Patient preferences for key drivers and facilitators of adoption of mHealth technology to manage depression: A discrete choice experiment.

BACKGROUND: In time, we may be able to detect the early onset of symptoms of depression and even predict relapse using behavioural data gathered through mobile technologies. However, barriers to adoption exist and understanding the importance of these factors to users is vital to ensure maximum adoption. METHOD: In a discrete choice experiment, people with a history of depression (N = 171) were asked to select their preferred technology from a series of vignettes containing four characteristics: privacy, clinical support, established benefit and device accuracy (i.e., ability to detect symptoms), with different levels. Mixed logit models were used to establish what was most likely to affect adoption. Sub-group analyses explored effects of age, gender, education, technology acceptance and familiarity, and nationality. RESULTS: Higher level of privacy, greater clinical support, increased perceived benefit and better device accuracy were important. Accuracy was the most important, with only modest compromises willing to be made to increase other factors such as privacy. Established benefit was the least valued of the attributes with participants happy with technology that had possible but unknown benefits. Preferences were moderated by technology acceptance, age, nationality, and educational background. CONCLUSION: For people with a history of depression, adoption of technology may be driven by the desire for accurate detection of symptoms. However, people with lower technology acceptance and educational attainment, those who were younger, and specific nationalities may be willing to compromise on some accuracy for more privacy and clinical support. These preferences should help shape design of mHealth tools.

Predictors of engagement with remote sensing technologies for symptom measurement in Major Depressive Disorder.

BACKGROUND: Remote sensing for the measurement and management of long-term conditions such as Major Depressive Disorder (MDD) is becoming more prevalent. User-engagement is essential to yield any benefits. We tested three hypotheses examining associations between clinical characteristics, perceptions of remote sensing, and objective user engagement metrics. METHODS: The Remote Assessment of Disease and Relapse - Major Depressive Disorder (RADAR-MDD) study is a multicentre longitudinal observational cohort study in people with recurrent MDD. Participants wore a FitBit and completed app-based assessments every two weeks for a median of 18 months. Multivariable random effects regression models pooling data across timepoints were used to examine associations between variables. RESULTS: A total of 547 participants (87.8% of the total sample) were included in the current analysis. Higher levels of anxiety were associated with lower levels of perceived technology ease of use; increased functional disability was associated with small differences in perceptions of technology usefulness and usability. Participants who reported higher system ease of use, usefulness, and acceptability subsequently completed more app-based questionnaires and tended to wear their FitBit activity tracker for longer. All effect sizes were small and unlikely to be of practical significance. LIMITATIONS: Symptoms of depression, anxiety, functional disability, and perceptions of system usability are measured at the same time. These therefore represent cross-sectional associations rather than predictions of future perceptions. CONCLUSIONS: These findings suggest that perceived usability and actual use of remote measurement technologies in people with MDD are robust across differences in severity of depression, anxiety, and functional impairment.

Pulmonary fibrosis presenting as an early manifestation of microscopic polyangiitis.

Microscopic polyangiitis (MPA) is a systemic small vessel vasculitis that is included in the pulmonary-renal syndromes. Although glomerulonephritis represents the major clinical feature of MPA indicative of renal involvement, diffuse alveolar haemorrhage is the classic manifestation of pulmonary involvement. However, pulmonary fibrosis is a less frequently reported pulmonary manifestation. Herein we describe a patient who was diagnosed with MPA presenting with radiographic evidence of pulmonary interstitial fibrosis as an early clinical manifestation accompanied by constitutional symptoms such as fever and weight loss. We also include a short literature review focusing on the association between pulmonary fibrosis and MPA.

Residual blood loss in single use dialyzers: effect of different membranes and flux.

AIM/BACKGROUND: The aim of this study was to evaluate the residual blood loss in new type single use dialyzers under the usually prevailing conditions during hemodialysis and to investigate whether or not this loss is dependent on dialyzer membrane composition or flux characteristics. MATERIALS AND METHODS: In 158 hemodialysis (HD) patients, 158 single used dialyzers were studied in corresponding HD sessions. 52/158 dialyzers were made from modified cellulose (acetate, CA or triacetate, CTA) membrane and 106 from synthetic ones (58 with ethyl-vinyl-alcohol (EVAL), 48 with polyacrilonitrile (AN69)). Of those dialyzers 85/158 (58 EVAL+27CA) were low flux (LF) while the other 73 were high flux (HF). Patients underwent 4 hour HD sessions and at the end of the session blood was drawn for the measurement of hematocrit (Ht) and hemoglobin (Hb). Additionally, after the end of dialysis the used dialyzers were rinsed with 1000 mL of 0.05% NH(3) solution in distilled water. The wash was collected and subsequently Hb was measured using the benzidine method. From the volume of the solution and its concentration of Hb, total Hb of the solution was measured and blood loss in terms of red blood cell (RBC) volume was estimated by the use of the formula: RBC (mL) = Total Hb (g) in the solution x patient's Ht (ml/dL) / Patient's Hb (g/dL). For results to be comparable between dialyzers, RBC volume/m(2) of dialyzer membrane was expressed. In 5/158 patients blood loss was also estimated in 6 consecutive HD sessions using the same type of dialyzer. RESULTS: For the sum of the dialyzers, blood loss / dialyzer in terms of RBC volume, expressed as median (range), was 0.978 mL (0.01-23.9). There was statistically significant (p<0.001 or p<0.05) higher blood loss with the use of AN69 dialyzer than with the other three. RBC HF >RBC LF (p<0.001) constrained the first group of patients to use a 6% higher dosage of ferrum and 3.5% higher dosage of erythropoietin than the other group to achieve the optimal hemoglobulin values. No difference existed regarding RBC between CA, CTA and EVAL membranes. RBC measured in the small group of 5/158 patients for 6 consecutive HD sessions with the same dialyzer showed a wide range of RBC loss indicating an effect of the human factor. CONCLUSIONS: Blood loss during HD sessions due to residual blood cell volume inside dialyzers is usually slight using new type single use dialyzers but, sometimes, it can be significant and may contribute to the development or deterioration of preexisting iron deficiency anemia. The results of this study indicated that this loss can be attributed to the membrane composition of the dialyzer or to the human factor and has nothing to do with the ultrafiltration coefficient of the dialyzer.