The aim of this paper is to present and validate a framework for assessing healthcare facilities in low-resource settings to collect evidence and inform policies on the harmonisation, regulation and contextualised design of medical devices. Methods A literature review and focus groups with several experts of medical device design, clinical engineering, health technology assessment and management, allowed the creation of a protocol, comprising two parts: a semi-structured interview and electrical safety measures. Results Three hospitals were assessed in Benin and three in Uganda. All the health centres resulted to be facing typical challenges for low-resource settings, including the lack of funding, expertise, a well-established maintenance program, spare parts and consumables, and unreliable power supplies. Conclusion As there is a paucity of information regarding low-resource settings, the proposed framework can be used by clinical or biomedical engineers to assess and thereby propose actions for improving the conditions of healthcare settings.
ObjectiveTo identify and assess the use of technologies, including mobile health technology, internet of things (IoT) devices and artificial intelligence (AI) in hypertension healthcare in sub-Saharan Africa (SSA).DesignSystematic review.Data sourcesMedline, Embase, Scopus and Web of Science.Eligibility criteriaStudies addressing outcomes related to the use of technologies for hypertension healthcare (all points in the healthcare cascade) in SSA.MethodsDatabases were searched from inception to 2 August 2021. Screening, data extraction and risk of bias assessment were done in duplicate. Data were extracted on study design, setting, technology(s) employed and outcomes. Blood pressure (BP) reduction due to intervention was extracted from a subset of randomised controlled trials. Methodological quality was assessed using the Mixed Methods Appraisal Tool.Results1717 hits were retrieved, 1206 deduplicated studies were screened and 67 full texts were assessed for eligibility. 22 studies were included, all reported on clinical investigations. Two studies were observational, and 20 evaluated technology-based interventions. Outcomes included BP reduction/control, treatment adherence, retention in care, awareness/knowledge of hypertension and completeness of medical records. All studies used mobile technology, three linked with IoT devices. Short Message Service (SMS) was the most popular method of targeting patients (n=6). Moderate BP reduction was achieved in three randomised controlled trials. Patients and healthcare providers reported positive perceptions towards the technologies. No studies using AI were identified.ConclusionsThere are a range of successful applications of key enabling technologies in SSA, including BP reduction, increased health knowledge and treatment adherence following targeted mobile technology interventions. There is evidence to support use of mobile technology for hypertension management in SSA. However, current application of technologies is highly heterogeneous and key barriers exist, limiting efficacy and uptake in SSA. More research is needed, addressing objective measures such as BP reduction in robust randomised studies.PROSPERO registration numberCRD42020223043.
Purpose This study evaluates the effects of non-invasive home telemonitoring methods of managing congestive heart failure (CHF) patients with particular focus on complexity of intervention, patient characteristics, patient severity, and key enabling technologies (KETs) adopted. Our goal was to capture all possible aspects of previously documented outcomes and provide updated and clearer evidence on mixed effects on common themes. Methods Randomized controlled trials (RCTs) published between 1 January 2012 and 6 June 2019, focusing on home telemonitoring of patients with only CHF or CHF coexisting with other chronic disease(s), were retrieved from online resources (PubMed, Embase, MEDLINE(R), Your journals@Ovid, Elsevier, and ClinicalTrials.gov). The snowball sampling method and forward citation tracking on Google Scholar were also adopted to identify additional relevant studies. Retrieved studies were in a language known by the authors (i.e., English, Spanish or Italian). Quality assessment of individual studies for shortcomings in design, management, evaluation, and reporting was done using the Cochrane risk of bias (RoB) tool. Variables of interest were synthesized as differences in relative risk (RR), or as weighted mean differences (WMD). Outcomes were assigned as primary or secondary based on a principal judgement of clinical importance, and secondarily on highest recurrent counts in included studies. Results In all, 28 RCTs involving 10,258 patients were included in the qualitative synthesis, out of which 24 were used for the quantitative synthesis. These studies focused on non-invasive telemonitoring practices for home monitoring of CHF patients, through the deployment of different kinds of electronic/mobile devices, with most having wireless communication capabilities. Moreover, studies focusing on implantable monitoring devices in terms of inputs, data and patient performance were also included. Brain natriuretic peptide (BNP) ((WMD = -27.75; 95% CI (-53.36, -2.14); p-value = 0.034), rehospitalization/hospitalization for heart failure (RR = 0.88; 95% CI (0.79, 0.98); p-value = 0.015), cardiovascular death/heart failure hospitalization (RR = 0.70; 95% CI (0.51, 0.97); p-value = 0.03), and six minute walk test (6MWT) (WMD = 25.61; 95% CI (9.22, 41.99); p-value = 0.002) significantly improved in the telemonitoring group, while the number of visits to a nurse (WMD = 1.42; 95% CI (0.33, 2.52); p-value = 0.011) increased considerably compared to usual care. Conclusion Although there were limitations to the evidence provided in this review such as wide variations in certain variables (e.g., sample populations, RoB assessment, telemonitoring tools, follow-up periods), issues with allocation concealment and blinding of participants and personnel, and paucity of data for synthesizing particular outcomes of interest, overall, telemonitoring seems to offer much better results in the treatment of CHF patients compared to usual care. Registration and protocol This systematic review and meta-analysis has been retrospectively registered in the Open Science Framework (OSF) repository with https://doi.org/10.17605/OSF.IO/NDXCP. All data related to this study, including the electronic supplementary data, can be found at this link: osf.io/57q3h.
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