Urs-Vito Albrecht

Mobile Technologies: Expectancy, Usage, and Acceptance of Clinical Staff and Patients at a University Medical Center

Background Despite their increasing popularity, little is known about how users perceive mobile devices such as smartphones and tablet PCs in medical contexts. Available studies are often restricted to evaluating the success of specific interventions and do not adequately cover the users’ basic attitudes, for example, their expectations or concerns toward using mobile devices in medical settings. Objective The objective of the study was to obtain a comprehensive picture, both from the perspective of the patients, as well as the doctors, regarding the use and acceptance of mobile devices within medical contexts in general well as the perceived challenges when introducing the technology. Methods Doctors working at Hannover Medical School (206/1151, response 17.90%), as well as patients being admitted to this facility (213/279, utilization 76.3%) were surveyed about their acceptance and use of mobile devices in medical settings. Regarding demographics, both samples were representative of the respective study population. GNU R (version 3.1.1) was used for statistical testing. Fisher’s exact test, two-sided, alpha=.05 with Monte Carlo approximation, 2000 replicates, was applied to determine dependencies between two variables. Results The majority of participants already own mobile devices (doctors, 168/206, 81.6%; patients, 110/213, 51.6%). For doctors, use in a professional context does not depend on age (P=.66), professional experience (P=.80), or function (P=.34); gender was a factor (P=.009), and use was more common among male (61/135, 45.2%) than female doctors (17/67, 25%). A correlation between use of mobile devices and age (P=.001) as well as education (P=.002) was seen for patients. Minor differences regarding how mobile devices are perceived in sensitive medical contexts mostly relate to data security, patients are more critical of the devices being used for storing and processing patient data; every fifth patient opposed this, but nevertheless, 4.8% of doctors (10/206) use their devices for this purpose. Both groups voiced only minor concerns about the credibility of the provided content or the technical reliability of the devices. While 8.3% of the doctors (17/206) avoided use during patient contact because they thought patients might be unfamiliar with the devices, (25/213) 11.7% of patients expressed concerns about the technology being too complicated to be used in a health context. Conclusions Differences in how patients and doctors perceive the use of mobile devices can be attributed to age and level of education; these factors are often mentioned as contributors of the problems with (mobile) technologies. To fully realize the potential of mobile technologies in a health care context, the needs of both the elderly as well as those who are educationally disadvantaged need to be carefully addressed in all strategies relating to mobile technology in a health context.

A mobile application improves therapy-adherence rates in elderly patients undergoing rehabilitation: A crossover design study comparing documentation via iPad with paper-based control.

AbstractMedication adherence is crucial for success in the management of patients with chronic conditions. This study analyzes whether a mobile application on a tablet aimed at supporting drug intake and vital sign parameter documentation affects adherence in elderly patients.Patients with coronary heart disease and no prior knowledge of tablet computers were recruited. They received a personal introduction to the mobile application Medication Plan, installed on an Apple iPad. The study was conducted using a crossover design with 3 sequences: initial phase, interventional phase (28 days of using the app system), and comparative phase (28 days of using a paper diary). Users experienced the interventional and comparative phases alternately.A total of 24 patients (12 males; mean age 73.8 years) were enrolled in the study. The mean for subjectively assessed adherence (A14-scale; 5-point Likert scale, from “never” to “very often” which results in a score from 0 to 56) before the study was 50.0 (SD = 3.44). After both interventions there was a significant increase, which was more pronounced after the interventional phase (54.0; SD = 2.01) than after the comparative phase (52.6; SD = 2.49) (for all pairs after both interventions, P <0.001). Neither medical conditions nor the number of drug intake (amount and frequency of drug taking) per day affected subjective adherence. Logging data showed a significantly stronger adherence for the medication app than the paper system for both blood pressure recordings (P <0.001) and medication intake (P = 0.033). The majority of participants (n = 22) stated that they would like to use the medication app in their daily lives and would not need further assistance with the app.A mobile app for medication adherence increased objectively and subjectively measured adherence in elderly users undergoing rehabilitation. The findings have promising clinical implications: digital tools can assist chronic disease patients achieve adherence to medication and to blood pressure measurement. Although this requires initial offline training, it can reduce complications and clinical overload because of nonadherence.

Chancen und Risiken von Gesundheits-Apps

Smart mobile devices are ubiquitous and are firmly integrated in almost everyone’s everyday life. Their success is largely based on the comfort they provide: users can easily look up information, communicate or use them as aides for various purposes, at almost any time or location. Another key factor for their success is on the developer’s side: while the computing power offered by the miniaturized high-performance technology integrated into smart devices is certainly part of the appeal, much of the success is also attributable to the ease of developing and distributing mobile applications, short apps, allowing almost anyone to make their ideas work on a mobile device. For users, obtaining these apps is just as easy. Apps are available for almost any purpose, and health and fitness are no exception. They are for example used to obtain health-related information for both private as well as professional purposes, but also for diagnostic or therapeutic purposes. This article will use a multidimensional approach to describe the opportunities and potentials of mobile technologies and specifically apps as well as the challenges they hold for various actors. It is based on the findings presented in the CHARISMHA study, which was funded by the Federal Ministry of Health and aimed at taking stock of the situation of mobile applications in health care as well as raising awareness about the various aspects that need to be considered when using mobile technologies in health care.

Relevance of Trust Marks and CE Labels in German-Language Store Descriptions of Health Apps: Analysis

Background In addition to mandatory CE marking (“CE” representing Conformité Européenne, with the CE marking being a symbol of free marketability in the European Economic Area) for medical devices, there are various seals, initiatives, action groups, etc, in the health app context. However, whether manufacturers use them to distinguish their apps and attach relevance to them is unclear. Objective The objective was to take a snapshot of quality seals, regulatory marks, and other orientation aids available on the German app market and to determine whether manufacturers deem such labels relevant enough to apply them to their apps, namely as reflected by mentions in app description texts in a typical app store (ie, Apple’s App Store). Methods A full survey of the metadata of 103,046 apps from Apple’s German App Store in the Medicine and Health & Fitness categories was carried out. For apps with German-language store descriptions (N=8767), these were automatically searched for the occurrence of relevant keywords and validated manually (N=41). In addition, the websites of various app seal providers were checked for assigned seals. Results Few manufacturers referenced seals in the descriptions (5/41), although this would have been expected more often based on the seals we were able to identify from the seal providers’ Web pages, and there were 34 of 41 that mentioned CE status in the descriptions. Two apps referenced an app directory curated by experts; however, this is not an alternative to CE marks and seals of approval. Conclusions Currently, quality seals seem to be irrelevant for manufacturers. In line with regulatory requirements, mentions of medical device status are more frequent; however, neither characteristic is effective for identifying high-quality apps. To improve this situation, a possibly legally obligatory, standardized reporting system should be implemented.

GC in Forensic Toxicology

This chapter describes the importance and the use of gas chromatography (GC) in forensic toxicology. GC is for instance commonly applied in the determination of volatile compounds. Ethanol determination, congener analysis and the determination of further volatile substances by means of headspace techniques are described as exemplary uses. Moreover, GC-MS plays an important role in the confirmation analysis of drugs of abuse. Other fields of application of GC-MS are hair testing and systematic toxicological analyses. In each section, application examples are given and relevant particularities are discussed in the context of forensic analysis.

Mobile Smarttracking - Finding Objective Parameters for Determining Fitness to Drive.

The misuse of alcohol and drugs has a big influence on traffic safety. For assessing whether a driver is impaired by alcohol or drugs, police conduct roadside tests, e.g. by breathalyzer or similar devices and also use other test batteries such as standardized field sobriety tests (SFT) that evaluate various psychophysical parameters. However, the way these tests are usually conducted often leads to subjective and investigator dependent results. For more objective results that allow to quantify the influence of illicit substances or alcohol using non-invasive test methods, specialized (laboratory) equipment has to be used. In order to allow for a more objective way of testing with devices already available in roadside situations, in our preliminary study, we chose horizontal gaze nystagmus (part of SFT) and implemented it for Android based devices.