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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 4 | Issue 3
Page Nos. 103-144

Online since Thursday, October 18, 2018

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EDITORIAL  

Digital technologies for personal health management and preventative healthcare p. 103
David John Wortley
DOI:10.4103/digm.digm_21_18  
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COMMENTARIES Top

Biomedical diagnostics for all: Democratization and personalization p. 106
Luyun Jiang
DOI:10.4103/digm.digm_22_18  
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New trends in the use of digital interventions for self-care management p. 109
Simon Hooper
DOI:10.4103/digm.digm_24_18  
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The digital handheld ultrasound device: A new portable diagnostic tool for healthcare. Will it replace the stethoscope? p. 113
Joseph S Alpert, Rajesh Janardhanan
DOI:10.4103/digm.digm_27_18  
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REVIEW ARTICLE Top

Digital technology for preventative health care in Myanmar p. 117
Phone Myint Hlaing, Thasaneeya Ratanaroutai Nopparatjamjomras, Suchai Nopparatjamjomras
DOI:10.4103/digm.digm_25_18  
The emerging rapidly developing new technologies bring digital applications into our society. Digital technology had been widely applied to various health-care fields including the area of preventative health care. Digital preventative health care is the provision of health-care services for the prevention of diseases, controlling of disease processes, and other health-care services related to preventative health care by the use of digital technology. It is an essential element in the future development of the health-care environment. This review article highlights the current situation of digital technology used in providing health-care services for disease prevention in Myanmar health-care environment. It also covers the future direction of implementing digital technology in other specific areas of preventative health care in Myanmar designed to provide health-care delivery and services more effectively.
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ORIGINAL ARTICLES Top

Televital signs monitoring compliance trial in Singapore p. 122
Jit Seng Tan, Shing Yuen Teo
DOI:10.4103/digm.digm_18_18  
Background and Objectives: The Singapore population is aging rapidly, with increased prevalence of chronic diseases and healthcare demand. Telemonitoring of vital signs will enable better care of the patient. However, daily monitoring requires a change in lifestyle and compliance may be an issue. Materials and Methods: A total of 18 patients in 4 demographics were identified. Telemonitoring equipment was deployed to them for 3 months. Results: After 3 months, the well individual did not use the monitoring devices. 50% of the patients with chronic medical disease <65 years old continued the use of the devices. 2 out of 7 activities of daily living (ADL) independent individuals >65 years old continued the daily monitoring and almost all (5 out of 6) ADL dependent patients continued daily routine monitoring. The dropout may be due to technical issues, user fatigue, change in caregiver or resistance to technology. Conclusions: Remote monitoring will be more successful if the individual already is doing routine self-monitoring or has a life-threatening health-related event. Technical support is also important to help retrain the person in using the devices and for troubleshooting.
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Delivering personalized dietary advice for health management and disease prevention p. 127
Steve Gardner, Marcin Pawlowski, Gert Lykke Møller, Claus Erik Jensen
DOI:10.4103/digm.digm_19_18  
Background and Objectives: Diet plays a huge role in health, both by increasing metabolic disease risks and acutely through adverse interactions with diseases and medications. Multimorbid and polypharmaceutical patients are at a particularly high risk of such interactions due to the number of drugs they take. This leads to avoidable hospitalizations and poor compliance. This study built and demonstrated a tool that provides personalized dietary advice that accounts for a patient's combination of disease and drugs in real-time on their mobile device. Methods: A comprehensive list of validated drug-disease-food interactions from several reputable sources was constructed. This was compiled into a knowledge graph using the RACE array logic platform. This interactions knowledge graph was used to power a personalized dietary advisor application on a mobile device. Results: Data from over 500,000 drug-disease-food interactions including 1,699 food ingredients and 9,526 disease interactions were compiled into a highly compressed knowledge model. This was used to inform recommendations for individual complex patients. It was also tested on virtual population of 10,000 multimorbid and polypharmaceutical patients. Conclusions: This study showed that digital health tools can provide highly contextual and adaptive responses from a single knowledge graph. The study showed it is possible to provide highly personalized health advice to complex patients in real-time on their own mobile device without having to hold such private information on a server. This enables highly secure, private and personalized digital health tools to be built.
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An observational study to assess the feasibility of remote monitoring of patients in the early postoperative period after elective surgery p. 133
Omar Faiz, Subramanian Nachiappan, Chukwuemeka Anele, Emma-Jane Roberts, Chris Barker
DOI:10.4103/digm.digm_26_18  
Background and Objectives: The utility of postdischarge remote monitoring with patient self-measurement of physiological parameters has not been utilized in the elective colorectal surgical setting till date. Before full application of this utility, patient-acquired measurements' accuracy, and ability to detect deviation from normal physiological must be assessed. This study aims to ascertain the congruency of patient-measured and nurse-measured readings in the postoperative in-hospital setting, before future application in the home setting. Methods: This is a prospective single-institution study comparing patient and nurse measured readings of blood pressure, heart rate, oxygen saturation, and temperature, in ambulatory patients in the postoperative setting. Patients were provided with and trained on the usage of a handheld computing device with bluetooth-enabled measuring adjuncts preoperatively. Patients were instructed to acquire two sets of readings per day for 2 days. These were compared with nurse-acquired measurements and extrapolated to the modified “National Early Warning Score” system. Inter-rater concordance was analyzed using the Bland–Altman method for raw physiological measurements and for modified-National Early Warning Score (NEWS) risk and response categories. Results: A total of 40 elective colorectal patients were prospectively approached. Twenty-seven completed the study with 25 patients (15 males, age range 18–79, undergoing a variety of colorectal procedures) accruing a total of 98 datasets of physiological parameter readings. There were no significant differences/bias between blood pressure (P = 0.572), heart rate (0.122), and oxygen saturation (P = 0.308) readings. Patient and linked nurse measurements for all patients elicited the same modified NEWS clinical risk and required response in all instances. Conclusion: Patient self-measurement of physiological parameters and subsequent derived modified NEWS categories using a remote monitoring system are comparable to nurse-acquired measurements. Remote monitoring is technically feasible, and the next steps would be to trial this technology in the home setting.
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CASE REPORT Top

Preliminary data of a game-based protocol for acute treatment of cervical spinal cord injury rehabilitation with Kinect p. 142
Luca Morganti, Antonio Ascolese, Daniele Vitelli, Michele Spinelli
DOI:10.4103/digm.digm_23_18  
Game-based rehabilitation proved its efficacy in recent years, and the areas of intervention are increasing. In this article, we report the definition of a protocol for the treatment of people suffering from acute cervical spinal cord injury and its preliminary application with five patients. A suite of serious games using Kinect as device for game sessions is adopted for upper-limb rehabilitation. The possibility to customize the training plans by selecting different games for each patient gives the chance to include game created for other training targets (e.g., balance) that train further body parts (e.g., the trunk) and that can thus adapt the training to specific patient's needs.
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