Browsing by Author "Gibson, Oliver"
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- ItemAcceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus.(2014-12-31) Hirst, Jane E; Mackillop, Lucy; Loerup, Lise; Kevat, Dev A; Bartlett, Katy; Gibson, Oliver; Kenworthy, Yvonne; Levy, Jonathan C; Tarassenko, Lionel; Farmer, AndrewThe increase in gestational diabetes mellitus GDM is challenging maternity services We have developed an interactive smartphone based remote blood glucose BG monitoring system GDm health The objective was to determine women s satisfaction with using the GDm health system and their attitudes toward their diabetes care In a service development program involving 52 pregnant women September 2012 to June 2013 BG was monitored using GDm health from diagnosis until delivery Following birth women completed a structured questionnaire assessing 1 general satisfaction 2 equipment issues and 3 relationship with the diabetes care team Responses were scored on a 7 point Likert type scale Reliability and validity of the questionnaire were assessed using statistical methods Of 52 women 49 completed the questionnaire 32 had glucose tolerance test confirmed GDM gestation at recruitment 29 4 weeks mean SD and 17 women previous GDM recommended for BG monitoring 18 6 weeks In all 45 of 49 women agreed their care was satisfactory and the best for them 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively 42 of 49 agreed GDm health fitted into their lifestyle and 46 of 49 agreed they had a good relationship with their care team Written comments supported these findings with very positive reactions from the majority of women Cronbach s alpha was 89 with factor analysis corresponding with question thematic trends This pilot demonstrates that GDm health is acceptable and convenient for a large proportion of women Effects on clinical and economic outcomes are currently under investigation in a randomized trial clinicaltrials gov NCT01916694
- ItemComparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial.(0000-00-00) Mackillop, Lucy; Hirst, Jane Elizabeth; Bartlett, Katy Jane; Birks, Jacqueline Susan; Clifton, Lei; Farmer, Andrew J; Gibson, Oliver; Kenworthy, Yvonne; Levy, Jonathan Cummings; Loerup, Lise; Rivero-Arias, Oliver; Ming, Wai-Kit; Velardo, Carmelo; Tarassenko, LionelBACKGROUND Treatment of hyperglycemia in women with gestational diabetes mellitus GDM is associated with improved maternal and neonatal outcomes and requires intensive clinical input This is currently achieved by hospital clinic attendance every 2 to 4 weeks with limited opportunity for intervention between these visits OBJECTIVE We conducted a randomized controlled trial to determine whether the use of a mobile phone based real time blood glucose management system to manage women with GDM remotely was as effective in controlling blood glucose as standard care through clinic attendance METHODS Women with an abnormal oral glucose tolerance test before 34 completed weeks of gestation were individually randomized to a mobile phone based blood glucose management solution GDm health the intervention or routine clinic care The primary outcome was change in mean blood glucose in each group from recruitment to delivery calculated with adjustments made for number of blood glucose measurements proportion of preprandial and postprandial readings baseline characteristics and length of time in the study RESULTS A total of 203 women were randomized Blood glucose data were available for 98 intervention and 85 control women There was no significant difference in rate of change of blood glucose 0 16 mmol L in the intervention and 0 14 mmol L in the control group per 28 days P 78 Women using the intervention had higher satisfaction with care P 049 Preterm birth was less common in the intervention group 5 101 5 0 vs 13 102 12 7 OR 0 36 95 CI 0 12 1 01 There were fewer cesarean deliveries compared with vaginal deliveries in the intervention group 27 101 26 7 vs 47 102 46 1 P 005 Other glycemic maternal and neonatal outcomes were similar in both groups The median time from recruitment to delivery was similar intervention 54 days control 49 days P 23 However there were significantly more blood glucose readings in the intervention group mean 3 80 SD 1 80 and mean 2 63 SD 1 71 readings per day in the intervention and control groups respectively PUnder 001 There was no significant difference in direct health care costs between the two groups with a mean cost difference of the intervention group compared to control of 1044 95 CI 2186 to 99 There were no unexpected adverse outcomes CONCLUSIONS Remote blood glucocse monitoring in women with GDM is safe We demonstrated superior data capture using GDm health Although glycemic control and maternal and neonatal outcomes were similar women preferred this model of care Further studies are required to explore whether digital health solutions can promote desired self management lifestyle behaviors and dietetic adherence and influence maternal and neonatal outcomes Digital blood glucose monitoring may provide a scalable practical method to address the growing burden of GDM around the world TRIAL REGISTRATION ClinicalTrials gov NCT01916694 https clinicaltrials gov ct2 show NCT01916694 Archived by WebCite at http www webcitation org 6y3lh2BOQ
- ItemA pilot study: dose adaptation of capecitabine using mobile phone toxicity monitoring - supporting patients in their homes.(2014-09-04) Weaver, Andrew; Love, Sharon B; Larsen, Mark; Shanyinde, Milensu; Waters, Rachel; Grainger, Lisa; Shearwood, Vanessa; Brooks, Claire; Gibson, Oliver; Young, Annie M; Tarassenko, LionelPURPOSE Real time symptom monitoring using a mobile phone is potentially advantageous for patients receiving oral chemotherapy We therefore conducted a pilot study of patient dose adaptation using mobile phone monitoring of specific symptoms to investigate relative dose intensity of capecitabine level of toxicity and perceived supportive care METHODS Patients with breast or colorectal cancer receiving capecitabine completed a symptom temperature and dose diary twice a day using a mobile phone application This information was encrypted and automatically transmitted in real time to a secure server with moderate levels of toxicity automatically prompting self care symptom management messages on the screen of the patient s mobile phone or in severe cases a call from a specialist nurse to advise on care according to an agreed protocol RESULTS Patients n 26 completed the mobile phone diary on 92 6 of occasions Twelve patients had a maximum toxicity grade of 3 46 2 The average dose intensity for all patients as a percentage of standard dose was 90 In eight patients the dose of capecitabine was reduced and in eight patients the dose of capecitabine was increased Patients and healthcare professionals involved felt reassured by the novel monitoring system in particular during out of hours CONCLUSION It is possible to optimise the individual dose of oral chemotherapy safely including dose increase and to manage chemotherapy side effects effectively using real time mobile phone monitoring of toxicity parameters entered by the patient
- ItemA real-time, mobile phone-based telemedicine system to support young adults with type 1 diabetes.(2005-11-01) Farmer, Andrew; Gibson, Oliver; Hayton, Paul; Bryden, Kathryn; Dudley, Christina; Neil, Andrew; Tarassenko, LionelTelemedicine systems have been proposed as a means of supporting people with diabetes in the self management of their condition Requirements for monitoring parameters of care including glycaemic control extent of analysis and interpretation of data patient clinician contacts and involvement of a multidisciplinary care team with effective communication can be addressed by telemedicine systems We describe the development and implementation of an innovative real time telemedicine system based around transmission and feedback of data to and from a mobile phone Proprietary Java based programs were used to link a blood glucose meter to a mobile phone In addition to immediate transmission of blood glucose data information about insulin dose eating patterns and physical exercise were collected Immediate feedback to the phone included a colour histogram to draw attention to levels of control over glycaemia over the previous two weeks Clinicians supporting patients had access to summary screens identifying users not testing and those with levels of blood glucose outside pre defined limits More detailed graphical displays of data were used to provide data about control of insulin dose and the degree to which it was modified in response to diet and exercise The system has been evaluated in a clinical trial conducted in secondary care and is now being adapted for use in a trial in primary care which is designed to assess its effectiveness in providing integrated management for the patient general practitioner and pharmacist
- ItemStepwise self-titration of oral glucose-lowering medication using a mobile telephone-based telehealth platform in type 2 diabetes: a feasibility trial in primary care.(2013-02-26) Nagrebetsky, Alexander; Larsen, Mark; Craven, Anthea; Turner, Jane; McRobert, Nicky; Murray, Elizabeth; Gibson, Oliver; Neil, Andrew; Tarassenko, Lionel; Farmer, AndrewBACKGROUND Telehealth supported clinical interventions may improve diabetes self management We explored the feasibility of stepwise self titration of oral glucose lowering medication guided by a mobile telephone based telehealth platform for improving glycemic control in type 2 diabetes METHODS We recruited 14 type 2 diabetes patients to a one year feasibility study with 1 1 randomization Intervention group patients followed a stepwise treatment plan for titration of oral glucose lowering medication with self monitoring of glycemia using real time graphical feedback on a mobile telephone and remote nurse monitoring using a Web based tool We carried out an interim analysis at 6 months RESULTS We screened 3476 type 2 diabetes patients 94 of the ineligible did not meet the eligibility criteria for hemoglobin A1c HbA1c or current treatment Mean standard deviation patient age at baseline was 58 11 years HbA1c was 65 12 mmol mol 8 1 1 1 body mass index was 32 9 6 4 kg m2 median interquartile range IQR diabetes duration was 2 6 0 6 to 4 7 years and 10 71 were men The median IQR change in HbA1c from baseline to six months was 10 21 to 3 mmol mol 0 9 1 9 to 0 in the intervention group and 5 13 to 6 mmol mol 0 5 1 2 to 0 6 in the control group Six out of seven intervention group patients and four out of seven control group patients changed their oral glucose lowering medication p 24 CONCLUSIONS Self titration of oral glucose lowering medication in type 2 diabetes with self monitoring and remote monitoring of glycemia is feasible and further studies using adapted recruitment strategies are required to evaluate whether it improves clinical outcomes