The development of mobile applications for the diagnosis and management of pregnant women with pre-eclampsia is described. These applications are designed for use by community-based health care providers (c-HCPs) in health facilities and during home visits to collect symptoms and perform clinical measurements (including pulse oximeter readings). The clinical data collected in women with pre-eclampsia are used as the inputs to a predictive model providing a risk score for the development of adverse outcomes. Based on this risk, the applications provide recommendations on treatment, referral, and reassessment. c-HCPs can access patient records across multiple visits, using multiple devices that are synchronized using a secure Research Electronic Data Capture server. A unique feature of these applications is the ability to measure oxygen saturation with a pulse oximeter connected to a smartphone (Phone Oximeter). The mobile health application development process, including challenges encountered and solutions are described.
BackgroundPre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter.ObjectiveThe aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system.MethodsDevelopment of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town.ResultsAfter ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7). To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec).ConclusionsBy including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway.
Objective: To assess the incremental value of blood oxygen saturation (SpO 2 ) as a predictor in the miniPIERS model, a risk prediction model for adverse outcomes among women with a diagnosis of hypertensive disorder of pregnancy (HDP) in lowresourced settings .Methods: Using data from a prospective cohort including 852 women admitted to hospital for a HDP, the association between SpO 2 and adverse maternal outcome was assessed using logistic regression . The miniPIERS model was recalibrated and extended to include SpO 2 . The incremental value of adding SpO 2 to the model was measured using a net reclassification index (NRI), sensitivity, specificity, positive and negative predictive values, and likelihood ratios .Results: SpO 2 of < 93% was associated with a 30-fold increase in risk (95% CI 14 to 68) of adverse maternal outcome compared to women with SpO 2 > 97% . After recalibration and extension, the miniPIERS model including SpO 2 (vs . not including SpO 2 ) had improved sensitivity (32 .8% vs . 49 .6%) at the cost of minimally decreased specificity (91.5% vs. 96.2%) with a NRI of 0.122. Conclusion:SpO 2 is a significant independent predictor of risk in women with a HDP . Adding SpO 2 to the miniPIERS model improved the model's ability to correctly identify high-risk patients who would benefit most from interventions. RésuméObjectif : Évaluer la valeur cumulative de la saturation en oxygène (SaO 2 ) à titre de facteur prédictif dans le cadre du modèle miniPIERS, soit un modèle de prévision des risques en ce qui concerne les issues indésirables chez les femmes ayant obtenu un diagnostic de trouble hypertensif de la grossesse (THG) dans des milieux qui ne disposent que de faibles ressources . Méthodes
Objectives: The objective was to validate an existing theoretical model for the mechanics of constant peak displacement cardiopulmonary resuscitation (CPR) using experimental data taken using various back support surfaces at different chest compression (CC) rates.Methods: A CPR simulator was used to perform constant peak displacement CC on a weighted fullbody CPR training manikin supported on surfaces of varying stiffness at different CC rates. The net sternum-to-spine displacement, combined chest and mattress displacement, and axial reaction force were measured during each test. The experimental results were compared to theoretical predictions from the constant peak displacement CPR model. Results:The theoretical model predictions matched the experimental data to within a mean difference of 11.7% at a CC rate of 42 compressions per minute (cpm), 10.0% at a CC rate of 60 cpm, and 10.1% at a CC rate of 96 cpm, for a target maximum sternal displacement of 5.0 cm. The model predictions also show that when the back support stiffness is less than 250 N ⁄ cm, the benefit of using a backboard is greater than for stiffer support surfaces.Conclusions: Good quantitative agreement between the experimental data and the theoretical model suggests that the constant peak displacement CPR model provides reasonable prediction of CC mechanics during CPR over a wide range of CC rates. Conflicts in the literature are also explained by showing that backboards can significantly enhance CPR CC performance when the back support stiffness is less than 250 N ⁄ cm, while for surfaces with higher stiffness, the benefit of using a backboard is reduced.
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