Browsing by Author "Tarassenko, Lionel"
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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
- ItemChemotherapy side-effect management using mobile phones.(2009-02-16) Larsen, Mark E; Rowntree, Joanna; Young, Annie M; Pearson, Sarah; Smith, Justine; Gibson, Oliver J; Weaver, Andrew; Tarassenko, LionelColorectal cancer is a major health problem in developed countries accounting for a significant proportion of deaths in the population Advances in chemotherapy treatment have led to therapy being delivered in the home setting which presents challenges in ensuring that treatment related side effects are detected and reported to clinical staff in an appropriate time frame A telemedicine system has been developed using a mobile phone platform to allow patients to complete symptom diaries which trigger alerts paged to their nurse in the event of severe side effects Six patients used this system for two cycles of oral chemotherapy Two cases of moderate symptoms deteriorating to more severe conditions were observed and individual self care and treatment advice were presented to these patients
- ItemClinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial.(2012-03-26) Ryan, Dermot; Price, David; Musgrave, Stan D; Malhotra, Shweta; Lee, Amanda J; Ayansina, Dolapo; Sheikh, Aziz; Tarassenko, Lionel; Pagliari, Claudia; Pinnock, HilaryOBJECTIVE To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies DESIGN Multicentre randomised controlled trial with cost effectiveness analysis SETTING UK primary care PARTICIPANTS 288 adolescents and adults with poorly controlled asthma asthma control questionnaire ACQ score 1 5 from 32 practices INTERVENTION Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms drug use and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring MAIN OUTCOME MEASURES Changes in scores on asthma control questionnaire and self efficacy knowledge attitude and self efficacy asthma questionnaire KASE AQ at six months after randomisation Assessment of outcomes was blinded Analysis was on an intention to treat basis RESULTS There was no significant difference in the change in asthma control or self efficacy between the two groups ACQ mean change 0 75 in mobile group v 0 73 in paper group mean difference in change 0 02 95 confidence interval 0 23 to 0 19 KASE AQ score mean change 4 4 v 2 4 mean difference 2 0 0 3 to 4 2 The numbers of patients who had acute exacerbations steroid courses and unscheduled consultations were similar in both groups with similar healthcare costs Overall the mobile phone service was more expensive because of the expenses of telemonitoring CONCLUSIONS Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards The mobile technology was not cost effective TRIAL REGISTRATION Clinical Trials NCT00512837
- 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
- ItemThe CYMPLA trial. Mobile phone-based structured intervention to achieve asthma control in patients with uncontrolled persistent asthma: a pragmatic randomised controlled trial.(2009-11-30) Ryan, Dermot; Pinnock, Hilary; Lee, Amanda J; Tarassenko, Lionel; Pagliari, Claudia; Sheikh, Aziz; Price, David
- ItemEfficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial.(2014-02-03) Bobrow, Kirsty; Brennan, Thomas; Springer, David; Levitt, Naomi S; Rayner, Brian; Namane, Mosedi; Yu, Ly-Mee; Tarassenko, Lionel; Farmer, AndrewBACKGROUND Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes but delivery on a wide scale and at low cost is challenging Some trials evaluating clinical interventions using short message service SMS text messaging systems have shown important outcomes although evidence is limited We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low resource setting We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care METHODS DESIGN The SMS Text message Adherence suppoRt trial StAR is a pragmatic individually randomised three arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town South Africa The intervention is a structured programme of clinic appointment medication pick up reminders medication adherence support and hypertension related education delivered remotely using an automated system with either informational or interactive SMS text messages Usual care is supplemented by infrequent non hypertension related SMS text messages Participants are 1 1 1 individually randomised to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender age baseline systolic blood pressure years with hypertension and previous clinic attendance The primary outcome is the change in mean systolic blood pressure at 12 month follow up from baseline measured with research staff blinded to trial allocation Secondary outcomes include the proportion of patients with 80 or more of days medication available proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg hospital admissions health status retention in clinical care satisfaction with treatment and care and patient related quality of life Anonymised demographic data are collected on non participants DISCUSSION The StAR trial uses a novel low cost system based on widely available mobile phone technology to deliver the SMS based intervention manage communication with patients and measure clinically relevant outcomes The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low resource setting TRIAL REGISTRATION NCT02019823
- ItemImplementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study.(2009-06-03) Turner, Jane; Larsen, Mark; Tarassenko, Lionel; Neil, Andrew; Farmer, AndrewBACKGROUND Initiating and adjusting insulin treatment for people with type 2 diabetes T2D requires frequent clinician contacts both face to face and by telephone We explored the use of a telehealth system to offer additional support to these patients METHODS Twenty three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment The intervention included a standard algorithm for self titration of insulin dose a Bluetooth enabled glucose meter linked to a mobile phone an integrated diary to record insulin dose feedback of charted blood glucose data and telehealth nurse review with telephone follow up Additional contact with patients was initiated when no readings were transmitted for 3 days or when persistent hyper or hypoglycaemia was identified Reponses of patients and clinicians to the system were assessed informally RESULTS The mean SD patient age was 58 years 12 with 78 male The mean SD diabetes duration was 6 4 years 4 5 HbA1c at baseline was 9 5 2 2 and the decrease in HbA1c at three months was 0 52 0 91 with an insulin dose increase of 9 units 26 A mean SD of 160 93 blood glucose readings was transmitted per patient in these three months Practice nurses and general practitioners GPs viewed the technology as having the potential to improve patient care Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse CONCLUSIONS Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses the technology improved the support available for T2D patients commencing insulin treatment
- ItemMobile health for drug dose optimisation.(2012-01-18) Larsen, Mark E; Farmer, Andrew; Weaver, Andrew; Young, Annie; Tarassenko, LionelMobile health monitoring in the management of long term conditions has potential benefits for patient care especially when coupled with active adjustment of medication dosage We report studies of patient led self titration of oral glucose lowering medication OGLM and insulin in type 2 diabetes and dose adjustments including dose increases in oral chemotherapy for metastatic colorectal or breast cancer Monitoring compliance was high in each case and the feasibility of patients self titrating OGLM or insulin following an agreed treatment plan was demonstrated Chemotherapy dose increases supported by detailed toxicity profiles collected by phone have also been demonstrated
- ItemAn Optimised Algorithm for Accurate Steps Counting From Smart-Phone Accelerometry.(0000-00-00) Salvi, Dario; Velardo, Carmelo; Brynes, Jamieson; Tarassenko, LionelStep counting from smart phones allows a wide range of applications related to fitness and health Estimating steps from phones accelerometers is challenging because of the multitude of ways a smart phone can be carried We focus our work on the windowed peak detection algorithm which has previously been shown to be accurate and efficient and thus suitable for mobile devices We explore and optimise further the algorithm and its parameters making use of data collected by three volunteers holding the phone in six different positions In order to simplify the analysis of the data we also built a novel device for the detection of the ground truth steps Over the collected data set the algorithm reaches 95 average accuracy We implemented the algorithm for the Android OS and released it as an open source project A separate dataset was collected with the algorithm running on the smart phone for further validation The validation confirms the accuracy of the algorithm in real time conditions
- 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 randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446).(2005-10-26) Farmer, Andrew J; Gibson, Oliver J; Dudley, Christina; Bryden, Kathryn; Hayton, Paul M; Tarassenko, Lionel; Neil, AndrewTo determine whether a system of telemedicine support can improve glycemic control in type 1 diabetes
- 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
- ItemSMARTHealth India: Development and Field Evaluation of a Mobile Clinical Decision Support System for Cardiovascular Diseases in Rural India.(2014-12-09) Praveen, Devarsetty; Patel, Anushka; Raghu, Arvind; Clifford, Gari D; Maulik, Pallab K; Mohammad Abdul, Ameer; Mogulluru, Kishor; Tarassenko, Lionel; MacMahon, Stephen; Peiris, DavidBACKGROUND Cardiovascular disease CVD is the major cause of premature death and disability in India and yet few people at risk of CVD are able to access best practice health care Mobile health mHealth is a promising solution but very few mHealth interventions have been subjected to robust evaluation in India OBJECTIVE The objectives were to develop a multifaceted mobile clinical decision support system CDSS for CVD management and evaluate it for use by public nonphysician health care workers NPHWs and physicians in a rural Indian setting METHODS Plain language clinical rules were developed based on standard guidelines and programmed into a computer tablet app The algorithm was validated and field tested in 11 villages in Andhra Pradesh involving 11 NPHWs and 3 primary health center PHC physicians A mixed method evaluation was conducted comprising clinical and survey data and in depth patient and staff interviews to understand barriers and enablers to the use of the system Then this was thematically analyzed using NVivo 10 RESULTS During validation of the algorithm there was an initial agreement for 70 of the 42 calculated variables between the CDSS and SPSS software outputs Discrepancies were identified and amendments were made until perfect agreement was achieved During field testing NPHWs and PHC physicians used the CDSS to screen 227 and 65 adults respectively The NPHWs identified 39 88 227 of patients for referral with 78 69 88 of these having a definite indication for blood pressure BP lowering medication However only 35 24 69 attended a clinic within 1 month of referral with 42 10 24 of these reporting continuing medications at 3 month follow up Physicians identified and recommended 17 11 65 of patients for BP lowering medications Qualitative interviews identified 3 interrelated interview themes 1 the CDSS had potential to change prevailing health care models 2 task shifting to NPHWs was the central driver of change and 3 despite high acceptability by end users actual transformation was substantially limited by system level barriers such as patient access to doctors and medicines CONCLUSIONS A tablet based CDSS implemented within primary health care systems has the potential to help improve CVD outcomes in India However system level barriers to accessing medical care limit its full impact These barriers need to be actively addressed for clinical innovations to be successful TRIAL REGISTRATION Clinical Trials Registry of India CTRI 2013 06 003753 http ctri nic in Clinicaltrials showallp php mid1 6259AndEncHid 51761 70513AnduserName CTRI 2013 06 003753 Archived by WebCite at http www webcitation org 6UBDlrEuq
- 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
- ItemTelemedicine-supported insulin optimisation in primary care.(2010-11-25) Larsen, Mark E; Turner, Jane; Farmer, Andrew; Neil, Andrew; Tarassenko, LionelWe investigated the feasibility of a mobile phone based system for patients with type 2 diabetes who had recently commenced insulin therapy but remained poorly controlled The system was evaluated in a feasibility study in a general practice setting with 23 patients over six months A total of 22 patients successfully completed the study and used the system for a mean of 217 days range 162 376 Blood glucose control improved as reflected by a mean decrease in HbA 1c of 0 66 P 0 05 with the mean insulin dose increasing by 17 units P 0 006 Blood glucose monitoring compliance was high with readings available for 6 2 days per week although use of the mobile phone decreased during the study On average the mobile phone diary was used for 3 5 days per week Insulin dose adjustments were made throughout the study by all patients but not as frequently as would be expected for the degree of hyperglycaemia observed
- ItemUsing a mobile health application to support self-management in COPD: a qualitative study.(2014-07-01) Williams, Veronika; Price, Jonathan; Hardinge, Maxine; Tarassenko, Lionel; Farmer, AndrewBACKGROUND Telehealth shows promise for supporting patients in managing their long term health conditions such as chronic obstructive pulmonary disease COPD However it is currently unclear how patients and particularly older people may benefit from these technological interventions AIM To explore patients expectations and experiences of using a mobile telehealth based mHealth application and to determine how such a system may impact on their perceived wellbeing and ability to manage their COPD DESIGN AND SETTING Embedded qualitative study using interviews with patients with COPD from various community NHS services respiratory community nursing service general practice and pulmonary rehabilitation METHOD An embedded qualitative study was conducted to which patients were recruited using purposive sampling to achieve maximum variation Interviews were carried out prior to receiving the mHealth system and again after a 6 month period Data were analysed using a grounded theory approach RESULTS The sample comprised 19 patients aged 50 85 years with varied levels of computer skills Patients identified no difficulties in using the mHealth application The main themes encapsulating patients experience of using the mHealth application related to an increased awareness of the variability of their symptoms onset of exacerbation and recovery time and reassurance through monitoring continuity of care CONCLUSION Patients were able to use the mHealth application interpret clinical data and use these within their self management approach regardless of previous knowledge Telehealth interventions can complement current clinical care pathways to support self management behaviour