Cost effectiveness review of text messaging, smartphone application, and website interventions targeting T2DM or hypertension

Digital health interventions have been shown to be clinically-effective for type 2 diabetes mellitus (T2DM) and hypertension prevention and treatment. This study synthesizes and compares the cost-effectiveness of text-messaging, smartphone application, and websites by searching CINAHL, Cochrane Central, Embase, Medline and PsycInfo for full economic or cost-minimisation studies of digital health interventions in adults with or at risk of T2DM and/or hypertension. Costs and health effects are synthesised narratively. Study quality appraisal using the Consensus on Health Economic Criteria (CHEC) list results in recommendations for future health economic evaluations of digital health interventions. Of 3056 records identified, 14 studies are included (7 studies applied text-messaging, 4 employed smartphone applications, and 5 used websites). Ten studies are cost-utility analyses: incremental cost-utility ratios (ICUR) vary from dominant to €75,233/quality-adjusted life year (QALY), with a median of €3840/QALY (interquartile range €16,179). One study finds no QALY difference. None of the three digital health intervention modes is associated with substantially better cost-effectiveness. Interventions are consistently cost-effective in populations with (pre)T2DM but not in populations with hypertension. Mean quality score is 63.0% (standard deviation 13.7%). Substandard application of time horizon, sensitivity analysis, and subgroup analysis next to transparency concerns (regarding competing alternatives, perspective, and costing) downgrades quality of evidence. In conclusion, smartphone application, text-messaging, and website-based interventions are cost-effective without substantial differences between the different delivery modes. Future health economic studies should increase transparency, conduct sufficient sensitivity analyses, and appraise the ICUR more critically in light of a reasoned willingness-to-pay threshold

Comparison of Preoperative Evaluation with the Pathological Report in Intraductal Papillary Mucinous Neoplasms: A Single-Center Experience

The key to the successful management of pancreatic cystic neoplasm (PCN), among which intraductal papillary mucinous neoplasm (IPMN) is the one with the highest risk of advanced neoplasia in resected patients, is a careful combination of clinical, radiological, and histopathological findings. This study aims to perform the comparison of a preoperative evaluation with pathological reports in IPMN and further, to evaluate and compare the diagnostic performance of European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) and Fukuoka Consensus guidelines (FCG). We analyzed 106 consecutive patients diagnosed with different types of PCN, among whom 68 had IPMN diagnosis, at the Clinical Center of Serbia. All the patients diagnosed with IPMNs were stratified concerning the presence of the absolute and relative indications according to EEBGPCN and high-risk stigmata and worrisome features according to FCG. Final histopathology revealed that IPMNs patients were further divided into malignant (50 patients) and benign (18 patients) groups, according to the pathological findings. The preoperative prediction of malignancy according to EEBGPCN criteria was higher than 70% with high sensitivity of at least one absolute or relative indication for resection. The diagnostic performance of FCG was shown as comparable to EEBGPCN. Nevertheless, the value of false-positive rate for surgical resection showed that in some cases, overtreating patients or treating them too early cannot be prevented. A multidisciplinary approach is essential to adequately select patients for the resection considering at the same time both the risks of surgery and malignancy

Enhanced absorption of TiO 2 nanotubes by N-doping and CdS quantum dots sensitization: insight into the structure

International audienc

TiO 2 /ZrO 2 THIN FILMS SYNTHESIZED BY PLD IN LOW PRESSURE N-, C-AND/OR O-CONTAINING GASES: STRUCTURAL, OPTICAL AND PHOTOCATALYTIC PROPERTIES

Doped TiO 2 /ZrO 2 films were obtained by Pulsed Laser Deposition method under different synthesis conditions. The onset of absorption spectra was red shifted for the films obtained in N 2 containing gas mixtures, while a broad absorption in visible was observed in the case of films deposited in CH 4 atmosphere. The presence of O-Ti-N bonds revealed by XPS corresponded to the highest photocatalytic performance. XPS spectra of the samples obtained in N 2 /CH 4 gas mixtures evidenced a more effective incorporation of nitrogen in the structure due to oxygen deficiency. Nevertheless, no atomic carbon presence in the TiO 2 /ZrO 2 structures has been detected

MARVEL: Multimodal Extreme Scale Data Analytics for Smart Cities Environments

none47A Smart City based on data acquisition, handling and intelligent analysis requires efficient design and implementation of the respective AI technologies and the underlying infrastructure for seamlessly analyzing the large amounts of data in real-time. The EU project MARVEL will research solutions that can improve the integration of multiple data sources in a Smart City environment for harnessing the advantages rooted in multimodal perception of the surrounding environment.noneBajovic, Dragana; Bakhtiarnia, Arian; Bravos, George; Brutti, Alessio; Burkhardt, Felix; Cauchi, Daniel; Chazapis, Antony; Cianco, Claire; Dall'Asen, Nicola; Delic, Vlado; Dimou, Christos; Djokic, Djordje; Escobar-Molero, Antonio; Esterle, Lukas; Eyben, Florian; Farella, Elisabetta; Festi, Thomas; Geromitsos, Artemios; Giakoumakis, Giannis; Hatzivasilis, George; Ioannidis, Sotiris; Iosifidis, Alexandros; Kallipolitou, Theodora; Kalogiannis, Grigorios; Kiousi, Akrivi; Kopanaki, Despina; Marazakis, Manolis; Markopoulou, Stella; Muscat, Adrian; Paissan, Francesco; Lobo, Tomas Pariente; Pavlovic, Dusan; Raptis, Theofanis P.; Ricci, Elisa; Saez, Borja; Sahito, Farhan; Scerri, Kenneth; Schuller, Bjorn; Simic, Nikola; Spanoudakis, George; Tomasi, Alex; Triantafyllopoulos, Andreas; Valerio, Lorenzo; Villazan, Javier; Wang, Yiming; Xuereb, Andre; Zammit, JohanBajovic, Dragana; Bakhtiarnia, Arian; Bravos, George; Brutti, Alessio; Burkhardt, Felix; Cauchi, Daniel; Chazapis, Antony; Cianco, Claire; Dall'Asen, Nicola; Delic, Vlado; Dimou, Christos; Djokic, Djordje; Escobar-Molero, Antonio; Esterle, Lukas; Eyben, Florian; Farella, Elisabetta; Festi, Thomas; Geromitsos, Artemios; Giakoumakis, Giannis; Hatzivasilis, George; Ioannidis, Sotiris; Iosifidis, Alexandros; Kallipolitou, Theodora; Kalogiannis, Grigorios; Kiousi, Akrivi; Kopanaki, Despina; Marazakis, Manolis; Markopoulou, Stella; Muscat, Adrian; Paissan, Francesco; Lobo, Tomas Pariente; Pavlovic, Dusan; Raptis, Theofanis P.; Ricci, Elisa; Saez, Borja; Sahito, Farhan; Scerri, Kenneth; Schuller, Bjorn; Simic, Nikola; Spanoudakis, George; Tomasi, Alex; Triantafyllopoulos, Andreas; Valerio, Lorenzo; Villazan, Javier; Wang, Yiming; Xuereb, Andre; Zammit, Joha

MARVEL: multimodal extreme scale data analytics for smart cities environments

Summarization: A Smart City based on data acquisition, handling and intelligent analysis requires efficient design and implementation of the respective AI technologies and the underlying infrastructure for seamlessly analyzing the large amounts of data in real-time. The EU project MARVEL will research solutions that can improve the integration of multiple data sources in a Smart City environment for harnessing the advantages rooted in multimodal perception of the surrounding environment.Παρουσιάστηκε στο: 2021 International Balkan Conference on Communications and Networkin

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes : a systematic review and meta-analysis of randomised controlled trials

Background Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available. Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A1c (HbA1c) in adults with type 2 diabetes, published in English from Jan 1, 2009. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA1c at 3 months or more. Cochrane risk of bias 2 was used to assess risk of bias. Data on reach, uptake, and feasibility were summarised narratively and data on HbA1c reduction were synthesised in a meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence. The study was registered with PROSPERO, CRD42021247845. Findings Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis. 20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites. Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions. Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA1c) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications. Overall, digital health intervention group participants had a –0·30 (95% CI –0·42 to –0·19) percentage point greater reduction in HbA1c, compared with control group participants. The difference in HbA1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (–0·42% [–0·63 to –0·20]) and via SMS (–0·37% [–0·57 to –0·17]), but not when delivered via websites (–0·09% [–0·64 to 0·46]). Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall. Interpretation Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control. However, the studies' heterogeneity should be recognised. Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention. Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management. Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes. Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension : a systematic review and meta-analysis of randomised controlled trials

Background Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. Findings Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a –3·62 mm Hg (95% CI –5·22 to –2·02) greater reduction in systolic blood pressure, and a –2·45 mm Hg (–3·83 to –1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (–2·45 mm Hg [–4·15 to –0·74]); however, there were no statistically significant reductions for SMS interventions (–1·80 mm Hg [–4·60 to 1·00]) or website interventions (–3·43 mm Hg [–7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. Interpretation SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility