A review on intelligent wearables: Uses and risks

Intelligent wearable technology is becoming very popular in application fields such as clinical medicine and healthcare, health management, workplaces, education, and scientific research. Using the four-element model of technological behavior, the first part of this review briefly introduces issues related to the uses of intelligent wearables, including the technologies (i.e., what kind of intelligent wearables are used?), the users (i.e., who use intelligent wearables?), the activities involving the technologies (i.e., in what activities or fields intelligent wearables are used?), and the effects of technology usages (i.e., what benefits intelligent wearables bring?). The second part of this review focuses on the risks of using intelligent wearables. This part summarized five common risks (i.e., privacy risks, safety risks, performance risks, social and psychological risks, and other risks) in the use of intelligent wearables. The review ends with a discussion of future research.

The full article can be downloaded below.  

Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool

Participants were followed up for 8 weeks in the community by senior pharmacists to identify MRH (adverse drug reactions, harm from non-adherence, harm from medication error). Three data sources provided MRH and healthcare use information: hospital readmissions, primary care use, participant telephone interview. Candidate variables for prognostic modelling were selected using two systematic reviews, the views of patients with MRH and an expert panel of clinicians. Multivariable logistic regression with backward elimination, based on the Akaike Information Criterion, was used to develop the PRIME tool. The tool was internally validated.

1116 out of 1280 recruited participants completed follow-up (87%). Uncertain MRH cases (’possible’ and ’probable’) were excluded, leaving a tool derivation cohort of 818. 119 (15%) participants experienced ’definite’ MRH requiring healthcare use and 699 participants did not. Modelling resulted in a prediction tool with eight variables measured at hospital discharge: age, gender, antiplatelet drug, sodium level, antidiabetic drug, past adverse drug reaction, number of medicines, living alone. The tool’s discrimination C-statistic was 0.69 (0.66 after validation) and showed good calibration. Decision curve analysis demonstrated the potential value of the tool to guide clinical decision making compared with alternative approaches.

The PRIME tool could be used to identify older patients at high risk of MRH requiring healthcare use following hospital discharge. Prior to clinical use we recommend the tool’s evaluation in other settings.

The full article can be downloaded below.  

Reconceptualising precision public health

As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals’ unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.

The full article can be downloaded below.  

Liberating Telemedicine: Options to Eliminate the State-Licensing Roadblock

Aside from the ideal of eliminating government licensing of clinicians, or the second-best option of relying on states to open their borders to physicians licensed in other states, the most feasible option for expanding telemedicine is for Congress to define the location of the practice of telemedicine as that of the physician, treating digital patients like patients who physically make a trip across state or national borders to secure medical care.

Under such a law, a physician would need only one license to engage in the practice of telemedicine, and would be responsible for only one set of licensing rules—those of the state in which the physician practices. Existing telemedicine providers would be able to recruit physicians in greater numbers and to provide higher-quality and lower-cost services to far more patients. The ability of patients in emergent situations or with rare illnesses to obtain care from top specialists would expand dramatically. New entrants into a national market for telemedicine would drive down prices for both telemedicine and in-person medical services.

The full article can be downloaded below.  

Can Synthetic Biology Make Insulin Faster, Better and Cheaper?

Rising insulin prices have become a dangerous norm for diabetics. Whether on Twitter, TV, or public radio, the insulin market has the world’s attention — and for all the wrong reasons. 

Insulin prices are not only skyrocketing (they increased by 99% from 2012 to 2016); lack of access is killing Americans. People with Type 1, Type 2, and even gestational diabetes need to take insulin to regulate their blood sugar levels. Insulin is the signal that tells our cells to take in glucose and convert it to energy. Without this molecule, glucose builds up in the bloodstream and can cause serious complications, including cardiovascular disease. 

We are at the precipice of a profound public health crisis. If insulin has been around for nearly fifty years, and production has become cheaper over time, how did we get here? And what can synthetic biology do about these circumstances? 

The full Forbes article can be viewed at this link.  

InsightRX Raises $10 Million To Personalize Drug Doses

On September 20, InsightRX, a precision medicine company, announced the closing of a $10 million Series A funding round led by HealthX Ventures with participation from Rock Health, OSF Healthcare, Leawood Venture Capital, Premier Inc. and previous investor GreatPoint Ventures.

Using patient-specific data, quantitative pharmacology models, and what is known as Bayesian forecasting, InsightRX have built software to help clinicians prescribe optimal doses of powerful medications, increasing the likelihood of the most therapeutic benefit with the least side effects. InsightRX’s software is currently in use across more than 100 drug and therapeutic areas, including oncology and infectious diseases and through this approach, hospitals, care teams and patients could realize a number of benefits.

The full Forbes article can be viewed at this link.  

Population Health Vs. Personalized Medicine: Lost In Translation?

Evidence-based medicine, it seems commonsensical; who could argue about using the best evidence available to make treatment decisions? The difficulty, of course, is that the evidence comes from studies of large populations, often expressed in terms of average responses; and as a clinician, you want to tailor the care to the one member of the population in front of you, your patient. How do you reconcile population-based evidence with the desire for personalized care?

The full article from the American Council on Science and Health can be viewed at this link.  

Primary Care Is Integral To Improving U.S. Healthcare, But Is Falling Further Behind

Judging from healthcare advertisements on the Internet, television, and radio, specialists rule the roost as healthcare providers in the U.S. healthcare system. From orthopedic surgeons to cancer centers to ophthalmologists, it's hard to avoid the onslaught of advertising for specialist care. In the U.S., primary care is not featured nearly as prominently in advertising or the media.

But, increasing primary care access is seen as essential to improving population health. Effective primary care can help reduce emergency room visits and hospitalizations. However, in most U.S. states, primary care spending represents 5%-7% of total healthcare expenditures, which is less than half of the 14% average in Western European countries.

The federal government estimates that approximately 84 million Americans presently lack adequate access to primary care.

The full Forbes article can be viewed at this link.  

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

The aim of this systematic review and meta‐analysis was to synthesise the evidence relating to medication non‐adherence and its association with health outcomes in people aged ≥50 years.

Seven databases were searched up to February 2019 for observational studies that measured medication (non‐)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264).

Sixty‐six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta‐analyses. A meta‐analysis including 3 studies measuring medication non‐adherence in adults aged ≥55 years showed a significant association with all‐cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta‐analysis including 2 studies showed that medication non‐adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long‐term mortality risk in comparison to medication non‐adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98).

Medication non‐adherence may be significantly associated with all‐ cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.

The full article can be downloaded below.  

In-Depth: Telehealth providers working with colleges to supplement students' behavioral health, physical care

Fall has arrived, and with it comes the annual migration of millions of young adults leaving their homes for the promises of higher learning. For a substantial portion of these students, the trek means a transition from their family’s usual healthcare provider to their campus’s health services or other nearby sources for care — a gap that telehealth vendors are eager to fill.

“These students are often far away from home,” Robbie Cape, CEO and co-founder of texting-based primary care startup 98point6, told MobiHealthNews. “As a demographic, [they] have the lowest percentage affiliation with a primary care physician. Over 55% of college students, Gen Z, have a PCP, so that means over 45% do not. They do not have a relationship with a PCP at all, which makes 98point6 a great option for them. Not only that, but … 1.7 million university students don’t have any access to healthcare coverage, which again makes our offer very, very compelling for them.”

What's more, with the rate of college enrollment ticking upward with each passing year, several universities and student groups will likely need a scalable solution to fit their healthcare needs, said Alon Matas, founder and president of BetterHelp, a Teladoc subsidiary that provides behavioral health and counseling services.

“I think there’s actually a crisis in the student population,” Matas told MobiHealthNews. “The schools have gotten bigger, more students, but the capacity of the counseling centers and health centers hasn’t changed. We hear all the time about campuses with 10,000 students and one counselor. They cannot handle that much, so there have to be solutions like telehealth that come in, otherwise this will escalate."

The full Mobi Health News article can be viewed at this link.