Is there and do we need evidence on eHealth interventions?

The proliferation of information and communication technology (ICT) is transforming the healthcare, as an information-intensive sector, in a way that has never been witnessed before. The use of ICT in health or eHealth has the potential to improve the quality of health services, improve access to services and reduce cost. Huge investments in eHealth initiatives have been made by many countries based on this potential. A body of evidence is being developed to show the value of eHealth. Research and evaluation in eHealth should be comprehensive and not only limited to technology. There is a need for more research in this area using a multidisciplinary approach and teams.     

The impact of eHealth on the quality and safety of health care: a systematic overview

Background

There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we undertook a systematic review of systematic reviews assessing the effectiveness and consequences of various eHealth technologies on the quality and safety of care.

Methods and Findings

We developed novel search strategies, conceptual maps of health care quality, safety, and eHealth interventions, and then systematically identified, scrutinised, and synthesised the systematic review literature. Major biomedical databases were searched to identify systematic reviews published between 1997 and 2010. Related theoretical, methodological, and technical material was also reviewed. We identified 53 systematic reviews that focused on assessing the impact of eHealth interventions on the quality and/or safety of health care and 55 supplementary systematic reviews providing relevant supportive information. This systematic review literature was found to be generally of substandard quality with regards to methodology, reporting, and utility. We thematically categorised eHealth technologies into three main areas: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. We found that despite support from policymakers, there was relatively little empirical evidence to substantiate many of the claims made in relation to these technologies. Whether the success of those relatively few solutions identified to improve quality and safety would continue if these were deployed beyond the contexts in which they were originally developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment strategies are lacking.

Conclusions

There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and “techno-enthusiasts” as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology''s life cycle. Such evaluation should be characterised by careful attention to socio-technical factors to maximise the likelihood of successful implementation and adoption. Please see later in the article for the Editors'' Summary     

Capteurs pour la télésurveillance médicale. Capteurs,algorithmes et réseaux

In the field of telemedicine, eHealth aims at remotely monitoring the health status of the patient living independently at home. In this paper we describe some principles of such systems with some running examples.     

IMPROV-ED trial: eHealth programme for faster recovery and reduced healthcare utilisation after CABG

Netherlands Heart Journal - After coronary artery bypass grafting (CABG), healthcare utilisation is high and is partly unplanned. eHealth applications have been proposed to reduce healthcare...     

Engagement with eHealth Self-Monitoring in a Primary Care-Based Weight Management Intervention

Background

While eHealth approaches hold promise for improving the reach and cost-effectiveness of behavior change interventions, they have been challenged by declining participant engagement over time, particularly for self-monitoring behaviors. These are significant concerns in the context of chronic disease prevention and management where durable effects are important for driving meaningful changes.

Purpose

“Be Fit, Be Well” was an eHealth weight loss intervention that allowed participants to self-select a self-monitoring modality (web or interactive voice response (IVR)). Participants could change their modality. As such, this study provides a unique opportunity to examine the effects of intervention modality choice and changing modalities on intervention engagement and outcomes.

Methods

Intervention participants, who were recruited from community health centers, (n = 180) were expected to self-monitor health behaviors weekly over the course of the 24-month intervention. We examined trends in intervention engagement by modality (web, IVR, or changed modality) among participants in the intervention arm.

Results

The majority (61%) of participants chose IVR self-monitoring, while 39% chose web. 56% of those who selected web monitoring changed to IVR during the study versus no change in those who initially selected IVR. Self-monitoring declined in both modalities, but completion rates were higher in those who selected IVR. There were no associations between self-monitoring modality and weight or blood pressure outcomes.

Conclusions

This is the first study to compare web and IVR self-monitoring in an eHealth intervention where participants could select and change their self-monitoring modality. IVR shows promise for achieving consistent engagement.     

Intelligent security and privacy solutions for enabling personalized telepathology

Starting with the paradigm change of health systems towards personalized health services, the paper introduces the technical paradigms to be met for enabling ubiquitous pHealth including ePathology. The system-theoretical, architecture-centric approach to mobile, pervasive and autonomous solutions has to be based on an open component system framework such as the Generic Component Model. The crucial challenge to be met for comprehensive interoperability is multi-disciplinary knowledge representation, which must be integrated into the aforementioned framework. The approach is demonstrated for security and privacy services fundamental for any eHealth or ePathology environment.     

Genome sequences of five Salmonella enterica serovar Heidelberg isolates associated with a 2011 multistate outbreak in the United States

Salmonella enterica serovar Heidelberg has caused numerous outbreaks in humans. Here, we report draft genomes of five isolates of serovar Heidelberg associated with the recent (2011) multistate outbreak linked to ground turkey in the United States. Isolates 2011K-1110 and 2011K-1132 were recovered from humans, while isolates 2011K-1138, 2011K-1224, and 2011K-1225 were recovered from ground turkey. Whole-genome sequence analysis of these isolates provides a tool for studying the short-term evolution of these epidemic clones.     

Coding for pathology tests - strengths and weaknesses

Laboratory professionals will increasingly find themselves called upon to assist with the coding of pathology test requests and reported results in the era of the e-Health Record (EHR). EHR users from outside pathology, including patients and clinicians, will expect seamless integration of pathology services, and question variations in test nomenclature, units, reference intervals, and interpretive comments. Scientists and pathologists will need to be ready to work with colleagues outside their traditional scientific disciplines, along with IT and terminology experts, to resolve illogical historical variations, highlight differences that might endanger patient safety, and help lay the foundations for evolving e-health systems that enhance healthcare without eroding the interpretive value of pathology reports from different laboratories. An overview of medical terminologies and Australasian eHealth harmonisation programs is also provided.     

Virtual health care center in Georgia

Application of telemedicine systems to cover distant geographical areas has increased recently. However, the potential usefulness of similar systems for creation of national networks does not seem to be widely appreciated. The article describes the "Virtual Health Care Knowledge Center in Georgia" project. Its aim was the set up of an online integrated web-based platform to provide remote medical consultations and eLearning cycles. The project "Virtual Health Care Knowledge Center in Georgia" was the NATO Networking Infrastructure Grant dedicated for development of telemedicine in non-NATO countries. The project implemented a pilot to organize the creation of national eHealth network in Georgia and to promote the use of innovative telemedicine and eLearning services in the Georgian healthcare system. In June 2007 it was continued under the NATO Networking Infrastructure Grant "ePathology--Virtual Pathology Center in Georgia as the Continuation of Virtual Health Care Center".     

Towards an intelligent exploitation of heterogeneous and distributed resources in cooperative environments of eHealth

The objective of this research work is to empower healthcare information systems to deliver high quality information anytime and anywhere and to present distributed and heterogeneous resources access solutions which perfectly meet user requirements in different contexts. To reach this objective, we propose in this paper a new framework, called ONtology Oriented Framework for Pervasive Applications and Services (ONOF-PAS), and mainly based on: 1) interrelated ontological models representing the main entities in pervasive computing, such as Organization, Actor, Task, Service, Process, Object, Resources, etc.; 2) rule-based reasoning to infer the available and capable resources required by each task. The main functionality of the ONOF-PAS framework is to capture and to process the acquired knowledge about the user's context, the tasks they perform, the availability and capabilities of the required resources, and the organizations that own or manage these resources. Our framework allows healthcare information systems to infer the needed resources by linking each user-task with the required, available and capable resources taking into account the clinical conditions of the patients. The ONOF-PAS framework has been successfully applied in the telemedicine domain in order to provide practical and efficient resources access solutions that better meet the contexts and the expectations of the eHealth actors.     

Newly identified HMO-2011-type phages reveal genomic diversity and biogeographic distributions of this marine viral group

Viruses play critical roles in influencing biogeochemical cycles and adjusting host mortality, population structure, physiology, and evolution in the ocean. Marine viral communities are composed of numerous genetically distinct subfamily/genus-level viral groups. Among currently identified viral groups, the HMO-2011-type group is known to be dominant and broadly distributed. However, only four HMO-2011-type cultivated representatives that infect marine SAR116 and Roseobacter strains have been reported to date, and the genetic diversity, potential hosts, and ecology of this group remain poorly elucidated. Here, we present the genomes of seven HMO-2011-type phages that were isolated using four Roseobacter strains and one SAR11 strain, as well as additional 207 HMO-2011-type metagenomic viral genomes (MVGs) identified from various marine viromes. Phylogenomic and shared-gene analyses revealed that the HMO-2011-type group is a subfamily-level group comprising at least 10 discernible genus-level subgroups. Moreover, >2000 HMO-2011-type DNA polymerase sequences were identified, and the DNA polymerase phylogeny also revealed that the HMO-2011-type group contains diverse subgroups and is globally distributed. Metagenomic read-mapping results further showed that most HMO-2011-type phages are prevalent in global oceans and display distinct geographic distributions, with the distribution of most HMO-2011-type phages being associated with temperature. Lastly, we found that members in subgroup IX, represented by pelagiphage HTVC033P, were among the most abundant HMO-2011-type phages, which implies that SAR11 bacteria are crucial hosts for this viral group. In summary, our findings substantially expand current knowledge regarding the phylogenetic diversity, evolution, and distribution of HMO-2011-type phages, highlighting HMO-2011-type phages as major ecological agents that can infect certain key bacterial groups.Subject terms: Bacteriophages, Biodiversity, Microbial ecology     

Converted neural cells: induced to a cure?

Many neurodegenerative disorders such as Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS) and others often occur as a result of progressive loss of structure or function of neurons. Recently, many groups were able to generate neural cells, either differentiated from induced pluripotent stem cells (iPSCs) or converted from somatic cells. Advances in converted neural cells have opened a new era to ease applications for modeling diseases and screening drugs. In addition, the converted neural cells also hold the promise for cell replacement therapy (Kikuchi et al., 2011; Krencik et al., 2011; Kriks et al., 2011; Nori et al., 2011; Rhee et al., 2011; Schwartz et al., 2012). Here we will mainly discuss most recent progress on using converted functional neural cells to treat neurological diseases and highlight potential clinical challenges and future perspectives.     

iPSCs: induced back to controversy

Several recent reports (Mayshar et?al., 2010; Laurent et?al., 2011; Lister et?al., 2011; Gore et?al., 2011; Hussein et?al., 2011) uncover genetic and epigenetic alterations in induced pluripotent stem cells, stimulating debate about their future. However, will these important findings really impact what we hope to gain?     

Megaplasmid pRme2011a of Sinorhizobium meliloti is not required for viability

We report the curing of the 1,360-kb megaplasmid pRme2011a from Sinorhizobium meliloti strain Rm2011. With a positive selection strategy that utilized Tn5B12-S containing the sacB gene, we were able to cure this replicon by successive rounds of selecting for deletion formation in vivo. Subsequent Southern blot, Eckhardt gel, and pulsed-field gel electrophoresis analyses were consistent with the hypothesis that the resultant strain was indeed missing pRme2011a. The cured derivative grew as well as the wild-type strain in both complex and defined media but was unable to use a number of substrates as a sole source of carbon on defined media.     

Genomics in 2011: challenges and opportunities

As we come to the end of 2011, Genome Biology has asked some members of our Editorial Board for their views on the state of play in genomics. What was their favorite paper of 2011? What are the challenges in their particular research area? Who has had the biggest influence on their careers? What advice would they give to young researchers embarking on a career in research?     

Precarious legality: regularizing Central American migrants in Mexico

Regularization programmes for undocumented migrants are generally viewed as a form of transition from “illegality” to a secure legal status. Yet, as we argue in this article, in many countries, such as Mexico, this transition is often incomplete and reversible. This article discusses regularization programmes for undocumented migrants in Mexico before and after the introduction of the 2011 Migration Law and illustrates that the status migrants obtain is precarious, that is insecure and conditional upon their ability to meet requirements for status renewal. Focusing on Central Americans in Mexico, we suggest that many migrants have been unable to obtain or renew their status after new procedures were put in place in 2011. Coining the legality granted through Mexico’s regularization process “precarious legality”, we attribute it to the contradiction between Mexico’s stated respect for migrants’ human rights and the de facto commitment to immigration control.     

Mapping Architectural, Phenological, and Fruit Quality QTLs in Apricot

The F1 population “Harostar”?×?“Rouge de Mauves” was used to perform a quantitative trait loci (QTL) mapping for tree architecture traits (i.e., tree diameter, total branch number, tree shape); time to initial reproductive bud break; and fruit quality traits (i.e., ground color, fruit form, soluble solid content) using data collected from 2010 to 2012. For architectural traits, interval mapping detected QTLs only in “Rouge de Mauves” on linkage group 1 for trunk diameter in 2010, on LG6 for total branch number in 2010, and on LG1 and LG5 for tree shape for both years 2010 and 2011 combined. QTLs were detected only in “Harostar” for time to initial reproductive bud break on LG1 and LG4 in 2011. For fruit quality traits, data were collected in 2011 and 2012. QTLs were identified on LG1 in 2011 and on LG4 in 2012 for soluble solid content, on LG3 for ground color in both years, on LG7 only in 2011, and on LG3 for fruit form in both years. The QTLs that we identified were compared to those previously identified in other Prunus spp.     

As we come to the end of 2011, several members of the Genome Biology Editorial Board give their views on the state of play in genomics

As we come to the end of 2011, Genome Biology has asked some members of our Editorial Board for their views on the state of play in genomics. What was their favorite paper of 2011? What are the challenges in their particular research area? Who has had the biggest influence on their careers? What advice would they give to young researchers embarking on a career in research?     

Development of a novel recombinant strain Zygosacharomyces rouxii JL2011 for 1,3-propanediol production from glucose

1,3-propanediol (1,3-PDO) is one of the most important industrial chemicals due to its highly desired properties and its wide applications as a key component of the emerging polymer industry. Biotechnology route has been one of the most interesting methods for 1,3-PDO production, whereas, the dha genes were essential to 1,3-PDO biosynthesis. In this study, we cloned and placed the dha cassettes under the control of a glyceraldehyde 3-phosphate dehydrogenase gene promoter pGAP and homologous ZrFPS1 gene promoter pZrfps1; these two promoters were further integrated into the chromosome of Z. rouxii JL2011 to generate recombinant strain JL2011-GZ and JL2011-ZZ, respectively. The results showed that the two strains could produce 1,3-PDO from glucose with a final yield of 6.9 and 10.3 g/l, respectively. The engineered strain JL2011-ZZ showed a 2.3- and 1.5-fold increase in the specific activities and final concentration of 1,3-PDO, respectively, with respect to JL2011-GZ. Batch fermentation with aerobic/micro-aerobic combined strategy of JL2011-ZZ resulted a titer of 17.1 g/l and a yield from glucose of 8.6 %. These results demonstrated that JL2011-ZZ would be a potential strain for 1,3-PDO production from glucose.     

Testing the level of ant activity associated with quorum sensing: an empirical approach leading to the establishment and test of a null-model (response to the comment of Richardson et al.)

In a paper in this journal (Nouvellet et al., 2010), we presented results from experiments on the behaviour of the Pharaoh's ant, Monomorium pharaonis, along with a substantial statistical and theoretical analysis of the results. In a minor part of our paper, we compared our results with the related work of Richardson et al. (2010a). These authors have subsequently commented on our interpretation of their work (Richardson et al., 2011). In this Letter we respond to the comments of Richardson et al. (2011), and give detailed arguments why we stand by our original conclusions.