Training cognitive functions using mobile apps in breast cancer patients: systematic review

Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient’s home. Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients

Methods to Facilitate the Capture, Use, and Reuse of Structured and Unstructured Clinical Data.

Electronic health records (EHRs) have great potential to improve quality of care and to support clinical and translational research. While EHRs are being increasingly implemented in U.S. hospitals and clinics, their anticipated benefits have been largely unachieved or underachieved. Among many factors, tedious documentation requirements and the lack of effective information retrieval tools to access and reuse data are two key reasons accounting for this deficiency. In this dissertation, I describe my research on developing novel methods to facilitate the capture, use, and reuse of both structured and unstructured clinical data. Specifically, I develop a framework to investigate potential issues in this research topic, with a focus on three significant challenges. The first challenge is structured data entry (SDE), which can be facilitated by four effective strategies based on my systematic review. I further propose a multi-strategy model to guide the development of future SDE applications. In the follow-up study, I focus on workflow integration and evaluate the feasibility of using EHR audit trail logs for clinical workflow analysis. The second challenge is the use of clinical narratives, which can be supported by my innovative information retrieval (IR) technique called “semantically-based query recommendation (SBQR)”. My user experiment shows that SBQR can help improve the perceived performance of a medical IR system, and may work better on search tasks with average difficulty. The third challenge involves reusing EHR data as a reference standard to benchmark the quality of other health-related information. My study assesses the readability of trial descriptions on ClinicalTrials.gov and found that trial descriptions are very hard to read, even harder than clinical notes. My dissertation has several contributions. First, it conducts pioneer studies with innovative methods to improve the capture, use, and reuse of clinical data. Second, my dissertation provides successful examples for investigators who would like to conduct interdisciplinary research in the field of health informatics. Third, the framework of my research can be a great tool to generate future research agenda in clinical documentation and EHRs. I will continue exploring innovative and effective methods to maximize the value of EHRs.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135845/1/tzuyu_1.pd

Status and recommendations of technological and data-driven innovations in cancer care:Focus group study

Background: The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)-funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. Objective: This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020-funded projects. Methods: Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. Results: Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. Conclusions: Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations

Designing personalised mHealth solutions: An overview

Introduction: Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation. Materials and Methods: We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques. Results: Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self- management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed. Discussion: Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it. Conclusions: Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques

The usability, acceptability, and satisfaction of a digital mental health tool for patients with breast and prostate cancer

The impact and use of digital health tools vary considerably among individuals dealing with somatic illnesses, such as cancer. This variability can be attributed to several factors, such as sociodemographic characteristics, baseline mental health, perception of the intervention’s usefulness, ease of use, and early engagement with the system. In this thesis, we aimed to examine the influence and interaction among these indicators on the usability, acceptability, satisfaction, and clinical effectiveness of a digital health tool in individuals with breast and prostate cancer. All studies were based on data from the NEVERMIND trial, a clinical randomized controlled trial that included patients with five different somatic illnesses. Our study included 255 participants (at baseline) who were diagnosed with breast or prostate cancer. Half of the participants (n=129) were allocated to the NEVERMIND system, whereas the other half (n=125) were allocated to the treatment as usual (control) group. Those in the NEVERMIND system group were involved in the use of the NEVERMIND digital health tool, comprising a mobile app and sensorized shirt (shirt), over a 12-week period. Data from baseline assessments and follow-ups at four and 12 weeks were used. The aim was to assess the usability, acceptability, and satisfaction of the NEVERMIND system, as well as the factors associated with these dimensions. This Ph.D. project also examined how usability and acceptability impacted the clinical effectiveness of the NEVERMIND system on depressive and stress symptoms. Study I. We investigated the association between baseline sociodemographic characteristics and usability assessed at four and 12 weeks of using the NEVERMIND system among 108 patients with breast and prostate cancer who received and used the system. The NEVERMIND system had good usability according to the usability questionnaires. Higher favourability of the mobile app was observed among women (breast cancer patients) compared to men (prostate cancer patients); however, men had significantly higher use of the overall system. Study II. The relationships between sex, education, baseline depressive and stress symptoms, perceived ease of use, perceived usefulness, and system usage at various stages were examined using Bayesian Structural Equation Modelling in a path analysis of 129 patients with breast and prostate cancer. Higher perceived usefulness and initial usage were associated with a higher level of usage at 12 weeks. The results indicated that a better understanding of the system’s benefits and early engagement were key drivers of its sustained use and clinical effectiveness in improving mental health outcomes. Study III. In a sample of 255 patients with breast and prostate cancer, we examined the relationship between the clinical effectiveness, usability, and acceptability of the NEVERMIND system when treating depressive and stress symptoms in patients with breast and prostate cancer. The results showed that patients in the NEVERMIND group had a greater reduction in depressive symptoms than those in the control group at the 12-week follow-up. The findings also showed that users who utilized the system for more than six weeks experienced a statistically significant decrease in both depressive symptoms and stress symptoms compared to those who used it for less than two weeks. Study IV. This study looked at the overall satisfaction of users (68 with breast cancer and 39 with prostate cancer) with the NEVERMIND system. Satisfaction was measured at four and 12 weeks using a one-item questionnaire with two open-ended follow-up questions about user experiences. An inductive and deductive thematic analysis was conducted by using the NEVERMIND system’s components as a sensitizing concept which was then refined and interpreted through the lens of Information Systems (IS) success model. The findings show that 68.24% of users rated the system as good or excellent at four weeks, with a slight decrease to 65.42% at 12 weeks. Three themes emerged from the thematic analysis: (1) Fostering Personal Agency and Motivation, (2) Engagement and Interaction Experiences, and (3) Content Quality and Relevance. Gender differences emerged in the prioritization of emotional support among female users and self-awareness among male users. The satisfaction and challenges faced by users underscore the importance of a user-centric approach that focuses on holistic well-being, user engagement, personalized content, and technical stability. This study also contributes to the broader literature by utilizing IS success model as a framework for interpreting user satisfaction. Conclusions. Higher levels of usability, acceptability, and satisfaction in the NEVERMIND system may contribute to improving the mental health outcomes of patients with breast and prostate cancer, both independently from each other, and even more so when high levels of engagement, acceptance, use, and satisfaction coexist. They emphasize the importance of perceived usefulness, initial engagement, and user-centric design in different components of the NEVERMIND system and confirms the multidimensionality of successful digital health tools implementation. Moreover, the notable differences in usability and preference between genders indicate that tailored and personalized strategies might serve as effective means to address diverse user needs. Taken together, these insights strengthen scientific evidence for healthcare experts and digital health innovators and developers, guiding them towards creating and designing digital health tools through user-centric and multi-domain approaches

THE HIGH COST OF LOW VALUE CARE

The main focus of this study is bridging the evidence gap between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From our work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, we integrated the highly validated Wells\u27 criteria into the electronic health record at two of our major academic tertiary hospitals. The Wells\u27 clinical decision support tool triggered for patients being evaluated for PE and therefore determined a patients\u27 pretest probability for having a PE. There were 12,759 patient visits representing 11,836 patients, 51% had no D-dimer, 41% had a negative D-dimer, and 9% had a positive D-dimer. Our study gave us an opportunity to determine which patients were very low probabilities for PE, with no need for further testing

Building a flexible CBT model based on structured data for the COPE app

Master's Thesis in InformaticsINF399MAMN-PROGMAMN-IN