Gamification to improve adherence to clinical treatment advice : improving adherence to clinical treatment

This chapter looks at how gamification of existing technology can be used to incorporate the factors that have been found to improve patient adherence. Lack of adherence to medical advice is a major problem because it reduces the likelihood of improved health outcomes and is a waste of costly and scarce resources. To provide intrinsically motivating game mechanics we discuss the use of an embodied virtual character to build an ongoing therapeutic alliance with the patient. Extrinsically motivating game mechanics are added via a game based on the token economy. The intention is to empower, engage and encourage the patient to adhere with the medical advice. A case study is provided for the condition of paediatric incontinence.31 page(s

A Review of the use of information communication technology to aid decision-making for live kidney donors and recipients

To understand the role that information communication technology (ICT) might play in addressing the informational and decision-making needs of live kidney donors and recipients, a comprehensive literature search was conducted to identify studies that describe the features of technological support used by living kidney donors and recipients and their perspectives on this technology. We searched MEDLINE, EMBASE, PsycINFO and CINAHL databases and reviewed articles from 2000 through August 2014. Descriptive synthesis was used to analyse the findings and group the technologies into information, communication, decision-making and account management tools. The use of websites for information and social-networking sites for communication were the key technologies in current use to support donors and recipients. We note a lack of decision-making tools and specific support for the live donor kidney transplantation (LDKT) decision process. We offer a set of recommendations, which combines the technologies and features identified in the review with additional features to address the identified gap. These recommendations can be used by health organisations and system developers to extend existing or design new ICT systems that can help live kidney donors and recipients by increasing their awareness about live kidney donation, improve psychosocial support, and assist in the difficult LDKT decision-making process.12 page(s

Strategies for increasing recruitment to randomised controlled trials: systematic review.

BACKGROUND: Recruitment of participants into randomised controlled trials (RCTs) is critical for successful trial conduct. Although there have been two previous systematic reviews on related topics, the results (which identified specific interventions) were inconclusive and not generalizable. The aim of our study was to evaluate the relative effectiveness of recruitment strategies for participation in RCTs. METHODS AND FINDINGS: A systematic review, using the PRISMA guideline for reporting of systematic reviews, that compared methods of recruiting individual study participants into an actual or mock RCT were included. We searched MEDLINE, Embase, The Cochrane Library, and reference lists of relevant studies. From over 16,000 titles or abstracts reviewed, 396 papers were retrieved and 37 studies were included, in which 18,812 of at least 59,354 people approached agreed to participate in a clinical RCT. Recruitment strategies were broadly divided into four groups: novel trial designs (eight studies), recruiter differences (eight studies), incentives (two studies), and provision of trial information (19 studies). Strategies that increased people's awareness of the health problem being studied (e.g., an interactive computer program [relative risk (RR) 1.48, 95% confidence interval (CI) 1.00-2.18], attendance at an education session [RR 1.14, 95% CI 1.01-1.28], addition of a health questionnaire [RR 1.37, 95% CI 1.14-1.66]), or a video about the health condition (RR 1.75, 95% CI 1.11-2.74), and also monetary incentives (RR1.39, 95% CI 1.13-1.64 to RR 1.53, 95% CI 1.28-1.84) improved recruitment. Increasing patients' understanding of the trial process, recruiter differences, and various methods of randomisation and consent design did not show a difference in recruitment. Consent rates were also higher for nonblinded trial design, but differential loss to follow up between groups may jeopardise the study findings. The study's main limitation was the necessity of modifying the search strategy with subsequent search updates because of changes in MEDLINE definitions. The abstracts of previous versions of this systematic review were published in 2002 and 2007. CONCLUSION: Recruitment strategies that focus on increasing potential participants' awareness of the health problem being studied, its potential impact on their health, and their engagement in the learning process appeared to increase recruitment to clinical studies. Further trials of recruitment strategies that target engaging participants to increase their awareness of the health problems being studied and the potential impact on their health may confirm this hypothesis. Please see later in the article for the Editors' Summary

How trustworthy are apps for maternal and child health?

Mobile technologies have become important tools for promoting and implementing healthcare. A key feature of smartphones and tablet computers is their ability to run software applications (apps), which can address specific health-related areas, including maternal and child health; however, there is little independent regulation or guidance for the development and publication of health apps in many countries, including Australia. This research examined health apps in two major app stores (Google and Apple) that address maternal and child health. Ten free maternal and child health apps available in Google and Apple stores were examined to evaluate their trustworthiness and technical performance. This was determined based on evidence of health professional involvement and use of evidence-based medical content, as well as an evaluation of functionality, usability and security. Only four of the ten apps examined were developed with the involvement of health professionals and four provided information from evidence-based medical content. Significantly, only four were fully functional, two were fully usable and three adequately implemented security mechanisms to guarantee privacy of user data. Two of the apps were inoperative. In conclusion, this study found great variation in the quality of content, functionality and security of ten maternal and child health apps. These results suggest developers, owners and health providers should work to improve maternal and child health apps, consumers need help to determine the trustworthiness of health apps, and sponsors and regulators should establish standards and endorse compliant health apps.8 page(s

Treatment of enuresis : alarm monotherapy versus a multi-modal treatment apporach in a multi-disciplinary clinic

The objective of this study was to compare outcomes between alarm monotherapy and multi-modal treatment for enuresis and to identify predictors of treatment failure. Consecutive children with enuresis were referred to an alarm clinic or a multi-disciplinary clinic and followed over 1 year. In the alarm clinic, children received bed alarm therapy for 3 months. In the multi-disciplinary clinic, children were assessed and advised regarding fluid consumption, with treatment of daytime bladder symptoms and bowel dysfunction. Persisting enuresis after daytime symptoms were addressed were treated with alarm therapy. From January 2003 to December 2004, 269 children were referred - 86 to the alarm clinic and 183 to the multi-disciplinary clinic (of which 56% received alarm therapy). Groups were similar at baseline (mean age 9 years, 65% boys and 86% primary monosymptomatic nocturnal enuresis), but more from the multi-disciplinary clinic had previously received enuresis treatment (79% vs 59% p=0.001). There was no difference in outcomes between groups at completion of treatment (51% versus 66% dry, p=0.07) and at 12 months (65% versus 60%, p=0.7), but more from the multi-disciplinary clinic were lost to follow-up. Those who received multi-modal treatment incorporating alarm therapy had improved outcomes compared with alarm monotherapy (78% versus 51% dry, p=0.01). Children previously treated with desmopressin (OR 0.11), bladder training (OR 0.35) or who had a history of soiling at presentation (OR 0.28) were less likely to respond to treatment. It was concluded that, in a multi-modal treatment approach, delayed commencement of alarm therapy may affect treatment outcomes.7 page(s