Effectiveness of embodied evaluation of mobile applications: A qualitative study.

As a consequence of technological advances, the number of devices has increased, with the emergence of different smartphones, tablets, and smartwatches present in both personal and professional activities. As a result, mobile applications have been developed, and with them comes the need for techniques and methods that provide support for conducting evaluation and prototyping since the current approaches are limited and cannot support the complexity and the need for understanding the context. The overall goal of the study is to evaluate the applicability of adopting a situated and embodied approach to mobile application usability testing. The aspects of postmodern and phenomenological approaches were taken into consideration. The study was conducted using the technique of digital ethnography, in particular the re-enactment technique, combined with qualitative research techniques to capture the evidence that the situated and embodied approach allows for capturing the perceptions and experience of the participants about the use of the application under evaluation. As motivation, there is the theoretical and methodological evolution and contribution and the proof that the postmodern and situated approach allows us to evaluate the usability of mobile applications in a complete way, considering the context and the user experience. The results show aspects of experience, reflections, perceptions, contingencies, practices, and meanings that go beyond the complexity of interactions and context with the use of the application, reinforcing the effectiveness of the use of the situated prototyping approach.

Machine Learning Algorithms for Activity-Intensity Recognition Using Accelerometer Data.

In pervasive healthcare monitoring, activity recognition is critical information for adequate management of the patient. Despite the great number of studies on this topic, a contextually relevant parameter that has received less attention is intensity recognition. In the present study, we investigated the potential advantage of coupling activity and intensity, namely, Activity-Intensity, in accelerometer data to improve the description of daily activities of individuals. We further tested two alternatives for supervised classification. In the first alternative, the activity and intensity are inferred together by applying a single classifier algorithm. In the other alternative, the activity and intensity are classified separately. In both cases, the algorithms used for classification are k-Nearest Neighbors (KNN), Support Vector Machine (SVM), and Random Forest (RF). The results showed the viability of the classification with good accuracy for Activity-Intensity recognition. The best approach was KNN implemented in the single classifier alternative, which resulted in 79% of accuracy. Using two classifiers, the result was 97% accuracy for activity recognition (Random Forest), and 80% for intensity recognition (KNN), which resulted in 78% for activity-intensity coupled. These findings have potential applications to improve the contextualized evaluation of movement by health professionals in the form of a decision system with expert rules.

Meu Estágio Enfermagem: criação e avaliação de um protótipo de aplicativo para apoio no estágio curricular supervisionado em enfermagem / My Nursing Internship: creation and evaluation of an application prototype to support the supervised curricular internship in nursing

Introdução: O estágio curricular supervisionado é um importante instrumento utilizado na formação dos profissionais de enfermagem, que visa proporcionar aos alunos o aperfeiçoamento das técnicas de enfermagem e o desenvolvimento de uma visão crítica e reflexiva da profissão. Entretanto, não são poucas as dificuldades enfrentadas pelas envolvidos ao longo deste processo, incluindo questões burocráticas, organizativas e pedagógicas. Algumas dessas dificuldades podem ser amenizadas com o uso de tecnologias educacionais digitais especialmente desenvolvidas para esse fim, uma vez que permitem acesso a informações com bases científicas, controle de horários, realização de registros e cálculos, entre outras atividades pertinentes ao estágio. Objetivo: Desenvolver e avaliar um protótipo de aplicativo educacional para apoiar alunos e docentes durante os estágios. Método: Trata-se de uma pesquisa aplicada, exploratória e descritiva, de produção tecnológica. No desenvolvimento do protótipo do aplicativo, utilizou-se como referencial metodológico o Design Thinking, para os momentos de inspiração, implementação e ideação, precedido de revisão da literatura sobre as dificuldades enfrentadas pelos alunos e docentes durante os ECS. Posteriormente, foi desenvolvida a primeira versão do protótipo para interação com especialistas em inovação e tecnologia e alunos de enfermagem, resultando na nova versão submetida à avaliação de nove juízes docentes enfermeiros, nove especialistas em informática e nove alunos do curso técnico em enfermagem. Na avaliação do protótipo foram utilizados os instrumentos System Usability Scale, Net Promoter Score e de Avaliação da Qualidade Adaptado de Sperandio (2008). Na análise dos dados foram empregadas técnicas de estatísticas descritivas. Para concordância entre os avaliadores, adotou-se a análise AC1, de acordo com Gwet (2008). Resultados: Foi desenvolvido um protótipo de aplicativo de média fidelidade, com as seguintes funcionalidades: disponibilização das escalas de estágio, chat de comunicação entre docentes e alunos, registro de presença no estágio com geolocalização, disponibilização das técnicas de enfermagem, checklist das técnicas realizadas, recurso para cálculos de medicação e gotejamento, registros de enfermagem, consulta dos planos de trabalho docente, informações para segurança do paciente, código de ética e normas e rotinas dos estágios. Com base nas avaliações foi possível considerar a viabilidade do protótipo de aplicativo. As avaliações do score SUS alcançaram o melhor resultado possível, com valores de 91,4 e 91,9 entre os alunos e enfermeiros docentes, respectivamente. O NPS ficou na zona de excelência com média de respostas 94,4. Na avaliação da qualidade nos itens funcionalidade, confiabilidade, usabilidade, eficiência, manutenibilidade e portabilidade, a média das respostas dos enfermeiros docentes, alunos e especialistas em informática ficou dentro do esperado. Importantes sugestões foram feitas e permitirão novas implementações a partir da visão dos usuários finais. A avaliação dos especialistas em informática identificou a necessidade de melhorias, sobretudo nos itens confiabilidade, eficiência, manutenibilidade e portabilidade. A avaliação da concordância evidenciou a discordância dos avaliadores, o que reitera a necessidade de aperfeiçoar versões futuras do protótipo, bem como de considerar novas avaliações. Conclusão: O protótipo de aplicativo desenvolvido tem potencial para colaborar no desenvolvimento dos ECS em enfermagem, além de apresentar caráter inovador. Além disso, considera-se relevante a avaliação futura dos aspectos pedagógicos, não contemplados neste estudo

Introduction: The supervised curricular internship is an important instrument used in the training of nursing professionals, which aims to provide students with the improvement of nursing techniques and the development of a critical and reflective view of the profession. However, there are many difficulties faced by those involved throughout this process, including bureaucratic, organizational and pedagogical issues. Some of these difficulties can be alleviated with the use of digital educational technologies specially developed for this purpose, as they allow access to scientifically based information, control of schedules, carrying out records and calculations, among other activities relevant to the internship. Objective: Develop and evaluate an educational application prototype to support students and faculty during internships. Method: This is an applied, exploratory and descriptive research of technological production. In the development of the application prototype, Design Thinking was used as a methodological framework, for moments of inspiration, implementation and ideation, preceded by a literature review on the difficulties faced by students and teachers during the ECS. Subsequently, the first version of the prototype was developed for interaction with innovation and technology specialists and nursing students, resulting in the new version being evaluated by nine nurse faculty judges, nine informatics specialists and nine students from the technical nursing course. In the evaluation of the prototype, the instruments System Usability Scale, Net Promoter Score and Quality Assessment Adapted from Sperandio (2008) were used. In the data analysis descriptive statistics techniques were used. For agreement between the evaluators, the AC1 analysis was adopted, according to Gwet (2008). Results: A prototype of a medium-fidelity application was developed, with the following features: availability of internship schedules, communication chat between professors and students, registration of internship attendance with geolocation, availability of nursing techniques, checklist of performed techniques, resource for medication and drip calculations, nursing records, consultation of teacher work plans, patient safety information, code of ethics and internship rules and routines. Based on the evaluations, it was possible to consider the feasibility of the application prototype. The evaluations of the SUS score achieved the best possible result, with values of 91.4 and 91.9 among students and teaching nurses, respectively. NPS was in the zone of excellence with an average of 94.4 responses. In assessing the quality of the items functionality, reliability, usability, efficiency, maintainability and portability, the average of the responses of professors, students and computer specialists was within expectations. Important suggestions were made and will allow new implementations from the end users' perspective. The assessment of computer specialists identified the need for improvements, especially in the items reliability, efficiency, maintainability and portability. The agreement assessment evidenced the evaluators' disagreement, which reiterates the need to improve future versions of the prototype, as well as to consider new assessments. Conclusion: The developed application prototype has the potential to collaborate in the development of ECS in nursing, in addition to presenting an innovative character. In addition, the future assessment of pedagogical aspects not covered in this study is considered relevant

Tecnologia computacional para gerenciar o cuidado e indicadores relacionados à lesão por pressão / Computational technology to manage care and indicators related to pressure injury

A maioria dos casos de Lesões por Pressão são evitáveis desde que os pacientes em risco sejam identificados precocemente e haja uma correta definição de estratégias de prevenção. Quando as medidas preventivas não são suficientes e surge uma lesão é imprescindível uma correta avaliação e monitoramento da sua evolução. No entanto, a avaliação e monitoramento baseados apenas no olhar e documentação manual do profissional de saúde são subjetivos e muitas vezes imprecisos. As Tecnologias da Informação e Comunicação podem auxiliar nesse sentido, pois essas ferramentas possibilitam a divulgação e atualização de conhecimentos, além de possuírem ferramentas que apoiam a tomada de decisão na prática clínica. Neste espoco, esta pesquisa teve por objetivo desenvolver e avaliar um sistema computacional para gerenciar o cuidado e os indicadores relacionados às lesões por pressão. Trata-se de um estudo aplicado, metodológico e descritivo do tipo coorte prospectivo. A pesquisa foi realizada em etapas que envolveram o desenvolvimento de um sistema computacional, composto por um aplicativo e um sistema web, e testar na prática clínica essa ferramenta. O aplicativo auxilia na avaliação beira-leito do risco do paciente para desenvolver lesão por pressão, sugere cuidados preventivos personalizados e, se o paciente possuir lesão, auxilia na avaliação e registro do estado da lesão por meio de um algoritmo de processamento de imagens. O sistema web, realiza o armazenamento e processamento dos dados baseado nas avaliações beira-leito, nesse sistema é possível consultar estatísticas, tais como incidência, área de tecidos lesado, tempo médio de permanência na unidade, entre outras. Para testar na prática clínica, utilizou-se o sistema em duas Unidades de Terapia Intensiva durante o período de 60 dias, nesse período 126 pacientes foram acompanhados desde sua internação até alta, transferência ou óbito. A pesquisa demonstrou que, apesar das unidades estudadas apresentarem taxas de incidências semelhantes, quando considerado o tempo de internação dos pacientes e área da lesão, observou-se uma significativa diferença entre as unidades. Ainda, nos testes realizados com os usuários finais, o sistema computacional se mostrou altamente preciso e confiável, comprovando sua qualidade técnica e funcional. Neste sentido, o sistema computacional desta pesquisa pode ser uma ferramenta potencial para auxiliar na assistência aos pacientes institucionalizados e no monitoramento de indicadores relacionados as lesões por pressão. Ainda, espera-se que este trabalho contribua para a ampliação de pesquisas cujos objetos de estudo sejam o desenvolvimento de softwares para a saúde

Most cases of Pressure Injury are preventable as long as patients at risk are early identified and strategies for prevention are correctly defined. When preventive measures are not enough and an injury arises, a correct assessment and monitoring of its evolution is essential. However, evaluation and monitoring based only on the healthcare professional's observation and manual record is subjective and often inaccurate. The Information and Communication Technologies can help this issue, since these tools allow the dissemination and updating of knowledge, besides having tools that support decision making in clinical practice. In this context, this research aimed to develop and evaluate a computational system to manage care and indicators related to pressure injuries. It is an applied, methodological and descriptive study of the prospective cohort type. The research was carried out in stages that involved the development of a computational system, composed of an application and a web system, and the test in the clinical practice of this tool. The application assists in assessing the patient's risk of developing pressure injury, suggests personalized preventive care and, if the patient has an injury, assists in assessing and recording the lesion's condition through a digital image processing algorithm. The web system performs data storage and processing based on bedside assessments, which makes it possible to consult statistics such as incidence, area of damaged tissue, average time of permanence in the unit, among others. In the clinical practice test, the system was used in two Intensive Care Units during a 60-day period. During this period, 126 patients were followed from their hospitalization until discharge, transference or death. The research showed that, although the units studied presented similar incidence rates, when considering the length of hospital stay and the area of the lesion, a significant difference was observed between the units. Furthermore, in the tests performed with the application users, the computational system proved to be highly accurate and reliable, proving its technical and functional quality. In this sense, the computational system of this research can be a potential tool to assist healthcare professionals to care of patients and to monitor indicators related to pressure injuries. Still, it is expected that this work contributes to the expansion of research whose objectives are the development of healthcare softwares

Understanding Monitoring Technologies for Adults With Pain: Systematic Literature Review.

BACKGROUND: Monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, monitoring patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain; however, no previous study has reviewed the contextual information that a monitoring system may capture to characterize a patient's situation. OBJECTIVE: The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adults with pain, and (2) construct a model of the context information that may be used to implement apps and devices aimed at monitoring adults with pain. METHODS: A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore) using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. RESULTS: In the final analysis, 87 articles were included and 53 of them (61%) used technologies to collect contextual information. A total of 49 types of context information were found and a five-dimension (activity, identity, wellness, environment, physiological) model of context information to monitor adults with pain was proposed, expanding on a previous model. Most technological interfaces for pain monitoring were wearable, possibly because they can be used in more realistic contexts. Few studies focused on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. CONCLUSIONS: The design of monitoring devices and interfaces for adults with pain must deal with the challenge of selecting relevant contextual information to understand the user's situation, and not overburdening or inconveniencing users with information requests. A model of contextual information may be used by researchers to choose possible contextual information that may be monitored during studies on adults with pain.

Enhancing knowledge flow in a health care context: a mobile computing approach.

BACKGROUND: Advances in mobile computing and wireless communication have allowed people to interact and exchange knowledge almost anywhere. These technologies support Medicine 2.0, where the health knowledge flows among all involved people (eg, patients, caregivers, doctors, and patients' relatives). OBJECTIVE: Our paper proposes a knowledge-sharing environment that takes advantage of mobile computing and contextual information to support knowledge sharing among participants within a health care community (ie, from patients to health professionals). This software environment enables knowledge exchange using peer-to-peer (P2P) mobile networks based on users' profiles, and it facilitates face-to-face interactions among people with similar health interests, needs, or goals. METHODS: First, we reviewed and analyzed relevant scientific articles and software apps to determine the current state of knowledge flow within health care. Although no proposal was capable of addressing every aspect in the Medicine 2.0 paradigm, a list of requirements was compiled. Using this requirement list and our previous works, a knowledge-sharing environment was created integrating Mobile Exchange of Knowledge (MEK) and the Easy to Deploy Indoor Positioning System (EDIPS), and a twofold qualitative evaluation was performed. Second, we analyzed the efficiency and reliability of the knowledge that the integrated MEK-EDIPS tool provided to users according to their interest topics, and then performed a proof of concept with health professionals to determine the feasibility and usefulness of using this solution in a real-world scenario. RESULTS: . Using MEK, we reached 100% precision and 80% recall in the exchange of files within the peer-to-peer network. The mechanism that facilitated face-to-face interactions was evaluated by the difference between the location indicated by the EDIPS tool and the actual location of the people involved in the knowledge exchange. The average distance error was <6.28 m for an indoor environment. The usability and usefulness of this tool was assessed by questioning a sample of 18 health professionals: 94% (17/18) agreed the integrated MEK-EDIPS tool provides greater interaction among all the participants (eg, patients, caregivers, doctors, and patients' relatives), most considered it extremely important in the health scenario, 72% (13/18) believed it could increase the knowledge flow in a health environment, and 67% (12/18) recommend it or would like to recommend its use. CONCLUSIONS: The integrated MEK-EDIPS tool can provide more services than any other software tool analyzed in this paper. The proposed integrated MEK-EDIPS tool seems to be the best alternative for supporting health knowledge flow within the Medicine 2.0 paradigm.

Modelo arquitetural para geração de alertas aplicado ao monitoramento de pacientes em ambiente hospitalar / Architectural model for generating alerts applied to the monitoring of patients in a hospital environment

O aumento nas demandas por gerenciamento, controle e monitoramento das informações na área da automação hospitalar tem promovido um maior volume de pesquisas que são indutoras do processo de inovação tecnológica na área da saúde. Neste contexto, um aspecto considerado importante na automatização do monitoramento de pacientes consiste na eficiência em detectar e informar em tempo hábil as anomalias encontradas nos sinais vitais dos pacientes. O procedimento de notificar as ocorrências dessas anomalias à equipe médica pode ser implementado por meio da geração e envio de alertas (sonoros ou visuais). Verificando a relevância desse tipo de demanda no ambiente hospitalar, o presente artigo descreve uma arquitetura que tem como fundamento a geração e o envio de alertas, cujos dados são advindos de pacientes internados em Unidades de Terapia Intensiva (UTI). A premissa foi, portanto, otimizar o processo de comunicação das anomalias detectadas de modo que a equipe médica responsável seja notificada de tais eventos de maneira mais eficiente. A arquitetura de comunicação, definida para o ambiente hospitalar, baseou-se em estudos realizados na UTI do Hospital Universitário Onofre Lopes (HUOL). Tais estudos possibilitaram uma análise de requisitos que permitiu definir um gerador de alertas personalizados, e o envio desses para dispositivos móveis das equipes médicas. O processo de envio dos alertas foi baseado em um algoritmo de escalonamento de tempo real, fazendo uso de um middleware e de computação móvel e distribuída, sendo esses os aspectos inovadores dessa arquitetura.

The increase in demand for the management, control and monitoring of information in hospitals has promoted a greater volume of research that induces the process of technological innovation in healthcare. In this context, an important aspect to consider in the automation of patient monitoring is the efficiency to detect and report anomalies in patients’  vital signs in a timely manner. The procedure for notifying the medical staff of these anomalies can be implemented by generating and sending alerts (either audible or visual). Noting the relevance of this demand in the hospital environment, this paper describes an architecture based on the generation and transmission of alerts, whose data are coming from patients hospitalized in intensive care units (ICU). The premise was therefore to optimize the procedure for reporting deficiencies so that the medical staff in charge is notified of such events more efficiently. The communication architecture in hospitals, used in this paper, was based on studies conducted at the ICU of the University Hospital Onofre Lopes (HUOL). These studies allowed an analysis of requirements that lead to the definition of a generator of custom alerts, and the sending of these alerts to mobile devices kept by medical staff. The process of sending those alerts was based on a real time scheduling algorithm making use of a middleware and both mobile and distributed computing, which are the innovative aspects of this architecture.