ASSESSMENT OF RISK SCORES FOR THE PREDICTION AND DETECTION OF TYPE 2 DIABETES MELLITUS IN CLINICAL SETTINGS

Health and sociological indicators confirm that life expectancy is increasing, and so, the years that patients have to live with chronic diseases and co-morbidities. Type 2 Diabetes is one of the most common chronic diseases, specially linked to overweight and ages over sixty. As a metabolic disease, Type 2 Diabetes affects multiple organs by causing damage in blood vessels and nervous system at micro and macro scale. Mortality of subjects with diabetes is three times higher than the mortality for subjects with other chronic diseases. On the one hand, the management of diabetes is focused on the maintenance of the blood glucose levels under a threshold by the prescription of anti-diabetic drugs and a combination of healthy food habits and moderate physical activity. Recent studies have demonstrated the effectiveness of new strategies to delay and even prevent the onset of Type 2 Diabetes by a combination of active and healthy lifestyle on cohorts of mid to high risk subjects. On the other hand, prospective research has been driven on large groups of population to build risk scores which aim to obtain a rule for the classification of patients according to the odds for developing the disease. Currently there are more than two hundred models and risk scores for doing this, but a few have been properly evaluated in external groups and, to date, none of them has been tested on a population based study. The research study presented in this doctoral thesis strives to use externally validated risk scores for the prediction and detection of Type 2 Diabetes on a population data base in Hospital La Fe (Valencia, Spain). The study hypothesis is that the integration of existing prediction and detection risk scores on Electronic Health Records increases the early-detection of high risk cases. To evaluate this hypothesis three studies on the clinical, user and technology dimensions have been driven to evaluate the extent to which the models and the hospital is ready to exploit such models to identify high risk groups and drive efficient preventive strategies. The findings presented in this thesis suggest that Electronic Health Records are not prepared to massively feed risk models. Some of the evaluated models have shown a good classification performance, which accompanied to the well-acceptance of web-based tools and the acceptable technical performance of the information and communication technology system, suggests that after some work these models can effectively drive a new paradigm of active screening for Type 2 Diabetes.Los indicadores de salud y sociológicos confirman que la esperanza de vida está aumentando, y por lo tanto, los años que los pacientes tienen que vivir con enfermedades crónicas y comorbilidades. Diabetes tipo 2 es una de las enfermedades crónicas más comunes, especialmente relacionadas con el sobrepeso y edades superiores a los sesenta años. Como enfermedad metabólica, la diabetes tipo 2 afecta a múltiples órganos causando daño en los vasos sanguíneos y el sistema nervioso a escala micro y macro. La mortalidad de sujetos con diabetes es tres veces mayor que la mortalidad de sujetos con otras enfermedades crónicas. Por un lado, la estrategia de manejo se centra en el mantenimiento de los niveles de glucosa en sangre bajo un umbral mediante la prescripción de fármacos antidiabéticos y una combinación de hábitos alimentarios saludables y actividad física moderada. Estudios recientes han demostrado la eficacia de nuevas estrategias para retrasar e incluso prevenir la aparición de la diabetes tipo 2 mediante una combinación de estilo de vida activo y saludable en cohortes de sujetos de riesgo medio a alto. Por otro lado, la investigación prospectiva se ha dirigido a grupos de la población para construir modelos de riesgo que pretenden obtener una regla para la clasificación de las personas según las probabilidades de desarrollar la enfermedad. Actualmente hay más de doscientos modelos de riesgo para hacer esta identificación, no obstante la inmensa mayoría no han sido debidamente evaluados en grupos externos y, hasta la fecha, ninguno de ellos ha sido probado en un estudio poblacional. El estudio de investigación presentado en esta tesis doctoral pretende utilizar modelos riesgo validados externamente para la predicción y detección de la Diabetes Tipo 2 en una base de datos poblacional del Hospital La Fe de Valencia (España). La hipótesis del estudio es que la integración de los modelos de riesgo de predicción y detección existentes la práctica clínica aumenta la detección temprana de casos de alto riesgo. Para evaluar esta hipótesis, se han realizado tres estudios sobre las dimensiones clínicas, del usuario y de la tecnología para evaluar hasta qué punto los modelos y el hospital están dispuestos a explotar dichos modelos para identificar grupos de alto riesgo y conducir estrategias preventivas eficaces. Los hallazgos presentados en esta tesis sugieren que los registros de salud electrónicos no están preparados para alimentar masivamente modelos de riesgo. Algunos de los modelos evaluados han demostrado un buen desempeño de clasificación, lo que acompañó a la buena aceptación de herramientas basadas en la web y el desempeño técnico aceptable del sistema de tecnología de información y comunicación, sugiere que después de algún trabajo estos modelos pueden conducir un nuevo paradigma de la detección activa de la Diabetes Tipo 2.Els indicadors sociològics i de salut confirmen un augment en l'esperança de vida, i per tant, dels anys que les persones han de viure amb malalties cròniques i comorbiditats. la diabetis de tipus 2 és una de les malalties cròniques més comunes, especialment relacionades amb l'excés de pes i edats superiors als seixanta anys. Com a malaltia metabòlica, la diabetis de tipus 2 afecta múltiples òrgans causant dany als vasos sanguinis i el sistema nerviós a escala micro i macro. La mortalitat de subjectes amb diabetis és tres vegades superior a la mortalitat de subjectes amb altres malalties cròniques. D'una banda, l'estratègia de maneig se centra en el manteniment dels nivells de glucosa en sang sota un llindar mitjançant la prescripció de fàrmacs antidiabètics i una combinació d'hàbits alimentaris saludables i activitat física moderada. Estudis recents han demostrat l'eficàcia de noves estratègies per a retardar i fins i tot prevenir l'aparició de la diabetis de tipus 2 mitjançant una combinació d'estil de vida actiu i saludable en cohorts de subjectes de risc mitjà a alt. D'altra banda, la investigació prospectiva s'ha dirigit a grups específics de la població per construir models de risc que pretenen obtenir una regla per a la classificació de les persones segons les probabilitats de desenvolupar la malaltia. Actualment hi ha més de dos-cents models de risc per fer aquesta identificació, però la immensa majoria no han estat degudament avaluats en grups externs i, fins ara, cap d'ells ha estat provat en un estudi poblacional. L'estudi d'investigació presentat en aquesta tesi doctoral utilitza models de risc validats externament per a la predicció i detecció de diabetis de tipus 2 en una base de dades poblacional de l'Hospital La Fe de València (Espanya). La hipòtesi de l'estudi és que la integració dels models de risc de predicció i detecció existents la pràctica clínica augmenta la detecció de casos d'alt risc. Per avaluar aquesta hipòtesi, s'han realitzat tres estudis sobre les dimensions clíniques, de l'usuari i de la tecnologia per avaluar fins a quin punt els models i l'hospital estan disposats a explotar aquests models per identificar grups d'alt risc i conduir estratègies preventives. Les troballes presentades sugereixen que els registres de salut electrònics no estan preparats per alimentar massivament models de risc. Alguns dels models avaluats han demostrat una bona classificació, el que va acompanyar a la bona acceptació d'eines basades en el web i el rendiment tècnic acceptable del sistema de tecnologia d'informació i comunicacions implementat. La conclusió es que encara es necesari treball per que aquests models poden conduir un nou paradigma de la detecció activa de la diabetis de tipus 2.Martínez Millana, A. (2017). ASSESSMENT OF RISK SCORES FOR THE PREDICTION AND DETECTION OF TYPE 2 DIABETES MELLITUS IN CLINICAL SETTINGS [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/86209TESI

Public Health Innovations Program tailored to Master on Telecommunications’ Students

[EN] Developed and under-developed countries are facing several challenges related to public health and sustainability of health care systems. New challenges demand of the collaborative action of multiple stakeholders with different backgrounds. In the late years, telecommunication engineers are involved in a wide range of companies and institutions to help designing and building innovative and efficient solutions, among which public health is a paradigmatic example. In this paper authors introduce a program for teaching public health principles and tools focused at telecommunications master students. The program is presented in five practices of three hours duration (fifteen hours overall). The sessions are structured in the classic problem-solving methodology in which the students must respond to concrete and general questions by the application of knowledge, practice and reasoning. Each practice includes theoretical framework introduction, provision of tools and use of open repositories to complete the assignments. The covered topics are: mobile health and usability, open data, data mining, Internet of Things and wearable and process mining.Martínez Millana, A.; Martínez Mateu, L.; Guillem Sánchez, MS.; Traver Salcedo, V. (2021). Public Health Innovations Program tailored to Master on Telecommunications’ Students. En Proceedings INNODOCT/20. International Conference on Innovation, Documentation and Education. Editorial Universitat Politècnica de València. 137-144. https://doi.org/10.4995/INN2020.2020.11860OCS13714

Performance assessment of a closed-loop system for diabetes management

Telemedicine systems can play an important role in the management of diabetes, a chronic condition that is increasing worldwide. Evaluations on the consistency of information across these systems and on their performance in a real situation are still missing. This paper presents a remote monitoring system for diabetes management based on physiological sensors, mobile technologies and patient/ doctor applications over a service-oriented architecture that has been evaluated in an international trial (83,905 operation records). The proposed system integrates three types of running environments and data engines in a single serviceoriented architecture. This feature is used to assess key performance indicators comparing them with other type of architectures. Data sustainability across the applications has been evaluated showing better outcomes for full integrated sensors. At the same time, runtime performance of clients has been assessed spotting no differences regarding the operative environmentThe authors wish to acknowledge the consortium of the METABO project (funded by the European Commission, Grant nr. 216270) for their commitment during concept development and trial execution.Martínez Millana, A.; Fico, G.; Fernández Llatas, C.; Traver Salcedo, V. (2015). Performance assessment of a closed-loop system for diabetes management. Medical and Biological Engineering and Computing. 53(12):1295-1303. doi:10.1007/s11517-015-1245-3S129513035312Bellazzi R, Larizza C, Montani A et al (2002) A telemedicine support dor diabetes management: the T-IDDM project. Comput Methods Programs Biomed 69:147–161Boloor K, Chirkova R, Salo T, Viniotis Y (2011) Analysis of response time percentile service level agreements in soa-based applications. IEEE global telecommunications conference (GLOBECOM 2011), dec. 2011, pp 1–6Cartwright M et al (2013) Effect of telehealth on quality of life and psychological outcomes over 12 months: nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial. BMJ 346:f653Chen I-Y et al (2008) Pervasive digital monitoring and transmission of pre-care patient biostatics with an OSGi, MOM and SOA based remote health care system. In: Proceedings of the 6th annual IEEE international conference on PerCom. Hong KongFico G, Fioravanti A, Arredondo MT, Leuteritz JP, Guillén A, Fernandez D (2011) A user centered design approach for patient interfaces to a diabetes IT platform. Conf Proc IEEE Eng Med Biol Soc 2011:1169–1172Fioravanti A, Fico G, Arredondo MT, Salvi D, Villalar JL (2010) Integration of heterogeneous biomedical sensors into an ISO/IEEE 11073 compliant application. In: Engineering in medicine and biology society (EMBC), 2010 Annual international conference of the IEEE, pp 1049–1052García Saez G et al (2009) Architecture of a wireless personal assistant for telemedical diabetes care. Int J Med Inform 9(78):391–403Gómez EJ, Hernando ME et al (2008) The INCA system: a further step towards a telemedical artificial pancreas. IEEE Trans Inf Technol Biomed 12(4):470–479Harrison’s Principles of Internal Medicine (2011) McGraw-Hill. ISBN:978-0071748896. Ed. July 2011Ke X, Li W et al (2010) WCDMA KPI framework definition methods and applications. ICCET proceedings V4-471–V4-475Klonof D (2013) Twelve modern digital technologies that are transforming decision making for diabetes and all areas of health care. J Diabetes Sci Technol 7(2):291–295Lanzola G et al (2007) Going mobile with a multiaccess service for the management of diabetic patients. J Diabetes Sci Technol 1(5):730–737Ma C et al (2006) Empowering patients with essential information and communication support in the context of diabetes. Int J Med Inform 75(8):577–596Müller AJ, Knuth M, Nikolaus KS, Krivánek R, Küster F, Hasslacher C (2013) First clinical evaluation of a new percutaneous optical fiber glucose sensor for continuous glucose monitoring in diabetes. J Diabetes Sci Technol 7:13Nundy S et al (2012) Using mobile health to support chronic care model: developing an institutional model. Int J Telemed Appl 2012, Art Id 871925. doi: 10.1155/2012/871925Obstfelder A, Engeseth KH, Wynn R (2007) Characteristic of succesfully implemented telemedical applications. Implement Sci 2:25Pravin P et al (2012) A framework for the comparison of mobile patient monitoring systems. J Biomed Inf 45:544–556Reichel A, Rietzsch H, Ludwig B, Röthig K, Moritz A, Bornstein S (2013) Self-adjustment of insulin dose using graphically depicted self-monitoring of blood glucose measurements in patients with type 1 diabetes mellitus. J Diabetes Sci Technol 7(1):156–162Ryan D et al (2012) Clinical and cost effectiveness of mobile phone supported self-monitoring of asthma: multicenter randomized controlled trial. BMJ 344:e1756Schade DS et al (2005) To pump or not to pump. Diabetes Technol Therapeutics 7:845–848Stravroula G, Bartsocas CS et al (2010) SMARTDIAB: a communication and information technology approach for the intelligent monitoring, management and follow-up of type 1 diabetes patients. IEEE Trans Inf Technol Biomed 14(3):622–633The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329(14):977–986Trief PM, Morin PC, Izquierdo R, Teresi JA, Eimicke JP, Goland R, Starren J, Shea S, Winstock RS (2006) Depression and glycaemic control in elderly etchnically diverse patients with diabetes: the IDEATel project. Diabetes Care 29(4):830–835van der Weegentres S et al (2013) The development of a mobile monitoring and feedback tool to stimulate physical activity of people with a chronic disease in primary care: a user-centered design. JMIR 1(2):e8Wakefield BJ et al (2014) Effect of home telemonitoring on glycemic and blood pressure control in primary care clinic patients with diabetes. Telemed e-Health 20(3):199–205. doi: 10.1089/tmj.2013.0151Winkler S et al (2011) A new telemonitoring system intended for chronic heart failure patients using mobile technology—Feasibility Study. Int J Cardiol 153:55–58Zhou YY, Kanter MH, Wang JJ, Garrido T (2010) Improved quality at kaiser permanente through e-mail between physicians and patients. Health Aff 29(7):1370–137

From specialized to core course in Telecommunications degree: Experiences from digital electronic design and verification

[EN] The European Higher Education Area (EHEA) defines the competences for professional practice of a Telecommunications Engineer. The School of Telecommunication Engineering of the Universitat Politècnica de València (Valencia, Spain) provides an integrated education program consisting of a Graduate (GITST) + Master (MUIT). The GITST course offers four specialization tracks: Electronics, Telematics, Communication Systems and Multimedia for the proper acquisition of knowledge and competences of the future Telecommunications Engineers. In 2018, the graduate program has implemented a structural change in the organization of subjects for reinforcing important skills, in which a course on digital electronics design and verification (Integration of Digital Systems, ISDIGI) has been transformed into a core subject of the study plan. In this paper, we describe the methodology and adaptation of ISDIGI (i.e. a project-based learning intermediate HDL course that includes design and verification abilities) to the new GITST Curriculum. In addition, this paper describes the process of moving from specialized to core subject.Martínez Millana, A.; Liberos Mascarell, A.; Monzó Ferrer, JM.; Martínez Peiró, MA.; Martínez Pérez, JD.; Gadea Gironés, R. (2020). From specialized to core course in Telecommunications degree: Experiences from digital electronic design and verification. Editorial Universitat Politècnica de València. 229-238. https://doi.org/10.4995/INN2019.2019.10133OCS22923

The Potential of Self-Management mHealth for Pediatric Cystic Fibrosis: Mixed-Methods Study for Health Care and App Assessment

Background: Remote care services and patient empowerment have boosted mobile health (mHealth). A study of user needs related to mHealth for pediatric cystic fibrosis (PCF) identified the set of preferred features mobile apps should support; however, the potential use of PCF apps and their suitability to fit into PCF clinical management remains unexplored. Objective: We examine whether PCF holds potential for the implementation of mHealth care. Methods: The study is based on a literature review and qualitative analysis of content and was conducted in two parts: (1) we reviewed scientific and gray literature to explore how European countries manage PCF and conducted a qualitative study of 6 PCF units and (2) we performed a systematic review of apps available in the myhealthapps.net repository searching for cystic fibrosis (CF) management and nutrition apps, which we analyzed for characteristics, business models, number of downloads, and usability. Results: European CF routine care guidelines are acknowledged in most European countries, and treatments are fully covered in almost all countries. The majority of teams in CF units are interdisciplinary. With respect to the systematic review of apps, we reviewed 12 apps for CF management and 9 for general nutrition management in the myhealthapps.net directory. All analyzed apps provided functionalities for recording aspects related to the disease and nutrition such as medication, meals, measurements, reminders, and educational material. None of the apps reviewed in this study supported pancreatic enzyme replacement therapy. CF apps proved to be less appealing and usable than nutrition apps (2.66 [SD 1.15] vs 4.01 [SD 0.90]; P<.001, z-value: –2.6). User needs detected in previous research are partially matched by current apps for CF management. Conclusions: The health care context for PCF is a unique opportunity for the adoption of mHealth. Well-established clinical guidelines, heterogeneous clinical teams, and coverage by national health care systems provide a suitable scenario for the use of mHealth solutions. However, available apps for CF self-management do not cover essential aspects such as nutrition and education. To increase the adoption of mHealth for CF self-management, new apps should include these features.European Commission / MyCyFAPP H2020–64380

Desarrollo e implantación de un sistema de evaluación objetiva del aprendizaje individual en trabajos grupales en grupos numerosos de asignaturas de ingeniería

[EN] Teamwork is one of the most common teaching methodologies to achieve learning objectives in groups with a large number of students. The evaluation oriented to the group final result does not always adjust to the knowledge really acquired by each member of the team. The different instruments (diaries, portfolios) that are used to objectively assess the individual contribution of each member to group work could be a great workload for both students and teachers, especially in large groups. In this work, an evaluation system has been developed in polyform-T for the objective assessment of individual student learning in group work in groups with a large number of students of engineering subjects. Although initially it represents an important effort for the implementation of this system, in the medium and long term it is highly sustainable. The evaluation by means of a test type test in polyform-T is considered an appropriate technique by a large part of the students despite 55% of the students show some resistance towards the individualized evaluation of group activities. The different indicators show that the test difficulty level is appropriate, although there is a general feeling of lack of time to complete it among the students.[ES] El trabajo en equipo es una de las metodologías docentes más comunes para conseguir los objetivos de aprendizaje en grupos numerosos. La evaluación orientada al resultado final grupal no siempre se ajusta a los conocimientos realmente adquiridos por cada miembro del equipo. Los distintos instrumentos (diarios, portafolios) que se utilizan para valorar objetivamente la aportación individual de cada miembro al trabajo grupal podrían suponer una gran carga de trabajo tanto para el alumnado como el profesorado, especialmente en grupos numerosos. En este trabajo, se ha desarrollado un sistema de evaluación en Poliforma-T para la valoración objetiva del aprendizaje individual del alumno en trabajos grupales en grupos numerosos de asignaturas de ingeniería. Aunque inicialmente supone un esfuerzo importante para la puesta en marcha de este sistema, a medio y largo plazo es altamente sostenible. La evaluación mediante examen de tipo test en Poliforma-T es considerada una técnica apropiada por gran parte del alumnado pese el 55% de los alumnos muestra cierta resistencia hacia la evaluación individualizada de las actividades grupales. Los distintos indicadores muestrean que el nivel de dificultad del test es apropiado, aunque entre los alumnos hay una sensación general de falta de tiempo para la realización del mismo.Este trabajo está subvencionado por el Vicerrectorado de Estudios, Calidad y Acreditación de la UPV (PIME B04, Convocatoria 2017-2018).Ye Lin, Y.; Prats Boluda, G.; Garcia Casado, FJ.; Martínez Millana, A.; Guijarro Estelles, E.; Martínez De Juan, JL. (2018). Desarrollo e implantación de un sistema de evaluación objetiva del aprendizaje individual en trabajos grupales en grupos numerosos de asignaturas de ingeniería. En IN-RED 2018. IV Congreso Nacional de Innovación Educativa y Docencia en Red. Editorial Universitat Politècnica de València. 1336-1346. https://doi.org/10.4995/INRED2018.2018.8564OCS1336134

Process mining for healthcare: Characteristics and challenges

Process mining techniques can be used to analyse business processes using the data logged during their execution. These techniques are leveraged in a wide range of domains, including healthcare, where it focuses mainly on the analysis of diagnostic, treatment, and organisational processes. Despite the huge amount of data generated in hospitals by staff and machinery involved in healthcare processes, there is no evidence of a systematic uptake of process mining beyond targeted case studies in a research context. When developing and using process mining in healthcare, distinguishing characteristics of healthcare processes such as their variability and patient-centred focus require targeted attention. Against this background, the Process-Oriented Data Science in Healthcare Alliance has been established to propagate the research and application of techniques targeting the data-driven improvement of healthcare processes. This paper, an initiative of the alliance, presents the distinguishing characteristics of the healthcare domain that need to be considered to successfully use process mining, as well as open challenges that need to be addressed by the community in the future.This work is partially supported by ANID FONDECYT 1220202, Dirección de Investigación de la Vicerrectoría de Investigación de la Pontificia Universidad Católica de Chile - PUENTE [Grant No. 026/ 2021]; and Agencia Nacional de Investigación y Desarrollo [Grant Nos. ANID-PFCHA/Doctorado Nacional/2019–21190116, ANID-PFCHA/ Doctorado Nacional/2020–21201411]. With regard to the co-author Hilda Klasky, this manuscript has been authored by UT-Battelle, LLC, under contract DE-AC05-00OR22725 with the US Department of Energy (DOE). The US government retains and the publisher, by accepting the article for publication, acknowledges that the US government retains a nonexclusive, paid-up, irrevocable, worldwide license to publish or reproduce the published form of this manuscript, or allow others to do so, for US government purposes. DOE will provide public access to these results of federally sponsored research in accordance with the DOE Public Access Plan (http://energy.gov/downloads/doe-public-accessplan).Peer ReviewedArticle signat per 55 autors/es: Jorge Munoz-Gama (a)* , Niels Martin (b,c)* , Carlos Fernandez-Llatas (d,g)* , Owen A. Johnson (e)* , Marcos Sepúlveda (a)* , Emmanuel Helm (f)* , Victor Galvez-Yanjari (a)* , Eric Rojas (a) , Antonio Martinez-Millana (d) , Davide Aloini (k) , Ilaria Angela Amantea (l,q,r) , Robert Andrews (ab), Michael Arias (z) , Iris Beerepoot (o) , Elisabetta Benevento (k) , Andrea Burattin (ai), Daniel Capurro (j) , Josep Carmona (s) , Marco Comuzzi (w), Benjamin Dalmas (aj,ak), Rene de la Fuente (a) , Chiara Di Francescomarino (h) , Claudio Di Ciccio (i) , Roberto Gatta (ad,ae), Chiara Ghidini (h) , Fernanda Gonzalez-Lopez (a) , Gema Ibanez-Sanchez (d) , Hilda B. Klasky (p) , Angelina Prima Kurniati (al), Xixi Lu (o) , Felix Mannhardt (m), Ronny Mans (af), Mar Marcos (v) , Renata Medeiros de Carvalho (m), Marco Pegoraro (x) , Simon K. Poon (ag), Luise Pufahl (u) , Hajo A. Reijers (m,o) , Simon Remy (y) , Stefanie Rinderle-Ma (ah), Lucia Sacchi (t) , Fernando Seoane (g,am,an), Minseok Song (aa), Alessandro Stefanini (k) , Emilio Sulis (l) , Arthur H. M. ter Hofstede (ab), Pieter J. Toussaint (ac), Vicente Traver (d) , Zoe Valero-Ramon (d) , Inge van de Weerd (o) , Wil M.P. van der Aalst (x) , Rob Vanwersch (m), Mathias Weske (y) , Moe Thandar Wynn (ab), Francesca Zerbato (n) // (a) Pontificia Universidad Catolica de Chile, Chile; (b) Hasselt University, Belgium; (c) Research Foundation Flanders (FWO), Belgium; (d) Universitat Politècnica de València, Spain; (e) University of Leeds, United Kingdom; (f) University of Applied Sciences Upper Austria, Austria; (g) Karolinska Institutet, Sweden; (h) Fondazione Bruno Kessler, Italy; (i) Sapienza University of Rome, Italy; (j) University of Melbourne, Australia; (k) University of Pisa, Italy; (l) University of Turin, Italy; (m) Eindhoven University of Technology, The Netherlands; (n) University of St. Gallen, Switzerland; (o) Utrecht University, The Netherlands; (p) Oak Ridge National Laboratory, United States; (q) University of Bologna, Italy; (r) University of Luxembourg, Luxembourg; (s) Universitat Politècnica de Catalunya, Spain; (t) University of Pavia, Italy; (u) Technische Universitaet Berlin, Germany; (v) Universitat Jaume I, Spain; (w) Ulsan National Institute of Science and Technology (UNIST), Republic of Korea; (x) RWTH Aachen University, Germany; (y) University of Potsdam, Germany; (z) Universidad de Costa Rica, Costa Rica; (aa) Pohang University of Science and Technology, Republic of Korea; (ab) Queensland University of Technology, Australia; (ac) Norwegian University of Science and Technology, Norway; (ad) Universita degli Studi di Brescia, Italy; (ae) Lausanne University Hospital (CHUV), Switzerland; (af) Philips Research, the Netherlands; (ag) The University of Sydney, Australia; (ah) Technical University of Munich, Germany; (ai) Technical University of Denmark, Denmark; (aj) Mines Saint-Etienne, France; (ak) Université Clermont Auvergne, France; (al) Telkom University, Indonesia; (am) Karolinska University Hospital, Sweden; (an) University of Borås, SwedenPostprint (published version

mHealth intervention to improve quality of life in patients with chronic diseases during the COVID-19 crisis in Paraguay: A study protocol for a randomized controlled trial

Background Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system. Objectives The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay. Method A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm). Conclusions It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic

Metodologías de evaluación tecnológica para sistemas de telemedicina: Análisis, propuesta de mejora y evaluación práctica

[ES] El presente trabajo fin de máster propone mejoras en la metodología para la evaluación y validación técnica de sistemas de telemedicina para la gestión de enfermedades crónicas. Dicha evaluación se debe basar en estudios científicos y normas internacionales y debe tener el objetivo de servir de base como metodología de evaluación de soluciones de telemedicina en cualquier ámbito independientemente de sus componentes. En un ejercicio práctico la metodología de evaluación técnica se aplicará sobre el sistema METABO para la gestión de pacientes con diabetes.[EN] This final master thesis aims to enhance the current methodologies used to assess and validate technical issues of chronic disease management telemedicine systems. The enhancement has to have its basis in scientific research and international frameworks and has to be valid to evaluate telemedicine systems independently of the components that build it. Furtherly, the proposed evaluation methodology is applied in METABO system, focused on the management of diabetic patientsMartínez Millana, A. (2013). Metodologías de evaluación tecnológica para sistemas de telemedicina: Análisis, propuesta de mejora y evaluación práctica. http://hdl.handle.net/10251/38040Archivo delegad

The Potential of Self-Management mHealth for Pediatric Cystic Fibrosis: Mixed-Methods Study for Health Care and App Assessment

Background: Remote care services and patient empowerment have boosted mobile health (mHealth). A study of user needs related to mHealth for pediatric cystic fibrosis (PCF) identified the set of preferred features mobile apps should support; however, the potential use of PCF apps and their suitability to fit into PCF clinical management remains unexplored. Objective: We examine whether PCF holds potential for the implementation of mHealth care. Methods: The study is based on a literature review and qualitative analysis of content and was conducted in two parts: (1) we reviewed scientific and gray literature to explore how European countries manage PCF and conducted a qualitative study of 6 PCF units and (2) we performed a systematic review of apps available in the myhealthapps.net repository searching for cystic fibrosis (CF) management and nutrition apps, which we analyzed for characteristics, business models, number of downloads, and usability. Results: European CF routine care guidelines are acknowledged in most European countries, and treatments are fully covered in almost all countries. The majority of teams in CF units are interdisciplinary. With respect to the systematic review of apps, we reviewed 12 apps for CF management and 9 for general nutrition management in the myhealthapps.net directory. All analyzed apps provided functionalities for recording aspects related to the disease and nutrition such as medication, meals, measurements, reminders, and educational material. None of the apps reviewed in this study supported pancreatic enzyme replacement therapy. CF apps proved to be less appealing and usable than nutrition apps (2.66 [SD 1.15] vs 4.01 [SD 0.90]; P<.001, z-value: –2.6). User needs detected in previous research are partially matched by current apps for CF management. Conclusions: The health care context for PCF is a unique opportunity for the adoption of mHealth. Well-established clinical guidelines, heterogeneous clinical teams, and coverage by national health care systems provide a suitable scenario for the use of mHealth solutions. However, available apps for CF self-management do not cover essential aspects such as nutrition and education. To increase the adoption of mHealth for CF self-management, new apps should include these features.publishedVersio