Is assessment still the pending issue of health apps?

22 Mar
Marta Millaret

An article in JAMA has recently been published presenting the first smart watch approved by the FDA to predict epileptic seizures. It is called Embrace, a connected device which detects seizures linked to movement and electric fluctuations in the skin of a person and sends an alert so they can receive medical attention.

Last February, the Mobile World Congress was held in Barcelona. Among the different activities to be highlighted which are organised around this congress there is one called 4 Years From Now (#4YFN18), the part of the Mobile which connects companies, investors and institutions with each other to encourage collaboration in developing different ideas, business models and technological solutions.

The Digital Health & Wellness Summit 2018, organised by 4YFN Connecting Startups, the Mobile World Capital Barcelona and the Mobile World Congress with the collaboration of ECHAlliance, the European Connected Health Alliance, is the meeting point of technological and health issues. This year, among others, Neil Gomes, Maria Salido and Elena Torrente participated.

Neil Gomes from the Thomas Jefferson University of the USA pointed out that one of the challenges in mHealth is facilitating feedback between patients and health professionals.

Maria Salido, co-founder and CEO of the health app, SocialDiabetes, raised key issues for success with health apps: regulation + industry + users. And in particular, she highlighted the importance of the final users. An article published in The Economist was much commented on here with a provocative title:

Elena Torrente, Digital Health Coordinator at DKV, commented on Digital Doctor, a health app that incorporates a detector of symptoms and a tool to request a doctor’s appointment. She pointed out that there were more women than men in the user profile of the app.

In general, there was consensus on the fact that prior to developing an app, an analysis to identify needs must be done. That is, the first step should be to detect the needs of a user and then, based on the mapping of these needs, the moment would come to develop technological solutions.

The content of all these presentations is available and you can also read a compilation of the main ideas that were highlighted here and here.

Despite it not being the main subject of their presentations, in the follow up debate the need and convenience of assessment was brought up. At present, there are already 320,000 health apps on the market. But,… How are they assessed? Who does this? With what criteria? Can we already talk about the safe prescription of health apps?

We close the circle once again with the conceptual framework of mHealth Assessment published in JMIR mHealth and uHealth with which the Agency for Health Quality and Assessment of Catalonia (AQuAS) provides the culture of assessment to the everyday reality in which we find ourselves (in 2016 it was published in the first quartile, in the categories “Health Care Sciences & Services” and “Medical Informatics”, respectively, in the Journal Citation Reports). There are an increasing number of health apps and the debate concerning their assessment remains open.

Post written by Marta Millaret (@MartaMillaret).

Hip and knee arthroplasty: What prosthesis did you say I would get? (part two)

1 Feb
Olga Martínez, Xavier Mora

We continue the interview with Olga Martínez expert at the Catalan Arthroplasty Register (RACat) and Xaxier Mora, specialist in traumatology and orthopaedic surgery with a Master in biomaterials.

The aim of today’s post is to know a little more about prostheses and the biomaterials used in arthroplasties.

With this post and the previous one, we have wanted to present the opinions of these two professionals.

Are all prostheses the same?

Xavier: No, because each patient is different. Therefore, the orthopaedic surgeon will recommend one type of prosthesis or another, depending on the extent to which the bone is affected, the patients’ age, associated diseases and the daily activity of a the patient.

Olga: At present, there are different types of prosthesis on the market in terms of design, materials used in their manufacture and the way they are anchored to the bone. There are prostheses that range from replacing only a part of the joint to more complex joint replacements in situations where bone damage is extensive.

As a user of the health system, to which hospital should I go to receive the best prosthesis?

Xavier: One cannot talk about better or worse prostheses because all prostheses used for implants have to follow a standardised procedure according to specific international standards, such as those of the American FDA and the European CE seal of approval, for materials that will be implanted in humans. In the same way, hospitals in Catalonia are certified to be able to carry out this type of surgery.

Olga: The prostheses which are commercialised in Catalonia meet the international standards of quality and public hospitals base their choices of prostheses on the scientific evidence available. This is allows them to select those with the best results according to arthroplasty registries, using recommendations from different institutions such as the NICE (National Institute of Healthcare and Clinical Excellence) and the ODEP (Orthopaedic Data Evaluation Panel).

Olga: In addition, the new European legislation passed in 2016, regarding implants used in health, aims to increase the supervision of the industry by implementing stricter norms and regulations including the obligation of clinical assessment, while at the same time fostering innovation in this field.

Who does the research into the best materials available and what factors are taken into account?

Olga: These days, the research of new materials and manufacturing techniques as well as the design and improvement of new prosthetic implants is a multidisciplinary process. The contributions of orthopaedic surgeons are especially important together with studies in joint biomechanics and surgical technique. In Catalonia there are research centres in biomaterials such as Leitat and the Technical University of Catalonia (UPC).

Olga: From the AQuAS we have written up and published short reports on biomaterials (polyethylene, cements and ceramics and metals) aimed at professionals that work in services of orthopaedic surgery and traumatology, with the aim of updating their knowledge.

Reports available in Catalan:

Xavier: Nowadays, when manufacturing new materials, the interaction between the surface of a biomaterial and the bone is taken into account more and more often, so that bone cells can consider an implant as part of its own structure and thereby avoid the prosthesis from moving about because this is one of the biggest problems in getting an implant to function well.

How have materials evolved since the first prostheses to the present day?

Olga: The discovery of new materials and/or the progress made both in terms of manufacturing techniques and the knowledge gained in the biomechanics of the human body have influenced the design of prostheses over time.

Xavier: The first experiences in joint implants date back to the 20s of last century. One of the first attempts at replacing the surface of the head of the hip was done by manufacturing a metal socket or dome (Smith-Petersen).

Xavier: In the last 20 years, many important advances have been made regarding the use of new biomaterials, much safer and of greater resistance to wear, thus extending the life of an implant in a biological environment such as the human body. Together with metallic biomaterials, these days ceramic biomaterials are used with good results in relation to their integration in bone tissue.

Xavier: On the other hand, research in 3D technology has paved the way for a more precise surgery, and in the future it will be possible to manufacture more personalised implants.

Xavier and Olga: We both agree that we are getting closer and closer to having a prosthesis that is for life.