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Conway V, Hukins C, Sharp S, Collins PF. Nutritional Support in Malnourished Outpatients with Chronic Obstructive Pulmonary Disease (COPD): A Randomized Controlled Pilot Study. Nutrients 2024; 16:1696. [PMID: 38892629 PMCID: PMC11174753 DOI: 10.3390/nu16111696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/29/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Background: The evidence for nutritional support in COPD is almost entirely based on ready-to-drink oral nutritional supplements (ONSs). This study aimed to explore the effectiveness of powdered ONSs alongside individualized dietary counseling in the management of malnutrition. (2) Methods: Malnourished outpatients with COPD were randomized to receive either routine care (Group A: counseling + recommended to purchase powdered ONSs) or an enhanced intervention (Group B: counseling + provision of powdered ONSs at no cost to the patient) for 12 weeks. Outcomes of interest were nutritional intake, weight status, and quality of life. (3) Results: A total of 33 outpatients were included, categorized as follows: Group A (n = 21); Group B (n = 12); severely malnourished (n = 9), moderately malnourished (n = 24), mean BMI 18.0 SD 2.5 kg/m2. No differences were observed between groups at baseline or at week 12; however, analysis of the whole cohort (Group A + B) revealed nutrition intervention resulted in significant improvements in protein intake (+25.4 SD 53.4 g/d; p = 0.040), weight (+1.1 SD 2.6 kg; p = 0.032) and quality of life (-4.4 SD 10.0; p = 0.040). Only 41.2% of Group A and 58.3% of Group B reported consuming ONSs at week 12. Adherence to ONSs was associated with weight gain (+1.9 SD 2.5 kg vs. +0.4 SD 2.5 kg; p = 0.098). (4) Conclusions: Nutritional support results in significant improvements in nutrition status and quality of life in malnourished outpatients with COPD. However, improvements are associated with adherence to ONSs, suggesting the type of ONSs and how they are provided are important considerations in clinical practice and future studies.
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Affiliation(s)
- Valerie Conway
- Nutrition and Dietetics, Brisbane South Chronic Disease Service, Metro South Hospital and Health Service, Wynnum, QLD 4178, Australia;
| | - Craig Hukins
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia;
| | - Stacey Sharp
- Department of Nutrition and Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia;
| | - Peter F. Collins
- Nutrition and Dietetics, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
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2
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Dillon MP, Bishop K, Ridgewell E, Clarke L, Kumar S. Describe the population receiving orthotic/prosthetic services using telehealth in Australia, and their experience and satisfaction: a quantitative and qualitative investigation. Disabil Rehabil 2024; 46:1188-1203. [PMID: 37070568 DOI: 10.1080/09638288.2023.2196094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Telehealth may help meet the growing demand for orthotic/prosthetic services. Despite the resurgence of telehealth due to COVID-19, there is limited evidence to inform policy and funding decisions, nor guide practitioners. METHODS Participants were adult orthosis/prosthesis users or parents/guardians of child orthosis/prosthesis users. Participants were convenience sampled following an orthotic/prosthetic telehealth service. An online survey included: demographics, Telehealth Usability Questionnaire, and the Orthotic Prosthetic Users Survey - Client Satisfaction with Services. A subsample of participants took part in a semi-structured interview. RESULTS Most participants were tertiary educated, middle-aged, female, and lived in metropolitan or regional centres. Most telehealth services were for routine reviews. Most participants chose to use telehealth given the distance to the orthotic/prosthetic service, irrespective of whether they lived in metropolitan cities or regional areas. Participants were highly satisfied with the telehealth mode and the clinical service they received via telehealth. While orthosis/prosthesis users were highly satisfied with the clinical service received, and the telehealth mode, technical issues affected reliability and detracted from the user experience. Interviews highlighted the importance of high-quality interpersonal communication, agency and control over the decision to use telehealth, and a degree of health literacy from a lived experience of using an orthosis/prosthesis.
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Affiliation(s)
- Michael P Dillon
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Bundoora, Australia
| | - Katie Bishop
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Bundoora, Australia
| | - Emily Ridgewell
- Australian Orthotic Prosthetic Association, Camberwell, Australia
| | - Leigh Clarke
- Australian Orthotic Prosthetic Association, Camberwell, Australia
| | - Saravana Kumar
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Trivedi R, Elshafie S, Tackett R, Young H, Sattler ELP. Effectiveness and Feasibility of Telehealth-Based Dietary Interventions Targeting Cardiovascular Disease Risk Factors: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49178. [PMID: 38363635 PMCID: PMC10907949 DOI: 10.2196/49178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/17/2023] [Accepted: 11/24/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Telehealth-based dietary interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic; however, data regarding their effectiveness and feasibility are limited. OBJECTIVE We aimed to examine (1) the effectiveness of telehealth-based dietary interventions in improving clinical CVD risk factors and (2) the feasibility of these interventions among individuals with CVD. METHODS To conduct this systematic review and meta-analysis of randomized controlled trials (RCTs), 2 investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms and included English-language RCTs published between January 2000 and July 2022. The Cochrane Risk of Bias tool was used to assess RCT quality. To evaluate intervention effectiveness, weight, BMI, systolic and diastolic blood pressure, and levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood glucose were compared postintervention in telehealth and usual care (UC) groups. Feasibility was determined through the number of participants retained in intervention and UC groups. Pooled data for each CVD outcome were analyzed using a random effects model. Mean difference (MD), standardized MD, or risk ratio were calculated using R software. RESULTS A total of 13 RCTs with 3013 participants were included in the analysis to assess the effectiveness and feasibility of telehealth-based dietary interventions among individuals with CVD. Participants had a mean age of 61.0 (SD 3.7) years, and 18.5% (n=559) were women. Approximately one-third of RCTs were conducted in the United States (n=4, 31%). Included studies used telephone, app, text, audio-visual media, or website-based interventions. Of the 13 included studies, 3 were of high quality, 9 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD -2.74, 95% CI -4.93 to -0.56) and low-density lipoprotein cholesterol (standardized MD -0.11, 95% CI -0.19 to -0.03) to be significantly improved among individuals with CVD as a result of telehealth-based dietary interventions compared to UC. No significant difference in effectiveness was detected for weight, BMI, and levels of diastolic blood pressure, total cholesterol, high-density lipoprotein, and triglycerides between telehealth-based dietary interventions and UC among those with CVD. There was no significant difference between the feasibility of telehealth-based dietary interventions versus UC. Significant I2 indicated moderate to considerable heterogeneity. CONCLUSIONS Telehealth-based dietary interventions show promise in addressing CVD risk factors.
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Affiliation(s)
- Rupal Trivedi
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Shaimaa Elshafie
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Randall Tackett
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Henry Young
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Elisabeth Lilian Pia Sattler
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
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4
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Bergschöld JM, Gunnes M, Eide AH, Lassemo E. Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews. JMIR Aging 2024; 7:e50286. [PMID: 38252472 PMCID: PMC10845034 DOI: 10.2196/50286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. OBJECTIVE This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. METHODS The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database. RESULTS A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. CONCLUSIONS Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa.
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Affiliation(s)
| | - Mari Gunnes
- Department of Health, SINTEF Digital, Trondheim, Norway
| | - Arne H Eide
- Department of Health, SINTEF Digital, Oslo, Norway
| | - Eva Lassemo
- Department of Health, SINTEF Digital, Trondheim, Norway
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Rabat Restrepo JM, Rebollo Pérez IM, García Luna PP, Pereira Cunill JL, Vílchez López FJ, Gonzalo Marín M, Yestes Doblas C, Martínez Ortega AJ, Martínez-Ramírez MJ, Losada Morell C, Rojas García J, Ortiz Sánchez M, Obando de la Corte J, Macías Colorado Campiña ME. [Consensus on criteria and minimum data set for the referral of candidate patients for home enteral nutrition teleconsultation: TELENUT project]. NUTR HOSP 2024. [PMID: 38258660 DOI: 10.20960/nh.04702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. OBJECTIVES to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. METHODS three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). RESULTS three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. CONCLUSIONS three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.
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Affiliation(s)
| | | | - Pedro P García Luna
- Servicio de Endocrinología y Nutrición. Hospital Universitario Virgen del Rocío
| | | | | | | | - Carmen Yestes Doblas
- Servicio de Endocrinología y Nutrición. Hospital Universitario Clínico San Cecilio
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Terp R, Kayser L, Lindhardt T. An educative nutritional intervention supporting older hospital patients to eat sufficiently using eHealth: a mixed methods feasibility and pilot study. BMC Geriatr 2024; 24:22. [PMID: 38177992 PMCID: PMC10768306 DOI: 10.1186/s12877-023-04582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/10/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Insufficient food intake is common in older hospital patients and increases the risk of readmission, mortality, and decline in functional status. To improve food intake in older patients, an eHealth solution (Food'n'Go) enabling them to participate in their own nutritional care was implemented in a hospital unit. We developed an educative nutritional intervention (ENI) to support hospitalized older adults (aged ≥ 65 years) to participate in their own nutritional care using Food'n'Go. In this study, we evaluate the feasibility of the ENI and its potential to improve nutritional intake. METHODS Feasibility was evaluated using process evaluation, and nutritional intake was examined by using a pre- and post-test design. Assessment of feasibility: Contextual factors (availability of Food'n'Go and prevalence of counseling by a dietitian); Intervention fidelity (whether patients were informed of nutrition and Food'n'Go, and whether their needs for support were assessed); and Mechanism of impact (patients' knowledge and skills related to nutrition and the use of Food'n'Go and their acceptance of the ENI). Assessment of nutritional intake: Patients' intake of protein and energy based on one-day observations before implementation of the ENI (pre-test; n = 65) and after a three-month intervention (post-test; n = 65). RESULTS Feasibility: Food'n'Go was available for more patients after the intervention (85 vs. 64%, p = .004). Most patients managed the use of Food'n'Go and were involved in ordering their food, but only a few monitored their food intake. Information on nutrition was not provided sufficiently to all patients. In general, the ENI had high acceptability among the patients. Nutritional intake: Compared to patients in the pre-test, patients in the post-test had a higher daily mean intake of energy (kJ) (6712 (SD: 2964) vs. 5660 (SD: 2432); difference 1052 (95% CI 111-1993)), and of protein (g) (60 (SD: 28) vs. 43 (SD: 19); difference 17 (95% CI 9-26)). Likewise, there was an increase in the mean attainment of protein requirements: 73% (SD: 34) vs. 59% (SD: 29) (p = .013). CONCLUSION The ENI is feasible for supporting hospitalized older adults to participate in their own nutrition using eHealth and preliminary results indicate that it may lead to an increasing energy and protein intake.
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Affiliation(s)
- Rikke Terp
- Department of Internal Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Hospitalsvej 1, 2900, Hellerup, Denmark
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7
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Baş D, Sönmez Ö, Koç ES, Celayir ÖM, Hajhamidiasl L, Tontaş E. Is virtual nutritional counseling efficacious for cancer patients during the COVID-19 pandemic? J Telemed Telecare 2024; 30:79-89. [PMID: 36912038 PMCID: PMC10014450 DOI: 10.1177/1357633x231158831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/04/2023] [Indexed: 03/14/2023]
Abstract
This study investigates the outcomes of virtual nutritional counseling (VNC) for oncology patients during the Covid-19 pandemic. Our study evaluated the nutritional status data of cancer patients at the baseline and after VNC. An oncology dietitian evaluated the patients by video calling each patient via WhatsApp and sent an individual nutrition diet plan and recommendations via e-mail. Patient-Generated Subjective Global Assessment (PG-SGA) was used as a screening and evaluation tool to assess nutritional status. A total of 157 patients with a mean age of 55.8 ± 14.7 (r = 19-89) were included in the study. Researchers detected at least one nutrition-related sign in 77.7% of patients. After the VNC and based on the final PG-SGA assessments, 62.2% of the patients whose baseline PG-SGA Score-B improved to Score-A, 12.5% with a baseline PG-SGA Score-C improved to Score-A and 54.2% with a baseline Score-C improved to a Score-B (χ2 = 55,000, P < 0.001). Based on the number of VNCs, the improvement in malnutrition status following two sessions and three or more sessions was found to be 17.6% and 35.7%, respectively (P < 0.001). Our results confirm that VNC can improve the nutritional status of cancer patients. Hence, nutritional counseling should be an integral part of oncological treatment.
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Affiliation(s)
- Dilşat Baş
- Department of Nutrition and Dietetics, School of Health Sciences, İstanbul Galata University, İstanbul, Türkiye
- Department of Nutrition and Dietetics, Acıbadem Altunizade Hospital, İstanbul, Türkiye
| | - Özlem Sönmez
- Department of Medical Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Türkiye
| | - Elif Sitre Koç
- Department of Internal Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Türkiye
| | - Özde Melisa Celayir
- Department of Medical Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Türkiye
| | - Ladan Hajhamidiasl
- Department of Nutrition and Dietetics, Institute of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye
| | - Ebru Tontaş
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, USA
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LoBuono DL, Milovich M. A Scoping Review of Nutrition Health for Older Adults: Does Technology Help? Nutrients 2023; 15:4402. [PMID: 37892477 PMCID: PMC10609927 DOI: 10.3390/nu15204402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) "track, plan, and execute" nutrition management and for (2) "assessing" technology use. "Track, plan, and execute" includes tracking food intake, planning for changes, and executing a plan. "Assessing" technology use is collecting nutrition data from a provider's or an older adult's self-use of technology to understand dietary intake. Hardware is the second most type of technology used, with tablet computers for software and internet access. The findings reveal that software for older adults lacks standardization, the Internet of Things is a promising area, the current device emphasis is the tablet computer, and broadband internet access is essential for nutrition care. Only 38 studies were published in the last five years, indicating that nutrition management for older adults with hardware or software has not reached a significant research mass.
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Affiliation(s)
- Dara L. LoBuono
- Department of Health and Exercise Science, School of Nursing and Health Professions, Rowan University, James Hall Room 1035, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
| | - Michael Milovich
- Department of Marketing and Business Information Systems, Rohrer College of Business, Rowan University, Business Hall Room 316, 201 Mullica Hill Road, Glassboro, NJ 08028, USA;
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Klee D, Pyne D, Kroll J, James W, Hirko KA. Rural patient and provider perceptions of telehealth implemented during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:981. [PMID: 37700286 PMCID: PMC10496200 DOI: 10.1186/s12913-023-09994-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Understanding perceptions of telehealth implementation from patients and providers can improve the utility and sustainability of these programs, particularly in under-resourced rural settings. The purpose of this study was to evaluate both patient and provider perceptions of telehealth visits in a large rural healthcare system during the COVID-19 pandemic. To promote sustainability of telehealth approaches, we also assessed whether the percentage of missed appointments differed between in-person and telehealth visits. METHODS Using anonymous surveys, we evaluated patient preferences and satisfaction with telehealth visits from November 2020 -March 2021 and assessed perceptions of telehealth efficiency and value among rural providers from September-October 2020. We examined whether telehealth perceptions differed according to patients' age, educational attainment, insurance status, and distance to clinical site and providers' age and length of time practicing medicine using ANOVA test. We also examined whether the percentage of missed appointments differed between in-person and telehealth visits at a family practice clinic within the rural healthcare system from April to September 2020 using a Chi-square test. RESULTS Over 73% of rural patients had favorable perceptions of telehealth visits, and satisfaction was generally higher among younger patients. Patients reported difficulty with scheduling follow-up appointments, lack of personal contact and technology challenges as common barriers. Over 80% of the 219 providers responding to the survey reported that telehealth added value to their practice, while 36.6% agreed that telehealth visits are more efficient than in-person visits. Perception of telehealth value and efficiency did not differ by provider age (p = 0.67 and p = 0.67, respectively) or time in practice (p = 0.53 and p = 0.44, respectively). Technology challenges for the patient (91.3%) and provider (45.1%) were commonly reported. The percentage of missed appointments was slightly higher for telehealth visits compared to in-person visits, but the difference was not statistically significant (8.7% vs. 8.0%; p = 0.39). CONCLUSIONS Telehealth perceptions were generally favorable among rural patients and providers, although satisfaction was lower among older patients and providers. Our findings suggest that telehealth approaches may add value and efficiency to rural clinical practice. However, technology issues for both patients and providers and gaps in care coordination need to be addressed to promote sustainability of telehealth approaches in rural practice.
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Affiliation(s)
- David Klee
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA.
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
- , 1400 Medical Campus Drive, Traverse City, MI, 49684, USA.
| | - Derek Pyne
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - Joshua Kroll
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - William James
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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10
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Rettinger L, Kuhn S. Barriers to Video Call-Based Telehealth in Allied Health Professions and Nursing: Scoping Review and Mapping Process. J Med Internet Res 2023; 25:e46715. [PMID: 37526957 PMCID: PMC10427933 DOI: 10.2196/46715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses. OBJECTIVE This review aimed to identify and map the perceived barriers to the use of video call-based telehealth interventions among allied health professionals and nurses. METHODS A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call-based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups. RESULTS A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication. CONCLUSIONS This review identified key barriers to video call-based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers.
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Affiliation(s)
- Lena Rettinger
- Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Vienna, Austria
- Institute of Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Sebastian Kuhn
- Institute of Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
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Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023; 401:951-966. [PMID: 36716756 DOI: 10.1016/s0140-6736(22)02612-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong Special Administrative Region, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Location VU University Medical Center, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Public Health research institute and Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Meredith SJ, Roberts H, Grocott MPW, Jack S, Murphy J, Varkonyi-Sepp J, Bates A, Lim SER. Frail2Fit study protocol: a feasibility and acceptability study of a virtual multimodal intervention delivered by volunteers to improve functional outcomes in older adults with frailty after discharge from hospital. BMJ Open 2023; 13:e069533. [PMID: 36927597 PMCID: PMC10030662 DOI: 10.1136/bmjopen-2022-069533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. In response to the COVID-19 pandemic, healthcare has increasingly turned to virtual modes of delivery and there is interest in the use of trained volunteers to deliver PA and nutrition interventions. We aim to evaluate the feasibility and acceptability of training hospital volunteers to deliver an online intervention, comprising exercise, behaviour change and nutrition support, to older people with frailty after discharge from hospital. METHODS We will use a quasi-experimental mixed methods approach. Hospital volunteers (n=6) will be trained to deliver an online, 3-month, multimodal intervention to frail (Clinical Frailty Scale ≥5) adults ≥65 years (n=30) after discharge from hospital. Feasibility will be assessed by determining the number of volunteers recruited, trained and retained at the end of the study; the proportion of intervention sessions delivered; participant recruitment, retention and adherence to the intervention. To determine the acceptability of the intervention, interviews will be conducted among a purposive sample of older adults, and volunteers. Secondary outcomes will include physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy for managing chronic disease and PA. Outcomes will be measured at baseline, 3 months and 6 months. ANALYSIS Descriptive statistics will be used to describe feasibility and adherence to the intervention. Secondary outcomes at baseline will be compared at 3 and 6 months. Interviews will be transcribed verbatim and analysed using thematic analysis. ETHICS AND DISSEMINATION Health Research Authority ethical approval was obtained on 30 May 2022 (reference: 22/WA/0155). Results will be disseminated through peer-reviewed journal articles, volunteer organisations, National Health Service communication systems and social media platforms. A toolkit will be developed to facilitate roll out of volunteer training. TRIAL REGISTRATION NUMBER NCT05384730.
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Affiliation(s)
- Samantha Jane Meredith
- Academic Geriatric Medicine, University of Southampton Faculty of Medicine, Southampton, Hampshire, UK
- NIHR ARC Wessex, University of Southampton, Southampton, UK
| | - Helen Roberts
- Academic Geriatric Medicine, University of Southampton Faculty of Medicine, Southampton, Hampshire, UK
- NIHR ARC Wessex, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton / University of Southampton, Southampton, UK
| | - Michael P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton / University of Southampton, Southampton, UK
- Clinical and Experimental Science, University of Southampton, Southampton, UK
| | - Sandy Jack
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton / University of Southampton, Southampton, UK
- Clinical and Experimental Science, University of Southampton, Southampton, UK
| | - Jane Murphy
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Judit Varkonyi-Sepp
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton / University of Southampton, Southampton, UK
- Clinical and Experimental Science, University of Southampton, Southampton, UK
- Clinical Health Psychology Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Bates
- Clinical and Experimental Science, University of Southampton, Southampton, UK
- Nursing, Midwifery, and Health, University of Southampton, Southampton, UK
| | - Stephen Eu Ruen Lim
- Academic Geriatric Medicine, University of Southampton Faculty of Medicine, Southampton, Hampshire, UK
- NIHR ARC Wessex, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton / University of Southampton, Southampton, UK
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Dawson J, McLean C. Nutrition in Conservative Kidney Management: From Evidence to Practice. Semin Nephrol 2023; 43:151399. [PMID: 37506469 DOI: 10.1016/j.semnephrol.2023.151399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Conservative kidney management (CKM) is a treatment option for kidney failure, particularly for the elderly and those with co-morbidities. Dietitians can play an important role in the provision of CKM by enhancing patients' quality of life through the management of nutrition impact symptoms (symptoms that result in decreased eating, including anorexia, nausea, dry mouth, and taste changes), as well as symptoms that result from malnutrition, including fatigue, weakness, activity intolerance, slow wound healing, and low mood. There are many gaps in the literature regarding optimal nutritional recommendations for patients on CKM. More research is needed on symptom management and interventions to delay or slow the progression of malnutrition and frailty. This article provides an overview of important nutritional considerations, a synthesis of the current literature, and recommendations for application of evidence into the practice of CKM.
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Affiliation(s)
- Jessica Dawson
- Department of Nutrition and Dietetics, St George Hospital, Sydney, New South Wales, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
| | - Cameron McLean
- Department of Nutrition and Dietetics, St George Hospital, Sydney, New South Wales, Australia; School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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14
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Mabeza RMS, Maynard K, Tarn DM. Influence of synchronous primary care telemedicine versus in-person visits on diabetes, hypertension, and hyperlipidemia outcomes: a systematic review. BMC PRIMARY CARE 2022; 23:52. [PMID: 35313804 PMCID: PMC8936383 DOI: 10.1186/s12875-022-01662-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Telemedicine can be used to manage various health conditions, but there is a need to investigate its effectiveness for chronic disease management in the primary care setting. This study compares the effect of synchronous telemedicine versus in-person primary care visits on patient clinical outcomes.
Methods
A systematic review of studies published in PubMed and Web of Science between 1996 and January 2021 was performed using keywords related to telemedicine, diabetes, hypertension, and hyperlipidemia. Included studies compared synchronous telemedicine versus in-person visits with a primary care clinician, and examined outcomes of hemoglobin A1c (HbA1c), blood pressure, and/or lipid levels.
Results
Of 1724 citations screened, 7 publications met our inclusion criteria. Included studies were published between 2000 and 2018. Three studies were conducted in the United States, 2 in Spain, 1 in Sweden, and 1 in the United Kingdom. The telemedicine interventions investigated were multifaceted. All included synchronous visits with a primary care provider through videoconferencing and/or telephone, combined with other components such as asynchronous patient data transmission. Five studies reported on HbA1c changes, 5 on blood pressure changes, and 3 on changes in lipid levels. Compared to usual care with in-person visits, telemedicine was associated with greater reductions in HbA1c at 6 months and similar HbA1c outcomes at 12 months. Telemedicine conferred no significant differences in blood pressure and lipid levels compared to in-person clinic visits.
Conclusions
A systematic review of the literature found few studies comparing clinical outcomes resulting from synchronous telemedicine versus in-person office visits, but the existing literature showed that in the primary care setting, telemedicine was not inferior to in-person visits for the management of diabetes, hypertension, or hypercholesterolemia. These results hold promise for continued use of telemedicine for chronic disease management.
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15
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Johns T, Huot C, Jenkins JC. Telehealth in Geriatrics. Prim Care 2022; 49:659-676. [DOI: 10.1016/j.pop.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Wright HH, O’Shea MC, Sekula J, Mitchell LJ. Assessment of communication skills using telehealth: considerations for educators. Front Med (Lausanne) 2022; 9:841309. [PMID: 35979204 PMCID: PMC9377413 DOI: 10.3389/fmed.2022.841309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The main aim of this study was to explore the views and perceptions of dietetic educators on their ability to assess communication skills of undergraduate student dietitians in a telehealth setting. A secondary aim was to provide recommendations to educators when assessing these skills using telehealth. Methods A descriptive qualitative study design was used. Australian and New-Zealand dietetic educators used a validated global communication rating scale to evaluate three pre-recorded telehealth encounters. Educators then answered a series of open-ended questions on their ability to assessed communication skills in the telehealth environment. Analysis Inductive analysis allowed the emergence of themes and sub-themes independent of a specific framework or theory. Peer debriefing and triangulation increased research rigor. Results Twenty-four educators were included in this study with the majority (87.5%) having > 10 years experience as a dietetic educator, and 41.6% (n = 10) with experience in assessing dietetics student using telehealth. Most (76%) educators reported the assessment of non-verbal communication skills were challenging in the telehealth environment. Five themes and 15 subthemes emerged relating to advice for students and educators when assessing communication skills and a checklist was developed from recommendations that students and educators can use when preparing, planning, implementing, and assessing telehealth consultations. Conclusion Assessing student communication skills via telehealth provides a useful opportunity with the growing use of the online environment, however, it also presents challenges that must be taken into consideration. While verbal communication skills are easier to assess than non-verbal, both need to be adapted for the telehealth setting.
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Affiliation(s)
- Hattie H. Wright
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
- Sunshine Coast Health Institute, Britinya, QLD, Australia
- *Correspondence: Hattie H. Wright,
| | - Marie-Claire O’Shea
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Julia Sekula
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lana J. Mitchell
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
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Shima M, Piovacari SMF, Steinman M, Pereira AZ, dos Santos OFP. Telehealth for Nutritional Care: A Tool for Improving Patient Flow in Hospitals. TELEMEDICINE REPORTS 2022; 3:117-124. [PMID: 35860304 PMCID: PMC9282778 DOI: 10.1089/tmr.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hospitals are constantly searching for opportunities to improve efficiency, and telehealth (TH) has recently emerged as a strategy to assist in patient flow. We evaluated two methods of dietary counseling offered to patients in the time period between the medical and final hospital discharge. Counseling was given either via the TH group or the face to face (FTF) group to the patients and their respective impact was evaluated on the patients' satisfaction and on the hospital patient flow. METHODS This study was a prospective, randomized clinical trial where patients were randomized to receive dietary counseling via TH (use of tablet) or FTF at the time of hospital discharge. We evaluate the duration of time between medical discharge and hospital discharge; between requesting dietary counseling and dietitian's arrival; and duration of dietary counseling. At the end of dietary counseling, both groups received a patient satisfaction questionnaire to answer. RESULTS A total of 159 patients were randomized to receive dietary counseling via TH (TH, n = 78) or FTF (FTF, n = 81). The two groups TH and FTF did not differ in terms of the median time between (1) medical and hospital discharge; (2) requesting counseling and the dietitian's arrival; and (3) duration of dietary counseling. Both groups mostly reported being "satisfied" or "above expectations," and the FTF group scored "highest satisfaction" more often relative to the dietitian's work and interaction and on confidence in the dietitian's orientations. Finally, in the TH group, 90.7% graded likely-4 or very likely-5 when asked whether dietary counseling can be conducted entirely via TH, and 92% answered "4" or "5" when asked whether they would recommend dietary counseling via TH. CONCLUSIONS Although the FTF group had a greater overall satisfaction relative to the TH group, TH proved to be a useful tool for dietary counseling.The trial has only Institutional Review Board approval (protocol 2685-16).
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Affiliation(s)
- Mayumi Shima
- Clinical Nutrition Service, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Milton Steinman
- Supervisor of the General Surgery Residency and Professor of Medicine, Emergency Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrea Z. Pereira
- Oncology and Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Zhang Y, Leuk JSP, Teo WP. Domains, feasibility, effectiveness, cost, and acceptability of telehealth in aging care: a scoping review of systematic reviews (Preprint). JMIR Aging 2022; 6:e40460. [PMID: 37071459 PMCID: PMC10155091 DOI: 10.2196/40460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/02/2022] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. OBJECTIVE This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care; synthesize evidence of telehealth's feasibility, effectiveness, cost benefits, and acceptability in the context of aging care; identify gaps in the literature; and determine the priorities for future research. METHODS Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. RESULTS A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger sample sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into individual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. CONCLUSIONS Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population.
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Affiliation(s)
- Yichi Zhang
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
- Ageing Research Institute for Society and Education, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore
| | - Jessie Siew-Pin Leuk
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Bogin MH, Chandra A, Manggaard J, Thorsteinsdottir B, Hanson GJ, Takahashi PY. Telehealth Use and Hospital Readmission Rates in Long-term Care Facilities in Southeastern Minnesota During the COVID-19 Pandemic. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 6:186-192. [PMID: 35281694 PMCID: PMC8904139 DOI: 10.1016/j.mayocpiqo.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To determine whether the length of a telehealth visit predicted the risk of hospital readmission at 30 days in skilled nursing facilities (SNFs) in southeastern Minnesota during the coronavirus disease 2019 pandemic. Patients and Methods This was a retrospective cohort study conducted in SNFs located in southeastern Minnesota from March 1, 2020 through July 15, 2020. The primary outcomes included hospitalization within 30 days of a video visit, and the secondary outcome was the number of provider video visits during the stay at an SNF. The primary predictor was the duration of video visits, and we collected the data regarding other known predictors of hospitalization. We used the χ2 test for categorical variables and multivariate conditional logistic regression. Results We included 722 patients (mean age, 82.8 years [SD, 10.8 years]). Of those, 76 SNF residents (10.5%) were rehospitalized within 30 days. The average length of a video visit was 34.0 minutes (SD, 22.7 minutes) in admitted residents compared with 30.0 minutes (SD, 15.9 minutes) in nonadmitted residents. After full adjustment, there was no difference in the video visit duration between admitted and nonadmitted residents (odds ratio, 1.01; 95% CI, 0.99-1.03). The number of subsequent provider video visits was 2.26 (SD, 1.9) in admitted residents vs 1.58 (SD, 1.6), which was significant after adjustment (odds ratio, 1.17; 95% CI, 1.02-1.34). Conclusion There was no difference in the length of video visits for hospitalized SNF residents vs those who were not hospitalized within 30 days of a video visit. There were more visits in residents with hospital readmission. This may reflect the acuity of care for patients requiring a hospital stay. More research is needed to determine the ideal use of telehealth during the coronavirus disease 2019 pandemic in the postacute and long-term care environment.
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Affiliation(s)
| | - Anupam Chandra
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer Manggaard
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Bjoerg Thorsteinsdottir
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Gregory J Hanson
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
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Latif J, Elizabeth Weekes C, Julian A, Frost G, Murphy J, Abigail Tronco-Hernandez Y, Hickson M. Strategies to ensure continuity of nutritional care in patients with COVID-19 infection on discharge from hospital: A rapid review. Clin Nutr ESPEN 2022; 47:106-116. [PMID: 35063190 PMCID: PMC8603263 DOI: 10.1016/j.clnesp.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022]
Abstract
Background & aims The risk of malnutrition in people with COVID-19 is high; prevalence is reported as 37% in general medical inpatients, 53% in elderly inpatients and 67% in ICU. Thus, nutrition is a crucial element of assessment and treatment. This rapid review aimed to evaluate what evidence is available to inform evidence-based decision making on the nutritional care of patients hospitalised with COVID-19 infection. Methods Cochrane Rapid Reviews guidance was followed; the protocol was registered (CRD42020208448). Studies were selected that included patients with COVID-19, pneumonia, respiratory distress syndrome and acute respiratory failure, in hospital or the community, and which examined nutritional support. All types of studies were eligible for inclusion except non-systematic reviews, commentaries, editorials and single case studies. Six electronic databases were searched: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PubMed, CINAHL and MedRxiv. Results Twenty-six articles on COVID-19 were retrieved, including 11 observational studies, five guidelines and 10 opinion articles. Seven further articles on pneumonia included three RCTs, one unblinded trial, three observational studies, and one systematic review on rehabilitation post-ICU admission for respiratory illness. The evidence from these articles is presented narratively and used to guide the nutritional and dietetic care process. Conclusions Older patients with COVID-19 infection are at risk of malnutrition and addressing this may be important in recovery. The use of nutritional management strategies applicable to other acute conditions are recommended. However, traditional screening and implementation techniques need to be modified to ensure infection control measures can be maintained. The most effective nutritional interventions require further research and more detailed guidance on nutritional management post-discharge to support long-term recovery is needed.
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21
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Development of a diabetes mobile healthcare system and clinical application in China: a narrative review. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Kunonga TP, Spiers GF, Beyer FR, Hanratty B, Boulton E, Hall A, Bower P, Todd C, Craig D. Effects of Digital Technologies on Older People's Access to Health and Social Care: Umbrella Review. J Med Internet Res 2021; 23:e25887. [PMID: 34821564 PMCID: PMC8663708 DOI: 10.2196/25887] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/23/2021] [Accepted: 10/15/2021] [Indexed: 01/22/2023] Open
Abstract
Background The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective In this study, we synthesized evidence on the impact of digital technologies on older adults’ access to health and social services. Methods We conducted an umbrella review of systematic reviews published from January 2000 to October 2019 using comprehensive searches of 6 databases. We looked for reviews in a population of adults aged ≥65 years in any setting, reporting outcomes related to the impact of technologies on access to health and social care services. Results A total of 7 systematic reviews met the inclusion criteria, providing data from 77 randomized controlled trials and 50 observational studies. All of them synthesized findings from low-quality primary studies, 2 of which used robust review methods. Most of the reviews focused on digital technologies to facilitate remote delivery of care, including consultations and therapy. No studies examined technologies used for first contact access to care, such as online appointment scheduling. Overall, we found no reviews of technology to facilitate first contact access to health and social care such as online appointment booking systems for older populations. Conclusions The impact of digital technologies on equitable access to services for older people is unclear. Research is urgently needed in order to understand the positive and negative consequences of digital technologies on health care access and to identify the groups most vulnerable to exclusion.
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Affiliation(s)
- Tafadzwa Patience Kunonga
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Frances Spiers
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona R Beyer
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elisabeth Boulton
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Alex Hall
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Chris Todd
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Dawn Craig
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Baena-Díez JM, Gonzalez-Casafont I, Cordeiro-Coelho S, Fernández-González S, Rodríguez-Jorge M, Pérez-Torres CUF, Larrañaga-Cabrera A, García-Lareo M, de la Arada-Acebes A, Martín-Jiménez E, Pérez-Orcero A, Hernández-Ibáñez R, Gonzalo-Voltas A, Bermúdez-Chillida N, Simón-Muela C, del Carlo G, Bayona-Faro C, Rey-Reñones C, Aguilar-Palacio I, Grau M. Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2. Healthcare (Basel) 2021; 9:healthcare9111548. [PMID: 34828594 PMCID: PMC8621826 DOI: 10.3390/healthcare9111548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 12/26/2022] Open
Abstract
Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.
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Affiliation(s)
- Jose Miguel Baena-Díez
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), 08007 Barcelona, Spain;
- IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
| | - Isabel Gonzalez-Casafont
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Sara Cordeiro-Coelho
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Soledad Fernández-González
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Migdalia Rodríguez-Jorge
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Clara Uxía Fernández Pérez-Torres
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Andrea Larrañaga-Cabrera
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Manel García-Lareo
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Ana de la Arada-Acebes
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Esther Martín-Jiménez
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Almudena Pérez-Orcero
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Rosario Hernández-Ibáñez
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Ana Gonzalo-Voltas
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Noemí Bermúdez-Chillida
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Consuelo Simón-Muela
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Guillermo del Carlo
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Carolina Bayona-Faro
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Cristina Rey-Reñones
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), 08007 Barcelona, Spain;
- Unit of Research Support Camp de Tarragona, Catalan Institute of Health (ICS), 43202 Tarragona, Spain
| | - Isabel Aguilar-Palacio
- Research Group in Health Services of Aragon, (GRISSA) IIS Aragón, University of Zaragoza, 50009 Zaragoza, Spain;
| | - María Grau
- IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
- Serra Húnter Fellow, Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 08003 Barcelona, Spain
- Correspondence:
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Munk T, Svendsen JA, Knudsen AW, Østergaard TB, Thomsen T, Olesen SS, Rasmussen HH, Beck AM. A multimodal nutritional intervention after discharge improves quality of life and physical function in older patients - a randomized controlled trial. Clin Nutr 2021; 40:5500-5510. [PMID: 34656032 DOI: 10.1016/j.clnu.2021.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/07/2021] [Accepted: 09/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many older hospitalized patients are at nutritional risk or malnourished and the nutritional condition is often further impaired during hospitalization. When discharged to own home, a "Nutrition Gap" often occurs, causing inadequate dietary intake, and potentially impeded recovery. Previously, cross-sectorial studies of single component nutritional intervention have shown a limited effect on clinically relevant outcomes. We hypothesized that a multimodal nutritional intervention is necessary to elicit a beneficial effect on clinically relevant outcomes. METHODS A randomized controlled trial was performed for a period of 16 weeks. At discharge, the intervention group (IG) received dietetic counselling including a recommendation of daily training, an individual nutrition plan and a package containing foods and drinks covering dietary requirements for the next 24 h. Further, a goodie-bag containing samples of protein-rich milk-based drinks were provided. Information regarding recommendations of nutritional therapy after discharge was systematically and electronically communicated to the municipality. The dietician performed telephone follow-ups on day 4 and 30 and a home visit at 16 weeks. The control group (CG) received standard treatment. The primary outcome was readmissions within 6 month, secondary outcomes were Length of Stay (LOS), Health Related Quality of Life (EQ-5D-3L), nutritional status, physical function (30s-CST) and mortality. This trial was registered under ClinicalTrials.gov Identifier no. NCT03488329. RESULTS We included 191 patients (IG: n = 93). No significant difference was seen in readmissions within 6 month (IG: 45% vs. CG: 45%, Risk Ratio (RR): 0.96 0.71-1.31, p = 0.885). At the 16-weeks follow-up more patients in the IG reached at least 75% of energy and protein requirements (82% vs. CG: 61%, p = 0,007). The energy (kcal) and protein intake (g) per kg was significantly higher in the IG (26.4 kcal/kg (±7.4) vs. 22.6 (±7.4), p = 0.0248) (1.1 g/kg (±0.3) vs. 0.9 g/kg (±0.3). Furthermore, significant lower weight loss was seen in IG (0.7 (±4.3) vs. -1.4 (±3.6), p = 0.002). A significant and clinically relevant difference was found in the EQ-5D-3L VAS-score (IG: mean 61.6 ± 16.2 vs. CG: 53.3 ± 19.3, p = 0.011) (Δ14.3 (±15.5) vs. Δ5.6 (±17.2), p = 0.002). A significant difference in mean 30s-CST in IG was also found (7.2 (±4.3) vs. 5.3 (±4.1), p = 0.010). The improvements in physical function were of clinical relevance in both groups, but significantly higher in the IG (Δ4.2 (±4.4) vs. Δ2.2 (±2.5), p = 0.008). In fact, 86% in IG experienced improvements in the 30s-CST compared with 68% in the CG (p = 0.022). LOS was found to be lower at all time points, however not significant (30 days: -3 (-8.5 to 2.5), p = 0.276, 16 weeks: -4 (-10.2 to 2.2, p = 0.204), 6 months: -3 (-9.3 to 3.3, p = 0346)). All-cause mortality was not different between groups, however RR showed a non-significantly 47% reduction at day 30 (0.53 (0.14-2.05, p = 0.499)) and a 17% reduction at 16 weeks (0.83 (0.40-1.73, p = 1.000)) in IG. Per protocol (PP) analysis revealed a non-significant decrease of 32% in readmission at 6 months (RR: 0.68 (0.42-1.08), p = 0.105). CONCLUSION The present study, using a multimodal nutritional approach, revealed no significant effect on readmissions however a significant positive effect on nutritional status, quality of life and physical function was found. The improvements in quality of life and physical function were of clinical relevance. No significant effect was found on LOS and mortality.
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Affiliation(s)
- Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark.
| | - Jonas Anias Svendsen
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark
| | - Anne Wilkens Knudsen
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark
| | - Tanja Bak Østergaard
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark
| | - Thordis Thomsen
- Research Unit, Department of Anesthesiology, Herlev Gentofte University Hospital, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Clinical Institute, Aalborg University Hospital, Denmark
| | - Henrik Højgaard Rasmussen
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark; Centre for Nutrition and Bowel Disease & Danish Nutrition Science Centre, Aalborg University Hospital, Clinical Institute, Aalborg University, Denmark
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark; University College Copenhagen, Faculty of Health, Institute of Nursing and Nutrition, Copenhagen, Denmark
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Moloney L, Jarrett B. Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2108-2140.e6. [PMID: 34581276 DOI: 10.1016/j.jand.2020.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.
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Affiliation(s)
- Lisa Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
| | - Brittany Jarrett
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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Gomes LA, Gregório MJ, Iakovleva TA, Sousa RDD, Bessant J, Oliveira P, Branco JC, Canhão H, Rodrigues AM. A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study. J Med Internet Res 2021; 23:e26871. [PMID: 34463638 PMCID: PMC8459887 DOI: 10.2196/26871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/19/2021] [Accepted: 05/06/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. OBJECTIVE This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. METHODS A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). RESULTS A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean -3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean -0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean -1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. CONCLUSIONS The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants' fatigue and physical function. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.6626.
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Affiliation(s)
- Luís Antunes Gomes
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | | | - Rute Dinis de Sousa
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - John Bessant
- University of Exeter Business School, Exeter, United Kingdom
| | - Pedro Oliveira
- Copenhagen Business School, Copenhagen, Denmark.,NOVA School of Business and Economics, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jaime C Branco
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Serviço de Reumatologia do Hospital Egas Moniz - Centro Hospitalar Lisboa Ocidental (CHLO-EPE), Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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Perceived Usefulness of Telehealth Among Rural Medical Providers: Barriers to Use and Associations with Provider Confidence. ACTA ACUST UNITED AC 2021; 6:567-571. [PMID: 34109271 PMCID: PMC8178023 DOI: 10.1007/s41347-021-00215-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/14/2021] [Accepted: 05/28/2021] [Indexed: 11/11/2022]
Abstract
Objective Telehealth has been identified as an efficient and safe way of increasing access to healthcare during the COVID-19 pandemic. Understanding providers’ perceptions of telehealth usage in rural communities may help other communities understand barriers and concerns related to implementation, during and post-pandemic. This study aimed to (a) examine rates of telemedicine use among rural providers, (b) determine whether changes in telehealth use in this group were associated with provider confidence and perceived usefulness of technology, (c) compare these providers’ perceptions of the “usefulness” of technology prior to and during the COVID-19 pandemic, and (d) examine barriers to implementation and use of telehealth within a rural sample. Method Six-hundred eighty-six medical providers working at a rural Pennsylvania teaching hospital and associated satellite clinics were surveyed anonymously. Surveys included the Perceived Usefulness of Technology Scale and questions to identify barriers that prohibited the use of telehealth. Findings/Results Of 136 respondents, 86% reported no prior experience using virtual technology for patient encounters. Use of telehealth care increased by 34% following the pandemic. Provider confidence in his/her/their abilities was positively associated with increased use of telehealth and perceived usefulness of technology. Provider-identified barriers to implementation included necessity of physical exams and lack of technological literacy. Conclusions Both medical providers and patients continue to face various barriers to seamless integration of care. Devising ways to increase self-confidence and efficacy for use of telehealth among providers might be an additional way to increase telehealth use.
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Sharma A, Bowman R, Ettema SL, Gregory SR, Javadi P, Johnson MD, Butcher ML, Mutua E, Stack BC, Crosby DL. Rapid telehealth implementation into an otolaryngology practice during the COVID-19 pandemic. Laryngoscope Investig Otolaryngol 2021; 6:386-393. [PMID: 34195358 PMCID: PMC8223471 DOI: 10.1002/lio2.552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Report outcomes of rapid implementation of telehealth across an academic otolaryngology-head and neck surgery department during the COVID-19 pandemic. METHODS This is a retrospective, single-institution study of rapid deployment of telehealth during the COVID-19 pandemic. Characteristics of patients were compared between those who agreed and those who declined telehealth care. Reasons for declining telehealth visits were ascertained. Characteristics of telehealth visits were collected and patients were asked to complete a post-visit satisfaction survey. RESULTS There was a 68% acceptance rate for telehealth visits. In multivariable analysis, patients were more likely to accept telehealth if they were being seen in the facial plastics subspecialty clinic (odds ratio [OR] 59.55, 95% confidence interval [CI] 2.21-1607.52; P = .015) compared to the general otolaryngology clinic. Patients with Medicare (compared to commercial insurance) as their primary insurance were less likely to accept telehealth visits (OR 0.10, 95% CI 0.01-0.77; P = .027). Two hundred and thirty one patients underwent telehealth visits; most visits (69%) were for established patients and residents were involved in 38% of visits. There was an 85% response rate to the post-visit survey. On a scale of one to ten, the median satisfaction score was 10 and 99% of patients gave a score of 8 or higher. Satisfaction scores were higher for new patient visits than established patient visits (P = .020). CONCLUSION Rapid implementation of telehealth in an academic otolaryngology-head and neck surgery department is feasible. There was high acceptance of and satisfaction scores with telehealth. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Arun Sharma
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Ryan Bowman
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Sandra L. Ettema
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Stacie R. Gregory
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Pardis Javadi
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Matthew D. Johnson
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Marissa L. Butcher
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Evans Mutua
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Brendan C. Stack
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
| | - Dana L. Crosby
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
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Schoufour JD, Tieland M, Barazzoni R, Ben Allouch S, van der Bie J, Boirie Y, Cruz-Jentoft AJ, Eglseer D, Topinková E, Visser B, Voortman T, Tsagari A, Weijs PJM. The Relevance of Diet, Physical Activity, Exercise, and Persuasive Technology in the Prevention and Treatment of Sarcopenic Obesity in Older Adults. Front Nutr 2021; 8:661449. [PMID: 34109204 PMCID: PMC8180560 DOI: 10.3389/fnut.2021.661449] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022] Open
Abstract
The aging population faces two conditions that threaten healthy aging: high fat mass (obesity) and low muscle mass and function (sarcopenia). The combination of both-referred to as sarcopenic obesity-synergistically increases the risk of adverse health outcomes. The two conditions often co-occur because they reinforce each other and share common etiologies, including poor nutrition and inactivity. All aging people are at risk of gaining weight and losing muscle mass and could benefit from improvements in physical activity, exercise and dietary intake. one specific window of opportunity is during the transient time of retirement, as older adults already need to restructure their daily activities. It is key to change lifestyle behavior in a sustainable manner, providing scientifically proven, personalized, and acceptable principles that can be integrated in daily life. Health technologies (e.g., applications) can provide promising tools to deliver personalized and appealing lifestyle interventions to a large group of people while keeping health care costs low. Several studies show that health technologies have a strong positive effect on physical activity, exercise and dietary intake. Specifically, health technology is increasingly applied to older people, although strong evidence for long term effects in changing lifestyle behavior is generally lacking. Concluding, technology could play an important role in the highly warranted prevention of sarcopenic obesity in older adults. Although health technology seems to be a promising tool to stimulate changes in physical activity, exercise and dietary intake, studies on long lasting effects and specifically targeted on older people around the time of retirement are warranted.
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Affiliation(s)
- Josje D Schoufour
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Michael Tieland
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Somaya Ben Allouch
- Digital Life Research Group, Faculty of Digital Media and Creative Industry, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Joey van der Bie
- Digital Life Research Group, Faculty of Digital Media and Creative Industry, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Yves Boirie
- University Clermont Auvergne, Human Nutrition Unit, INRA, CRNH Auvergne, CHU Clermont-Ferrand, Clinical Nutrition Department, Clermont-Ferrand, France
| | | | - Doris Eglseer
- Department of Nursing Science, Medical University Graz, Graz, Austria
| | - Eva Topinková
- First Faculty of Medicine, Department of Geriatrics, Charles University, Prague, Czechia.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czechia
| | - Bart Visser
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Amalia Tsagari
- Department of Clinical Nutrition, KAT General Hospital, Athens, Greece
| | - Peter J M Weijs
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam Public Health Institute, VU University, Amsterdam, Netherlands
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An Experimental Education Project for Consultations of Older Adults during the Pandemic and Healthcare Lockdown. Healthcare (Basel) 2021; 9:healthcare9040425. [PMID: 33917509 PMCID: PMC8067444 DOI: 10.3390/healthcare9040425] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/20/2023] Open
Abstract
Objective: To develop a mentor-supervised, interprofessional, geriatric telemedicine experiential education project in response to the COVID-19 pandemic. Method: Medical and pharmacy students collaborated via remote consultations to address the coexistence of multimorbidity and polypharmacy in geriatric patients. In-depth interviews of students and patients as well as Likert scale-based telephonic survey were performed for a comprehensive evaluation of the project’s significance. Results: To date, 49 consultations have been conducted. Remote consultations performed by medical and pharmacy students working collaboratively were beneficial for both students, participants. Conclusions and Practice Implications: This experimental education project provided students with authentic challenges while simultaneously delivering care to the older adults who are susceptible to disruption of care associated with the pandemic. Further development and expanded implementation of such approaches may be a post-pandemic practice to provide more accessible care for senior patients while incorporating interprofessional education.
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Lanctin DP, Merced‐Nieves F, Mallett RM, Arensberg MB, Guenter P, Sulo S, Platts‐Mills TF. Prevalence and Economic Burden of Malnutrition Diagnosis Among Patients Presenting to United States Emergency Departments. Acad Emerg Med 2021; 28:325-335. [PMID: 31724782 DOI: 10.1111/acem.13887] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Malnutrition is a potentially remediable condition that when untreated contributes to poor health and economic outcomes. While assessment of malnutrition risk is improving, its identification rate and economic burden in emergency departments (EDs) is largely unknown. We sought to determine prevalence and economic burden of diagnosed malnutrition among patients presenting to U.S. EDs. METHODS This is a retrospective analysis of Healthcare Cost and Utilization Project Nationwide Emergency Department Sample data. Malnutrition prevalence was confirmed via International Classification of Diseases, 9th Edition, diagnosis codes. The economic burden was assessed by comparing probability of hospitalization and the average total charges between propensity-score matched visits with and without a malnutrition diagnosis. RESULTS Data from 238 million ED visits between 2006 and 2014 were analyzed. Over this period, the prevalence of diagnosed malnutrition increased for all demographic categories assessed. For older adults (≥65 years), the prevalence increased from 2.5% (2006) to 3.6% (2014). Older age, high-income community residence, Western region, urban areas, and Medicare coverage were associated with higher diagnosis prevalence. Malnutrition diagnosis was associated with a 4.23 (95% confidence interval [CI] = 3.93 to 4.55) times higher odds of hospitalization and $21,892 higher mean total charges (95% CI = $19,593 to $24,192). CONCLUSIONS While malnutrition is currently diagnosed at a low rate in U.S. EDs, the economic burden of malnutrition is substantial in this care setting. Given the potential for systematic malnutrition screening and treatment protocols to alleviate this burden, future research is warranted.
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Affiliation(s)
| | | | | | | | - Peggi Guenter
- the American Society for Parenteral and Enteral Nutrition Silver Spring MD
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van den Helder J, Verlaan S, Tieland M, Scholten J, Mehra S, Visser B, Kröse BJA, Engelbert RHH, Weijs PJM. Digitally Supported Dietary Protein Counseling Changes Dietary Protein Intake, Sources and Distribution in Community-Dwelling Older Adults. Nutrients 2021; 13:nu13020502. [PMID: 33546451 PMCID: PMC7913661 DOI: 10.3390/nu13020502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
Digitally supported dietary counselling may be helpful in increasing the protein intake in combined exercise and nutritional interventions in community-dwelling older adults. To study the effect of this approach, 212 older adults (72.2 ± 6.3 years) were randomised in three groups: control, exercise, or exercise plus dietary counselling. The dietary counselling during the 6-month intervention was a blended approach of face-to-face contacts and videoconferencing, and it was discontinued for a 6-month follow-up. Dietary protein intake, sources, product groups, resulting amino acid intake, and intake per eating occasion were assessed by a 3-day dietary record. The dietary counselling group was able to increase the protein intake by 32% at 6 months, and the intake remained 16% increased at 12 months. Protein intake mainly consisted of animal protein sources: dairy products, followed by fish and meat. This resulted in significantly more intake of essential amino acids, including leucine. The protein intake was distributed evenly over the day, resulting in more meals that reached the protein and leucine targets. Digitally supported dietary counselling was effective in increasing protein intake both per meal and per day in a lifestyle intervention in community-dwelling older adults. This was predominantly achieved by consuming more animal protein sources, particularly dairy products, and especially during breakfast and lunch.
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Affiliation(s)
- Jantine van den Helder
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Correspondence: (J.v.d.H.); (P.J.M.W.); Tel.: +31-(62)-1155919 (J.v.d.H.)
| | - Sjors Verlaan
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; or
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
| | - Jorinde Scholten
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
| | - Sumit Mehra
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- CREATE-IT Applied Research, Amsterdam University of Applied Sciences, 1091 GC Amsterdam, The Netherlands
| | - Bart Visser
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
| | - Ben J. A. Kröse
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Informatics Institute, University of Amsterdam, 1090 GH Amsterdam, The Netherlands
| | - Raoul H. H. Engelbert
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Peter J. M. Weijs
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, VU University, 1081 HV Amsterdam, The Netherlands
- Correspondence: (J.v.d.H.); (P.J.M.W.); Tel.: +31-(62)-1155919 (J.v.d.H.)
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Wundersitz C, Caelli A, Georgy J, Musovic A, Manning R, Prause M, Robertson J, Taylor NF. Conducting community rehabilitation review sessions via videoconference: A feasibility study. Aust J Rural Health 2020; 28:603-612. [PMID: 33382473 DOI: 10.1111/ajr.12665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To determine the feasibility of conducting a single videoconferencing session (telerehabilitation) instead of a face-to-face home visit for a review appointment in a community rehabilitation program. DESIGN A feasibility study based on Bowen's framework was used to determine demand, acceptability, limited efficacy and practicality of telerehabilitation. The study involved qualitative and quantitative data analysis. SETTING Two Victorian community rehabilitation programs providing services to large geographical catchment zones in the outer fringe of a metropolitan area. PARTICIPANTS Ten adult clients receiving home-based therapy and 5 allied health clinicians working in the program. INTERVENTIONS Clients participated in a single review therapy appointment (telerehabilitation) from physiotherapy, dietetics or speech pathology using the health network's videoconferencing platfrom and the client's own electronic device. MAIN OUTCOME MEASURES Demand was assessed by calculating the percentage of eligible clients able to participate compared to total number of home-based clients. Acceptability, practicality and limited efficacy were explored through qualitative analysis of semi-structured interviews. RESULTS Nearly one quarter of clients screened met eligibility criteria, indicating a large potential demand for telerehabilitation. Telerehabilitation was highly acceptable for clinicians and clients participating in speech pathology and dietitian sessions as these contain targeted education and talking-based therapy. It was less accepted in physiotherapy, where there is a more hands-on approach. Telerehabilitation was practical and efficient for both clinicians and clients, especially when time was allowed for training and initial troubleshooting. CONCLUSION Telerehabilitation is a feasible modality for review sessions in community rehabilitation and helps improve efficient use of clinician and client time. It is more appropriate for disciplines that use education and talking-based therapy compared with hands-on therapy. Older clients are accepting of new technology with support and education.
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Affiliation(s)
- Claire Wundersitz
- Community Rehabilitation Program, Eastern Health, Upper Ferntree Gully, Vic., Australia
| | - Adrian Caelli
- Community Rehabilitation Program, Eastern Health, Upper Ferntree Gully, Vic., Australia
| | - Jessica Georgy
- Community Rehabilitation Program, Eastern Health, Upper Ferntree Gully, Vic., Australia
| | - Amie Musovic
- Community Rehabilitation Program, Eastern Health, Upper Ferntree Gully, Vic., Australia
| | - Renita Manning
- Community Rehabilitation Program, Eastern Health, Upper Ferntree Gully, Vic., Australia
| | - Melissa Prause
- Community Rehabilitation Program, Eastern Health, Upper Ferntree Gully, Vic., Australia
| | - Janet Robertson
- Community Rehabilitation Program, Eastern Health, Upper Ferntree Gully, Vic., Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Vic., Australia.,College of Science, Health and Engineering, La Trobe University, Bundoora, Vic., Australia
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35
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Ena J. Telemedicine for COVID-19. Rev Clin Esp 2020. [PMID: 32564939 PMCID: PMC7321035 DOI: 10.1016/j.rceng.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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36
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Beck AM, Husted MM, Weekes CE, Baldwin C. Interventions to Support Older People's Involvement in Activities Related to Meals. A Systematic Review. J Nutr Gerontol Geriatr 2020; 39:155-191. [PMID: 33079642 DOI: 10.1080/21551197.2020.1834484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this systematic review is to assess whether old people should be actively involved in activities related to meals to support quality of life, nutritional status and functional abilities related to meals. Two electronic databases Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness were searched, supported by PubMed citation, snowball searches. Eleven primary studies were included. The quality was low. No studies assessed the effect on health-related quality of life. Three types of interventions to support activities related to meals were identified: Meal-related activities to facilitate improved autonomy seemed to overall improve nutritional intake, physical and social function related to meals, plus mealtime coping. Interventions of encouragement and reinforcement by staff to facilitate independence in eating seemed to have beneficial effect on nutritional intake and physical function related to meals. Interventions using food preparation and cooking to support participation seemed to have beneficial effects on social function related to meals and mealtime coping. There is an urgent need for good quality, adequately powered studies in this area and among old people in all health care settings.
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Affiliation(s)
- Anne Marie Beck
- Faculty of Health, University College Copenhagen, Copenhagen, Denmark.,Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - C Elizabeth Weekes
- Department of Nutrition and Dietetics, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
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Eze ND, Mateus C, Cravo Oliveira Hashiguchi T. Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One 2020; 15:e0237585. [PMID: 32790752 PMCID: PMC7425977 DOI: 10.1371/journal.pone.0237585] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation. Methods This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool. Results Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings. Conclusion This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.
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Affiliation(s)
- Nkiruka D Eze
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Céu Mateus
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Tiago Cravo Oliveira Hashiguchi
- Health Division Organisation for Economic Co-operation and Development, Directorate for Employment, Labour and Social Affairs, Paris, France
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Kelly JT, Allman-Farinelli M, Chen J, Partridge SR, Collins C, Rollo M, Haslam R, Diversi T, Campbell KL. Dietitians Australia position statement on telehealth. Nutr Diet 2020; 77:406-415. [PMID: 32596950 PMCID: PMC7540717 DOI: 10.1111/1747-0080.12619] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022]
Abstract
It is the position of Dietitians Australia that clients can receive high‐quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth‐delivered dietetic consultations are comparable to those delivered in‐person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth‐delivered dietetic consultations as a responsive and cost‐effective alternative or complement to traditional in‐person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet‐related health and well‐being, regardless of their location, income or literacy level, thereby addressing current inequities.
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Affiliation(s)
- Jaimon T Kelly
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Juliana Chen
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clare Collins
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Megan Rollo
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Rebecca Haslam
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | | | - Katrina L Campbell
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
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Frost R, Nimmons D, Davies N. Using Remote Interventions in Promoting the Health of Frail Older Persons Following the COVID-19 Lockdown: Challenges and Solutions. J Am Med Dir Assoc 2020; 21:992-993. [PMID: 32553491 PMCID: PMC7247453 DOI: 10.1016/j.jamda.2020.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Danielle Nimmons
- Department of Primary Care and Population Health, University College London, London, UK
| | - Nathan Davies
- Department of Primary Care and Population Health, University College London, London, UK
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Knotowicz H, Haas A, Coe S, Furuta GT, Mehta P. Opportunities for Innovation and Improved Care Using Telehealth for Nutritional Interventions. Gastroenterology 2019; 157:594-597. [PMID: 31376397 DOI: 10.1053/j.gastro.2019.04.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Holly Knotowicz
- Department of Audiology, Speech-Language Pathology, and Learning Services, Children's Hospital Colorado, Aurora, Colorado
| | - Angela Haas
- Department of Audiology, Speech-Language Pathology, and Learning Services, Children's Hospital Colorado, Aurora, Colorado
| | - Stephanie Coe
- Department of Audiology, Speech-Language Pathology, and Learning Services, Children's Hospital Colorado, Aurora, Colorado
| | - Glenn T Furuta
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Digestive Health Institute, Aurora, Colorado
| | - Pooja Mehta
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Digestive Health Institute, Aurora, Colorado.
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Volkert D, Beck AM, Cederholm T, Cereda E, Cruz-Jentoft A, Goisser S, de Groot L, Großhauser F, Kiesswetter E, Norman K, Pourhassan M, Reinders I, Roberts HC, Rolland Y, Schneider SM, Sieber CC, Thiem U, Visser M, Wijnhoven HAH, Wirth R. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. J Clin Med 2019; 8:E974. [PMID: 31277488 PMCID: PMC6678789 DOI: 10.3390/jcm8070974] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023] Open
Abstract
Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany.
| | - Anne Marie Beck
- Department Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
- Herlev and Gentofte University Hospital, 2703 Herlev, Denmark
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, 701 05 Uppsala, Sweden
- Theme Ageing, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Sabine Goisser
- Heidelberg University Centre for Geriatric Medicine and Network Aging Research (NAR), University of Heidelberg, 69126 Heidelberg, Germany
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, 6708 WE Wageningen, The Netherlands
| | - Franz Großhauser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Kristina Norman
- German Institute for Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, 14558 Nuthetal, Germany
- Research Group on Geriatrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Maryam Pourhassan
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Helen C Roberts
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse, France
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06200 Nice, France
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Ulrich Thiem
- Centre of Geriatrics and Gerontology, Albertinen-Haus, Hamburg, and Chair of Geriatrics and Gerontology, University Medical Centre Eppendorf, 20246 Hamburg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
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42
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Shigekawa E, Fix M, Corbett G, Roby DH, Coffman J. The Current State Of Telehealth Evidence: A Rapid Review. Health Aff (Millwood) 2019; 37:1975-1982. [PMID: 30633674 DOI: 10.1377/hlthaff.2018.05132] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Policy makers and practitioners show a continued interest in telehealth's potential to increase efficiency and reach patients facing access barriers. However, telehealth encompasses many applications for varied conditions and populations. It is therefore difficult to draw broad conclusions about telehealth's efficacy. This rapid review examines recent evidence both about telehealth's efficacy by clinical area and about telehealth's impact on utilization. We searched for systematic reviews and meta-analyses of the use of telehealth services by patients of any age for any condition published in English in the period January 2004-May 2018. Twenty systematic reviews and associated meta-analyses are included in this review, covering clinical areas such as mental health and rehabilitation. Broadly, telehealth interventions appear generally equivalent to in-person care. However, telehealth's impact on the use of other services is unclear. Many factors should be carefully considered when weighing the evidence of telehealth's efficacy, including modality, evidence quality, population demographics, and point-in-time measurement of outcomes.
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Affiliation(s)
- Erin Shigekawa
- Erin Shigekawa ( ) is a consultant, John Snow, Inc. (JSI), in San Francisco, California. She was a principal analyst in the California Health Benefits Review Program, University of California Berkeley, when this work was completed
| | - Margaret Fix
- Margaret Fix is a research associate at the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco
| | - Garen Corbett
- Garen Corbett is director of the California Health Benefits Review Program, University of California Berkeley
| | - Dylan H Roby
- Dylan H. Roby is an associate professor in and associate chair of the Department of Health Services Administration at the University of Maryland School of Public Health, in College Park; an adjunct associate professor in the Fielding School of Public Health, University of California Los Angeles (UCLA); and a faculty associate in the UCLA Center for Health Policy Research
| | - Janet Coffman
- Janet Coffman is a full adjunct professor at the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco
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Avanesova AA, Shamliyan TA. Worldwide implementation of telemedicine programs in association with research performance and health policy. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Marshall S, van der Meij BS, Milte R, Collins CE, de van der Schueren MA, Banbury M, Warner MM, Isenring E. Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study. JMIR Res Protoc 2019; 8:e12647. [PMID: 31038466 PMCID: PMC6658316 DOI: 10.2196/12647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting. OBJECTIVE The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial. METHODS This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility. RESULTS Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission. CONCLUSIONS This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12647.
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Affiliation(s)
- Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Barbara S van der Meij
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Dietetics and Foodservices, Mater Health, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Rachel Milte
- Institute for Choice, University of South Australia, Adelaide, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Marian Ae de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands.,Department of Nutrition and Dietetics, HAN University of Applied Sciences, Amsterdam, Netherlands
| | - Mark Banbury
- Northern NSW Local Health District, NSW Health, Tweed Heads, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Molly M Warner
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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Roberts HC, Lim SER, Cox NJ, Ibrahim K. The Challenge of Managing Undernutrition in Older People with Frailty. Nutrients 2019; 11:E808. [PMID: 30974825 PMCID: PMC6521101 DOI: 10.3390/nu11040808] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022] Open
Abstract
Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation.
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Affiliation(s)
- Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Stephen E R Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
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Crichton M, Craven D, Mackay H, Marx W, de van der Schueren M, Marshall S. A systematic review, meta-analysis and meta-regression of the prevalence of protein-energy malnutrition: associations with geographical region and sex. Age Ageing 2019; 48:38-48. [PMID: 30188972 DOI: 10.1093/ageing/afy144] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 08/07/2018] [Indexed: 11/13/2022] Open
Abstract
Background protein-energy malnutrition is a major health concern in home-dwelling older adults, particularly in the context of an ageing population. Therefore, a systematic review and meta-analysis was undertaken to determine the prevalence of malnutrition among older adults living independently in the community according to geographical region, sampling frame, rurality and sex. Methods six electronic databases were searched until September 2016. Original research studies which used the Mini Nutritional Assessment, Patient-Generated Subjective Global Assessment or Subjective Global Assessment to determine nutrition status in community samples with a mean age of ≥65 years were critically appraised and pooled using meta-analysis. Meta-regression was used to explore predictors of malnutrition prevalence in pooled statistics with high heterogeneity. Results 111 studies from 38 countries (n = 69,702 participants) were included. The pooled prevalence of malnutrition in the older community setting ranged from 0.8% (95% CI: 0.2-1.7%) in Northern Europe to 24.6% (95% CI: 0.0-67.9%) in South-East Asia. Of all sampling frames, participants receiving homecare services had the highest prevalence at 14.6% (95% CI: 9.9-20.0%). Malnutrition prevalence in rural communities (9.9%; 95% CI: 4.5-16.8%) was double that in urban communities (5.7%; 95% CI: 4.2-7.3%) and higher among females than males (odds ratio = 1.45 [95% CI: 1.27-1.66]; P < 0.00001). Conclusions the results of this review provide strategic insight to develop public and community health priorities for preventing malnutrition and associated poor health outcomes.
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Affiliation(s)
- Megan Crichton
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Dana Craven
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Hannah Mackay
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Wolfgang Marx
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- School of Allied Health, La Trobe University, Victoria, Australia
- Food & Mood Centre, IMPACT SRC, School of Medicine, Deakin University, Geelong, Australia
| | - Marian de van der Schueren
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centres, VUmc, Amsterdam, the Netherlands
| | - Skye Marshall
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
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