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Don t ruin your reputation. It is almost certain that they can give him a gentle and affectionate wife. The vast array of smartphones, mobile tablets and mobile medical and health-related apps on offer today see the app examples presented earlier in this article provides consumers with an unprecedented opportunity to achieve their health and healthcare goals, and overcome many obstacles along the way. However, with such a booming industry also come concerns, risk and potential dangers.

It is perhaps surprising that relatively very little research has been undertaken so far as of to investigate the validity and efficacy of these devices and apps in the contexts of health and healthcare.

Here, we will briefly present several evaluation and validation studies exploring the diversity of health and healthcare-related apps.

Diabetes management One of the most well studied areas is that of diabetes management. A review conducted by Demidowich et al. The mean composite usability score which evaluated six standard features per app was Medical imaging Another fascinating area of investigation is that of tablet iPad [Apple, Inc.


Such mobile apps pose particular advantages in emergency settings. Several studies have been conducted to compare the efficacy of the iPad to diagnose pulmonary embolism and intracranial haemorrhage versus conventional Picture Archiving and Communications System PACS or liquid-crystal display LCD monitor systems.

The studies have found the iPad to be equivalent to conventional methods, but express the need for conducting further research to examine minor discrepancies [ 76 - 78 ].

In addition, the iPad is being explored as an aid in laparoscopic training for residents and for percutaneous kidney access [ 79 , 80 ]. Global health and infectious diseases The need for affordable, reliable and prompt diagnostic and therapeutic measures is especially evident in the global health infectious disease arena.

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A study performed in rural Bangladesh demonstrated that basic mobile phone technology is both efficient and effective in improving case detection and management of malaria [ 82 ]. Mobile phone messaging has been proposed and investigated as a method to improve medication adherence and communication in HIV management, but a systematic review published in by van Veltoven et al.

Further studies are needed to adequately assess this topic.

Pain management using smartphone-based diaries An innovative and novel use of smartphone technology is in the realm of pain management. Pain is an incredibly diverse and prevalent state that it is often hard for patients to describe, which makes it even harder for caregivers to diagnose and treat. Smartphone technology has the potential to revolutionise real-time pain reporting. In a usability testing study published in , a smartphone-based e-diary was successfully used by children and adolescents with sickle cell disease to report pain symptoms [ 34 ].

A randomised clinical trial has shown women with chronic widespread pain experience fewer catastrophising events rumination, expecting the worst, and feeling helpless when using smartphone-based diaries with immediate therapist feedback [ 85 ].

Similar studies have shown successful usability of smartphone pain assessment in wheelchair users and adolescents with cancer [ 86 , 87 ]. Dermatology The field of dermatology is also taking advantage of the technological smartphone revolution.

One randomised community trial provided text message reminders to use sunscreen daily as the intervention for sun protection, to prevent sunburns in the near term and skin cancer in the long term , and monitored dispensed sunscreen.

Text messages increased sunscreen use, with greater daily adherence [ 46 ]. Text messaging has also been investigated as a tool for improving motivation and treatment adherence in patients with psoriasis.

Multimedia text and photos messaging Multimedia Messaging Service[MMS] has proven to be a promising tool in teledermatology, where it has been used to send digital photographs of skin conditions to specialist dermatologists for diagnosis.

One study compared MMS photographs sent to dermatologists at a university hospital versus separate face-to-face visits in 40 patients.

This study employed two dermatologists for the multimedia message diagnosis and two separate dermatologists for the face-to-face visits. Another potential use of smartphones in dermatology involves apps targeted for patients. In particular, apps have been designed to aid patients with suspicious skin lesions to determine if their lesion is benign or malignant. A study published in in JAMA Dermatology analysed four of these apps and discovered that the ability of apps to assess melanoma risk is highly variable.

A major conclusion of this study was that extreme caution should be exercised when consumers use apps to assess their medical risks, since many apps are subjected to very little or absolutely no regulatory oversight [ 39 ].

For example, O'Neill and Brady [ 12 ] recently questioned the reliability of unregulated medical apps specifically applied towards colorectal diseases. With such a little medical professional involvement in the design of the majority of these apps, increased regulation of some kind is definitely required if we were to improve accountability for app content [ 12 ]. Similarly, in another study by Visvanathan et al. The lack of medical professional involvement in the design of the majority of these apps again undermines users' ability to be informed regarding app content quality.

Visvanathan et al. Ferrero and colleagues [ 38 ] investigated the potential danger of clinical dermatology apps targeting patients, calling for FDA regulation of such apps. Likewise, Robson et al.

Huckvale et al. Demidowich et al. O'Neill and Brady [ 98 ] pointed to apps where inaccuracy or inconsistency could potentially cost lives, citing their experience with opioid conversion calculators. They examined 23 different opioid conversion medical apps and found alarming inconsistencies in their outputs. Such medical apps could present a real risk to patients if the apps do not work as intended.

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The FDA has already cleared a handful of mobile medical apps [ ] that are either used as an accessory to an FDA-regulated medical device or transform a mobile platform into a regulated medical device e.

The combined system and app allows clinicians to image the eye fundus exams and save the images for later review or sharing with colleagues [ ]. In a must-read IEEE Spectrum article published in September , Strickland presented a list of top-five requests to the FDA that came out of a survey of key industry figures on what they would like to see in FDA rules for medical apps [ ].

The requests deal essentially with the need to crisply define the boundaries between apps that have to be regulated by the FDA and apps that do not have to go through the certification process.

But many apps with dosage calculator functions currently marketed in the UK still do not carry the CE mark to show that they have been registered as class I medical devices with the MHRA in England or one of the corresponding regulatory bodies in other EU countries [ ].

The likelihood of an app being treated as a medical device by the MHRA depends on what the app does and the corresponding level of patient risk associated with it. High risk apps, e.

According to MHRA, if an app is purely a record archiving and retrieval system electronic health records , it is unlikely to be considered a medical device; however, if it includes a module that interprets data or performs some calculation, then it is likely that this particular component may be considered a medical device. Decision-support apps are also generally not considered a medical device by MHRA if they just provide existing i.

However, if the apps perform a calculation or interpret or interpolate data and the clinician does not review the raw data, then such apps may be considered medical devices for MHRA purposes. Nevertheless, an app performing simple and straightforward calculations such as BMI body mass index should not be treated as a medical device, but a dosage calculator that recommends a dose based on individual patient details should be [ , ].

As part of the technical documentation, app developers will also need to have undertaken a controlled test and risk assessment to demonstrate that their app supports and improves upon any existing process used to present the same information or function.

Developers can submit their apps for review and possible listing in the Library. A proper app store cf. These are not trivial tasks, and could prove very demanding and well beyond the remits of the NHS, when one considers the thousands of medical and health apps that a specialised health apps store would have to deal with. These aspects or factors are also equally important in the case of health-related and medical apps that are excluded from conventional software as a medical device regulations.

Medical and health app reviewers, such as the curators of the above mentioned NHS Health Apps Library, should cover and perhaps rate in some way these aspects in any app review or assessment they undertake where applicable , to allow end users to make informed comparisons and decisions about which apps to download and use. Make the team stronger before leaving, and survive if you leave. Moreover, Liu Qing did not intend to stay here for too long.

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