shown that earlier treatment of exacerbations results in faster recovery, and reduced risk of hospital admission. Helping patients to better detect exacerbations early is therefore important. This PhD focuses on measuring overnight heart rate and oxygen saturation, which we hypothesised would provide the best chance of detecting COPD exacerbations earlier than changes in symptoms. // Aim: To evaluate the potential of monitoring physiological variables to provide earlier detection of exacerbations of COPD. // Methods: Firstly, a systematic review was conducted to assess the existing literature on predicting exacerbations of COPD by monitoring physiological variables. Next, two clinical tele-health datasets were accessed, from two different NHS services in London, to report the impact of false alarms on tele-health service, and to examine the feasibility of using downloadable data from home non-invasive ventilation to detect exacerbations resulting in hospitalisation. National and international surveys were conducted to explore the techniques that have been used by healthcare providers on how to customise tele-health alarm limits for each individual, and to explore healthcare providers’ perceptions of tele-health for COPD. These preliminary projects enabled me to formulate my research question and main PhD hypothesis, tested using a prospective randomised controlled trial. Patients were randomised into two groups (one measured physiology only in the morning versus overnight continuous measurement) and patients were monitored for up to six months or the first exacerbation, whichever was sooner. Patients’ acceptance of continuous overnight monitoring was assessed at the end of the study. // Results: Existing studies that used physiological variables were small and heterogeneous using different variables and different protocols. The majority of medical alarms received by tele-health teams are false. Most patients reported a positive acceptance of being monitored overnight. Continuous overnight monitoring identified changes at exacerbation earlier than once-daily monitoring, and earlier than symptoms. Changes in physiological variables were correlated with changes in symptoms during non-stable phases. There is widespread UK national and international use of tele-health monitoring physiological variables in COPD without sufficient evidence base. // Conclusion: Monitoring physiological parameters may be useful in assisting earlier detection of COPD exacerbations but further, robust studies are required to confirm this. A particular challenge is how to set alarm limits for individual patients given the heterogeneity inherent in COPD and COPD exacerbations

Features of a mobile health intervention to manage chronic obstructive pulmonary disease: a qualitative study

Background: The use of mobile health (mHealth) interventions has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes. Further research is needed to determine which mHealth features are required to potentially enhance COPD self-management. Aim: The aim of this study was to explore the potential features of an mHealth intervention for COPD management with healthcare providers (HCPs) and patients with COPD. It could inform the development and successful implementation of mHealth interventions for COPD management. Methods: This was a qualitative study. We conducted semi-structured individual interviews with HCPs, including nurses, pharmacists and physicians who work directly with patients with COPD. Interviews were also conducted with a diverse sample of patients with COPD. Interview topics included demographics, mHealth usage, the potential use of medical devices and recommendations for features that would enhance an mHealth intervention for COPD management. Results: A total of 40 people, including nurses, physicians and pharmacists, participated. The main recommendations for the proposed mHealth intervention were categorised into two categories: patient interface and HCP interface. The prevalent features suggested for the patient interface include educating patients, collecting baseline data, collecting subjective data, collecting objective data via compatible medical devices, providing a digital action plan, allowing patients to track their progress, enabling family members to access the mHealth intervention, tailoring the features based on the patient’s unique needs, reminding patients about critical management tasks and rewarding patients for their positive behaviours. The most common features of the HCP interface include allowing HCPs to track their patients’ progress, allowing HCPs to communicate with their patients, educating HCPs and rewarding HCPs. Conclusion: This study identifies important potential features so that the most effective, efficient and feasible mHealth intervention can be developed to improve the management of COPD

[Abstract] How to secure better outcomes for everybody in asthma management: the international-medicines use review health technology assessment (international-MUR HTA)

Aims: This project is looking at the development and application of the novel tool (International–Medicines-Use-Review-Health-Technology-Assessment; International-MUR HTA) in community practice that for the first time is able to meet better asthma control and secure added value service in asthma management. More specifically it allows to: evaluate the quality of care delivered in terms of economic impact (for patient-provider-society), health outcomes and patient benefits; collect real-world evidence and evaluate longterm effect of care; provide different stakeholders with evidence-based information that would help formulate health policies in community practice that are safe, effective, patient-focused and cost-effective, balancing access to innovation and cost containment. Crucially, the tool can also support the delivery of a cost-effective and cost-saving intervention for asthma patients based on the success of the Italian-Medicines-Use-Review (I-MUR) trial [1]. Methods: Evidence from the Italian-Medicine-Use-Review (I-MUR) trial showed that the I-MUR intervention provided by the community pharmacists in asthma is effective, cost-saving and cost-effective.1 The trial allowed to model a novel framework (International-MUR-HTA) that would enable to routinely deliver the intervention, but also collect and analyse patient relevant data on its clinical-effectiveness, quality-of-life and cost-effectiveness. I-MUR-HTA was discussed within three expert-panel discussions including policy-makers, commissioners, academics, healthcare-professionals and patientrepresentatives in Italy,2 UK3 and Brussels/Europe.4 The current plan includes testing the use of the tool in RW environment across European regions. Results: Evidence collected from the expert discussions confirmed that International-MUR-HTA information is relevant to meet current NICE target for cost-effective service delivery and this is what is needed to support the evaluation of innovative effective and cost-effective health policies and promote their implementation across nations. Its implementation is underway and real-world pilots are planned to take place in different European regions. Conclusion: the International-MUR-HTA appears to be an innovative tool to promote active patient involvement into policy-decision-making and community service implementation