Mobile videoconferencing for enhanced emergency medical communication - a shot in the dark or a walk in the park? ‐‐ A simulation study

Background: Videoconferencing on mobile phones may enhance communication, but knowledge on its quality in various situations is needed before it can be used in medical emergencies. Mobile phones automatically activate loudspeaker functionality during videoconferencing, making calls particularly vulnerable to background noise. The aim of this study was to investigate if videoconferencing can be used between lay bystanders and Emergency Medical Dispatch (EMD) operators for initial emergency calls during medical emergencies, under suboptimal sound and light conditions. Methods: Videoconferencing was tested between 90 volunteers and an emergency medical dispatcher in a standardized scenario of a medical emergency. Three different environments were used for the trials: indoors with moderate background noise, outdoors with daylight and much background noise, and outdoors during nighttime with little background noise. Thirty participants were recruited for each of the three locations. After informed consent, each participant was asked to use a video mobile phone to communicate with an EMD operator. During the video call the EMD operator gave instructions for tasks to be performed by the participant. The video quality from the caller to the EMD was evaluated by the EMD operator and rated on a five step scale ranging from “not able to see” to “good video quality”. Sound quality between participants and EMD operators was assessed by a method developed for this trial. Kruskal – Wallis and Chi-square tests were used for statistical analysis. Results: Video quality was significantly different between the groups (p <0.001), and the nighttime group had lower video quality. For most sessions in the nighttime group it was still possible to see actions done at the simulated emergency site. All participants were able to perform their tasks according to the instructions given by dispatchers, although with a need for more repetitions during sessions with much background noise. No calls were rated by dispatchers as incomprehensible due to low sound quality and only 3% of the calls were considered somewhat difficult or very difficult to understand. Conclusions: Videoconferencing on mobile phones can be used for the initial emergency call during medical emergencies also in suboptimal conditions

Videokonferanse og mobiltelefoner: Nye muligheter for 113

Denne oppgaven handler om kombinasjonen av telemedisin og akuttmedisin. Vi ønsket å undersøke om de siste års utvikling innen mobiltelefonteknologi har gitt muligheter som kan utnyttes av AMK. Vi har gjennomført en eksperimentell studie, hvor vi gjennom 90 kasus har testet kvaliteten på videokonferanse mellom lekfolk og AMK-sentral. De 90 kasusene var fordelt på tre forskjellige lokalisasjoner som skulle representere ulike utfordringer med tanke på lysforhold og bakgrunnsstøy: Inne på et kjøpesenter med gode lysforhold og moderat bakgrunnsstøy, ute i dagslys ved en trafikkert gate med mye bakgrunnsstøy og ute om kvelden, i en mørk gate uten bakgrunnsstøy og med svært dårlige lysforhold. Hovedfunnet i vår studie er at bildekvaliteten i den mørke gaten var dårligere enn på de to andre lokalisasjonene. Vi fant også en forskjell i forsøkdeltakernes oppfattelse av instruksjoner som ble gitt av AMK-operatøren, der gruppen med lite bakgrunnsstøy kom bedre ut enn de to andre gruppene. Vi har ikke sammenlignet videokonferanse med tradisjonell telefoni, og kan derfor ikke dra noen konklusjoner for hvordan kommunikasjonen er med video i forhold til uten. Vi kan likevel konkludere med at videokonferanse kan gi god lydkvalitet både til og fra skadested, men at bildekvaliteten avhenger av lysforholdene

Automatically Generated Smartphone Data in Young Patients With Newly Diagnosed Bipolar Disorder and Healthy Controls

Background: Smartphones may facilitate continuous and fine-grained monitoring of behavioral activities via automatically generated data and could prove to be especially valuable in monitoring illness activity in young patients with bipolar disorder (BD), who often present with rapid changes in mood and related symptoms. The present pilot study in young patients with newly diagnosed BD and healthy controls (HC) aimed to (1) validate automatically generated smartphone data reflecting physical and social activity and phone usage against validated clinical rating scales and questionnaires; (2) investigate differences in automatically generated smartphone data between young patients with newly diagnosed BD and HC; and (3) investigate associations between automatically generated smartphone data and smartphone-based self-monitored mood and activity in young patients with newly diagnosed BD. Methods: A total of 40 young patients with newly diagnosed BD and 21 HC aged 15–25 years provided daily automatically generated smartphone data for 3–779 days [median (IQR) = 140 (11.5–268.5)], in addition to daily smartphone-based self-monitoring of activity and mood. All participants were assessed with clinical rating scales. Results: (1) The number of outgoing phone calls was positively associated with scores on the Young Mania Rating Scale and subitems concerning activity and speech. The number of missed calls (p = 0.015) and the number of outgoing text messages (p = 0.017) were positively associated with the level of psychomotor agitation according to the Hamilton Depression Rating scale subitem 9. (2) Young patients with newly diagnosed BD had a higher number of incoming calls compared with HC (BD: mean = 1.419, 95% CI: 1.162, 1.677; HC: mean = 0.972, 95% CI: 0.637, 1.308; p = 0.043) and lower self-monitored mood and activity (p's < 0.001). (3) Smartphone-based self-monitored mood and activity were positively associated with step counts and the number of outgoing calls, respectively (p's < 0.001). Conclusion: Automatically generated data on physical and social activity and phone usage seem to reflect symptoms. These data differ between young patients with newly diagnosed BD and HC and reflect changes in illness activity in young patients with BD. Automatically generated smartphone-based data could be a useful clinical tool in diagnosing and monitoring illness activity in young patients with BD