Content uploaded by Amanda Edwards-Stewart
Author content
All content in this area was uploaded by Amanda Edwards-Stewart on Mar 30, 2017
Content may be subject to copyright.
A preview of the PDF is not available
An Analysis of Personal Technology Use by Service Members and Military Behavioral Health Providers
Abstract
Personal technology use is ubiquitous in the United States today and technology, in general, continues to change the face of health care. However, little is known about the personal technology use of military service members and the behavioral health care providers that treat them. This study reports the technology use of 1,101 active duty service members and 45 behavioral health care providers at a large military installation. Participants reported Internet usage; ownership of smartphones, tablets, and e-readers; usage of mobile applications (apps); and basic demographic information. Compared with providers, service members reported higher rates of smartphone ownership, were more likely to own Android smartphones than iPhones, and spent more time gaming. Both groups spent a comparable amount of time using social media. With the exception of gaming, however, differences between service members and providers were not statistically significant when demographics were matched and controlled. Among service members, younger respondents (18-34) were statistically more likely than older respondents (35-58) to own smartphones, spend time gaming, and engage in social media. Our findings can help inform provider's technology-based education and intervention of their patients and guide the development of new technologies to support the psychological health of service members.
... Military service members are also plugged into their smartphones, with over 60% of their digital content views on their smartphones [29]. Geofencing and Bluetooth beacon messaging are conducive to military installations because the demographic and geolocations of service members are relatively well defined, making targeted promotion easier. ...
... They also agreed that receiving these notifications would help them eat healthier. These results align with previous research showing that a geofencing campaign may positively influence dietary habits among adults [29] and with the larger literature around the effectiveness of mobile phone apps to promote healthier dietary and physical activity behaviors [33]. Our findings also align with a recent meta-analysis that found that nudging approaches for food choices can be particularly effective [22]. ...
Approximately 17% of military service members are obese. Research involving army soldiers suggests a lack of awareness of healthy foods on post. Innovative approaches are needed to change interactions with the military food environment. Two complementary technological methods to raise awareness are geofencing (deliver banner ads with website links) and Bluetooth beacons (real-time geotargeted messages to mobile phones that enter a designated space). There is little published literature regarding the feasibility of this approach to promote healthy behaviors in retail food environments. Thus, we conducted a formative feasibility study of a military post to understand the development, interest in, and implementation of EatWellNow, a multi-layered interactive food environment approach using contextual messaging to improve food purchasing decisions within the military food environment. We measured success based on outcomes of a formative evaluation, including process, resources, management, and scientific assessment. We also report data on interest in the approach from a Fort Bragg community health assessment survey (n = 3281). Most respondents agreed that they were interested in receiving push notifications on their phone about healthy options on post (64.5%) and that receiving these messages would help them eat healthier (68.3%). EatWellNow was successfully developed through cross-sector collaboration and was well received in this military environment, suggesting feasibility in this setting. Future work should examine the impact of EatWellNow on military service food purchases and dietary behaviors.
... Second, digital health technologies create opportunities for increased patient access and engagement with healthcare services. The majority of service members own a smartphone and thus have familiarity with the use of the tools required for digital healthcare services [28,29]. Traditional CBTI treatment sessions typically range from 5 weeks to several months. ...
Background
Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive behavioral treatment for insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Academy of Sleep Medicine, and the American College of Physicians. CBTI is highly effective but has limited scalability. It is often unavailable in clinical settings where service members receive sleep care. Digital technologies offer unique opportunities to scale and broaden the geographic reach of CBTI services and support increased patient access and engagement in behavioral sleep care. This study aims to evaluate the impact and acceptability of digital CBTI hubs to augment military treatment facilities’ capabilities in behavioral sleep medicine.
Methods
This is a multi-site, non-inferiority randomized clinical trial designed to compare the effects of in-person (face-to-face or virtual) insomnia care as usual at three military sleep clinics versus CBTI delivered remotely and asynchronously through digital CBTI hubs. Digital CBTI hubs are led by licensed, certified clinicians who use NOCTEM’s® evidence-based clinical decision support platform COAST™ (Clinician Operated Assistive Sleep Technology). Changes in insomnia severity and daytime symptoms of depression and anxiety will be compared at baseline, at 6–8 weeks, and at 3-month follow-up. Patient satisfaction with insomnia care as usual versus digital CBTI hubs will also be examined. We hypothesize that digital CBTI hubs will be non-inferior to insomnia care as usual for improvements in insomnia and daytime symptoms as well as patient satisfaction with insomnia care.
Discussion
Digital technology has a high potential to scale CBTI accessibility and delivery options required to meet the insomnia care needs of military service members. Digital CBTI hubs using COAST offer a novel approach to broaden service members’ access to CBTI and to serve as an augmentation strategy for existing sleep services at military treatment facilities. The pragmatic approach leveraging technology in this trial has the potential to rapidly inform clinical practice within the Defense Health Agency as well as other healthcare systems.
Trial registration
ClinicalTrials.gov NCT05490550. Registered on 14 July 2023.
... Second, digital health technologies create opportunities for increased patient access and engagement with healthcare services. The majority of service members own a smartphone, and thus have familiarity with use of the tools required for digital healthcare services [28,29]. Traditional CBTI treatment sessions typically range from ve weeks to several months. ...
• Background
Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive Behavioral Treatment for Insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Academy of Sleep Medicine, and the American College of Physicians. CBTI is highly effective but has limited scalability. It is often unavailable in clinical settings where service members receive sleep care. Digital technologies offer unique opportunities to scale and broaden the geographic reach of CBTI services and support increased patient access and engagement in behavioral sleep care. This study aims to evaluate the impact and acceptability of digital CBTI hubs to augment military treatment facilities’ capabilities in behavioral sleep medicine.
• Methods
This is a multi-site, non-inferiority randomized clinical trial designed to compare the effects of in-person (face-to-face or virtual) insomnia care as usual at three military sleep clinics versus CBTI delivered remotely and asynchronously through digital CBTI hubs. Digital CBTI hubs are led by licensed, certified clinicians who use NOCTEM’s® evidence-based clinical decision support platform COAST™ (Clinician Operated Assistive Sleep Technology). Changes in insomnia severity and daytime symptoms of depression and anxiety will be compared at baseline, at 6–8 weeks, and at 3-month follow-up. Patient satisfaction with insomnia care as usual versus digital CBTI hubs will also be examined. We hypothesize that digital CBTI hubs will be non-inferior to insomnia care as usual for improvements in insomnia and daytime symptoms as well as patient satisfaction with insomnia care.
• Discussion
Digital technology has a high potential to scale CBTI accessibility and delivery options required to meet the insomnia care needs of military service members. Digital CBTI hubs using COAST offers a novel approach to broaden service members' access to CBTI and to serve as an augmentation strategy for existing sleep services at military treatment facilities. The pragmatic approach leveraging technology in this trial has the potential to rapidly inform clinical practice within the Defense Health Agency as well as other healthcare systems.
Trial registration
ClinicalTrials.gov: NCT05490550. Registered on 14 July 2023, https://clinicaltrials.gov/study/NCT05490550?term=NCT05490550&rank=1
... • Assess the effect of other "time wasters," such as Internet and social media use (Edwards-Stewart et al., 2016). Even though technology use is often a means of relaxing from the stress of military life, the overuse of technologies can perpetuate sleep disturbances by increasing arousal right before bedtime (Troxel et al., 2015). ...
The overarching aim of the study was to assess attributes and aspects of video gaming in the United States Navy (USN) and Marine Corps (USMC). Data were collected from two USN surface ships (in port) and three commands of the USMC. Sailors completed a cross-sectional survey and a 10-day activity log. Marines completed the survey and participated in semi-structured focus groups. Response rates to the surveys ranged from ~7.5% for Marines to ~22.5% for Sailors. Respondents consisted of 86 Sailors and 927 Marines (age MD=24 years, 92.4% males, 84.2% enlisted).
From the 1,013 ADSMs, 91.6% reported playing video games (VGs) (age MD=23 years, 94.3% males, 86.1% enlisted). The information provided in the Marine focus groups along with the survey data of both Marines and Sailors suggest that video gaming is highly prevalent in the military. Many ADSMs began playing video games at 7 or 8 years of age. In general, self-identified gamers used problem-focused and emotion-focused coping styles more frequently than dysfunctional coping styles. Recreation was the most frequently reported motivational dimension for playing VGs, followed by coping with stress. Respondents reported playing VGs at home/off duty more often than when on duty or when underway/deployed. Sailors seem to be more consistent than Marines in their gaming habits. Depending on the setting, gamers reported playing VGs on average 3.75-6 days in a typical week for ~2-3 hours/day. Gamers reported playing VGs generally later in the day (i.e., after work and before bedtime) with 5% to 18% of gamers sleeping later due to VGs. Most gamers reported playing VGs in their racks or the mess decks/common areas when deployed/underway.
Gamers reported symptoms of depression (~23% of ADSMs), generalized anxiety disorder (~19%), excessive daytime sleepiness (~33%), and AUDIT-C scores suggestive of heavy drinking (39%). Also, ~32% of gamers reported dissatisfaction with their life. More excessive gamers tended to be younger, used dysfunctional coping styles more frequently, and played video games more frequently and for more hours. Also, more excessive gamers were more likely to report sleeping later because of playing video games, and exhibited more symptoms of major depression, generalized anxiety, and excessive daytime sleepiness. Depending on the criterion used, the prevalence of disordered gaming in the study samples ranged from 0 to 4.85%. Of those who reported playing VGs, ~50% of Marines and 25% of Sailors were identified as problematic gamers. We developed several recommendations and action items, including suggestions for follow-on research.
... Of note, most of these statistically significant differences (which were not surprising given our large sample size) were associated with small effect sizes, suggesting that any difference in experience for an individual user across the 2 platforms was relatively small. The greater reach, lower use, and lower distress among iOS users could have been shaped by VA OCC's broad distribution of iOS tablets to veterans (even though veterans themselves may be more likely to own Android smartphones [39]). Some veterans may have opened the app on the tablet but were not motivated to continue to use it because they did not have a particular need for it, in contrast to other veterans or users who searched, found, and installed the app on their own. ...
Background:
With widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated.
Objective:
We aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach.
Methods:
We examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users.
Results:
During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean -1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean -4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements.
Conclusions:
PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement.
... Of note, most of these statistically significant differences (which were not surprising given our large sample size) were associated with small effect sizes, suggesting that any difference in experience for an individual user across the 2 platforms was relatively small. The greater reach, lower use, and lower distress among iOS users could have been shaped by VA OCC's broad distribution of iOS tablets to veterans (even though veterans themselves may be more likely to own Android smartphones [39]). Some veterans may have opened the app on the tablet but were not motivated to continue to use it because they did not have a particular need for it, in contrast to other veterans or users who searched, found, and installed the app on their own. ...
BACKGROUND
With widespread smartphone ownership, mobile health (mHealth) apps can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the U.S. Departments of Veterans Affairs (VA) and Defense (DoD), was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated.
OBJECTIVE
We sought to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended prior work on PTSD Coach.
METHODS
We examined naturalistic usage of PTSD Coach during a one-year observation period between April 20, 2020 and April 19, 2021, using anonymous in-app event data to generate summary metrics for users.
RESULTS
During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app three times across three separate days for 18 minutes total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. Over 60% of users accessed one or more main content areas of the app (i.e., Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users. Users who provided initial distress ratings (44.3% of users, n = 56,971) endorsed relatively high momentary distress (M = 6.03, SD = 2.52, on a 0-10 scale), and use of coping tool modestly improved momentary distress (M = -1.38, SD = 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5; 13.7% of users, n = 17,589), PTSD symptoms were largely above clinical threshold (M = 49.80, SD = 16.36). Among users who completed at least two PCL-5s (3.9% of users, n = 4,989), PTSD symptoms decreased from the first to last assessment (M = -4.35, SD = 15.29), with approximately a third of these users (n = 1,585) experiencing clinically significant improvements.
CONCLUSIONS
PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with Version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement.
... Veterans are among the patient populations poised to benefit most from mobile health (mHealth) interventions. Similar to the general population, (Pew Research Center, 2019) the vast majority of veterans own a smartphone (Bush & Wheeler, 2015;Edwards-Stewart et al., 2016) and a significant number of veterans live in rural locations or have limited access to health care (Department of Veterans Affairs, 2020). The Department of Veterans Affairs (VA) and the Department of Defense (DoD) have made concerted efforts to develop free mental health apps to meet the needs of veterans and service members (Gould et al., 2019). ...
Given the substantial investment in the development of mental health mobile applications (apps), information about penetration in the patient populations of interest is critical. This study describes the proportion of veterans who are knowledgeable of and utilize the Department of Veteran Affairs (VA) and Department of Defense (DoD) mental health apps. A cross-sectional survey of 140 veterans was conducted in primary care and outpatient mental health clinics at a large VA facility. Ninety-one percent of veterans (n = 127) reported smartphone ownership. Of these, 42.5% and 20.4% had heard of and used at least one of the 22 VA/DoD mental health apps, respectively. When veterans were asked to pick the individual VA/DoD apps they had previously used from a list, the proportion of participants who reported prior use ranged from 0% (Moving Forward) to 6.5% (Mindfulness Coach). Treatment for psychiatric problems relevant to the apps did not predict veteran knowledge/use of the VA/DoD apps. Rates of app use remained low among veterans reporting symptoms/diagnoses apps were designed to address (e.g., 7.5% of veterans who reported posttraumatic stress disorder (PTSD) had used PTSD Coach). The most common barrier to app use (endorsed by 65.7% of participants) was awareness of the apps. Expansion of existing VA/DoD efforts to educate patients and providers treating relevant conditions is indicated. Evaluation of evidence-based mobile health support specialists in clinical settings may also be indicated. This study provides critical information to guide future dissemination efforts and to help evaluate the impact of investments to date. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Technology solutions such as mobile health can help to overcome these challenges (Armstrong et al., 2017;Gould, Kok, et al., 2019). Previous research has shown a technology adoption gap between patients and health care staff: Although patients are interested in using health technologies to supplement their care, health care staff often believe they are not interested and delay adoption (Bush et al., 2019;Connolly, et al., 2018;Edwards-Stewart et al., 2016;Gould, Kok, et al., 2019;Miller et al., 2019). As VA health care staff members, it is our role to meet Veterans where they are and provide the highest quality of care possible. ...
Rapid advances in health technologies require VA health care staff members to have a general working knowledge of consumer technologies, specifically mobile health apps, and to understand how these tools
are used for Veteran education, monitoring, and treatment. The U.S. Department of Veterans Affairs Mobile Health Practice Guide offers an overview of mobile health and includes essential tutorials, including how
to download apps and incorporate them into clinical settings. The guide is primarily tailored for VA health care staff across the continuum of care, and it can be used by staff members in U.S. Department of Defense
(DoD) and other health care systems.
Designed to inform decision-making in clinical settings, this guide describes the five core knowledge areas for integrating mobile technologies into health care. These core knowledge areas provide VA health care staff with the information necessary to effectively integrate mobile health technologies into their clinical practice to support Veteran care. Although this guide will include descriptions of specific mobile health apps developed by the U.S. federal government as examples and primarily focus on the
integration of apps in VA and military health care settings, the information and strategies provided for clinical integration of apps can be generalized to other mobile health apps and health care settings.
Veterans, Service members, and their families face unique challenges in accessing health care, including limited treatment options, confidentiality concerns, and the stigma associated with seeking professional
help. Frequent moves and deployments can also make treatment
difficult. Technology solutions such as mobile health can help to overcome these challenges. Previous research has shown a technology adoption gap between patients and health care staff: Although patients are interested in using health technologies to supplement their care, health care staff often believe they are not interested and delay adoption. As VA health care staff
members, it is our role to meet Veterans where they are and provide the highest quality of care possible. With the vast majority of Veterans owning smartphones and preferring the use of apps as a part of their care, VA health care staff members need to have adequate skills in mobile health competencies to efficiently use apps in clinical care.
VA health care staff has been slower to integrate mobile health technology into clinical practice due to a lack of awareness of and training on the subject. Putting knowledge into practice is a high priority for VA
and DoD, to provide the highest quality of care possible to our nation’s Service members and Veterans and their families. The VA Mobile Health Practice Guide, along with VA and DoD training programs, enables
health care professionals to increase their level of competency in the safe and effective integration of mobile health into clinical care. Although mobile health has considerable potential, standardized training is necessary before VA health care staff is assured of the evidence, safety, and value in altering traditional approaches to clinical care. Based on a decade of research, development, and training in the core knowledge areas needed to integrate mobile health into clinical practice, this guide aims to provide a
foundation of knowledge and enable VA health care staff to develop their skills and effectively integrate a variety of mobile health tools into their clinical work.
... Over 90% of US adults aged 18-49 own a smartphone, and the majority use mobile devices as their primary access to the internet (Pew Research Center 2019). Service members-who primarily come from this age group-similarly have rates of smartphone ownership over 90% (Bush and Wheeler 2015;Edwards-Stewart et al. 2016). Reviews have shown that mobile resources may have particular utility for conditions that directly affect service members (Cavanagh et al. 2019(Cavanagh et al. , 2020. ...
Military service members endorse stigma as a barrier to seeking psychological health care. In working to overcome this barrier, social media campaigns have shown positive effects. The current study illustrates efforts by the Department of Defense to optimize its social media strategy to promote help-seeking behavior and decrease stigma. Real Warriors Campaign staff conducted a performance and content analysis on the 50 Facebook and Twitter posts from the previous year that had the highest and lowest number of likes, shares, and comments (200 total posts). This analysis informed social media optimization, including decreasing content frequency, calls to action, increasing responses, and tailoring content with compelling videos and images designed for mobile devices. Interaction with the campaign was measured during two timeframes: (1) comparing the first 3 months of the optimized strategy to the prior 3 months and (2) a year-to-year comparison of the same calendar months in consecutive years. Results showed overall decreases in impressions, likes, and comment engagement but increases in key behaviors such as sharing content, visiting the website, and conversions to help-seeking behavior. These gains were shown despite decreasing the overall number of social media posts as part of the new strategy. There was a significant shift in interaction with the updated social media content, in line with industry trends. Optimizing outreach campaigns using iterative feedback can prioritize media elements that resonate and grab the attention of target audience members, ultimately driving behavior change with regard to military stigma and help seeking.
Online outreach campaigns are a potential public health method for reaching service members at risk for suicide. The Real Warriors Campaign website underwent a full redesign in 2019 to enhance its ability to provide crisis resources and increase engagement by adopting a mobile‐first strategy and implementing a responsive framework, meaning the site renders properly on all devices, including desktop, tablets, and mobile. Usability testing with end‐user service members led to several innovations on the website, including a one‐click banner that directly linked users on their mobile phones to crisis resources, the redesign of menus and content to better display on mobile devices, and promoting use of website resources through gateway topics. Comparing the 6 months before and after the mobile redesign showed significant increases in new mobile users, pages viewed on mobile devices, and new users coming to the site through social media. There was also a significant increase in specific help‐seeking actions by users, including use of referral links and live chat, as well as 200 individuals accessing crisis phone lines through new one‐click dialing banners. Suicide prevention campaigns should continue to optimize their online presence to reach groups at risk. This study of the website redesign from the Real Warriors Campaign illustrates several best practices in digital outreach as applied to suicide prevention, including leveraging usability testing, synching outreach material with social media, and ensuring mobile compatibility.
Abstract Rural trauma care has been regarded as being the "challenge for the next decade." Trauma patients in rural areas face more struggles than their urban counterparts because of the absence of specialized trauma care, delay in providing immediate care to trauma victims, and longer transport times to reach a trauma center. Telemedicine is a promising tool for facilitating rural trauma care. This stellar tool creates a real-time link between a remotely located specialist and the local healthcare provider, especially during the initial management of the trauma patient, involving resuscitation and even intubation. However, the high cost of purchasing, setting up, and maintaining all the needed equipment has made telemedicine an expensive proposition for rural hospitals, which frequently have limited budgets. But recently, new improvements in communication technology have made smartphones an indispensable part of daily life, even in rural areas. These devices have great potential to improve patient care and enhance medical education because of their wide adoption and ease of use. In this article, we describe our initial teletrauma experience and the effect of smartphone implementation in patient care and medical education at the University of Arizona Medical Center in Tucson.
The traditional otorhinoendoscope is widely used in the diagnosis of a variety of ear and nose diseases, but only one doctor can use it at a time. It is also very difficult to share observations from one doctor with another doctor. With advances in electronic health technology, the extended potential application of smartphones to support medical practice or mobile health has grown steadily.
The first phase of the study discussed how smartphones may be used for otorhinoscopic imaging and image management via an innovative adaptor. The second phase of the study was to evaluate the diagnostic capability of the smartphone-based otorhinoendoscope, as compared to the traditional otorhinoendoscope, and its application in mobile health and teleotolaryngology.
We designed a unique adaptor to connect the otorhinoendoscope and smartphone in order to perform smartphone-based otorhinoendoscopy. The main aim was to transform the smartphone into an otorhinoendoscope. We devised a method that would allow us to use the smartphone's camera to capture otorhinoscopic images. Using a freely available Web-based real-time communication application platform and the 3G (or WIFI) network, the smartphone-based otorhinoendoscope could synchronize the smartphone-based otorhinoscopic image with smartphones, tablet PCs, computer notebooks, or personal computers.
We investigated the feasibility of telemedicine using a smartphone, tablet PC, and computer notebook. Six types of clinical otorhinoscopic images were acquired via the smartphone-based otorhinoendoscope from six patients, which were examined in this study. Three teleconsultants (doctors A, B, and C) reviewed the six types of clinical otorhinoscopic images and made a telediagnosis. When compared to the face-to-face diagnosis, which was made in-person via a traditional otorhinoendoscope, the three teleconsultants obtained scores of a correct primary telediagnosis 83% (5/6), 100% (6/6), and 100% (6/6) of the time, respectively. When the clinical data were provided, the three teleconsultants obtained a correct secondary telediagnosis score of 100% (6/6), 100% (6/6), and 100% (6/6) of the time, respectively.
The use of previously available technologies in the absence of any additional expensive devices could significantly increase the quality of diagnostics while lowering extraneous costs. Furthermore, this could also increase the connectivity between most isolated family doctors and remote referral centers.
Combining low-cost wireless EEG sensors with smartphones offers novel opportunities for mobile brain imaging in an everyday context. Here we present the technical details and validation of a framework for building multi-platform, portable EEG applications with real-time 3D source reconstruction. The system - Smartphone Brain Scanner - combines an off-the-shelf neuroheadset or EEG cap with a smartphone or tablet, and as such represents the first fully portable system for real-time 3D EEG imaging. We discuss the benefits and challenges, including technical limitations as well as details of real-time reconstruction of 3D images of brain activity. We present examples of brain activity captured in a simple experiment involving imagined finger tapping, which shows that the acquired signal in a relevant brain region is similar to that obtained with standard EEG lab equipment. Although the quality of the signal in a mobile solution using an off-the-shelf consumer neuroheadset is lower than the signal obtained using high-density standard EEG equipment, we propose mobile application development may offset the disadvantages and provide completely new opportunities for neuroimaging in natural settings.
The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility.
From January 2012 onwards, the authors used smartphones and its WhatsApp application as a communication method amongst their team for various aspects of patient management and as a tool for academic endorsements.
During the period of this study, there were 116 episodes regarding patient management, which were handled, in a timely fashion by using this application. In addition opinion of rotating residents in the section was sought regarding the efficacy of this method of communication. Overall majority of residents were satisfied with this mode of communication.
This new method of communication is an effective method for clinical and academic endorsements. The method is cheap and quick and easy to operate.
Objective:
Although personal electronic devices, such as mobile phones, computers, and tablets, increasingly are being leveraged as vehicles for health in the civilian world, almost nothing is known about personal technology use in the U.S. military. In 2012 we conducted a unique survey of personal technologies used by U.S. military service members. However, with the rapidly growing sophistication of personal technology and changes in consumer habits, that knowledge must be continuously updated to be useful. Accordingly, we recently surveyed new samples of active duty service members, National Guard and Reserve, and veterans.
Materials and methods:
We collected data by online surveys in 2013 from 239 active, inactive, and former service members. Online surveys were completed in-person via laptop computers at a large military installation and remotely via Web-based surveys posted on the Army Knowledge Online Web site and on a Defense Center Facebook social media channel.
Results and conclusions:
We measured high rates of personal technology use by service members at home across popular electronic media. The most dramatic change since our earlier survey was the tremendous increase in mobile phone use at home for a wide variety of purposes. Participants also reported moderate non-work uses of computers and tablets while on recent deployment to Iraq and Afghanistan, but almost no mobile phone use, ostensibly because of military restrictions in the war zone. These latest results will enable researchers and technology developers target their efforts on the most promising and popular technologies for psychological health in the military.
We evaluated the diagnostic accuracy of teleconsultations for skin diseases common in the army using a smartphone multimedia messaging service (MMS). Images of skin lesions were obtained from 100 army patients using digital cameras built into smartphones. Three remotely located dermatologists received the dermatology images and associated clinical information via the MMS. The teledermatologists' diagnoses were compared with those obtained from face-to-face examinations. The three most common diagnoses made at the dermatology clinics were eczema, viral warts and fungal infections. The mean diagnostic agreement between face-to-face and teledermatology consultations was 71% (SD 2). The mean kappa coefficient was 0.73 (SD 0.06) for the three most common diagnostic categories. The mean values for sensitivity were 78% (SD 0), 88% (SD 21) and 61% (SD 11) for eczema, viral warts and fungal infections, respectively, and the specificity values were above 90% for these skin diseases. Teledermatology consultation using smartphones is simple. Although diagnoses using telemedicine do not perfectly match diagnoses from face-to-face consultations the diagnostic accuracy using smartphones is superior to that of clinicians who are not specialized in dermatology.
The US health care system is in the midst of an enormous change in the way health care providers and hospitals document, monitor, and share information about health and care delivery. Part of this transition involves a wholesale, but currently uneven, shift from paper-based records to electronic health record (EHR) systems. We used the most recent longitudinal survey of US hospitals to track how they are adopting and using EHR systems. Only 44 percent of hospitals report having and using what we define as at least a basic EHR system. And although 42.2 percent meet all of the federal stage 1 "meaningful-use" criteria, only 5.1 percent could meet the broader set of stage 2 criteria. Large urban hospitals continue to outpace rural and nonteaching hospitals in adopting EHR systems. The increase in adoption overall suggests that the positive and negative financial incentives currently in place across the US health care system are working as intended. However, achieving a nationwide health information technology infrastructure may require efforts targeted at smaller and rural hospitals.
Key findings:
In 2013, 78% of office-based physicians used any type of electronic health record (EHR) system, up from 18% in 2001. In 2013, 48% of office-based physicians reported having a system that met the criteria for a basic system, up from 11% in 2006. The percentage of physicians with basic systems by state ranged from 21% in New Jersey to 83% in North Dakota. In 2013, 69% of office-based physicians reported that they intended to participate (i.e., they planned to apply or already had applied) in "meaningful use" incentives. About 13% of all office-based physicians reported that they both intended to participate in meaningful use incentives and had EHR systems with the capabilities to support 14 of the Stage 2 Core Set objectives for meaningful use. From 2010 (the earliest year that trend data are available) to 2013, physician adoption of EHRs able to support various Stage 2 meaningful use objectives increased significantly. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized incentive payments to increase physician adoption of electronic health record (EHR) systems (1,2). The Medicare and Medicaid EHR Incentive Programs are staged in three steps, with increasing requirements for participation. To receive an EHR incentive payment, physicians must show that they are "meaningfully using" certified EHRs by meeting certain objectives (3,4). This report describes trends in the adoption of EHR systems from 2001 through 2013, as well as physicians' intent to participate in the EHR Incentive Programs and their readiness to meet 14 of the Stage 2 Core Set objectives for meaningful use in 2013.