The Usability and Effectiveness of Mobile Health Technology-Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review.

BACKGROUND: A growing number of mobile health (mHealth) technology-based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. OBJECTIVE: This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. METHODS: We performed a systematic review searching the following electronic databases for studies on mHealth technology-based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. RESULTS: Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects. CONCLUSIONS: Most studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care.

The impact of diagnostic criteria on the reproducibility of the hysteroscopic diagnosis of the septate uterus: a randomized controlled trial.

STUDY QUESTION: Does the use of diagnostic criteria in the hysteroscopic diagnosis of a septate uterus improve inter-observer agreement? SUMMARY ANSWER: Pre-set diagnostic criteria slightly improve the inter-observer reproducibility of hysteroscopy in diagnosing a uterine septum, although agreement remains moderate. WHAT IS KNOWN ALREADY: The inter-observer agreement on the hysteroscopic diagnosis of the septate uterus has been reported to be poor. STUDY DESIGN, SIZE, DURATION: From April 2013 until May 2014, a randomized controlled comparative inter-observer study was performed. A total of 191 gynecologists from 43 countries took part. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Each gynecologist was asked to assess 10 video recordings of hysteroscopy procedures with a specific focus on the internal uterine shape. The hysteroscopies had been performed in subfertile women and women with recurrent miscarriage. The recordings contained images of uterine cavities primarily diagnosed as septate, arcuate or normal. Participating gynecologists were randomized into two groups: one group received diagnostic criteria for a septate uterus before assessment of the videos (DC group), whereas the other group assessed the recordings without instruction (no DC group). The inter-observer agreement, expressed as the intra-class correlation coefficient (ICC), was compared between groups. Main outcomes were the inter-observer agreement on the uterine shape and the necessity of surgical correction. MAIN RESULTS AND THE ROLE OF CHANCE: Eighty-six observers were randomized to the DC group and 105 to the no DC group. The ICCs in the diagnosis of a septum were 0.59 versus 0.52, in the DC group and the non-DC group, respectively (P-value: 0.002). The overall agreement on the need for surgical correction was found to be moderate (DC ICC 0.43 versus no DC 0.39, P-value: 0.70). Most importantly, once a septate uterus had been diagnosed, the agreement on the need for surgery was poor in both groups (DC ICC 0.05 versus no DC ICC 0.02, P-value: 0.78). LIMITATIONS, REASONS FOR CAUTION: We used video recordings rather than studying real-time hysteroscopic procedures, which may have influenced the accuracy of the assessments. WIDER IMPLICATIONS OF THE FINDINGS: The reproducibility of hysteroscopy for the diagnosis of a septate uterus is moderate, even with the use of standardized criteria. The fact that the agreement among physicians on both the diagnosis of a uterine septum, as well as the decision to resect such septum after hysteroscopy is moderate, may imply that hysteroscopy is insufficient as single tool to diagnose and decide on treatment of a septate uterus. STUDY FUNDING/COMPETING INTERESTS: No study funding was received and no competing interests are present.

Inconclusive evidence that age predicts a prolonged or chronic course of acute rhinosinusitis in adults: a systematic review of the evidence base.

OBJECTIVE: To review the evidence whether the risk for a prolonged or chronic course increases with age in adult patients with acute rhinosinusitis. DATA SOURCES: PubMed, EMBASE, and the Cochrane Library. REVIEW METHODS: A comprehensive literature search was performed on March 24, 2013, and articles were screened and selected using predefined inclusion and exclusion criteria. Articles reporting studies on age as a predictor for the course in patients with acute rhinosinusitis were included. For included articles, the design of reported studies was assessed for directness of evidence and risk of bias. We aimed to extract hazard ratios for age as a continuous variable. RESULTS: Out of 13,382 unique publications, 3 articles with moderate risk of bias were included, with a maximum follow-up period of 30 days. The reported hazard ratios for recovery at 10, 15, and 30 days are 1.0 (95% confidence interval, 0.9-1.1) for age as a continuous variable, 0.86 (0.66-1.11) for age dichotomized at 38 years, and 0.58 (0.40-0.84) for age dichotomized for an increase with 20 years, respectively. CONCLUSION AND RECOMMENDATION: There is no evidence that age increases the risk for chronic rhinosinusitis in adult patients with acute rhinosinusitis. The literature is inconclusive that age increases the risk for a prolonged course of acute rhinosinusitis and, therefore, does not provide grounds for different management according to age of patients. As such, patients can be managed according to clinical practice guidelines with expectant observation and symptomatic treatment.