This study tests how mobile technologies empower teens and their families in managing complex daily lifelong intravenous (IV) home parenteral nutrition (HPN). Professionals' audiovisual assessment of teens via mobile iPads allows for early detection of signs of depression, poor HPN home IV care and the signs of the often fatal IV bloodstream infections. Our 12 integrated mTEENconnect interventions target serious teen problems using our 24/7 website with scientifically validated: (1) illustrations of national IV clinical and HPN home care guides; (2) step-by-step algorithms for managing the 48 known recurring HPN home problems; (3) music-inducing naps to decrease fatigue/depression and increase alertness for IV care; and (4) skill-building games for preventing infections and depression and increasing peer support via encrypted safe social media. Our automated prompted message ?applications? reinforce healthy independent living activities specific for teens. Our small pilot found teens engaged in and highly rated each of our 12 interventions and the iPad professional and teen audiovisual assessments and discussions. After 4 months in the pilot, these teens had increased quality of life and social support, no depression, and 1 teen had early detection/treatment of an IV infection. We use our multipoint unit or ?bridge? technology for simultaneous interactions among teens, parents, and multiple professionals. All connections are encrypted for privacy and HIPAA compliance. Our interventionist is a PhD certified adolescent psychologist who has conducted her own funded telehealth teen depression studies. She will use a robust teen depression inventory. All research staff are trained to use our long-standing and approved IRB procedures on managing suicide ideation and mood disorders in group discussions.
Specific Aims are to test the effects of the mTeenConnect interventions delivered via iPad to HPN teens and their parents on: (1) quality of life, health status, fatigue, depression; (2) teens' IV infections; and (3) use of healthy independent living activities (skill-building games, restorative music-guided naps, and safe social media with professionals and peers). As in previous studies, our IT informatics engineering specialist has developed software to track use of all 12 iPad interventions and to time the length of social media discussions in minutes, both measures used in analyses of outcomes. Subjects will anonymously evaluate (1) their preparedness for home care, (2) the iPad social media, and (3) satisfaction with the mobile connections for health-care. Nested linear mixed model analyses are used to test outcomes over time. This clinical trial uses a teen evidence-based intervention comparator group to allow head-to-head comparisons of outcomes and costs. The econometric efficiency statistics of Data Envelopment Analysis (DEA) are used by our team health care economist to determine the iPad delivery costs relative outcomes and to teens health services use.
This study tests how mobile technologies empower teens and their parents in managing complex home intravenous (IV) care by increasing their care access to health professionals and engaging them in healthy living activities for managing their life-long daily home IV infusions. Professionals' real-time home observation via computer tablet cameras and audiovisual assessment of teens IV catheters and catheter insertion sites can provide early detection of the often fatal blood stream sepsis infections. Millions of dollars are spent annually on the USs most costly but preventable diagnosis of IV sepsis, and the frequent concomitant diagnosis of depression, both in the top 25 NIH research priority. S: SON OGR Faculty Grants-SON Smith, C Grants NIH R01 HF Teen Ipads 9-23-15 Smithprojectnarrative.Docx
| Smith, Carol E; Werkowitch, Marilyn; Yadrich, Donna Macan et al. (2017) Identification of Depressive Signs in Patients and Their Family Members During iPad-based Audiovisual Sessions. Comput Inform Nurs 35:352-357 |
