BACKGROUND: Hospitals, patients, and health-care workers are legally protected by international humanitarian law and the Geneva Convention. However, since Oct 7, 2023, the health-care system in the Gaza Strip, occupied Palestinian territory, has been under unprecedented direct military attacks by Israel, with support for patients proving to be challenging for the remaining health-care workers. Peer-to-peer telemedicine holds promise for assisting surgeons in high-risk, low-resource environments, but might be of reduced utility in extremely austere settings.
METHODS: We present a patient case series of traumatic injuries shared in an international telemedicine group by the surgical team at Nasser Medical Complex, also known as Nasser Hospital, the largest remaining partially functioning hospital in Gaza. WhatsApp (Meta; Menlo Park, CA, USA), a widely available and user-friendly end-to-end encrypted smartphone application, was used to facilitate consultations for weapon-inflicted injuries. All the presented patient cases were shared after obtaining verbal consent from the patients and discussed through a multidisciplinary team approach. The group was developed into a community with more than 15 specialty and injury-oriented subgroups and over 1000 members who joined through non-targeted social media outreach followed by snowball recruitment. Prospective registration and formal ethics approval in Gaza was impossible because the Ministry of Health, including the local Helsinki Committee, had suspended all operations. In June, 2024, we obtained ethics approval from the local Helsinki committee in Gaza.
RESULTS: We present 12 select patient case studies from a pool of hundreds of patients admitted to Nasser Hospital between Jan 28 and Feb 12, 2024. Four (33%) of the 12 patients were female and eight (67%) were male, with four patients (33%) being children (younger than 18 years). The age range was between 3 years and 70 years, with a median age of 25 years. Most patients presented with penetrating injuries (11 [92%] of 12), with six patients presenting with wounds secondary to fragment injury, and five patients presenting with wounds due to gunshots. One patient presented with a direct blast injury. The site of reported injuries included head and neck areas (four [33%] of 12), abdomen (four [33%] of 12), chest (three [25%] of 12), pelvis (two [17%] of 12), and limbs (one [8%] of 12). Most patients were lost to follow-up (11 [92%] of 12) and were affected by the invasion of the hospital by the Israeli Defense Forces, which subsequently rendered the hospital non-functional. One patient died following their injury.
CONCLUSIONS: The health-care team at the now non-functioning Nasser Hospital in southern Gaza adapted their allocation and distribution of extremely low resources and relied on smartphones for specialised telemedicine outreach purposes. This enhanced the capability of the medical teams in management of mass casualties of military assaults that few are trained to work in. Nonetheless, the options available to a health-care system that is under-staffed, under-served, and under siege, are extremely constrained, regardless of such telemedicine initiatives.
BACKGROUND: None.

The paper evaluates the DARS Traffic Plus mobile application within a realistic driving simulator environment to assess its impact on driving safety and user experience, particularly focusing on the Cooperative Intelligent Transport Systems (C-ITS). The study is positioned within the broader context of integrating mobile technology in vehicular environments to enhance road safety by informing drivers about potential hazards in real time. A combination of experimental methods was employed, including a standardised user experience questionnaire (meCUE 2.0), measuring quantitative driving parameters and eye-tracking data within a driving simulator, and post-experiment interviews. The results indicate that the mobile application significantly improved drivers\' safety perception, particularly when notifications about hazardous locations were received. Notifications displayed at the top of the mobile screen with auditory cues were deemed most effective. The study concludes that mobile applications like DARS Traffic Plus can play a crucial role in enhancing road safety by effectively communicating hazards to drivers, thereby potentially reducing road accidents and improving overall traffic safety. Screen viewing was kept below the safety threshold, affirming the app\'s efficacy in delivering crucial information without distraction. These findings support the integration of C-ITS functionalities into mobile applications as a means to augment older vehicle technologies and extend the safety benefits to a broader user base.

BACKGROUND: Patient-driven innovation in health care is an emerging phenomenon with benefits for patients with chronic conditions, such as cystic fibrosis (CF). However, previous research has not examined what may facilitate or hinder the implementation of such innovations from the provider perspective.
OBJECTIVE: The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics.
METHODS: A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9%, in Sweden; n=1, 11.1%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis.
RESULTS: We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16%-23%), middle (25%-47%), or high (58%-95%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers\' perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability.
CONCLUSIONS: For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers\' perspectives on what generates value is essential.

Over the past few decades, Information and Communication Technologies (ICT) have revolutionized the fields of nursing and patient healthcare management. This scoping review and the accompanying case studies shed light on the extensive scope and impact of ICT in these critical healthcare domains. The scoping review explores the wide array of ICT tools employed in nursing care and patient healthcare management. These tools encompass electronic health records systems, mobile applications, telemedicine solutions, remote monitoring systems, and more. This article underscores how these technologies have enhanced the efficiency, accuracy, and accessibility of clinical information, contributing to improved patient care. ICT revolution has revitalized nursing care and patient management, improving the quality of care and patient satisfaction. This review and the accompanying case studies emphasize the ongoing potential of ICT in the healthcare sector and call for further research to maximize its benefits.

BACKGROUND: Understanding the role of adherence to home exercise programs for survivors of stroke is critical to ensure patients perform prescribed exercises and maximize effectiveness of recovery.
METHODS: Survivors of hemiparetic stroke with impaired motor function were recruited into a 7-day study designed to test the utility and usability of a low-cost wearable system and progressive-challenge cued exercise program for encouraging graded-challenge exercise at-home. The wearable system comprised two wrist-worn MetaMotionR+ activity monitors and a custom smartphone app. The progressive-challenge cued exercise program included high-intensity activities (one repetition every 30 s) dosed at 1.5 h per day, embedded within 8 h of passive activity monitoring per day. Utility was assessed using measures of system uptime and cue response rate. Usability and user experience were assessed using well-validated quantitative surveys of system usability and user experience. Self-efficacy was assessed at the end of each day on a visual analog scale that ranged from 0 to 100.
RESULTS: The system and exercise program had objective utility: system uptime was 92 ± 6.9% of intended hours and the rate of successful cue delivery was 99 ± 2.7%. The system and program also were effective in motivating cued exercise: activity was detected within 5-s of the cue 98 ± 3.1% of the time. As shown via two case studies, accelerometry data can accurately reflect graded-challenge exercise instructions and reveal differentiable activity levels across exercise stages. User experience surveys indicated positive overall usability in the home settings, strong levels of personal motivation to use the system, and high degrees of satisfaction with the devices and provided training. Self-efficacy assessments indicated a strong perception of proficiency across participants (95 ± 5.0).
CONCLUSIONS: This study demonstrates that a low-cost wearable system providing frequent haptic cues to encourage graded-challenge exercise after stroke can have utility and can provide an overall positive user experience in home settings. The study also demonstrates how combining a graded exercise program with all-day activity monitoring can provide insight into the potential for wearable systems to assess adherence to-and effectiveness of-home-based exercise programs on an individualized basis.

Sharing Economy apps, such as Uber, Airbnb, and TaskRabbit, have generated a substantial consumer interest over the past decade. The unique form of peer-to-peer business exchange these apps have enabled has been linked to significant levels of economic growth, helping people in resource-constrained communities to build social capital and move up the economic ladder. However, due to the multidimensional nature of their operational environments, and the lack of effective methods for capturing and describing their end-users\' concerns, Sharing Economy apps often struggle to survive. To address these challenges, in this paper, we examine crowd feedback in ecosystems of Sharing Economy apps. Specifically, we present a case study targeting the ecosystem of food delivery apps. Using qualitative analysis methods, we synthesize important user concerns present in the Twitter feeds and app store reviews of these apps. We further propose and intrinsically evaluate an automated procedure for generating a succinct model of these concerns. Our work provides a first step toward building a full understanding of user needs in ecosystems of Sharing Economy apps. Our objective is to provide Sharing Economy app developers with systematic guidelines to help them maximize their market fitness and mitigate their end-users\' concerns and optimize their experience.

This study empirically evaluates the functionality coverage of 18 mobile applications (apps) for Postnatal care including a recently developed app in Morocco \"Mamma&Baby\". This evaluation is based on a comparison of the COSMIC _ISO 19,761 functional size of these apps with the score obtained in a previous evaluation based on functions extraction through a quality assessment questionnaire. This comparison allows to discuss the relationship between the functional size of the 18 apps, their users\' ratings in the Play Store as well as the number of downloads. While for most of the assessed apps, there is only a small shift between the rankings of the two evaluations, for some apps, the shift is huge due to the number of features added and not covered by the score previously obtained. This study illustrates the use of COSMIC as an effective method for corrective or evolutionary updates since it takes into account all the functions and features of postnatal apps. For the \"Mamma&Baby\" app, efforts are required to boost the number of downloads, optimize its visibility, and attract the highest number of users.

BACKGROUND: Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology.
METHODS: In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays.
BACKGROUND: Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences.
BACKGROUND: NCT05998239; pre-results.

BACKGROUND: Advances in health have highlighted the need to implement technologies as a fundamental part of the diagnosis, treatment, and recovery of patients at risk of or with health alterations. For this purpose, digital platforms have demonstrated their applicability in the identification of care needs. Nursing is a fundamental component in the care of patients with cardiovascular disorders and plays a crucial role in diagnosing human responses to these health conditions. Consequently, the validation of nursing diagnoses through ongoing research processes has become a necessity that can significantly impact both patients and health care professionals.
OBJECTIVE: We aimed to describe the process of developing a mobile app to validate the nursing diagnosis \"intolerance to physical activity\" in patients with acute myocardial infarction.
METHODS: We describe the development and pilot-testing of a mobile system to support data collection for validating the nursing diagnosis of activity intolerance. This was a descriptive study conducted with 11 adults (aged ≥18 years) who attended a health institution for highly complex needs with a suspected diagnosis of coronary syndrome between August and September 2019 in Floridablanca, Colombia. An app for the clinical validation of activity intolerance (North American Nursing Diagnosis Association [NANDA] code 00092) in patients with acute coronary syndrome was developed in two steps: (1) operationalization of the nursing diagnosis and (2) the app development process, which included an evaluation of the initial requirements, development and digitization of the forms, and a pilot test. The agreement level between the 2 evaluating nurses was evaluated with the κ index.
RESULTS: We developed a form that included sociodemographic data, hospital admission data, medical history, current pharmacological treatment, and thrombolysis in myocardial infarction risk score (TIMI-RS) and GRACE (Global Registry of Acute Coronary Events) scores. To identify the defining characteristics, we included official guidelines, physiological measurements, and scales such as the Piper fatigue scale and Borg scale. Participants in the pilot test (n=11) had an average age of 63.2 (SD 4.0) years and were 82% (9/11) men; 18% (2/11) had incomplete primary schooling. The agreement between the evaluators was approximately 80% for most of the defining characteristics. The most prevalent characteristics were exercise discomfort (10/11, 91%), weakness (7/11, 64%), dyspnea (3/11, 27%), abnormal heart rate in response to exercise (2/10, 20%), electrocardiogram abnormalities (1/10, 9%), and abnormal blood pressure in response to activity (1/10, 10%).
CONCLUSIONS: We developed a mobile app for validating the diagnosis of \"activity intolerance.\" Its use will guarantee not only optimal data collection, minimizing errors to perform validation, but will also allow the identification of individual care needs.

Superapps (ie apps that integrate the features of multiple applications for a more convenient user experience) have become pervasive among Internet users. This case study examines a recent disruption to one such application: KakaoTalk - the most widely used messaging application in South Korea. Specifically, the case study examines a fire incident at the SK C&C data centre, which caused an extended outage for one of South Korea\'s leading tech companies - Kakao Corp. The review of this event reveals how ineffective disaster readiness resulted in inadequate fire response, leading to serious ripple effects across the data centre. During the outage, cyber-security threats rose. As a result of these disruptions, Kakao users turned to competitor apps, resulting in changing market dynamics. This case study highlights the unforeseen costs and socio-economic influences caused by such interruptions, highlighting the importance of holistic risk management strategies.