A Review of Telemedicine Interventions for Weight Loss

Abstract Purpose of Review Telemedicine has become popular as an alternative for in-person weight loss treatment during the COVID-19 pandemic. This review focuses on weight loss interventions utilizing real-time telemedicine. Recent Findings Telemedicine interventions are usually run as a weekly counseling and educational session or as a complement to a primarily Web-based intervention. A wide variety of healthcare professionals may provide the intervention. Common content includes portion control, increased physical activity, and relapse prevention. Self-monitoring is associated with intervention success. Modalities considered include online chats, text messages, phone calls, and videoconferences. Videoconferencing may be especially useful in capturing the interpersonal connection associated with in-person care but is understudied compared to other modalities. While many interventions show improvements in weight and weight-related outcomes, small sample sizes limit generalizability. Technology access and digital literacy are both necessary. Summary Telemedicine interventions can successfully help patients with obesity lose weight. Telemedicine interventions provide a safe, remote alternative and may expand treatment access to hard-to-reach populations. Further research is needed on telemedicine weight loss treatments for seniors, men, and ethnic minorities, as well as on the impact of long-term interventions.

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Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10081740 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1740

Author(s):

Marion Bareille ◽

Michaël Hardy ◽

Jonathan Douxfils ◽

Stéphanie Roullet ◽

Dominique Lasne ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Strength ◽

Small Sample ◽

The Common ◽

Small Sample Sizes ◽

Definition Of ◽

Reported Data ◽

Prophylactic Anticoagulation ◽

The Impact ◽

Heparin Neutralization

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

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Cannabis and breastfeeding

Paediatrics & Child Health ◽

10.1093/pch/pxaa037 ◽

2020 ◽

Vol 25 (Supplement_1) ◽

pp. S26-S28 ◽

Cited By ~ 1

Author(s):

Lisa Graves

Keyword(s):

Health Care Providers ◽

Small Sample ◽

Adverse Outcomes ◽

Care Providers ◽

High Quality ◽

High Quality Evidence ◽

Small Sample Sizes ◽

The Impact ◽

Quality Evidence

Abstract Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.

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Comparing the Keyto App and Device with Weight Watchers’ WW App for Weight Loss: Protocol for a Randomized Trial

JMIR Research Protocols ◽

10.2196/19053 ◽

2020 ◽

Vol 9 (8) ◽

pp. e19053

Author(s):

Sean R Locke ◽

Kaja Falkenhain ◽

Dylan A Lowe ◽

Terry Lee ◽

Joel Singer ◽

...

Keyword(s):

Weight Loss ◽

Cardiovascular Risk ◽

Randomized Trial ◽

Ketogenic Diet ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Ketogenic Diets ◽

Phone Calls ◽

Weight Watchers ◽

The Impact

Background Obesity and being overweight are major contributing factors for many diseases. Calorie restricted diets often fail to result in sustained long-term weight loss. Very low–carbohydrate, high-fat ketogenic diets have been suggested to have superior metabolic and weight loss effects. Keyto is a low-cost, highly scalable mobile health (mHealth) app paired with a noninvasive biofeedback tool aimed at facilitating weight loss through a personalized healthy and predominantly plant- and fish-based ketogenic diet. Objective This protocol describes a randomized trial comparing the efficacy of the Keyto mHealth app and device intervention to that of Weight Watchers’ WW app in individuals who are overweight or obese. The primary outcome is weight loss after 12 weeks. Secondary and exploratory outcomes, including metabolic and cardiovascular risk factors, will be assessed at 12, 24, and 48 weeks. Methods A total of 144 participants will be recruited and randomized to either the Keyto program or Weight Watchers program. Study participants will be guided through the study via video conference or phone calls and will undergo a fasting blood analysis performed by a third-party diagnostic lab at weeks 0 and 12 to assess metabolic and cardiovascular risk markers. All participants will be asked to weigh themselves daily on a study-provided Bluetooth-enabled scale. Participants randomized to the Keyto arm will also be asked to measure their breath acetone levels, a measure of ketosis, with the Keyto device 3 times per day. Results Recruitment started in December 2019. Rolling recruitment is expected to be completed by July 2020. Data collection and analysis of the primary intervention phase is expected to be completed in October 2020. The 24- and 48-week follow-ups are expected to be completed in January 2021 and July 2021, respectively. Conclusions This trial will provide high-quality evidence regarding the efficacy of the Keyto weight loss program in individuals who are overweight and obese in a free-living condition. This study also fills a gap by examining the impact of a ketogenic diet emphasizing plant- and fish-based fats on blood lipid profile and cardiovascular disease risk. Trial Registration ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707. International Registered Report Identifier (IRRID) DERR1-10.2196/19053

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The Impact of Self-monitoring of Blood Glucose on a Behavioral Weight Loss Intervention for Patients With Type 2 Diabetes

The Diabetes Educator ◽

10.1177/0145721712449434 ◽

2012 ◽

Vol 39 (3) ◽

pp. 397-405 ◽

Cited By ~ 11

Author(s):

Lisa M. McAndrew ◽

Melissa A. Napolitano ◽

Leonard M. Pogach ◽

Karen S. Quigley ◽

Kerri Leh Shantz ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Blood Glucose ◽

Weight Loss Intervention ◽

Behavioral Weight Loss ◽

Self Monitoring ◽

Behavioral Weight Loss Intervention ◽

The Impact

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Real-world data evaluating immunotherapy markers and checkpoint inhibitor response among GI cancers in a large community-based oncology network.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.113 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 113-113

Author(s):

Carissa Jones ◽

Rebecca Lachs ◽

Emma Sturgill ◽

Amanda Misch ◽

Caressa Lietman ◽

...

Keyword(s):

Checkpoint Inhibitor ◽

Small Sample ◽

Tumor Type ◽

Real World Data ◽

Loss To Follow Up ◽

Kaplan Meier ◽

Gi Cancers ◽

Small Sample Sizes ◽

Line Of Therapy ◽

The Impact

113 Background: Checkpoint inhibitor (CPI) therapies have shown prolonged survival in patients (pts) with microsatellite instability (MSI). Tumor mutation burden (TMB) has also been associated with benefit from CPIs, with pembrolizumab recently approved for solid tumors with a TMB of ≥10 muts/mb. However, the validity of a tissue-agnostic approach has been debated given the high degree of TMB variation across tumor types. We sought to evaluate the impact of TMB and MSI on CPI response in pts with advanced gastrointestinal (GI) cancers who received NGS profiling. Methods: Patients within the Sarah Cannon network with GI cancer and comprehensive next generation sequencing (NGS) data were identified through Genospace, Sarah Cannon’s clinico-genomic analytics platform. Microsatellite (MS) status [high (MSI-H) vs. stable (MSS)] was defined by NGS. TMB-high (TMB-H) was defined as ≥10 muts/mb. Kaplan-Meier estimates were used to examine time to treatment failure (TTF), defined as the time from therapy start to start of next therapy, death, or loss to follow-up. Results: We identified 5,788 pts with GI cancers who received NGS, of which 48% (N=3,603) had colorectal cancer (CRC). MS status was evaluated on 4,219 (66%) NGS reports, TMB on 2,922 (46%) reports, and both on 2,863 (45%) reports. MSI-H and TMB-H co-occurred on 127 reports (4%), MSS/TMB-H occurred on 312 reports (11%), and MSS/TMB-Low (TMB-L) occurred on 2,424 reports (85%). No reports were MSI-H/TMB-L. Overall, 580 pts (14%) received CPI therapy (N=52 MSI-H/TMB-H, N=41 MSS/TMB-H, N=215 MSS/TMB-L). Independent of line of therapy or tumor type, TTF was significantly shorter for CPI vs. non-CPI therapies [median TTF (mTTF)=151 vs. 238 days, respectively, p=3.4x10-9]. As expected, MSI-H was also associated with longer CPI TTF compared to MSS (mTTF=727 vs. 124 days, p=3.1x10-11). Due to small sample sizes, further analyses were focused on pts with CRC (Table). TMB-H was independently associated with longer CPI TTF compared to TMB-L (Table, p=9.2x10-10). Similarly, the co-occurrence of MSI-H/TMB-H was also associated with longer CPI TTF (Table). However, there was no difference in CPI TTF for MSS/TMB-H and MSS/TMB-L (Table, p=0.45). All pts who received non-CPI therapies, regardless of MS/TMB group, had longer TTF than MSS/TMB-H and MSS/TMB-L pts who received CPI (Table). mTTF [days (N)] for pts with CRC by biomarker. Conclusions: Despite recent tissue-agnostic approvals, TMB does not appear to be a good biomarker of CPI response in pts with CRC. Rather, time to CPI failure is associated with the co-occurrence of TMB-H with MSI-H. Continued research is needed to identify better biomarkers of response to immunotherapy in GI cancers. [Table: see text]

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The impact of the 30 most cited articles on hip arthroscopy: what is the subject matter?

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz067 ◽

2020 ◽

Vol 7 (1) ◽

pp. 14-21

Author(s):

Alexander von Glinski ◽

Emre Yilmaz ◽

Ryan Goodmanson ◽

Clifford Pierre ◽

Sven Frieler ◽

...

Keyword(s):

Surgical Treatment ◽

Hip Arthroscopy ◽

Randomized Clinical Trials ◽

Technical Note ◽

Small Sample ◽

Level Of Evidence ◽

Thomson Reuters ◽

Treatment Indications ◽

Small Sample Sizes ◽

The Impact

Abstract The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on recent surgical treatment. Due to advancements in hip arthroscopy, there is a widening spectrum of diagnostic and treatment indications. The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on contemporary surgical treatment. The Thomson Reuters Web of Science was used to identify the 30 most cited studies on hip arthroscopy between 1900 and 2018. These 30 articles generated 6152 citations with an average of 205.07 citations per item. Number of citations ranged from 146 to 461. Twenty-five out of the 30 papers were clinical cohort studies with a level of evidence between III and IV, encompassing 4348 patients. Four studies were reviewed (one including a technical note) and one a case report. We were able to identify the 30 most cited articles in the field of hip arthroscopy. Most articles were reported in high-impact journals, but reported small sample sizes in a retrospective setting. Prospective multi-arm cohort trials or randomized clinical trials represent opportunities for future studies.

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Experiences of Self-Monitoring in Self-Directed Weight Loss and Weight Loss Maintenance: Systematic Review of Qualitative Studies

Qualitative Health Research ◽

10.1177/1049732318784815 ◽

2018 ◽

Vol 29 (1) ◽

pp. 124-134 ◽

Cited By ~ 13

Author(s):

Jamie Hartmann-Boyce ◽

Anne-Marie Boylan ◽

Susan A. Jebb ◽

Paul Aveyard

Keyword(s):

Systematic Review ◽

Weight Loss ◽

Sense Of Self ◽

Weight Loss Maintenance ◽

Qualitative Studies ◽

Self Perception ◽

Self Monitoring ◽

Thematic Synthesis ◽

The Impact

The experience and role of self-monitoring in self-directed weight loss attempts may be distinctly different from that within formal interventions, and has yet to be fully explored. We systematically reviewed qualitative studies to examine experiences of self-monitoring as an aid to self-directed weight loss. Thematic synthesis was used to construct descriptive and analytical themes from the available data. In all, 22 studies (681 participants) were included, in which the uses of self-monitoring ranged from an aid to increase adherence to a tool for facilitating analysis. Self-monitoring also influenced and was influenced by self-perception and emotions. Feelings of shame were linked with abandonment of efforts. Findings highlight the centrality of interpretation of self-monitored data, the implications this interpretation has on sense of self, and the impact of broader discourses. Explicitly framing self-monitoring as a positive tool with which to aid analysis may encourage helpful use of this technique.

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Does Personalized Nutrition Increase Weight Loss Self-Efficacy?

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_027 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1310-1310

Author(s):

Lu Hu ◽

Chan Wang ◽

Huilin Li ◽

Margaret Curran ◽

Collin J Popp ◽

...

Keyword(s):

Weight Loss ◽

Real Time ◽

Self Efficacy ◽

Learning Algorithm ◽

Mobile App ◽

Small Sample ◽

Dietary Counseling ◽

Macronutrient Distribution ◽

The Impact

Abstract Objectives We examined whether a diet personalized to reduce postprandial glycemic response (PPGR) to foods increases weight loss self-efficacy. Methods The Personal Diet Study is an ongoing clinical trial that aims to compare two weight loss diets: a one-size-fits-all, calorie-restricted, low-fat diet (Standardized) versus a diet having the same calorie restriction but utilizing a machine learning algorithm to predict and reduce PPGR (Personalized). Both groups receive the same behavioral counseling to enhance weight loss self-efficacy. Both groups self-monitor dietary intake using a mobile app, with Standardized receiving real-time feedback on calories and macronutrient distribution, and Personalized receiving real time feedback on calories, macronutrient distribution, and predicted PPGR. We examined changes in self-efficacy between baseline and 3 mos, using the 20-item Weight Efficacy Lifestyle questionnaire (WEL). Linear mixed models were used to analyze differences, adjusting for age, gender, and race. Results The analyses included the first 75 participants to complete 3-mos assessments (41 Personalized and 34 Standardized). The majority of the participants were white (69.3%), female (61.3%), with a mean age of 61.7 years (SD = 9.9) and BMI of 33.4 kg/m2 (SD = 4.8). At baseline, WEL scores were similar between the 2 groups [Standardized WEL: 118.8 (SD = 27.6); Personalized WEL: 124.9 (SD = 29.5), P = 0.47]. At 3 mos, the WEL score was significantly improved in both groups [16.0 (SD = 4.1) in the Standardized group (P < 0.001) and 7.4 (SD = 3.7) in the Personalized group (P = 0.048)], but the between group difference was not significant (P = 0.12). Conclusions Personalized feedback on predicted PPGRs does not appear to enhance weight loss self-efficacy at 3 mos. The lack of significance may be related to the short follow-up period in these preliminary analyses, the small sample accrued to date, or the fact that WEL is designed to assess confidence in various situations (e.g., depressed, anxious) that may not be impacted by personalization. These analyses will be replicated with a larger sample using data obtained through the 6-mos follow-up. New self-efficacy measures may be required to assess the impact of personalized dietary counseling. Funding Sources This research was supported by the American Heart Association.

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Study rationale and protocol of the BARICO study: a longitudinal, prospective, observational study to evaluate the effects of weight loss on brain function and structure after bariatric surgery

BMJ Open ◽

10.1136/bmjopen-2018-025464 ◽

2019 ◽

Vol 9 (1) ◽

pp. e025464

Author(s):

Debby Vreeken ◽

Maximilian Wiesmann ◽

Laura N Deden ◽

Ilse A C Arnoldussen ◽

Esther Aarts ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Brain Function ◽

Neuropsychological Tests ◽

Small Sample ◽

Tissue Samples ◽

Patients Âgés ◽

Brain Structure And Function ◽

Small Sample Sizes

IntroductionWeight loss after bariatric surgery (BS) is often associated with improved cognition and structural brain recovery. However, improved cognition after BS is not always exhibited by patients, in fact, in some cases there is even a decline in cognition. Long-term consequences of BS weight loss, in terms of obesity and related diseases, can be hard to determine due to studies having short follow-up periods and small sample sizes.The aim of the BARICO study (BAriatric surgeryRijnstate and Radboudumc neuroImaging andCognition inObesity) is to determine the long-term effect of weight loss after BS on brain function and structure, using sensitive neuropsychological tests and (functional) MRI ((f)MRI). Secondary study endpoints are associated with changes in metabolic and inflammation status of adipose tissue, liver and gut, in relation to brain structure and function. Also, the possible correlation between weight loss, gut microbiota composition change and neuropsychological outcomes will be investigated.Methods and analysisData from 150 Dutch BS patients (ages between 35 and 55, men and women) will be collected at various time points between 2 months before and up to 10 years after surgery. Neuropsychological tests, questionnaires, blood, faeces and tissue samples will be collected before, during and after surgery to measure changes in cognition, microbiota, metabolic activity and inflammation over time. A subgroup of 75 participants will undergo (f)MRI in relation to executive functioning (determined by the Stroop task), grey and white matter volumes and cerebral blood flow. Regression analyses will be used to explore associations between weight loss and outcome measures.Ethics and disseminationThis study has been approved by the medical review ethics committee CMO Region Arnhem and Nijmegen (NL63493.091.17). Research findings will be published in peer-reviewed journals and at conferences.Trial registration numberNTR7288.

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The scale of it all: postcanine tooth size, the taxon-level effect, and the universality of Gould's scaling law

Paleobiology ◽

10.1666/08089.1 ◽

2010 ◽

Vol 36 (2) ◽

pp. 188-203 ◽

Cited By ~ 19

Author(s):

Lynn E. Copes ◽

Gary T. Schwartz

Keyword(s):

Body Mass ◽

Scaling Law ◽

Small Sample ◽

Tooth Size ◽

Mathematical Methods ◽

Scaling Relationship ◽

Small Sample Sizes ◽

Relationship Of ◽

The Impact ◽

Level Effect

In a seminal paper in 1975, Gould proposed that postcanine occlusal area (PCOA) should scale metabolically (0.75) with body mass across mammals. By regressing PCOA against skull length in a small sample of large-bodied herbivorous mammals, Gould provided some marginal support for this hypothesis, which he then extrapolated as a universal scaling law for Mammalia. Since then, many studies have sought to confirm this scaling relationship within a single order and have found equivocal support for Gould's assertion. In part, this may be related to the use of proxies for both PCOA and body mass, small sample sizes, or the influence of a “taxon-level effect,” rendering Gould's scaling “universal” problematic.Our goal was to test the universality of Gould's prediction and the impact of the taxon-level effect on regressions of tooth size on body mass in a large extant mammalian sample (683 species spanning 14 orders). We tested for the presence of two types of taxon-level effect that may influence the acceptance or rejection of hypothesized scaling coefficients. The hypotheses of both metabolic and isometric scaling can be rejected in Mammalia, but not in all sub-groups therein. The level of data aggregation also influences the interpretation of the scaling relationship. Because the scaling relationship of tooth size to body mass is highly dependent on both the taxonomic level of analysis and the mathematical methods used to organize the data, paleontologists attempting to retrodict body mass from fossilized dental remains must be aware of the effect that sample composition may have on their results.

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