OBJECTIVES: Although ambulance-based telemedicine has been reported to be safe and feasible, its clinical usefulness has not been well documented, and different prehospital management systems would yield different results. The authors evaluated the feasibility and usefulness of telemedicine-assisted direct medical control in the Korean emergency medical service system. METHODS: Twenty ambulances in the Busan area were equipped with a telemedicine system. Three-lead electrocardiogram, blood pressure, and pulse oximetry data from the patient and audiovisual input from the scene were transferred to a server. Consulting physicians used desktop computers and the internet to connect to the server. Both requesting emergency medical service (EMS) providers and consulting physicians were asked to fill out report forms and submit them for analysis. RESULTS: In the 41 cases in which telemedicine equipment was used, cellular phones were concomitantly used in 28 cases (68.35%) to compensate for the poor audio quality provided by the equipment. The EMS providers rated the video transmission quality with a 4-point average score (interquartile range [IQR] 2-5) on a 5-point scale, and they rated the biosignal transmission quality as 4 (IQR 3-5). The consulting physicians rated the video quality as 4 (IQR 2.5-4) and the biosignal quality as 4 (IQR 3-4). The physicians' ratings for usefulness for making diagnosis or treatment decisions did not differ significantly in relation to the method of communication used. CONCLUSIONS: Our study did not find any significant advantage of implementing telemedicine over the use of voice calls in delivering on-line medical control. More user-friendly, smaller devices with clear advantages over voice communication would be required before telemedicine can be successfully implemented in prehospital patient care.
Ambulances ; Blood Pressure ; Busan ; Cellular Phone ; Diagnosis ; Electrocardiography ; Emergency Medical Services ; Humans ; Internet ; Oximetry ; Patient Care ; Remote Consultation ; Telemedicine* ; Telemetry ; Voice

We report the case in order to examine the effect of a mobile application program ("Diabetes & Nutrition") developed in 2011-2012 for self-management in patients with type 2 diabetes and to recommend important considerations when the mobile application program is developed. A 46-year-old man was newly diagnosed with type 2 diabetes in 2013 and had no complications. The height of the patient was 168 cm and the body weight was 75.6 kg. Nutrition education was conducted according to a medical prescription, and follow-up nutrition education was conducted after 3 and 6 months. After nutrition education, the patient was engaged in self-management using "Diabetes & Nutrition" program during 3 months. At 3 months, the body weight had decreased by 4.4 kg (from 75.6 to 71.2 kg), waist circumference by 5 cm (from 88 to 83 cm) and HbA1c level from 7.9% to 6.1%. Also at 3 months, the medication was reduced from from the dose of 850 mg to the dose of 500 mg metformin per twice a day. Since then, the patient did not continue to use the "Diabetes & Nutrition" because the level of blood glucose had stabilized, and the patient felt inconvenient and annoying to use the program. At 6 months, no significant change in the body weight and body composition was observed in comparison with those at 3 months. The present case demonstrates that the early use of "Diabetes & Nutrition" could be helpful for self-management of glycemic control in patients with type 2 diabetes. Developing self-management mobile application programs in the future will require strategies of how to promote continuous use of application program and self-management of type 2 diabetes.
Blood Glucose ; Body Composition ; Body Weight ; Cellular Phone* ; Diabetes Mellitus, Type 2 ; Education ; Follow-Up Studies ; Humans ; Metformin ; Middle Aged ; Mobile Applications ; Nutrition Therapy ; Prescriptions ; Self Care* ; Waist Circumference

OBJECTIVES: In this study, we performed a preliminary investigation for establishing guidelines for the usage of smartphones in children and adolescents. METHODS: From March 2014 to August 2014, 182 board-certified psychiatrists were asked to participate in the survey ; 121 participants completed the questionnaire. The questionnaire was developed by the authors, mainly the Public Relations Committee of the Korean Academy of Child and Adolescent Psychiatry. It evaluates psychiatrists' opinions on the use of smartphones in children and adolescents. In addition, psychiatrists' attitudes towards their own usage of smartphones were assessed in order to determine the impact on their opinion towards the children's usage. RESULTS: Psychiatrists have recommended various opinions as the appropriate age to own a smartphone for the first time. Mean age recommended by psychiatrists is grade 7.7. One-hundred participants (82.6%) agreed to the age limit to own a smartphone for the first time. In addition all participants agreed to the necessity of a time limit in children and adolescents. Psychiatrists (17.4%) who disagree on the age limit in children considered the smartphone more useful by themselves compared to psychiatrists who agreed on the age limit. CONCLUSION: Most psychiatrists have recommended that an appropriate limit for smartphone usage in children and adolescents is needed.
Adolescent Psychiatry ; Adolescent* ; Cellular Phone ; Child* ; Humans ; Psychiatry* ; Public Relations

BACKGROUND: We developed for the first time a smartphone application designed for diabetes self-management in Korea and registered a patent for the relevant algorithm. We also investigated the user satisfaction with the application and the change in diabetes related self-care activities after using the application. METHODS: We conducted a questionnaire survey on volunteers with diabetes who were using the application. Ninety subjects responded to the questionnaire between June 2012 and March 2013. A modified version of the Summary of Diabetes Self-Care Activities (SDSCA) was used in this study. RESULTS: The survey results exhibited a mean subject age of 44.0 years old, and males accounted for 78.9% of the subjects. Fifty percent of the subjects had diabetes for less than 3 years. The majority of respondents experienced positive changes in their clinical course after using the application (83.1%) and were satisfied with the structure and completeness of the application (86.7%). Additionally, the respondents' answers indicated that the application was easy to use (96.7%) and recommendable to others (97.7%) and that they would continue using the application to manage their diabetes (96.7%). After using the Diabetes Notepad application, diabetes related self-care activities assessed by SDSCA displayed statistically significant improvements (P<0.05), except for the number of days of drinking. CONCLUSION: This smartphone-based application can be a useful tool leading to positive changes in diabetes related self-care activities and increase user satisfaction.
Cellular Phone ; Surveys and Questionnaires ; Diabetes Mellitus ; Drinking ; Humans ; Korea ; Male ; Mobile Applications ; Self Care* ; Volunteers ; Smartphone ; Surveys and Questionnaires

The use of smartphones has rapidly increased over the past few years. With the increasing use of smartphones, concern has been raised about the potential harmful effects on human health. In 2011, the International Agency for Research on Cancer of the World Health Organization classified radiofrequency electromagnetic fields as possibly carcinogenic to humans (group 2B) based on an increased risk for glioma associated with wireless phone use (i.e. mobile phones). In addition, several meta-analyses of case-control studies reported an increased risk of tumors associated with the use of mobile phones. Moreover, it has been reported that the overuse of mobile phones is associated with reproductive risks, addiction, and phantom vibration and ringing syndrome. Further large prospective cohort studies and randomized controlled trials are needed to confirm these associations. Until clear evidence is available that the use of smartphones is safe, their overuse should be avoided.
Case-Control Studies ; Cellular Phone ; Cohort Studies ; Electromagnetic Fields ; Glioma ; Humans ; International Agencies ; Vibration ; World Health Organization

PURPOSE: The purpose of this study was to identify cell phone addiction in school-age children and factors influencing addiction. METHODS: The participants were 163 parents of elementary school students in the 1st to 4th grades. Data were collected through self-report questionnaires completed by the parents, and analyzed using the SPSS/WIN 19.0 IBM program. RESULTS: Of the children, 86.5% were reported as being average users, 9.2%, at risk users, and 4.3%, at high risk users. Cell phone addiction in the children was significantly different according to games played by the children and parents' monthly income. Significant factors influencing cell phone addiction in the children were children's self-control, games played by the children, parents' cell phone addiction and parental control for children's cell phone use, explaining 24% of variance in cell phone addiction. CONCLUSION: The findings indicate that cell phone addiction in school-age children is influenced by parent-related factors as well as personal factors. Therefore approaches to education programs on cell phone use in school-age children should include parent-related factors as well as personal factors of the children.
Behavior, Addictive ; Cellular Phone* ; Child* ; Education ; Humans ; Parents ; Surveys and Questionnaires

OBJECTIVES: The objectives of this research were to develop and evaluate a cell phone application based on the standard protocol for personal health devices and the standard information model for personal health records to support effective blood glucose management and standardized service for patients with diabetes. METHODS: An application was developed for Android 4.0.3. In addition, an IEEE 11073 Manager, Medical Device Encoding Rule, and Bluetooth Health Device Profile Connector were developed for standardized health communication with a glucometer, and a Continuity of Care Document (CCD) Composer and CCD Parser were developed for CCD document exchange. The developed application was evaluated by five healthcare professionals and 87 users through a questionnaire comprising the following variables: usage intention, effort expectancy, social influence, facilitating condition, perceived risk, and voluntariness. RESULTS: As a result of the evaluation of usability, it was confirmed that the developed application is useful for blood glucose self-monitoring by diabetic patients. In particular, the healthcare professionals stated their own views that the application is useful to observe the trends in blood glucose change through the automatic function which records a blood glucose level measured using Bluetooth function, and the function which checks accumulated records of blood glucose levels. Also, a result of the evaluation of usage intention was 3.52 +/- 0.42 out of 5 points. CONCLUSIONS: The application developed by our research team was confirmed by the verification of healthcare professionals that accurate feedback can be provided to healthcare professionals during the management of diabetic patients or education for glucose management.
Blood Glucose ; Blood Glucose Self-Monitoring* ; Cellular Phone* ; Continuity of Patient Care ; Delivery of Health Care ; Education ; Glucose ; Health Communication ; Health Records, Personal ; Humans ; Intention ; Surveys and Questionnaires

OBJECTIVES: The use of Internet in the health domain is becoming a major worldwide trend. Millions of citizens are searching online health information and also publishing content about their health. Patients are engaging with other patients in online communities using different types of social media. The boundaries between mobile health, social media, wearable, games, and big data are becoming blurrier due the integration of all those technologies. In this paper we provide an overview of the major research challenges with the area of health social media. METHODS: We use several study cases to exemplify the current trends and highlight future research challenges. RESULTS: Internet is exploding and is being used for health purposes by a great deal of the population. Social networks have a powerful influence in health decisions. Given the lack of knowledge on the use of health social media, there is a need for complex multidisciplinary research to help us understand how to use social networks in favour of public health. A bigger understanding of social media will give health authorities new tools to help decision-making at global, national, local, and corporate level. CONCLUSIONS: There is an unprecedented amount of data that can be used in public health due the potential combination of data acquired from mobile phones, Electronic Health Records, social media, and other sources. To identify meaningful information from those data sources it is not trial. Moreover, new analytics tools will need to be developed to analyse those sources of data in a way that it can benefit healthcare professionals and authorities.
Cellular Phone ; Delivery of Health Care ; Electronic Health Records ; Health Communication ; Humans ; Information Storage and Retrieval ; Internet ; Public Health ; Public Health Informatics ; Social Media* ; Telemedicine

PURPOSE: On-line medical control, in addition to indirect control like protocols, is known to exert a positive effect on the quality of prehospital care. Because the decision-making process of directing physicians depends on the information provided by prehospital providers via telecommunication, brief and organized reporting of significant points is of paramount importance. METHODS: Telecommunications regarding direct medical control provided by emergency physicians in a university hospital were recorded from May 1 to June 30, 2012. All communications were between cellular phones. Analysis of the recorded dialogues was performed by an independent researcher. RESULTS: A total of 115 cases were included for analyses. Affiliated fire offices were reported in 107 (93.0%) cases, while certification of responding officers was reported in only 62 (53.9%) cases. All five vital signs were reported in only 9 cases (7.8%), including blood pressure, heart rate, respiration rate, temperature, and oxygen saturation. Procedures delivered before telephone contact were reported in 30.4% of cases, and reporting rate of patient response to treatment was 16.5%. Estimated times of arrival to the destined hospital were reported in only 8.7%. CONCLUSION: Reporting procedures regarding prehospital direct medical control should be concise and comprehensive, including essential elements like certification of the provider, consciousness and vital signs of the patient, and estimated time of hospital arrival.
Blood Pressure ; Cellular Phone ; Certification ; Consciousness ; Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Fires ; Heart Rate ; Humans ; Oxygen ; Physician Executives* ; Respiratory Rate ; Telecommunications ; Telephone ; Vital Signs

OBJECTIVES: This study aimed to determine the effect of mobile-based discussion versus computer-based discussion on self-directed learning readiness, academic motivation, learner-interface interaction, and flow state. METHODS: This randomized controlled trial was conducted at one university. Eighty-six nursing students who were able to use a computer, had home Internet access, and used a mobile phone were recruited. Participants were randomly assigned to either the mobile phone app-based discussion group (n = 45) or a computer web-based discussion group (n = 41). The effect was measured at before and after an online discussion via self-reported surveys that addressed academic motivation, self-directed learning readiness, time distortion, learner-learner interaction, learner-interface interaction, and flow state. RESULTS: The change in extrinsic motivation on identified regulation in the academic motivation (p = 0.011) as well as independence and ability to use basic study (p = 0.047) and positive orientation to the future in self-directed learning readiness (p = 0.021) from pre-intervention to post-intervention was significantly more positive in the mobile phone app-based group compared to the computer web-based discussion group. Interaction between learner and interface (p = 0.002), having clear goals (p = 0.012), and giving and receiving unambiguous feedback (p = 0.049) in flow state was significantly higher in the mobile phone app-based discussion group than it was in the computer web-based discussion group at post-test. CONCLUSIONS: The mobile phone might offer more valuable learning opportunities for discussion teaching and learning methods in terms of self-directed learning readiness, academic motivation, learner-interface interaction, and the flow state of the learning process compared to the computer.
Cellular Phone ; Humans ; Internet ; Learning* ; Mobile Applications ; Motivation ; Students, Nursing*