Blood glucose monitoring in diabetes mellitus: current issues in Diabetes

The measurement of blood glucose provides information on the effectiveness of blood glucose metabolism and guides interventions to achieve optimal glucose control within the body. Charlotte Gordon provides an overview of available technology

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain

An innovative approach to designing digital health solutions addressing the unmet needs of obese patients in Europe

According to the World Health Organization (WHO), the worldwide obesity rate has tripled since 1975. In Europe, more than half of the population is overweight and obese. Around 2.8 million people die each year worldwide as a result of conditions linked to being overweight or obese. This study aimed to analyze the policies, approaches, and solutions that address the social and health unmet needs of obese patients, at different levels, in order to simulate the definition of an integrated approach, and to provide and share examples of innovative solutions supporting health promotion, disease prevention, and integration of services to improve the collaboration between the different health and care stakeholders involved across the country and in the lives of obese patients. A collaborative approach involving various levels of government and regional experts from different European countries was applied to identify, explore, and evaluate different aspects of the topic, from the innovation perspective and focusing on a European and a regional vision. Currently, people prefer more foods rich in fats, sugars, and salt/sodium than fruits, vegetables, and fiber. This behavior leads to a significant negative impact on their health-related quality of life. Changes in healthcare systems, healthy policy, and approaches to patient care and better implementation of the different prevention strategies between all the stakeholders are needed, taking advantage of the digital transformation of health and care. Such changes can support obese patients in their fight against an unhealthy lifestyle and at the same time reduce healthcare costs

Planning, developing, and pilot testing a mobile health promotion program to prevent type 2 diabetes after gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is associated with an increased risk for type 2 diabetes (T2D) and related cardiometabolic disturbances. A healthy lifestyle with sufficient physical activity, a balanced nutrition, and psychosocial wellbeing decreases the risk of developing these conditions in the years following delivery. Current prevention programs for women after GDM insufficiently address the needs of a flexible, accessible, and practical tool for daily life in this target group. The aim of this dissertation project was to create a theory- and evidence-based scalable mobile health (mHealth) application that fulfils both academic and industrial standards, supports behavior change, and addresses the specific needs of women post-GDM. Methods: The Intervention Mapping approach was implemented to structure the development process. In the scope of this thesis, Intervention Mapping Steps 1 to 4 were applied as blueprint and analytical tool for planning, developing, and pilot testing the smartphone-based TRANGLE program to prevent T2D and related cardiometabolic disturbances in women post-GDM. In the Steps 1 to 3, we designed a theory- and evidence-based intervention model. In Step 4, we cooperated with industry to secure a high technological standard when translating the model into a practical intervention based on a smartphone app. For the associated user study and the clinical pilot trial, we used a mixed methods design based on validated questionnaires on user acceptance and lifestyle behavior, user logs, think alouds with semi-structured interviews, nutrition protocols, and clinical assessments. Results: The resulting TRIANGLE program is among the first mHealth apps for personalized stepwise habit change in the areas of physical activity, nutrition, and psychosocial wellbeing. The interactive app allows for self-pacing, addresses 11 behavioral determinants, and offers 39 behavior change methods to support individual lifestyle change. An associated online platform for healthcare practitioners allows for human coaching while a unique challenge system fosters habit change and education. Once a beta-version of the app and the coaching platform was available, the iterative development process comprised a user study with women post-GDM, followed by adaptations before the full program production. Lastly, a German multicenter randomized controlled pilot trial of the TRIANGLE program indicated first clinical effects for behavior change after six months of intervention. Women post-GDM showed a high acceptance and a high perceived impact of the program on their behavior. Conclusions: Using the Intervention Mapping approach, we developed an innovative mHealth solution for women post-GDM. The novel TRIANGLE program has the potential to prevent cardiometabolic disease as an easy to deliver technological support for behavior change. The program needs to be further refined and tested at a large scale. Intervention Mapping Steps 5 and 6 may support this implementation and evaluation process

Software Architectures for Smart Applications in the Management of Chronic Diseases: A Study of Reversibility of Diabetes 2

The paper proposes a software architecture for applications which use the reasoning upon SWRL enabled OWL ontologies and SQL like retrievals as core computational models. The application assists patients affected by diabetes 2, to personalize the reversibility of the condition through the diet and life style changes. The novelty is in (a) the deployment of SWRL enabled OWL ontologies in the management of data related to the personalisation of reversibility of diabetes 2 and in (b) the proposed software architecture, which contains and manipulates the SWRL enabled OWL ontology and SQL databases at the same time and transparently. The application, which has been implemented within the Java environment and NetBeans, is reusable in any other problem domain when the personalization of healthcare delivery is required. The proposed architecture also generates applications within Android environments without changing its style and the computational models

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

Implementation of a SMART Goal Intervention for Diabetic Patients: A Practice Change in Primary Care

Self-management techniques have been shown to be useful practice tools for providers managing patients with chronic disease. One valuable aspect of self-management is goal setting, whereby the patient is directed to create highly attainable personal goals to modify a selected behavior. Through the attainment of these goals, the patient begins to experience confidence and improved self-efficacy in managing chronic diseases such as diabetes. This paper provides background on the use of SMART goals for diabetic patients, how this practice change supports Meaningful Use objectives and helps meet the requirements for future reimbursement opportunities. A thorough organizational assessment of a Midwest primary care clinic is shared, including its implications for introducing a practice change project. Key results include a positive change in the providers’ attitudes in using SMART goals with diabetic patients. In addition, a cost analysis was completed to assist the office in creating a formal care management program. Results of the cost analysis are also discussed and include recommendations for a future care management program that incorporates SMART goals

An innovative approach for health care delivery to obese patients: from health needs identification to service integration

In Europe, more than half of the population is overweight or obese, and effort to design, validate, and implement innovative approaches is required to address social and health unmet needs of obese patients in terms of health promotion, disease prevention, and integration of services. The challenge is improving the collaboration between the different health and care stakeholders involved in the lives of obese patients, changing the socio-cultural attitude towards food intake and other behaviours leading to a negative impact on their health-related quality of life. The digital transformation of health and care can support changes in healthcare systems, healthy policy, and approaches to patient care and better implementation of the different health promotion and disease prevention strategies between all the stakeholders and support obese patients. Based on the previously experience adopted by Blueprint Partners with the Blueprint persona and user scenario in the context of models of care and prevention, health policies and analysis of risk factors affecting health and quality of life of obese subjects, the study aimed to simulate an integrated care pathway, through a multidisciplinary approach, developing and applying solutions and good clinical practices addressing the social and health unmet needs of obese patients. A pilot study assessed the quality of life (QoL), adherence to the Mediterranean diet, efficacy and interoperability of a digital health platform, Paginemediche. it. A qualitative approach has been adopted to identify and specify key digital solutions and high-impact user scenarios in Active and Healthy Ageing (AHA). To achieve a successful result, an iterative and collaborative approach has been followed to develop a user-centred perspective to the identification of solutions addressing health needs with different complexity along the entire life-course. Four initial key topic areas were chosen and used to identify different digital solutions that may meet the needs of the population segments defined by both age and the complexity of their health status. All data, derived from the industry representatives in the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), were collected via a survey to how digital solutions best met the needs of the various population segments represented by personas. Subsequently, innovative solutions were designed based on how a user from a target group interacts with technologies, developing "personas" belonging to specific "population segments" with different conditions and needs. Then, a high-impact user scenario, based on the correlation of personas' needs, good clinical practices and digital solutions available targeting needs which playing a role in the health and care delivery for the persona, has been developed. In the end, to evaluate how digital solutions and technologies can support obese patients during their weight loss or management of their related comorbidities in current service provision, ten obese patients were enrolled to evaluate a Digital Health platform, pagininemediche.it, developed. Matilde, the Blueprint persona developed, highlighted some of the main needs (social support, development of a health-friendly environment and educational program on healthy nutrition and physical activity) that may be addressed by integrating innovative solutions in the care of obese patients. Based on her profile, a high-impact user scenario diagram correlates health and social needs with digital solutions and can help key actors in the creation of a well-integrated care approach. Moreover, the evaluation of the digital platform, paginemediche.it, demonstrated how digital solutions can motivate and support obese patients in changing habits towards a healthy lifestyle, although no further statistical significance has been identified in the quality of life assessment because of the limited number of the patients, and short period of observation. Overweight or obese patients tend to be marginalized and the subject of a real social stigma. Digital solutions may be useful to overcome psychological factors that prevent obese patients from starting their journey for a lifestyle change. The suggested approach, which considers health needs, IT skills, socioeconomic context, interoperability, and integration gaps that may influence the adoption of innovative solutions tailored to improve health outcomes is person-centred, and identify what is important for obese patients. The implementation of a persona and user scenario approach may also be useful for the early involvement of end-users in solutions' design and adaptation, increasing adherence, and the effectiveness of digital solutions. Persona profiles, the user scenario, and the related digital solution also consider the potential benefits that can derive for both patients and health system in term of reduced emergency room admissions, waiting lists, and health related expenditures