MyHealthAvatar lifestyle management support for cancer patients

MyHealthAvatar (MHA) is built on the latest information and communications technology with the aim of collecting lifestyle and health data to promote citizen's wellbeing. According to the collected data, MHA offers visual analytics of lifestyle data, contributes to individualised disease prediction and prevention, and supports healthy lifestyles and independent living. The iManageCancer project aims to empower patients and strengthen self-management in cancer diseases. Therefore, MHA has contributed to the iManageCancer scenario and provides functionality to the iManageCancer platform in terms of its support of lifestyle management of cancer patients by providing them with services to help their cancer management. This paper presents two different MHA-based Android applications for breast and prostate cancer patients. The components in these apps facilitate health and lifestyle data presentation and analysis, including weight control, activity, mood and sleep data collection, promotion of physical exercise after surgery, questionnaires and helpful information. These components can be used cooperatively to achieve flexible visual analysis of spatiotemporal lifestyle and health data and can also help patients discover information about their disease and its management

Assessment and optimisation of wearable activity monitors within an enhanced recovery framework

Enhanced recovery after surgery (ERAS) is a model of care that aims to improve patient recovery after surgery. Wearable activity monitors (WAMs) have the potential to provide possible solutions to a wide range of clinical challenges. The aim of this thesis was to assess whether physical activity, measured by a WAM, can be used as a measurable marker of peri-operative well-being and recovery after surgery, and whether the WAM can therefore be used to assess and help improve recovery after surgery. A wrist-worn WAM was utilised to measure physical activity in a healthy normal cohort showing that it was feasible to monitor continuous physical activity in a healthy cohort in a free-living environment. Activity data were processed both at an individual level and as a group allowing further analysis and comparator with the surgical patient cohort. The WAM was used to measure objective physical activity data for a cohort of patients undergoing colorectal surgery. Activity was assessed pre-operatively at home, post-operatively on the in-patient ward and then on discharge home back into the community. The physical activity data gave insight into patients’ baseline function and their progression and recovery following their surgical procedure, with more detailed analysis showing the WAM’s ability to reflect the daily activities on the ward. There were statistically significant correlations between peri-operative physical activity and post-operative outcomes. The results from the use of WAMs within this thesis provide an opportunity for refining the ERAS concept through continuous, objective physical activity monitoring as well as the potential to enhance patient/clinician communication, leading to more personalised care and an improvement in post-operative outcomes.Open Acces

Validation of design artefacts for blockchain-enabled precision healthcare as a service.

Healthcare systems around the globe are currently experiencing a rapid wave of digital disruption. Current research in applying emerging technologies such as Big Data (BD), Artificial Intelligence (AI), Machine Learning (ML), Deep Learning (DL), Augmented Reality (AR), Virtual Reality (VR), Digital Twin (DT), Wearable Sensor (WS), Blockchain (BC) and Smart Contracts (SC) in contact tracing, tracking, drug discovery, care support and delivery, vaccine distribution, management, and delivery. These disruptive innovations have made it feasible for the healthcare industry to provide personalised digital health solutions and services to the people and ensure sustainability in healthcare. Precision Healthcare (PHC) is a new inclusion in digital healthcare that can support personalised needs. It focuses on supporting and providing precise healthcare delivery. Despite such potential, recent studies show that PHC is ineffectual due to the lower patient adoption in the system. Anecdotal evidence shows that people are refraining from adopting PHC due to distrust. This thesis presents a BC-enabled PHC ecosystem that addresses ongoing issues and challenges regarding low opt-in. The designed ecosystem also incorporates emerging information technologies that are potential to address the need for user-centricity, data privacy and security, accountability, transparency, interoperability, and scalability for a sustainable PHC ecosystem. The research adopts Soft System Methodology (SSM) to construct and validate the design artefact and sub-artefacts of the proposed PHC ecosystem that addresses the low opt-in problem. Following a comprehensive view of the scholarly literature, which resulted in a draft set of design principles and rules, eighteen design refinement interviews were conducted to develop the artefact and sub-artefacts for design specifications. The artefact and sub-artefacts were validated through a design validation workshop, where the designed ecosystem was presented to a Delphi panel of twenty-two health industry actors. The key research finding was that there is a need for data-driven, secure, transparent, scalable, individualised healthcare services to achieve sustainability in healthcare. It includes explainable AI, data standards for biosensor devices, affordable BC solutions for storage, privacy and security policy, interoperability, and usercentricity, which prompts further research and industry application. The proposed ecosystem is potentially effective in growing trust, influencing patients in active engagement with real-world implementation, and contributing to sustainability in healthcare

Personalised antimicrobial management in secondary care

Background: The growing threat of Antimicrobial Resistance (AMR) requires innovative methods to promote the sustainable effectiveness of antimicrobial agents. Hypothesis: This thesis aimed to explore the hypothesis that personalised decision support interventions have the utility to enhance antimicrobial management across secondary care. Methods: Different research methods were used to investigate this hypothesis. Individual physician decision making was mapped and patient experiences of engagement with decision making explored using semi-structured interviews. Cross-specialty engagement with antimicrobial management was investigated through cross-sectional analysis of conference abstracts and educational training curricula. Artificial intelligence tools were developed to explore their ability to predict the likelihood of infection and provide individualised prescribing recommendations using routine patient data. Dynamic, individualised dose optimisation was explored through: (i) development of a microneedle based, electrochemical biosensor for minimally invasive monitoring of beta-lactams; and (ii) pharmacokinetic (PK)-pharmacodynamic (PD) modelling of a new PK-PD index using C-Reactive protein (CRP) to predict the pharmacodynamics of vancomycin. Ethics approval was granted for all aspects of work explored within this thesis. Results: Mapping of individual physician decision making during infection management demonstrated several areas where personalised, technological interventions could enhance antimicrobial management. At specialty level, non-infection specialties have little engagement with antimicrobial management. The importance of engaging surgical specialties, who have relatively high rates of antimicrobial usage and healthcare associated infections, was observed. An individualised information leaflet, co-designed with patients, to provide personalised infection information to in-patients receiving antibiotics significantly improved knowledge and reported engagement with decision making. Artificial intelligence was able to enhance the prediction of infection and the prescribing of antimicrobials using routinely available clinical data. Real-time, continuous penicillin monitoring was demonstrated using a microneedle based electrochemical sensor in-vivo. A new PK-PD index, using C-Reactive Protein, was able to predict individual patient response to vancomycin therapy at 96-120 hours of therapy. Conclusion: Through co-design and the application of specific technologies it is possible to provide personalised antimicrobial management within secondary care.Open Acces

Enabling an ageing workforce: Using design to innovate the workplace and empower older workers

Australia’s population is ageing, but with enhanced health prospects and insufficient retirement funds, and industries impacted by a dwindling itinerate manual labour supply, workers will want, and may need, to remain in the workforce for longer. However, as people age, they lose muscular strength, experience a decline in physical and cognitive performance, and are more vulnerable to muscular-skeletal issues caused by repetitive or awkward movement patterns. Consequently, ageing workers in occupations that require sustained physical activities are at increased risk of injury and exacerbated physical decline and may experience ageist discrimination in the workplace that impacts their psychological wellbeing. This research, Enabling an Ageing Workforce, recognises the issues facing the older worker across a range of different workplace contexts and asks the question: How can design and new technologies address the compounding factors of an ageing (working) population and enable older workers to continue to be productive and effective whilst ensuring their personal wellbeing? Enabling an Ageing Workforce’ is a collaborative research and design project between RMIT University’s ‘Safeness by Design’ initiative and the Innovation Centre of WorkSafe Victoria. This project investigates ageing, wellbeing, and workplace safeness within specific industries to identify areas of concern, opportunities for design intervention, and the proposal of future-focused design solutions. The researchers conduct a substantial scope of enquiry, while concurrently undertaking a partnered design studio with Industrial Design students, to develop and respond with appropriate design solutions. The research identifies that safeness issues exist across specific industry contexts because of workplace culture, practices and predominant behaviours, specific work actions and activities, workplace design, economic and time pressures, and poor risk literacy, training and awareness. The design studio component sees students addressing research-identified issues across many industry sectors and workplace contexts to: • prevent musculoskeletal issues in healthcare workers in the homecare environment, • correct harmful movement behaviours in manufacturing environments, • support older workers in manual tasks, through assistive technologies, • address mental health in the construction industry, • reduce ladder injuries in the residential construction industry, • reduce vibration related injuries in the agricultural sector. This research reveals insights into how a ‘safeness by design’ lens can enable an ageing Australian workforce. Such an approach needs to balance pre-emptive and reactive safety measures, focusing on creating a safe and supportive working environment for all workers. Whilst it is important to support older workers to reduce risk or injury and to promote their capability and performance, enabling longevity, it is also critical to implement measures that protect younger workers from unsafe workplace behaviours, processes and expectations that can lead to longer-term impairment, and may result in them leaving that industry prematurely

Co-creation of a person-centred integrated digital health model of care for fragility hip fractures: a mixed methods pragmatic research

Hip fracture is among the most devastating events faced by older people. These fragility fractures often occur due to trivial or low trauma falls. Current treatment efforts have led to best practice management guidelines and clinical audits at the level of the acute hospital setting and, to a certain extent, immediate post-hospital discharge. However, concerns still exist in the areas of prevention and rehabilitation outcomes including quality of life, and functional independence. Based on emerging evidence, a more nuanced approach is required for future health services delivery which incorporates: 1) musculoskeletal health; 2) increasing burden of multimorbidities; and 3) societal influences and circumstances shaping individual’s health literacy including access to digital technology. The aim of this thesis work is to conduct a program of research focused on establishing a personcentred and integrated model of care for older people with hip fractures assisted by digital health technology and modern educational approaches. The goal is to improve outcomes such as health literacy, access, functional rehabilitation, and quality of life. Objectives 1. To map out digital health interventions by conducting a comprehensive systematic review, which evaluates the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery from fragility fractures. 2. To determine different phases of a research program for the development of a digital health hub enabled model of care focused on hip fracture rehabilitation through a dynamic conceptual framework. 3. To understand the perspective of older people with hip fractures, their family members, and residential aged carers, to inform the development of a personalised digital health hub and factors impacting the likelihood of potential usage. 4. To understand the perspectives of clinicians from various medical and surgical disciplines, allied health, and other relevant non-health stakeholders to inform the development of a digital health enabled model of care for fragility fractures. 5. To examine the process and management of innovation, and the strategic directions required to improve musculoskeletal healthcare at macro (policy), meso (service delivery), and micro (clinical practice) levels and discuss the critical role of different stakeholders in driving innovations in healthcare. 6. To describe a vision for future health care to address increasing population multimorbidity through the co-creation of personalised digital health hubs that recognise the importance of patient agency in driving the evolution of health services. This study emphasises that digital health solutions must be co-created and co-implemented by engaging relevant stakeholders including end consumers at the local contextual level. Developed countries such as Australia are emerging global leaders in contemporary research focused on advancing knowledge and filling gaps within existing health service delivery for older people.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202

Self-Tracking by People Living with Multiple Sclerosis: Supporting Experiences of Agency in a Chronic Neurological Condition

Multiple sclerosis is a complex neurological condition. It disrupts the central nervous system leading to an individual range of physical, cognitive, and mental impairments. Research has focused on the tracking of primary disease indicators and disability outcome measures to assess the progression of this condition. However, there is little knowledge on how technologies could support the needs of people with multiple sclerosis (MS) in self-tracking their health and wellbeing. Drawing on qualitative research and design methods this thesis provides two contributions. Firstly, it improves understanding of self-tracking in MS self-management. Interview participants reported regaining a sense of control over MS through intertwining individual self-care practices with different self-tracking tools, including paper notebooks and fitness wearables. They associated experiences of control with their agency to document their health in holistic ways, involving symptom monitoring and life journaling. However, participants criticised that self-tracking apps can impede their capacities, in particular when the user experience is focused on predefined health indicators and the optimisation of health behaviour. These findings highlight the need to support people’s individual self-care intentions and agentive capacities through customisable self- tracking approaches. Secondly, this thesis contributes the design of Trackly, a technology probe that supports people in defining and colouring pictorial trackers, such as body shapes. We identify benefits and challenges of customisable and pictorial self-tracking through a field study of Trackly in MS self-management. Having been able to support their individual self-care intentions with Trackly, participants reported a spectrum of interrelated experiences of agency, including ownership, identity, awareness, mindfulness, and control. Overall, this thesis provides a qualitative account and design perspective that demonstrate how adapting self-tracking technologies to individual care needs supported experiences of agency. These findings are particularly relevant to the design of technologies aimed at leveraging personally meaningful self-care and quality of life