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  • Worked on a project in YP publishing in establishing phone book on Phones. In islands such as Cayman, users had data plans. Jamaica prepaid phones and very few data plans. Use of SMS higher. Subsequently, in semester 1 of the MHI program, Joe Caffazoo presented on the topic of Remote Patient Monitoring and subsequently Emily Seto presented a pilot study being done by using cellular phone to .... At the Medicine 2.0 conference, after listening again to this presentation along with one by Carlos Rizo, I realized most of the solutions are most suited for rural areas which would be similiar to access in developing countries. Since then, mHealth in developing countries has taken a new dimension and one that I would like to review more intensely. As some one from a developing country, these solutions appear to be much more possible than the mainstream solutions using web-based solutions.
  • WHO, Chronic Disease Management strategy planners, family physicians, researchers, policy makers, privacy and regulatory, cognitive and behavioural science personsThe management and control of chronic disease - highly dependent on self-efficacy and increasing ICT interventions are required to assist in motivating, monitoring, and self reporting of behaviours from patients’ home.World Health Organization (WHO)finds itself needing to deal with the new pandemic of obesityand its accompanying non-communicable diseases (NCDs) whilethe challenge of childhood malnutrition has far from disappeared,TB and malaria rates are escalating, and the scourge of AIDShas emerged. apart from educational campaigns, the governments and healthservices of poor countries will have few effective public healthlevers with which they can try to arrest the trend.
  • Systolic (SBP) and diastolic blood pressures (DBP) significantly decreased by 9.1 and7.2mmHgrespectively at 8weeks fromthe baseline in the intervention group (p < 0.05).There were significant mean decreases in body weight and waist circumferenceby 1.6 kg (p < 0.05) and 2.8cm (p < 0.05) in the intervention group. control group increases in body weight and waist circumference (p < 0.05) mean changeswere also significant.
  • High density lipoprotein cholesterol (HDL-C) significantly increased,with a mean change of 3.7 mg/dl at 8weeks frombaseline in the intervention group (p < 0.05).The mean change of HDL-C in the control group was, however, not significant.
  • key internal validity issue is the degree to which the groups are comparable before the Selection – Bias: when we know specifically what the group differenceSelection threat: any factor other than the program that leads to posttest differences between groups. participantsshould be able to measure blood pressure, take medicine, andinput data into the website by themselves as well as to havetheir own cellular phone.
  • Selection-History Threat: any other event that occurs between pretest and posttest that the groups experience differently.Selection-Maturation Threat: maturation implies the normal, ongoing developmental process that would take place.Selection Instrumentation Threat - nonrandom dropout between pretest and posttest.
  • Bias #2 (# of persons from this group with this information is unknown)
  • mobile phone to collect up to four different physiological joint effort by engineers at Loughborough Universityin the United Kingdom the India Institute of Technology Delhi(IIT Delhi), the All India Institute of Medical Sciences, Aligarh Muslim University and London’s Kingston University - signals from a freely moving patient, including ECG, blood pressure, oxygen saturation and blood glucose level.

Catch It Presentation   Ict Intervention For Obese Patients With Hypertension Catch It Presentation Ict Intervention For Obese Patients With Hypertension Presentation Transcript

  • Cellular phone and Internet-based individual intervention on blood pressure and obesity in obese patients with hypertension Park MJ, Kim HS, Kim KS (2009), Click to edit Master subtitle style Presented By: Plumaletta Berry HAD5726 University of Toronto October 5, 2009
  • Research Paper 5/10/2009 5/10/200924/10/09 22 2
  • About the Authors Hee-Seung Kim Professor Degree Ph.D. in nursing Major Adult nursing care College of Nursing, Catholic University, 505 Banpo-Dong, Socho-Gu, Seoul 137-701, South Korea Min-Jeong Park ** College of Nursing, Catholic University, 505 Banpo-Dong, Socho-Gu, Seoul 137-701, South Korea Kyung-Soo Kim ** Family Medicine & Integrative Medicine, Seoul St. Mary’s Hospital, Catholic University Medical Center, #505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea 5/10/2009 5/10/200924/10/09 33 3
  • Why is the paper interesting, why was it picked? The ICT Development Index. Measuring the Information Society. International Telecommunication Union, 2009 [http://www.itu.int/ITUD/ict/publications/idi/2009/material/IDI2009_w5.pdf] 5/10/2009 5/10/200924/10/09 44 4
  • About Chronic Disease Management (CDM) - WHO Perspective  Coordination and strengthening of global advocacy and communication on key messages, resource mobilization, and the development of partnerships.  Aim is to ensure increased prominence of chronic disease and health promotion issues on the global health agenda World Health Organization: Chronic diseases and health promotion 2009 [2009 October 2]; 5/10/2009 5/10/200924/10/09 online : http://www.who.int/chp/about/en/ Available 55 5
  • For whom is this paper interesting, and why? Key health care stakeholders : health promotion and chronic disease (CD) prevention and control - low cost but effective technological evidence-based interventions (both developed and developing countries). Why? • CD highly dependent on self-efficacy • Remote patient monitoring – motivation and intervention to promote adherence and self reporting of behaviours Potential for supporting health through information and communication technology (ICT) is increasingly recognized given the exponential growth in cellular phones around the world. A.M. Prentice, The emerging epidemic of obesity in developing countries, Int. J. Epidemiol. 35 (2006), pp. 93–99. Cited By in Scopus (105) 5/10/2009 5/10/200924/10/09 66 6
  • Intervention Usage of short message service (SMS) by cellular phone and Internet A quasi-experimental design with pre- and follow-up tests. Intervention group - should be able to measure blood pressure, take medicine, and input data web based diary through the Internet or by cellular phones by themselves. Researchers compare individual data with basic personal history, including historical data, family history, smoking habits, BMI, blood pressure, and baseline laboratory data. Sent optimal recommendations as an intervention to each patient, by both SMS on cellular phone and Internet weekly. Control Group: Did not log into the website and were only informed of the study Goal of intervention - bring blood pressure, body weight, and serum lipids 5/10/2009 levels close to normal ranges. 5/10/200924/10/09 77 77
  • Setting Location: Urban city of South Korea Family medicine outpatient department - tertiary care hospital Population: 28 patients - assigned to an intervention group 21 patients – assigned to a control group. Intervention - Logged into website whenever it was convenient group and wherever Internet access was possible by the Internet or cellular phone. Physician Visit: Both groups met the hypertension doctor (attending physician) - one or two times during the 8 weeks. Physician - no knowledge of group patient belonged to. 5/10/2009 5/10/200924/10/09 88 88
  • Outcome Measures Chi square test, t-test, and Fisher’s exact tests : Test for the homogeneity of demographic and clinical characteristics between the intervention and control groups. Repeated-measures analysis of variance (ANOVA) : Determine the difference between groups and over time. When a significant difference was found by repeated-measures ANOVA, paired t-tests with Bonferroni correction were applied to identify specific differences. 5/10/2009 The data were analyzed using the SAS (version 8.12, SAS Institute, Cary, NC) program. 5/10/200924/10/09 99 9
  • Results 5/10/2009 5/10/200924/10/09 10
  • Results Cont’d 5/10/2009 5/10/200924/10/09 11
  • Conclusions The intervention using SMS of cellular phone and Internet improved blood pressure, body weight, waist circumference, and HDL-C at 8 weeks in obese hypertensive patients. 5/10/2009 5/10/200924/10/09 12
  • Cited Related Publishings  M. Korhonen, M. Kastarinen, M. Uusitupa, P. Puska and A. Nissinen, The effect of intensified diet counseling on the diet of hypertensive subjects in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland, Prev. Med. 36 (2003), pp. 8–16. Abstract | PDF (72 K) | View Record in Scopus | Cited By in Scopus (14)  D.F. Tate, R.R. Wing and R.A. Winett, Using Internet technology to deliver a behavioral weight loss program, JAMA 285 (2001), pp. 1172–1177. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (246)  A.P. Nunes, A.C. Rios, G.A. Cunha, A.C. Barretto and C.E. Negrão, The effects of nonsupervised exercise program, via Internet, on blood pressure and body composition in normotensive and prehypertensive individuals, Arq. Bras. Cardiol. 86 (2006), pp. 289–296. View Record in Scopus | Cited By in Scopus (4)  A.G. Logan, W.J. McIsaac, A. Tisler, M.J. Irvine, A. Saunders, A. Dunai, C.A. Rizo, D.S. Feig, M. Hamill, M. Trudel and J.A. Cafazzo, Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients, Am. J. Hypertens. 20 (2007), pp. 942– 948. Article | PDF (475 K) | View Record in Scopus | Cited By in Scopus (10)  J. Morak, K. Schindler, E. Goerzer, P. Kastner, H. Toplak, B. Ludvik and G. Schreier, A pilot study of mobile phone-based therapy for obese patients, J. Telemed.Telecare 14 (2008), pp. 147– 149. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (1) 5/10/2009 5/10/200924/10/09 13
  • Articles Previously Published  S.I. Kim and H.S. Kim, Effectiveness of mobile and Internet intervention in patients with obese type 2 diabetes, Int. J. Med. Inform. 77 (2008), pp. 399–404. Article | PDF (367 K) | View Record in Scopus | Cited By in Scopus (4)  Kim & Jeong, 2007 H.S. Kim and H.S. Jeong, A short-message service by cellular phone in type-2 diabetic patients for six months, Journal of Clinical Nursing 16 (2007), pp. 1082–1087. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (10)  Yoon & Kim, 2007 K.H.Yoon and H.S. Kim, A short message service by cellular phone in type 2 diabetic patients for 12 months, Diabetes Research and Clinical Practice 79 (2007), pp. 256–261.  H.S. Kim, M.S. Song, Technological intervention for patients with obesity and type 2 diabetes,Appl. Nurs. Res. (2007), in press. Cited By in Scopus (2)  Kim, 2007 H.S. Kim, A randomized controlled trial of a nurse short-message service by cellular phone for people with diabetes, International Journal of Nursing Studies 44 (2007), pp. 687–692. Article | PDF (139 K) | View Record in Scopus | Cited By in Scopus (10)  H.S. Kwon, J.H. Cho, H.S. Kim, B.R. Song, S.H. Ko, J.M. Lee, S.R. Kim, S.A. Chang, H.S. Kim, B.Y. Cha, K.W. Lee, H.Y. Son, J.H. Lee,W.C. Lee and K.H.Yoon, Establishment of blood glucose monitoring system using the internet, Diab. Care 27 (2004), pp. 478–483. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (46)  S.A. Chang, H.S. Kim, K.H.Yoon, S.H. Ko, H.S. Kwon, S.R. Kim,W.C. Lee, S.J.Yoo, H.S. Son, B.Y. Cha, K.W. Lee, H.Y. Son and S.K. Kang, Body mass index is the most Important determining factor for the degree of insulin resistance in non-obese type 2 diabetic patients in Korea, Metabolism 53 (2004), pp. 142–146. Article | PDF (371 K) | View Record in Scopus | Cited By in Scopus (15) 5/10/2009 5/10/200924/10/09 14
  • What other authors have published before Article Authors Year Result Two-Year Internet-Based Williamson etal 2006 Randomized Weight loss during the first 6 Randomized Controlled Trial controlled trial months - did not yield long- for Weight Loss in African- term loss due to reduced use American Girls of the web site over time http://www.nature.com/oby/journal/v14/n7 /abs/oby2006140a.html Effectiveness of mobile and Kim SI, Kim 2007 quasi- Intervention using SMS of internet intervention in HS. experimental personal cellular phone and patients with obese type 2 design with pre- Internet improved HbA(1)c diabetes and follow-up and 2HPPT at 3, 6, 9, and 12 tests. months in patients with obese type 2 diabetes. An Internet-based diabetes Silje C. 2007 two-group, Study suggests that SE can self-care intervention tailored Wangberg 1-month function as a moderator in a to self-efficacy (SE) interval pre- behavioural intervention for http://her.oxfordjournals.org/cgi/rep test–post-test diabetes self-care, and hence rint/23/1/170 randomized that initial level of SE controlled trial provides relevant information for tailoring such interventions. 5/10/2009 5/10/200924/10/09 15
  • Background information Rationale for Research 1: Limitation of studies on the direct efficacy of the cellular phone or Internet-based system on improving blood pressure, weight control, and serum lipid for the patients with obese hypertension. Rationale for Research II: The high death rates attributable to cardiovascular disease in South Korea are partly due to failure to obtain adequate treatment and management of hypertension – what’s not written in the paper Population size from which sample was drawn If Participants known to each other (not a selection factor) No stated means of assuring confidentiality of information collected from clients provided in paper Reasons why 4 persons refused the test at the end of the 8 weeks Norman C, (2004) Response to CATCH-IT Report by Cameron Norman: Evaluation of an Internet-Based Smoking 5/10/2009 5/10/200924/10/09 Cessation Program: Lessons Learned From a Pilot Study" . J Med Internet Res. 2004 Oct–Dec; 6(4): e47. 16
  • Background information – Cont'd – what’s not written in the paper No method of accounting for alternative explanations or measure of efficacy was provided No indication if measurements were recorded or communicated by the physician during visits No mention of where measures were obtained from and literature to support these No link throughout paper back to the high death rates attributable to cardiovascular disease and failure to manage hypertension No specifics on theoretical approach used for this study eg. (Cognitive Behavioral Therapy (self- and supported treatment) and Social Cognitive Theory) both not explicitly stated Norman C, (2004) Response to CATCH-IT Report by Cameron Norman: Evaluation of an Internet-Based Smoking Cessation Program: Lessons Learned From a Pilot Study" . J Med Internet Res. 2004 Oct–Dec; 6(4): e47. 5/10/2009 5/10/200924/10/09 17
  • What are the methodological issues, and is the result valid? 5/10/2009 5/10/200924/10/09 18
  • Internal Validity  Selection bias  Patients selected based on specific criteria  Selection threat  Control group may become "contaminated" by accessing a similar intervention from somewhere else on the web - Ethical concerns re monitoring Eysenbach G, Issues in evaluating health websites in an Internet-based randomized controlled trial, J Med Internet Res 2002;4(3):e17 5/10/2009 5/10/200924/10/09 19 http://www.socialresearchmethods.net/kb/intmult.php
  • Internal Validity- Cont’d  Selection-History Threat  Physician may select to disclose particular information, or if the patient wished, nurse or dietician came to aid with more individualized and detailed information relating to lifestyle modification.  Selection-Maturation Threat  Intervention group may access to other sources of information or similar intervention program  Selection-Instrumentation Threat  Control group, four subjects refused the test at 8weeks 5/10/2009 5/10/200924/10/09 http://www.socialresearchmethods.net/kb/intmult.php 20
  • Internal Validity - Cont’d  Selection-Mortality Threat  Low sample size (control group below effect size and drop off rate differs)  Low statistical power will limit greatly the level of confidence in all inferences that might be drawn from this study’s results.  Social Interaction threats  Opportunity for researchers to introduce bias in the interaction with patients via the intervention as SMS tailored in a particular way 5/10/2009 http://www.socialresearchmethods.net/kb/intmult.php 5/10/200924/10/09 21
  • External Validity three major threats to external validity -- people, places or times.  Population controlled to urban city of one hospital total of 49 persons (Cannot Generalize) 5/10/2009 5/10/200924/10/09 22
  • Results Valid?  daily living can have substantial and variable effects on blood pressure  patient preparation and measurement technique  equipment used is often inaccurate: No indication if blood pressure instruments by patient were properly calibrated and validated instrument was used; similarly for the body weight scale  All data were self-reported, and there was no objective confirmation of any of the data reported here.  Serium Lipid measures –3 out of the 4 required had no significant change – short period of study 5/10/2009 http://www.swinburne.edu.au/hosting/ijets/journal/V6N2/pdf/Article3Beddows.pdf 5/10/200924/10/09 randomized Controlled trial J Med Internet Res 2002;4(3):e17 23 Eysenbach G, Issues in evaluating health websites in an Internet-based
  • What are the methodological issues, and is the result valid? "Correlation does not imply causation" Given the limits on control of factors reported for the intervention and the external/internal validity issues, results cannot determine whether this association was causal. RESULTS NOT VALID http://www.swinburne.edu.au/hosting/ijets/journal/V6N2/pdf/Article3Beddows.pdf 5/10/2009 5/10/200924/10/09 Eysenbach G, Issues in evaluating health websites in an Internet-based randomized Controlled trial J Med Internet Res 2002;4(3):e17 24
  • Learn from this study Stakeholder Lessons Health professionals Pursuit of better health outcomes:- - a regularly based education from the medical team and - continuous self-monitoring through ICT intervention may be used as a tool in changing patient’s behaviour for self care at home in the short term. Consumers Can benefit from an individualized approach in which the care plan was formulated according to each persons characteristics. Intervention may promote greater self efficacy in stimulating and motivating the patients to perform self plan more enthusiastically from home. 5/10/2009 5/10/200924/10/09 25
  • Learn from this study Stakeholder Lesson Policy makers Initial level of research provide relevant information for tailoring behavioural intervention for diabetes education and self-care. Assessing the potential value of innovations in ICT interventions to advance the management and prevention of chronic disease over a sustainable period Researchers Addition to the body of literature on behavioural change through online interventions and will prompt development of more in-depth research. Results must be taken with caution based on the methodological issues associated with research. Inadequacies of the research will ease constraints previously associated with social research 5/10/2009 5/10/200924/10/09 26
  • What further research is required? Future work should explore whether long-term follow-up for a randomized controlled population using an intervention of SMS by cellular phone and Internet would affect the measurable factors of the patients with obese hypertension. This should evaluate if adherence to behaviour in self reporting of these factors would be sustainably over time or whether the association between use of the program and improved outcomes is causal. 5/10/2009 5/10/200924/10/09 27
  • What questions for the author arise? How were selection criteria for the measures determined? How was hypertension self-efficacy measured? How did you assure that the intervention group was actually using the intervention? How did you control for data quality? How do you propose researchers address the issue of validating self-reporting using remotely-delivered interventions? How did they determine persons who knew how to enter data using a computer versus the persons who didnot? Was the web-based diary developed on the guidelines for interactive health communication from SciPICH3 ? Will there be any follow-up research done on this and what is the period considered for the pre and post test? 5/10/2009 5/10/200924/10/09 28
  • 5/10/2009 5/10/200924/10/09 29
  • Blog Comments Summary  Generalizeability of the study to the general population is questionable.  Limited time period to examine lifestyle change - law of attrition  Sample not randomize – selection bias  Impact of study - general idea about entering data into a website, intervention not clearly defined  comparison between a face-to-face intervention and an online service is not part of the original objective of the study  Self reporting by the intervention group may not yield the most accurate data. 5/10/2009 5/10/200924/10/09 30
  • QUESTIONS?? 5/10/200924/10/09 31