Browsing by Author "Greenfield, Geva"
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- ItemAmerican Heart Association's Cholesterol CarePlan as a Smartphone-Delivered Web App for Patients Prescribed Cholesterol-Lowering Medication: Protocol for an Observational Feasibility Study.(0000-00-00) Woringer, Maria; Dharmayat, Kanika I; Greenfield, Geva; Bottle, Alex; Ray, Kausik KBACKGROUND Adoption of healthy lifestyle and compliance with cholesterol lowering medication reduces the risk of cardiovascular disease CVD The use of digital tools and mobile technology may be important for sustaining positive behavioral change OBJECTIVE The primary objective of this study is to evaluate the feasibility and acceptability of administering the Cholesterol CarePlan Web app developed by the American Heart Association aimed at improving lifestyle and medication adherence among patients prescribed cholesterol lowering medication The secondary objective is to assess the Web app s efficacy METHODS A prospective observational feasibility study will be conducted to demonstrate whether the Web app may be successfully taken up by patients and will be associated with improved clinical and behavioral outcomes The study will aim to recruit 180 study participants being prescribed cholesterol lowering medication for at least 30 days across 14 general practices in London England Potentially eligible patients will be invited to use the Web app on a smartphone and visit general practice for three 20 minute clinical assessments of blood pressure height weight smoking and nonfasting cholesterol over 24 weeks The feasibility of administering the Web app will be judged by recruitment and dropout statistics and the sociodemographic and comorbidity profile of consenting study participants consenting nonparticipants and all potentially eligible patients Acceptability will be assessed using patients readiness to embrace new technologies the usability of the Web app and patient satisfaction The efficacy of the Web app will be assessed by changes in medication adherence and clinical risk factors by levels of the Web app compliance RESULTS This study is currently funded by the American Heart Association Initial study recruitment will take place between February and July 2018 followed by patient follow up Patient level data will be obtained in January 2019 Data analysis will be completed by February 2019 Results will be submitted for publication in March 2019 CONCLUSIONS The potential of an app to improve patients lifestyle and management of cholesterol may inform the design of a randomized controlled trial and the delivery of more effective CVD prevention programs INTERNATIONAL REGISTERED REPORT IDENTIFIER IRRID PRR1 10 2196 9017
- ItemThe impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials.(0000-00-00) Lee, Puikwan A; Greenfield, Geva; Pappas, YannisBACKGROUND There is a growing body of evidence to support the use of telehealth in monitoring HbA1c levels in people living with type 2 diabetes However the overall magnitude of effect is yet unclear due to variable results reported in existing systematic reviews The objective of this study is to conduct a systematic review and meta analysis of systematic reviews of randomised controlled trials to create an evidence base for the effectiveness of telehealth interventions on glycemic control in adults with type 2 diabetes METHODS Electronic databases including The Cochrane Library MEDLINE EMBASE HMIC and PsychINFO were searched to identify relevant systematic reviews published between 1990 and April 2016 supplemented by references search from the relevant reviews Two independent reviewers selected and reviewed the eligible studies Of the 3279 references retrieved 4 systematic reviews reporting in total 29 unique studies relevant to our review were included Both conventional pairwise meta analyses and network meta analyses were performed RESULTS Evidence from pooling four systematic reviews found that telehealth interventions produced a small but significant improvement in HbA1c levels compared with usual care MD 0 55 95 CI 0 73 to 0 36 The greatest effect was seen in telephone delivered interventions followed by Internet blood glucose monitoring system interventions and lastly interventions involving automatic transmission of SMBG using a mobile phone or a telehealth unit CONCLUSION Current evidence suggests that telehealth is effective in controlling HbA1c levels in people living with type 2 diabetes However there is need for better quality primary studies as well as systematic reviews of RCTs in order to confidently conclude on the impact of telehealth on glycemic control in type 2 diabetes
- ItemSmartphone and tablet self management apps for asthma.(2013-12-02) Marcano Belisario, José S; Huckvale, Kit; Greenfield, Geva; Car, Josip; Gunn, Laura HBACKGROUND Asthma is one of the most common long term conditions worldwide which places considerable pressure on patients communities and health systems The major international clinical guidelines now recommend the inclusion of self management programmes in the routine management of patients with asthma These programmes have been associated with improved outcomes in patients with asthma However the implementation of self management programmes in clinical practice and their uptake by patients is still poor Recent developments in mobile technology such as smartphone and tablet computer apps could help develop a platform for the delivery of self management interventions that are highly customisable low cost and easily accessible OBJECTIVES To assess the effectiveness cost effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management of individuals with asthma SEARCH METHODS We searched the Cochrane Airways Group Register CAGR the Cochrane Central Register of Controlled Trials CENTRAL MEDLINE EMBASE PsycINFO CINAHL Global Health Library Compendex Inspec Referex IEEEXplore ACM Digital Library CiteSeer x and CAB abstracts via Web of Knowledge We also searched registers of current and ongoing trials and the grey literature We checked the reference lists of all primary studies and review articles for additional references We searched for studies published from 2000 onwards The latest search was run in June 2013 SELECTION CRITERIA We included parallel randomised controlled trials RCTs that compared self management interventions for patients with clinician diagnosed asthma delivered via smartphone apps to self management interventions delivered via traditional methods e g paper based asthma diaries DATA COLLECTION AND ANALYSIS We used standard methods expected by the Cochrane Collaboration Our primary outcomes were symptom scores frequency of healthcare visits due to asthma exacerbations or complications and health related quality of life MAIN RESULTS We included two RCTs with a total of 408 participants We found no cluster RCTs controlled before and after studies or interrupted time series studies that met the inclusion criteria for this systematic review Both RCTs evaluated the effect of a mobile phone based asthma self management intervention on asthma control by comparing it to traditional paper based asthma self management One study allowed participants to keep daily entries of their asthma symptoms asthma medication usage peak flow readings and peak flow variability on their mobile phone from which their level of asthma control was calculated remotely and displayed together with the corresponding asthma self management recommendations In the other study participants recorded the same readings twice daily and they received immediate self management feedback in the form of a three colour traffic light display on their phones Participants falling into the amber zone of their action plan twice or into the red zone once received a phone call from an asthma nurse who enquired about the reasons for their uncontrolled asthma We did not conduct a meta analysis of the data extracted due to the considerable degree of heterogeneity between these studies Instead we adopted a narrative synthesis approach Overall the results were inconclusive and we judged the evidence to have a GRADE rating of low quality because further evidence is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate In addition there was not enough information in one of the included studies to assess the risk of bias for the majority of the domains Although the other included study was methodologically rigorous it was not possible to blind participants or personnel in the study Moreover there are concerns in both studies in relation to attrition bias and other sources of bias One study showed that the use of a smartphone app for the delivery of an asthma self management programme had no statistically significant effect on asthma symptom scores mean difference MD 0 01 95 confidence interval CI 0 23 to 0 25 asthma related quality of life MD of mean scores 0 02 95 CI 0 35 to 0 39 unscheduled visits to the emergency department OR 7 20 95 CI 0 37 to 140 76 or frequency of hospital admissions odds ratio OR 3 07 95 CI 0 32 to 29 83 The other included study found that the use of a smartphone app resulted in higher asthma related quality of life scores at six month follow up MD 5 50 95 CI 1 48 to 9 52 for the physical component score of the SF 12 questionnaire MD 6 00 95 CI 2 51 to 9 49 for the mental component score of the SF 12 questionnaire improved lung function PEFR at four MD 27 80 95 CI 4 51 to 51 09 five MD 31 40 95 CI 8 51 to 54 29 and six months MD 39 20 95 CI 16 58 to 61 82 and reduced visits to the emergency department due to asthma related complications OR 0 20 95 CI 0 04 to 0 99 Both studies failed to find any statistical differences in terms of adherence to the intervention and occurrence of other asthma related complications AUTHORS CONCLUSIONS The current evidence base is not sufficient to advise clinical practitioners policy makers and the general public with regards to the use of smartphone and tablet computer apps for the delivery of asthma self management programmes In order to understand the efficacy of apps as standalone interventions future research should attempt to minimise the differential clinical management of patients between control and intervention groups Those studies evaluating apps as part of complex multicomponent interventions should attempt to tease out the relative contribution of each intervention component Consideration of the theoretical constructs used to inform the development of the intervention would help to achieve this goal Finally researchers should also take into account the role of ancillary components in moderating the observed effects the seasonal nature of asthma and long term adherence to self management practices