Mobile app care utility: Patients and caregivers perception.

157 Background: There is increasing appreciation for the insight provided by combining low-burden home-based remote digital measurements with patient and observer reported outcomes. In this study, we assessed perspectives of cancer patients and their caregivers on the utility of a mobile app combined with a smartwatch for collection of specific outcomes and to provide clinically actionable data. Methods: In a decentralized clinical trial we consented and enrolled (10/12/2020-4/30/2021) dyads that consisted of a cancer patient and their informal caregiver. All participants had to own an Apple iPhone 6 or higher. Patients were provided with an Apple watch 3 or 4 and downloaded a patient informed mobile app (DigiBioMarC). Caregivers only download a caregiver informed mobile app (TOGETHERCare). Participants were asked to use their respective app for 28 days during which time specific surveys and activity requests were delivered through the mobile app; digital measures of physical activity were collected via the smartwatch. At the end of the app usage period, questions were asked in a video interview about the patient and caregiver perspectives on use of their respective apps and what they believed could be impacted if their doctor were to receive the app information. Respondents could select Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree. Results: Fifty-four dyads were enrolled; four were unable to continue due to a decline in health. Questions were drafted and IRB approved in time to be asked of 45 dyads. The Table lists some results and the percent of respondents that selected Strongly Agree or Agree. Conclusions: Patients and caregivers reported that both apps would encourage them to take better care of themselves/be more physically active and would improve emotional wellbeing. A high proportion of respondents also felt the apps would improve communication with their doctor and provide early important information for the doctor to act upon compared to usual care. Additional work in a large randomized trial is planned to evaluate specific care outcomes. [Table: see text]

ASSESSMENT AND MANAGEMENT OF KEY RISK INDICATORS IN BANKS

The article describes the presence of the main risk indicators that occur in commercial banks, grouping them according to their scope, attachment of risks to the structural divisions of the bank as the owner. The use of a set of digital measurements to control key risk indicators, as well as methods for predicting and estimating the timing of deficiencies and deviations, are presented. The views oflocal and foreign scientists have been analyzed in the scientific literature on key risk indicators. At the same time, the ways to prevent and manage the main risks in commercial banks were studied and scientific proposals and conclusions were given.Keywords:key risk indicators, risk owner, risk coverage, key control indicators, risk management unit.

A systematic review and meta-analysis of studies of reactivity to objective digital measurement of health behaviour

Self-report measures of health behaviour have several limitations including measurement reactivity, i.e. changes in people’s behaviour, cognitions or emotions due to taking part in research. It is thus often recommended to use objective digital measurements instead; however, it is unclear whether they also induce reactivity. Therefore, this pre-registered systematic review and meta-analysis synthesised 31 studies, including 7 experimental studies with 18 effects. Most studies investigated reactivity to digital measurement of physical activity, reporting small but significant effects. Measurement reactivity may be amplified by (1) ease of changing the behaviour, (2) awareness of being measured and social desirability, and (3) resolving discrepancies between actual and desired behaviour through self-regulation. Measurement reactivity may be reduced by discarding the first days of measurement and by restricting visibility of the data. Studies on reactivity to measurement of other health behaviours were scarce, indicating the need for future rigorous experimental research.

Successful Management of Cleft Lip and Palate Malformation without Pre-Surgical Infant Orthopedics

Objective: To investigate the effect of lip closure on reduction of cleft palates when no pre-surgical infant orthopedics (PSIO) are used. Study design: Retrospective patient chart-review in our department for Cranio-Maxillofacial Surgery at the University Medical Centre Freiburg, Germany. 19 patients at the age of 5.9 ± 2.1 months with surgical treatment of uni- (UCLP), or bilateral cleft lip and palate (BCLP) without any use of PSIO were included. Results: Early soft tissue correction of the lip leads to an effective reduction of the maxillary arch without any use of PSIO. The presented conventional and digital measurements appeared to be reliable. A successful reduction of the cleft width (UCLP = 3.88 ± 2.42mm, BCLP = 7.33 ± 5.00mm), the width of the alveolar arch (1.91 ± 1.36mm) and the sagittal depth of the alveolar arch (3.07 ± 2.71 mm) could be achieved with the presented workflow. Conclusions: Cleft reduction was obtainable without PSIO when lip closure after Tennison-Randall was performed.

EVIDENCE Publication Checklist for Studies Evaluating Connected Sensor Technologies: Explanation and Elaboration

The EVIDENCE (EValuatIng connecteD sENsor teChnologiEs) checklist was developed by a multidisciplinary group of content experts convened by the Digital Medicine Society, representing the clinical sciences, data management, technology development, and biostatistics. The aim of EVIDENCE is to promote high quality reporting in studies where the primary objective is an evaluation of a digital measurement product or its constituent parts. Here we use the terms digital measurement product and connected sensor technology interchangeably to refer to tools that process data captured by mobile sensors using algorithms to generate measures of behavioral and/or physiological function. EVIDENCE is applicable to 5 types of evaluations: (1) proof of concept; (2) verification, (3) analytical validation, and (4) clinical validation as defined by the V3 framework; and (5) utility and usability assessments. Using EVIDENCE, those preparing, reading, or reviewing studies evaluating digital measurement products will be better equipped to distinguish necessary reporting requirements to drive high-quality research. With broad adoption, the EVIDENCE checklist will serve as a much-needed guide to raise the bar for quality reporting in published literature evaluating digital measurements products.

Digital Quantification of Occlusal Contacts: A Methodological Study

Objective: To compare the reliability of digital occlusal contacts quantification and the validity of digital occlusal contacts quantification with traditional methods used for occlusal contact determination. Subjects and Methods: Thirty participants, all of whom were students at the Sahlgrenska Academy, University of Gothenburg in Gothenburg, Sweden, were included in the study. Three different methods were used to evaluate occlusal contacts: (I) a digital examination of the patients’ casts, using the Ortho 3D Models (O3DM) software and measuring the total occlusal contact area in square millimeters (DE); (II) an examination involving the measurement of the total number of occlusal contacts on stone casts mounted in an articulator (AE); and (III) a clinical examination with the measurement of the total number of occlusal contacts with 8 μm-thick articulating foil (CE). Results: The repeated digital measurements (same casts scanned multiple times) showed a significant correlation of 0.85 (p < 0.01), which shows a diagnostic consistency. Furthermore, there was a significant correlation between the results obtained with the DE method and the AE of 0.41 (p < 0.05), and between those acquired with the AE method and the CE of 0.37 (p < 0.05). However, no significant correlation was found between the DE method and the CE method with a correlation coefficient of 0.10 (p > 0.05). Conclusions: Digital casts can be used for quantification of the total occlusal contact area (in mm2) owing to the high reliability of repeated measurements and the strong validity of the method compared to traditionally employed stone cast measurements.

Usefulness of digital measurements for functional evaluation of paediatric elbow range of motion

Background Elbow immobilization due to fractures of the upper limb is frequent in paediatric patients. Proper follow-up is critical to assess elbow functional recovery. Telemedicine can be an option for remote monitoring of these patients. The purpose of this study was to compare personal and virtual evaluation of elbow range of motion after long arm cast withdrawal in paediatric patients. Methods An observational cross-sectional study was carried out which included all paediatric patients with elbow immobilization in long arm casts treated at our centre. After cast withdrawal, elbow range of motion was evaluated by telemedicine and in office consultation in all four movements (flexion, extension, pronation and supination). Results Ninety-three patients met the selection criteria. Median age at time of immobilization was 8 years. Mean elbow immobilization time was 23 days (range 18–56 days). When comparing office and remote measurements, no statistical differences were found for any of the four elbow movements measured in our study. Conclusions Remote evaluation of elbow range of motion by telemedicine is technically feasible. We evaluated elbow range of motion in paediatric patients after immobilization and we did not find differences between digital and in office measurements. The results were similar to those obtained through assessment in the office. We believe that this is a useful tool to facilitate remote patient follow-up.

Two-Capacitor Direct Interface Circuit for Resistive Sensor Measurements

Direct interface circuits (DICs) avoid the need for signal conditioning circuits and analog-to-digital converters (ADCs) to obtain digital measurements of resistive sensors using only a few passive elements. However, such simple hardware can lead to quantization errors when measuring small resistance values as well as high measurement times and uncertainties for high resistances. Different solutions to some of these problems have been presented in the literature over recent years, although the increased uncertainty in measurements at higher resistance values is a problem that has remained unaddressed. This article presents an economical hardware solution that only requires an extra capacitor to reduce this problem. The circuit is implemented with a field-programmable gate array (FPGA) as a programmable digital device. The new proposal significantly reduces the uncertainty in the time measurements. As a result, the high resistance errors decreased by up to 90%. The circuit requires three capacitor discharge cycles, as is needed in a classic DIC. Therefore, the time to estimate resistance increases slightly, between 2.7% and 4.6%.

Digital Resilience Biomarkers for Personalized Health Maintenance and Disease Prevention

Health maintenance and disease prevention strategies become increasingly prioritized with increasing health and economic burden of chronic, lifestyle-related diseases. A key element in these strategies is the empowerment of individuals to control their health. Self-measurement plays an essential role in achieving such empowerment. Digital measurements have the advantage of being measured non-invasively, passively, continuously, and in a real-world context. An important question is whether such measurement can sensitively measure subtle disbalances in the progression toward disease, as well as the subtle effects of, for example, nutritional improvement. The concept of resilience biomarkers, defined as the dynamic evaluation of the biological response to an external challenge, has been identified as a viable strategy to measure these subtle effects. In this review, we explore the potential of integrating this concept with digital physiological measurements to come to digital resilience biomarkers. Additionally, we discuss the potential of wearable, non-invasive, and continuous measurement of molecular biomarkers. These types of innovative measurements may, in the future, also serve as a digital resilience biomarker to provide even more insight into the personal biological dynamics of an individual. Altogether, digital resilience biomarkers are envisioned to allow for the measurement of subtle effects of health maintenance and disease prevention strategies in a real-world context and thereby give personalized feedback to improve health.