The role of a clinician amid the rise of mobile health technology

Abstract Mobile health (mHealth) interventions have demonstrated promise in improving outcomes by motivating patients to adopt and maintain healthy lifestyle changes as well as improve adherence to guideline-directed medical therapy. Early results combining behavioral economic strategies with mHealth delivery have demonstrated mixed results. In reviewing these studies, we propose that the success of a mHealth intervention links more strongly with how well it connects patients back to routine clinical care, rather than its behavior modification technique in isolation. This underscores the critical role of clinician-patient partnerships in the design and delivery of such interventions, while also raising important questions regarding long-term sustainability and scalability. Further exploration of our hypothesis may increase opportunities for multidisciplinary clinical teams to connect with and engage patients using mHealth technologies in unprecedented ways.

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PHYSIATRY DURING COVID-19: A SURVEY BASED ANALYSIS

10.36106/ijsr/4201836 ◽

2021 ◽

pp. 48-51

Author(s):

Mrinal Joshi ◽

Aayushi Choudhary

Keyword(s):

Social Media ◽

Healthy Lifestyle ◽

Major Change ◽

Nationwide Survey ◽

Lifestyle Changes ◽

Health Crisis ◽

Rehabilitation Programs ◽

Practice Patient ◽

Musculoskeletal Rehabilitation

Introduction: The declaration of COVID 19 pandemic by WHO on 11th March 2020, is the dening global health crisis of the past 100 years. The following Nationwide survey was conducted to ascertain the sea changes this pandemic has brought in the physiatrist practice, patient management and preparing oneself to the challenges of rehabilitation in the POST COVID world. The survey covers the role and importance of social media in medical education and consultation in a POST COVID world. It also sheds light on the nancial implications and personal lifestyle changes that physiatrists are witnessing. A Google form comprising of 74 questions, divided in 3 se Material &Methods: ctions, was used to gather the requisite data on :- A) PRECOVID practice, management and lifestyle; B) Life during COVID pandemic; and C) Anticipated changes in POST COVID era. The survey was circulated to 400 physiatrist via various interactive groups who have been practicing either independently or in govt setups and associated hospitals nationwide. They were requested to submit their responses in a period of 30 days. In PRECOVID era an average Result: physiatrist was nely balancing his profession, personal lifestyle, learning and recreation. The LOCKDOWN clamped their practice which lead to nancial drought but hardly made a dent in productivity by engaging in webinars, reading and researching. The POST COVID time demands implementation of newer safety protocols like changes in setup, regulating the patient trafc, limiting daily procedures, engaging in distance learning through virtual conferences, maintaining a healthy lifestyle and constructing proper protocols for pulmonary, neurological and musculoskeletal rehabilitation programs for patients post recovery from COVID19, especially the patients weaning from ventilators. Conclusion: The effect of COVID19 demands major change in physiatrist professional practice like limiting consultation, following safety protocols, COVID testing, preparing consolidated program for POSTCOVID sequel. Social media is rightly poised to be a major tool for education, consultation, marketing and awareness. The role of teleconsultation needs to be reprised, recognised and regularised. Webinars and virtual conferences will nd more takers in future.

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Tweeting to Health

Clinical Pediatrics ◽

10.1177/0009922816653385 ◽

2016 ◽

Vol 56 (1) ◽

pp. 26-32 ◽

Cited By ~ 47

Author(s):

Arlene E. Chung ◽

Asheley C. Skinner ◽

Stephanie E. Hasty ◽

Eliana M. Perrin

Keyword(s):

Physical Activity ◽

Vegetable Intake ◽

Healthy Lifestyle ◽

Lifestyle Changes ◽

Descriptive Statistics ◽

Healthy Weight ◽

Physical Activity Intensity ◽

Sugar Sweetened Beverage ◽

Mhealth Intervention ◽

Activity Intensity

We developed and pilot tested a mHealth intervention, “Tweeting to Health,” which used Fitbits, Twitter, and gamification to facilitate support for healthy lifestyle changes in overweight/obese (OW) and healthy weight (HW) young adults. Participants tracked activity and diet using Fitbits and used Twitter for messaging for 2 months. Physical activity, dietary intake, and Tweets were tracked and participants completed surveys at enrollment, 1 month, and 2 months. Descriptive statistics were used to examine steps/day, physical activity intensity, lifestyle changes, and total Tweets. Participants were on average 19 to 20 years old and had familiarity with Twitter. OW participants had on average 11 222 daily steps versus 11 686 (HW). One-day challenges were successful in increasing steps. Participants increased fruit/vegetable intake (92%) and decreased their sugar-sweetened beverage intake (67%). Compliance with daily Fitbit wear (99% of all days OW vs 73% HW) and daily dietary logging (82% OW vs 73% HW) and satisfaction was high.

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The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab578 ◽

2021 ◽

Author(s):

Chandani Patel Chavez ◽

Kenneth Cusi ◽

Sushma Kadiyala

Keyword(s):

Evidence Synthesis ◽

Clinical Care ◽

Treatment Options ◽

Critical Role ◽

Risk Groups ◽

The United States ◽

Multidisciplinary Teams ◽

Consensus Statements ◽

Meta Analyses

Abstract Context The burden of cirrhosis from NAFLD is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that GLP-1RAs are beneficial versus steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH. Evidence acquisition Evidence from observational studies, randomized controlled trials, and meta-analyses. Evidence Synthesis Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (i.e., people with obesity, prediabetes or T2D). With no FDA-approved agents, weight loss is central to their successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management. Conclusion A paradigm change is developing between the endocrinologist’s greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.

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Reducing overuse by recognising the unintended harms of good intentions

BMJ evidence-based medicine ◽

10.1136/bmjebm-2019-111247 ◽

2019 ◽

pp. bmjebm-2019-111247

Author(s):

David Slawson ◽

Allen F Shaughnessy

Keyword(s):

Decision Making ◽

Medical Decision Making ◽

Clinical Care ◽

Critical Role ◽

Medical Decision ◽

Wide Acceptance ◽

Hierarchy Of Evidence ◽

Healthcare Interventions

Overdiagnosis and overtreatment—overuse—is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients’ quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what ‘ought to work’, based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what ‘does work’.

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How to Be Savvy About Gender Disparities in Academic Stroke Medicine

Stroke ◽

10.1161/strokeaha.120.029546 ◽

2020 ◽

Vol 51 (9) ◽

Author(s):

Aleksandra Pikula ◽

Luciana Catanese ◽

Cheryl D. Bushnell ◽

Valeria Caso ◽

Julie K. Silver

Keyword(s):

Clinical Care ◽

Critical Role ◽

Women's Leadership ◽

Gender Disparities ◽

Early Career ◽

Diagnostic Tools ◽

Career Stage ◽

Clinical Practices ◽

New Treatments

In the past decade, stroke medicine has evolved from discovery of innovative diagnostic tools to implementation of new treatments. These advances are projected to increase the demand for stroke neurologists in academic and clinical practices, but hopefully with equitable opportunities for everyone across the gender spectrum. Academic medicine provides opportunities to participate in clinical care, teaching, research, and administration. The early career stage is short-focused on finding an academic niche and developing new skills that will help you navigate the academic environment. A recent InterSECT article emphasized the critical role of women’s leadership in stroke medicine. In this article, we reflect on workforce gender disparities and provide 5 practical strategies that may help women overcome barriers and advance their work mission.

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Mobile-Health (mHealth) Intervention on Chronic Kidney Diseases: A Critical Review and Its Implications (Preprint)

10.2196/preprints.22908 ◽

2020 ◽

Author(s):

Ira Suarilah ◽

Chiu-Chu Lin ◽

Chich-Hsiu Hung

Keyword(s):

Mobile Health ◽

Health Care Professionals ◽

Kidney Diseases ◽

Health Interventions ◽

Evidence Based ◽

Chronic Kidney Diseases ◽

Mhealth Intervention ◽

Center Care

BACKGROUND eElectronic health (eHealth) chronic kidney disease (CKD) information is readily available over the mobile devices and placed as mobile-health (mHealth) information resources. The field of mHealth on CKD is promising in that it can empower individuals and delay the progress of the disease. OBJECTIVE This study aims to critically review published papers on the eHealth and its implication on mHealth of CKD. METHODS The academic databases EBSCO (CINAHL and PROQUEST), MEDLINE, PubMed, and Cochrane were systematically searched. Eight studies investigated the specific role of mHealth on CKD, including the detailed contents related to the conceptual acceptance and usage of technology in daily life, user, health care professionals, and the system’s bonding, mobile eHealth, content and evaluation of mHealth on CKD. RESULTS The available evidence on mHealth of CKD is limited and the findings indicate a discrepancy of the wording concept of mHealth. Those evidences might be caused by the scarce evidence on the effectiveness of using mHealth on CKD. CONCLUSIONS The limitation on the availability of CKD’s mobile health interventions that focus on patient education, behavior change and prevention contributes to inconsistent usage. Inadequate evidence might interrupt the development of mHealth intervention for individuals with CKD. Our findings illustrate the need on the conceptualizing of mHealth on CKD, acceptance and accessed, content, and evaluation focused on evidence-based will advance the quality of mHealth services, facilitate the continuity of mHealth application, and proposed patient-center-care.

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The Current Role of the Heavy/Light Chain Assay in the Diagnosis, Prognosis and Monitoring of Multiple Myeloma: An Evidence-Based Approach

Diagnostics ◽

10.3390/diagnostics11112020 ◽

2021 ◽

Vol 11 (11) ◽

pp. 2020

Author(s):

Rafael Ríos-Tamayo ◽

Noemí Puig ◽

Macarena Algarín ◽

José Luís García de Veas Silva ◽

Nuno Barbosa ◽

...

Keyword(s):

Multiple Myeloma ◽

Light Chain ◽

Clinical Care ◽

Critical Role ◽

Monitoring And Evaluation ◽

Care Process ◽

Laboratory Methods ◽

Serum Free Light Chain ◽

Tremendous Progress

Despite tremendous progress being made in recent years, multiple myeloma (MM) remains a challenging disease. The laboratory plays a critical role in the overall management of patients. The diagnosis, prognosis, clinical monitoring and evaluation of the response are key moments in the clinical care process. Conventional laboratory methods have been and continue to be the basis of laboratory testing in monoclonal gammopathies, along with the serum free light chain test. However, more accurate methods are needed to achieve new and more stringent clinical goals. The heavy/light chain assay is a relatively new test which can overcome some of the limitations of the conventional methods for the evaluation of intact immunoglobulin MM patients. Here, we report an update of the evidence accumulated in recent years on this method regarding its use in MM.

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Lifestyle considerations in multiple myeloma

Blood Cancer Journal ◽

10.1038/s41408-021-00560-x ◽

2021 ◽

Vol 11 (10) ◽

Author(s):

Yael N. Shapiro ◽

Jeffrey M. Peppercorn ◽

Andrew J. Yee ◽

Andrew R. Branagan ◽

Noopur S. Raje ◽

...

Keyword(s):

Multiple Myeloma ◽

Healthy Lifestyle ◽

Symptom Burden ◽

Well Being ◽

Lifestyle Changes ◽

Future Research ◽

Lifestyle Behaviors ◽

Length Of Treatment

AbstractAs the prognosis for multiple myeloma (MM) has significantly improved and patients remain on therapy longer, there is a need for supportive care interventions to optimize patient quality of life (QOL) and functional status over the course of cancer treatment. MM is characterized by a significant symptom burden and a relatively lower QOL compared to other cancers. This review evaluates the role of healthy lifestyle behaviors in improving both the physical functioning and psychological well-being of the MM population. We (1) describe the current literature on physical activity, weight management, diet, sleep, and substance use in the context of MM, (2) present important considerations for incorporating lifestyle factors into clinical practice, and (3) identify directions for future research. Developing MM-specific guidelines for modifiable lifestyle changes that take into account both the length of treatment and the unique disease features (i.e. osteolytic lesions and anemia) may provide a promising path for improved patient QOL and functioning.

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Wilder Penfield, Sir Arthur Currie, and the Montreal Neurological Institute

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.265 ◽

2017 ◽

Vol 45 (2) ◽

pp. 221-226 ◽

Cited By ~ 1

Author(s):

R. Mark Sadler

Keyword(s):

Clinical Care ◽

Critical Role ◽

Mutual Support ◽

Montreal Neurological Institute ◽

Neurological Patients

AbstractWilder Penfield and the Montreal Neurological Institute (MNI) are inextricably linked. It was Penfield’s unique idea to create a building with an academic atmosphere wherein basic neuroscience and clinical care of neurological patients would benefit from interaction and mutual support. It is clear that without Penfield that there would be no MNI; however, the role of another Canadian icon, Sir Arthur Currie, in the development of the MNI has heretofore been barely mentioned. The thesis of this paper is that Currie had a critical role in the gestation of the MNI that has generally been ignored.

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Role of nutritional support provided by qualified dietitians in the prevention and treatment of non-communicable diseases

Roczniki Państwowego Zakładu Higieny ◽

10.32394/rpzh.2019.0080 ◽

2019 ◽

pp. 235-241 ◽

Cited By ~ 1

Author(s):

Barbara Bednarczuk ◽

Anna Czekajło-Kozłowska

Keyword(s):

Nutritional Support ◽

Healthy Lifestyle ◽

Nutritional Therapy ◽

Communicable Diseases ◽

Lifestyle Changes ◽

Dietary Advice ◽

Dietary Counseling ◽

Non Communicable Diseases ◽

Prevention And Treatment

The role of dietitians is to counsel patients on special dietary modifications, develop dietary plans and provide dietary advice for healthy lifestyle in order to promote health and prevent disease. As lifestyle changes have become a primary reason for the increasing prevalence of non-communicable diseases in recent decades, it appears that nutritional therapy should play an important role in the multidisciplinary healthcare system. The aim of the review was to evaluate the role of nutritional support provided by dietitians in the prevention and treatment of chronic diseases in terms of its clinical and cost-effectiveness, according to their range of activity and qualifications. The evaluation was based on the review of the current literature. The costs of the treatment of non-communicable diseases encompass the costs of the treatment of the disease itself, costs of its complications and costs resulting from the decline of the productivity of patients. The results of studies indicate that nutritional support provides not only clinical but also cost benefits in the prevention and treatment of various non-communicable diseases. Every €1 spend on dietary counseling of patients with obesity or obesity-related diseases approximately returns a net €14 to €63 over a period of five years. Dietitians appear to be more effective in counseling overweight or obese patients with present risk factors compared to other specialists, however the barriers to accessing a qualified dietitian and problems with the reimbursement for services still exist. As adequate professional qualifications of dietitians appear to be an important factor determining the effectiveness of implemented dietary care, an additional training courses for dietitians and enhanced cooperation of hospitals and medical universities are needed.

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