Telehealth for rehabilitation and recovery after stroke: State of the evidence and future directions

2022 ◽  
pp. 174749302110624
Author(s):  
Coralie English ◽  
Maria Gabriella Ceravolo ◽  
Simone Dorsch ◽  
Avril Drummond ◽  
Dorcas BC Gandhi ◽  
...  
Keyword(s):  
Stroke Rehabilitation ◽  
Rapid Review ◽  
Current Evidence ◽  
Future Directions ◽  
Virtual Care ◽  
Clinical Community ◽  
Type 2 Error ◽  
Key Terms

Aims: The aim of this rapid review and opinion paper is to present the state of the current evidence and present future directions for telehealth research and clinical service delivery for stroke rehabilitation. Methods: We conducted a rapid review of published trials in the field. We searched Medline using key terms related to stroke rehabilitation and telehealth or virtual care. We also searched clinical trial registers to identify key ongoing trials. Results: The evidence for telehealth to deliver stroke rehabilitation interventions is not strong and is predominantly based on small trials prone to Type 2 error. To move the field forward, we need to progress to trials of implementation that include measures of adoption and reach, as well as effectiveness. We also need to understand which outcome measures can be reliably measured remotely, and/or develop new ones. We present tools to assist with the deployment of telehealth for rehabilitation after stroke. Conclusion: The current, and likely long-term, pandemic means that we cannot wait for stronger evidence before implementing telehealth. As a research and clinical community, we owe it to people living with stroke internationally to investigate the best possible telehealth solutions for providing the highest quality rehabilitation.

scholarly journals Type 2 diabetes in women of reproductive age

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Donna M. Williams ◽  
Kathryn Evans Kreider
Keyword(s):  
Type 2 Diabetes ◽  
Nurse Practitioners ◽  
Diabetes Management ◽  
Reproductive Age ◽  
Current Evidence ◽  
Evidence Based ◽  
Women Of Reproductive Age

The prevalence of type 2 diabetes in women of reproductive age ranges from 3% to 7%. Due to the common nature of this condition, it is imperative for nurse practitioners who care for women to understand evidence-based methods of diabetes management. The aim of this article is to describe current screening and diagnostic criteria for type 2 diabetes, discuss current evidence-based management and patient education necessary to prevent long-term complications, and provide the tools for a healthy reproductive plan in women with type 2 diabetes from puberty until menopause. Diabetes management extends well beyond glucose control, and nurse practitioners should be attuned to all factors that can impact cardiovascular risk and quality of life.

scholarly journals Should chloroquine and hydroxychloroquine be used to treat COVID-19? A rapid review

BJGP Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. bjgpopen20X101069 ◽  
Author(s):  
Kome Gbinigie ◽  
Kerstin Frie
Keyword(s):  
Clinical Trials ◽  
Relevant Literature ◽  
Safety Data ◽  
World Health ◽  
Rapid Review ◽  
Current Evidence ◽  
Long Term Follow Up

BackgroundOn the 11 March 2020, the World Health Organization (WHO) declared that COVID-19 was a pandemic. To date, there are no medical treatments for COVID-19 with proven effectiveness. Novel treatments and/or vaccines will take time to be developed and distributed to patients. In light of this, there has been growing interest in the use of existing medications, such as chloroquine (CQ) and hydroxychloroquine (HCQ), as potential treatments of this disease.AimTo establish the current evidence for the effectiveness of CQ and HCQ in treating COVID-19.Design & settingA rapid review of the literature was conducted.MethodElectronic searches in PubMed and Google Scholar were conducted on 21 March 2020. A further search was conducted in Google for relevant literature on 28 March 2020.ResultsThere is limited evidence of in vitro activity of CQ/HCQ against SARS-CoV-2. A number of in vivo clinical trials are underway. The empirical data available from two of these trials reveal conflicting results. Both trials are characterised by small numbers of participants (n = 30 and n = 36) and suffer methodological limitations. No medium or long-term follow-up data is available.ConclusionAt present, there is insufficient evidence to determine whether CQ/HCQ are safe and effective treatments for COVID-19. High quality, adequately powered randomised clinical trials in primary and secondary care settings are urgently required to guide policymakers and clinicians. These studies should report medium- and long-term follow-up results, and safety data.

scholarly journals Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Patricia Rios ◽  
Amruta Radhakrishnan ◽  
Chantal Williams ◽  
Naveeta Ramkissoon ◽  
Ba’ Pham ◽  
...  
Keyword(s):  
Long Term Care ◽  
Grey Literature ◽  
Rapid Review ◽  
Current Evidence ◽  
Cochrane Library ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Environmental Cleaning ◽  
Automated Method

Abstract Background The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF). Methods EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning® (CAL®). All search results were processed using CAL® to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second. Results Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff. Conclusions Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors. Systematic review registration PROSPERO CRD42020181993

scholarly journals Long-term noninvasive ventilation in COPD: current evidence and future directions

2021 ◽  
pp. 1-13
Author(s):  
Daniel S Majorski ◽  
Marieke L Duiverman ◽  
Wolfram Windisch ◽  
Sarah B Schwarz
Keyword(s):  
Noninvasive Ventilation ◽  
Current Evidence ◽  
Future Directions

scholarly journals Predicting Long-term Disability in Multiple Sclerosis: A Narrative Review of Current Evidence and Future Directions

2021 ◽  
Author(s):  
Bianca Weinstock-Guttman ◽  
Maria Pia Sormani ◽  
Pavle Repovic
Keyword(s):  
Multiple Sclerosis ◽  
Disease Progression ◽  
Panel Discussion ◽  
Current Evidence ◽  
Future Directions ◽  
Current State ◽  
Published Evidence ◽  
Disability Status ◽  
Insight Into

Abstract The ability to reliably monitor disease progression in patients with multiple sclerosis (MS) is integral to patient care. The Expanded Disability Status Scale (EDSS) is a commonly used tool to assess the disability status of patients with MS; however, it has limited sensitivity in detecting subtle changes in disability levels and, as a result, does not consistently provide clinicians with accurate insight into disease progression. At the 2019 European Committee for Treatment and Research in Multiple Sclerosis meeting in Stockholm, Sweden, a panel of neurologists met to discuss the limitations of the EDSS as a short-term predictor of MS progression. Prior to this panel discussion, a targeted literature review was conducted to evaluate published evidence on prognostic measures such as fatigue, physical assessments, and measures that are more taxing for patients, all of which may be useful to clinicians at different stages of the course of MS. This article summarizes currently available evidence in support of these measures. In addition, this article highlights the current state of expert clinical consensus regarding the current approaches used to predict and monitor disease progression and offers insight for future studies to assist clinicians in accurately monitoring disease progression in patients with MS.

scholarly journals Sodium–Glucose Cotransporter-2 Inhibitors and Heart Failure Prevention in Type 2 Diabetes

2019 ◽  
Vol 5 (3) ◽  
pp. 169-172 ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Javed Butler
Keyword(s):  
Heart Failure ◽  
Sglt2 Inhibitors ◽  
Current Evidence ◽  
Future Directions ◽  
Glucose Lowering ◽  
Sodium Glucose Cotransporter ◽  
Reduce Risk ◽  
Worse Prognosis

Diabetes and heart failure (HF) are closely linked, with one causing a worse prognosis in the other. The majority of anti-hyperglycaemic agents primarily reduce risk of ischaemic microvascular events without targeting the mechanisms involved for diabetes cardiomyopathy and HF. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have emerged as a novel class of glucose-lowering agents that have consistently reduced HF hospitalisations, unlike other agents. The authors discuss the current evidence and highlight possible future directions for the role of SGLT2 inhibitors in HF prevention.

scholarly journals P44 Type 2 diabetes mellitus in children: non-insulin medication, where are we up to?

2019 ◽  
Vol 104 (6) ◽  
pp. e35.2-e35
Author(s):  
R Austin ◽  
P Paul ◽  
D Hawcutt
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Case Reports ◽  
Health Concern ◽  
Current Evidence ◽  
Increased Risk ◽  
Dipeptidyl Peptidase 4 Inhibitors

BackgroundChildhood type 2 diabetes mellitus (T2DM) is a relatively rare condition but is an important health concern as its prevalence continues to rise. Current management consists of lifestyle modification, metformin and insulin. Several new pharmacological classes are currently used in adult medicine but are not yet available in paediatric care.In this review we will look at the current evidence for use of these newer medications in the paediatric population.MethodsA literature search (EMBASE, Medline, Pubmed, CINHAL) was performed for papers studying the use of non-insulin medications in children; including a separate search of ´clinicaltrials.gov´ to identify any ongoing trials in paediatric T2DM.ResultsNewer classes of medications include incretin mimetics, dipeptidyl peptidase-4-inhibitors, sodium/glucose-cotransporter-2-inhibitors, and thiazolidinediones. There have been a small number of pharmacokinetic/pharmacodynamic studies carried out in small cohorts of paediatric participants, but larger long-term efficacy and safety trials are lacking. These studies and individual case-reports have shown good tolerability but are unable to identify any long-term effects associated with these medications.Randomised controlled trials studying rosiglitazone and glimepiride use in children have been performed. However, safety concerns in adults and notable side-effects including weight gain, mean their future use is uncertain.Currently many relevant trials involving paediatric patients listed on ´clinicaltrials.gov´ are awaiting completion.ConclusionMedical management for T2DM in children remains limited. Ongoing studies are aiming to equip practitioners with wider treatment options in the future. However, there are concerns regarding the long-term safety of these medications due to the increased risk of pancreatitis, gallbladder conditions and bladder malignancy in adult patients.Paediatric T2DM patients suffer from complications earlier and more severely compared with adults, making this is a pressing issue. Long-term surveillance studies to identify adverse effects and a framework for highlighting research gaps are required to enable improvements in paediatric T2DM management.Disclosure(s)Nothing to disclose

scholarly journals Nutritional Supplements and Neuroprotective Diets and Their Potential Clinical Significance in Post-Stroke Rehabilitation

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2704
Author(s):  
Ewa Zielińska-Nowak ◽  
Natalia Cichon ◽  
Joanna Saluk-Bijak ◽  
Michał Bijak ◽  
Elzbieta Miller
Keyword(s):  
Stroke Rehabilitation ◽  
Nutritional Supplements ◽  
The Elderly ◽  
Stroke Recovery ◽  
New Approach ◽  
Post Stroke ◽  
Brain Recovery

Nutrition and rehabilitation are crucial in post-stroke recovery, especially in the elderly. Since stroke is the leading cause of long-term disability, there is a need to promote special, individually tailored nutrition strategies targeting older patients with low motor ability. Chronic stroke survivors have higher risk of developing nutrition-related chronic diseases, such as sarcopenia, anemia, type 2 diabetes mellitus and osteoporosis. Moreover, reduced motor activity, cognitive impairment and depression might be aggravated by poor malnutrition status. Accumulated data suggest that nutritional supplements and neuroprotective diets can be associated with better effectiveness of post-stroke rehabilitation as well as brain recovery. Therefore, this review focuses on preventive strategies that can improve dietary intake and change dietary patterns. We highlight the importance of neuroprotective diets, the problem of dysphagia and the role of nutrition in rehabilitation. This article focuses on potential nutritional supplements and neuroprotective diets that may have an impact on functional recovery during and after rehabilitation. Moreover, a new approach to post-stroke neuroplasticity including the use of agents from marine sources such as fucoxanthin and tramiprosate as compounds that might be used as potential neuroprotectants with antioxidative and anti-inflammatory properties is introduced.

Modulation of gut microbiota by dietary macronutrients in type 2 diabetes: a review

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Hong Jing Hang ◽  
Oumaima Battousse ◽  
Amutha Ramadas
Keyword(s):  
Type 2 Diabetes ◽  
Gut Microbiota ◽  
Gut Microbiome ◽  
Current Evidence ◽  
Dietary Interventions ◽  
Ketogenic Diets ◽  
Low Carbohydrate ◽  
Term Management

Dietary interventions have been a first-line strategy in the long-term management and prevention of type 2 diabetes mellitus (T2DM). Recently, low carbohydrate diets and ketogenic diets emerged as common dietary approaches in managing T2DM. Literature suggests macronutrients impose significant impacts on the gut microbiome related to glucose tolerance, insulin resistance and inflammation. Although there is insufficient literature on gut microbiota modulation via dietary macronutrient management, this area of study has been gradually gaining interest amongst researchers. This review describes the current evidence and summarizes specific dietary macronutrients' effects in sculpting the diverse gut microbiome. Potential crucial research concepts could help develop macronutrient-specific diets to modulate gut microbiota beneficial to T2DM management and pathogenesis.

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