Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

Parker S, Prince A, Thomas L On behalf of the IMPACT Study Group, et al. Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis. BMJ Open 2018;8:e019192. doi: 10.1136/bmjopen-2017-019192

The objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.

Setting and participants: Studies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.

Results: Eighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.

Conclusions: Research incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

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UK Space Agency & NHS England call for innovators to develop space tech to address major health and care challenges

NHS England | 2018| NHS England and UK Space Agency launch multi-million pound drive to improve patient care

As part of a joint initiative with NHS England, The UK Space Agency has announced a £4 million of funding that it is allocating to the NHS.  The funding is available to help address four  specific health and care challenges in the NHS.

These include:

  • Managing long term conditions including joining up health and care services
  • Earlier diagnosis of cancer
  • Transforming GP services and other primary care
  • Meeting mental health needs

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The initiative exists to design for use in space will be adapted into medical applications to improve NHS treatment and care. The four successful innovators will be supported by the UK Space Agency, NHS England and the European Space Agency

Space technology has a history of being utilised in the NHS, notable examples include a pill camera that patients swallow, wearables to prevent falls among the elderly, apps that help to prevent skin cancer, breast screening vans that send images to assessment centres

Professor Tony Young, NHS England’s national clinical director for innovation, said: “Throughout its 70 year history the NHS has been at the forefront of healthcare innovation.

“Through this competition we are seeking the latest greatest, ideas and technical solutions to help address the modern challenges facing our health and care services.”

The UK’s space industry builds 40 per cent of the world’s small satellites and 25 per cent of the world’s telecommunications satellites. It supports 40,000 jobs and generates £14 billion in revenue across the country.

Full details on how to become involved are available  from NHS England here

Dementia patients could remain at home longer thanks to ground breaking technology

Innovative new technology could enable people with dementia to receive round the clock observation and live independently in their own homes, a new study reports. | University of Surrey | via ScienceDaily

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Researchers from the University of Surrey in partnership with Surrey and Borders Partnership NHS Foundation Trust have developed state of the art Artificial  technologies, powered by machine learning algorithms, to monitor the wellbeing of people with dementia.

The study known as Technology Integrated Health Management (TIHM) for dementia, uses the ‘Internet of Things,’ a network of internet enabled devices (sensors, monitors and trackers) installed in homes, which can detect an immediate crisis as well as changes in people’s health and daily routines. Any change could indicate a potential health issue and if identified early could prevent a person from becoming seriously unwell and requiring emergency hospital admission.

The well-being of people with dementia can also be monitored using this innovative technology which can detect agitation and irritability.

Full story at ScienceDaily

Journal reference:  Shirin Enshaeifar, S. et al. | Health management and pattern analysis of daily living activities of people with dementia using in-home sensors and machine learning techniques | PLOS ONE |  2018; 13 (5):

 

 

NHS England scheme discovers four new innovations that will benefit patients

NHS England | April 2018 | Heart patients among those to benefit as NHS England backs innovation

A scheme run by NHS England to identify and fast track specific innovations into the NHS  is now in its second year.  It delivers improvements in patient care by cutting bureaucracy for clinicians and other innovators and encouraging uptake through the NHS. NHS England has just announced four innovations that have the potential to benefit patients.  Among the innovations is image analysis software that creates a 3D model of the heart and could prevent up to 35,000 patients a year undergoing invasive tests.  Other innovations identified include a suture which is designed to reduce infections, a new device that will reduce the number of infections from catheters and a ‘bowel scope’ to improve colorectal examinations.

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  • HeartFlow – Advanced image analysis software that creates a 3D model of the coronary arteries and analyses the impact that blockages have on blood flow to rapidly diagnose patients with suspected coronary artery disease. The use of the device can avoid the need for invasive investigations such as coronary angiography, usually carried out under local anaesthetic, where a catheter is passed through the blood vessels to the heart to release a dye before X-rays are taken. NICE estimate up to 35,000 people per year could be eligible.
  • Plus Sutures – A new type of surgical suture – stitching – that reduces the rate of surgery-linked infection (surgical site infection) such as MRSA, through the use of antimicrobial suture packs. There were 823 cases of MRSA reported in the NHS in 2016/17.
  • Endocuff Vision – A new type of ‘bowel scope’ that improves colorectal examination for patients undergoing bowel cancer tests. Bowel cancer is the fourth most common cancer in England with 34,000 people diagnosed each year. For every 1,000 people screened for cancer, it is estimated that six cases could be avoided thanks to early detection through the use of this device.
  • SecurAcath – A device to secure catheters that reduces the infection risk for patients with a peripherally inserted central catheter. The use of this equipment helps to reduce the time taken to care and treat dressing changes. This type of catheter is normally used in people needing intravenous access for several weeks or months in both inpatient and outpatient settings. NICE estimate up to 120,000 people per year could be eligible.

Professor Tony Young, National Clinical Lead for Innovation at NHS England, said: “For new innovations to flourish and spread at scale access to funding is critical, by buying these four innovations centrally NHS England has removed the barriers to the spread of these innovations so patients can benefit faster.

The NHS’ 15 Academic Health Science Networks across England – will take direct responsibility for accelerating uptake locally.

All information from NHS England, the news release can be read on this webpage

Artificial Intelligence in the NHS

This report illustrates the areas where artificial intelligence (AI) could help the NHS become more efficient and deliver better outcomes for patients. | Reform

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The report from Reform suggests that AI has the potential to:

  • help address the health and wellbeing gap by predicting which individuals or groups of individuals are at risk of illness and allow the NHS to target treatment more effectively towards them
  • give all health professionals and patients access to cutting edge diagnostics and treatment tailored to individual need, helping to reduce the care and quality gap
  • help address the efficiency and funding gap by automating tasks, triaging patients to the most appropriate services and allowing them to self-care

The report makes 16 recommendations, and also highlights the main barriers to the implementation of this technology, suggesting some potential solutions.

Full report: Thinking on its own: AI in the NHS

 

Mental health patients to benefit from new digital services

Seven areas across England are set to trail-blaze digital services for mental health patients, which will include innovative apps to improve care and online access to ‘real-time’ patient records. | NHS England

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NHS England has announced funding for seven mental health trusts to enable them to pioneer digital services for mental health patients.  It is intended that all key professionals involved in a patient’s care have access to real-time records – from triage and initial assessment, through to admissions or referrals, as well as transfer between services and follow up care.

The trusts will also develop remote, mobile and assistive technologies to empower patients to manage their conditions and enable family and carers to provide the best possible support.

The trusts will have up to £70m to invest in digital services – consisting £35m with additional match funding from themselves of £35m – in order to become ‘Global Digital Exemplars for Mental Health’ helping the organisations become world-leading in the use of IT, providing knowledge and expertise to the wider NHS in order to reduce time and costs for others.

This is all part of the NHS’ plan to harness technology to improve services and become more efficient.

The hospital of tomorrow in 10 points

Abstract

Technology has advanced rapidly in recent years and is continuing to do so, with associated changes in multiple areas, including hospital structure and function. Here we describe in 10 points our vision of some of the ways in which we see our hospitals, particularly those in developed countries, evolving in the future, including increased specialization, greater use of telemedicine and robots, the changing place of the intensive care unit, improved pre-hospital and post-hospital management, and improved end-of-life care.

New technology is going to increasingly impact how we practice medicine. We must learn how best to adapt to and encompass these changes if we are to achieve maximum benefit from them for ourselves and our patients. Importantly, while the future hospital will be more advanced technologically, it will also be more advanced on a personal, humane patient care level.

Full paper: Vincent, J.L. and Creteur, J.  The hospital of tomorrow in 10 points. Critical Care (2017) 21:93