scholarly journals A mHealth Intervention to Close the Guidelines-To-Practice Gap in Hypertension Treatment: Design of mGlide RCT (Preprint)

2020 ◽  
Author(s):  
Kamakshi Lakshminarayan ◽  
Thomas A Murray ◽  
Sarah M Westberg ◽  
John Connett ◽  
Val Overton ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Disease Risk ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Hypertension Treatment ◽  
Hypertension Control ◽  
Mhealth Intervention ◽  
Practice Gap ◽  
Diverse Patient Populations

BACKGROUND Sub-optimal treatment of hypertension remains a widespread problem particularly among minorities and socioeconomically disadvantaged groups. We present a health-system based intervention with diverse patient populations using readily available smart phone technology. This intervention is designed to empower patients and create partnerships between patients and their provider team to promote hypertension control. OBJECTIVE mGlide RCT is a NIH-funded randomized controlled trial, evaluating whether a mobile health (mHealth)-based intervention that is an active partnership between health care teams and patients results in better hypertension control rates than a state-of-clinical care comparison. METHODS We are recruiting 450 participants including stroke survivors and primary care patients with elevated cardiovascular disease risk from diverse health systems. These systems include an acute stroke service (n=100), an academic medical center (n=150) and community medical centers including Federally Qualified Health Centers serving low income and minority (Latino, Hmong, African American, Somali) patients (n=200). The primary aim tests the clinical effectiveness of the 6-month mHealth intervention versus standard of care. Secondary aims evaluate sustained hypertension control rates at 12 months; describe provider experiences of system usability and satisfaction; examine patient experiences, including medication adherence and medication use self-efficacy, self-rated health and quality of life, and adverse event rates; and complete a cost-effectiveness analysis. RESULTS Enrollment. To date, we have randomized 104 participants (52 intervention; 52 control). CONCLUSIONS This study will provide evidence for whether a readily available mHealth-care model is better than state-of-clinical care for bridging the guideline-to-practice gap in hypertension treatment in health systems serving diverse patient populations. CLINICALTRIAL Clinicaltrials.gov NCT03612271

scholarly journals Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny S. Lou ◽  
Charles W. Goss ◽  
Bradley A. Evanoff ◽  
Jennifer G. Duncan ◽  
Thomas Kannampallil
Keyword(s):  
Risk Factors ◽  
Clinical Education ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Work ◽  
Educational Opportunities ◽  
Missed Opportunities ◽  
Physician Trainee ◽  
At Home

Abstract Background The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns. Methods All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables. Results 22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33–6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47–1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16–5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038). Conclusions Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

scholarly journals Scoping review protocol: bladder cancer in Nigeria: what are the gaps in clinical care and research?

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041894
Author(s):  
Joyce Kibaru ◽  
Pinky Kotecha ◽  
Abdulkarim Muhammad Iya ◽  
Beth Russell ◽  
Muzzammil Abdullahi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Scoping Review ◽  
Low Income ◽  
Clinical Care ◽  
Grey Literature ◽  
Case Series ◽  
Cochrane Library ◽  
Future Research ◽  
Scoping Reviews ◽  
Local Risk

IntroductionBladder cancer (BC) is the 10th common cancer worldwide and ranks seventh in Nigeria. This scoping review aims to identify the gaps in clinical care and research of BC in Nigeria as part of the development of a larger national research programme aiming to improve outcomes and care of BC.Methods and analysisThis review will be conducted according to Arksey and O’Malley scoping review methodology framework. The following electronic databases will be searched: Medline (using the PubMed interface), Ovid Gateway (Embase and Ovid), Cochrane library and Open Grey literature. Two independent reviewers will screen titles and abstracts and subsequently screen full-text studies for inclusion, any lack of consensus will be discussed with a third reviewer. Any study providing insight into the epidemiology or treatment pathway of BC (RCTs, observations, case series, policy paper) will be included. A data chart will be used to extract relevant data from the included studies. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A consultation process will be carried out with a multidisciplinary team of Nigerian healthcare professionals, patients and scientists.Ethics and disseminationThe results will be disseminated through peer-reviewed publications. By highlighting the key gaps in the literature, this review can provide direction for future research and clinical guidelines in Nigeria (and other low-income and middle-income countries), where BC is more prevalent due to local risk factors and healthcare settings.

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

2019 ◽  
Vol 26 (11) ◽  
pp. 1385-1388 ◽  
Author(s):  
William E Yang ◽  
Lochan M Shah ◽  
Erin M Spaulding ◽  
Jane Wang ◽  
Helen Xun ◽  
...  
Keyword(s):  
Mobile Health ◽  
Healthy Lifestyle ◽  
Clinical Care ◽  
Critical Role ◽  
Lifestyle Changes ◽  
Mhealth Intervention ◽  
Early Results ◽  
Modification Technique ◽  
Behavior Modification Technique

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

scholarly journals BMI and Coronary Heart Disease Risk Among Low-Income and Underinsured Diabetic Patients

Diabetes Care ◽  
2014 ◽  
Vol 37 (12) ◽  
pp. 3204-3212 ◽  
Author(s):  
Nan Li ◽  
Peter T. Katzmarzyk ◽  
Ronald Horswell ◽  
Yonggang Zhang ◽  
Weiqin Li ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Low Income ◽  
Coronary Heart Disease Risk ◽  
Disease Risk ◽  
Diabetic Patients ◽  
Heart Disease Risk

scholarly journals Knowledge and understanding of cardiovascular disease risk factors in Sierra Leone: a qualitative study of patients’ and community leaders’ perceptions

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038523
Author(s):  
Agnieszka Ignatowicz ◽  
Maria Lisa Odland ◽  
Tahir Bockarie ◽  
Haja Wurie ◽  
Rashid Ansumana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Qualitative Study ◽  
Sierra Leone ◽  
Low Income ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cardiovascular Disease Risk Factors ◽  
Community Leaders ◽  
Major Barrier

ObjectivesPrevalence of cardiovascular disease risk factors (CVDRF) is increasing, especially in low-income countries. In Sierra Leone, there are no previous studies on the knowledge and the awareness of these conditions in the community. This study aimed to explore the knowledge and understanding of CVDRF, as well as the perceptions of the barriers and facilitators to accessing care for these conditions, among patients and community leaders in Sierra Leone.DesignQualitative study employing semistructured interviews and focus group discussions.SettingUrban and rural Bo District, Sierra Leone.ParticipantsInterviews with a purposive sample of 37 patients and two focus groups with six to nine community leaders.ResultsWhile participants possessed general knowledge of their conditions, the level and complexity of this knowledge varied widely. There were clear gaps in knowledge regarding the coexistence of CVDRF and their consequences, as well as the link between behavioural factors and CVDRF. An overarching theme from the data was the need to create an understanding and awareness of CVDRF in the community in order to prevent and improve management of these conditions. Cost was also seen as a major barrier to accessing care for CVDRFs.ConclusionsThe knowledge gaps identified in this study highlight the need to design strategies and interventions that improve knowledge and recognition of CVDRF in the community. Interventions should specifically consider how to develop and enhance awareness about CVDRF and their consequences. They should also consider how patients seek help and where they access it.

The We-Lead Model for Bridging the Low-Income Community Leadership Skills-Practice Gap

2017 ◽  
Vol 25 (1) ◽  
pp. 126-137 ◽  
Author(s):  
Wilson Majee ◽  
Laurel Goodman ◽  
Johanna Reed Adams ◽  
Kimberly Keller
Keyword(s):  
Low Income ◽  
Leadership Skills ◽  
Community Leadership ◽  
Practice Gap

scholarly journals Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes

2015 ◽  
Vol 23 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Lyndsay A Nelson ◽  
Shelagh A Mulvaney ◽  
Tebeb Gebretsadik ◽  
Yun-Xian Ho ◽  
Kevin B Johnson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Depressive Symptoms ◽  
Medication Adherence ◽  
Health Literacy ◽  
Low Income ◽  
Mhealth Intervention ◽  
Lower Health ◽  
The Relationship ◽  
Lower Health Literacy

Abstract Objective Mobile health (mHealth) interventions may improve diabetes outcomes, but require engagement. Little is known about what factors impede engagement, so the authors examined the relationship between patient factors and engagement in an mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes (T2DM). Materials and Methods Eighty patients with T2DM participated in a 3-month mHealth intervention called MEssaging for Diabetes that leveraged a mobile communications platform. Participants received daily text messages addressing and assessing medication adherence, and weekly interactive automated calls with adherence feedback and questions for problem solving. Longitudinal repeated measures analyses assessed the relationship between participants’ baseline characteristics and the probability of engaging with texts and calls. Results On average, participants responded to 84.0% of texts and participated in 57.1% of calls. Compared to Whites, non-Whites had a 63% decreased relative odds (adjusted odds ratio [AOR] = 0.37, 95% confidence interval [CI], 0.19-0.73) of participating in calls. In addition, lower health literacy was associated with a decreased odds of participating in calls (AOR = 0.67, 95% CI, 0.46-0.99, P = .04), whereas older age ( Pnonlinear = .01) and more depressive symptoms (AOR = 0.62, 95% CI, 0.38-1.02, P = .059) trended toward a decreased odds of responding to texts. Conclusions Racial/ethnic minorities, older adults, and persons with lower health literacy or more depressive symptoms appeared to be the least engaged in a mHealth intervention. To facilitate equitable intervention impact, future research should identify and address factors interfering with mHealth engagement.

scholarly journals Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045598
Author(s):  
Dylan P Griswold ◽  
Andres Gempeler ◽  
Angelos G Kolias ◽  
Peter J Hutchinson ◽  
Andres M Rubiano
Keyword(s):  
Health Systems ◽  
Systematic Reviews ◽  
Low Income ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Evidence Synthesis ◽  
Trauma Surgery ◽  
Experimental Studies ◽  
Protective Equipment ◽  
Cochrane Central Register

IntroductionMany healthcare facilities in low-income and middle-income countries are inadequately resourced and may lack optimal organisation and governance, especially concerning surgical health systems. COVID-19 has the potential to decimate these already strained surgical healthcare services unless health systems take stringent measures to protect healthcare workers (HCWs) from viral exposure and ensure the continuity of specialised care for patients. The objective of this broad evidence synthesis is to identify and summarise the available literature regarding the efficacy of different personal protective equipment (PPE) in reducing the risk of COVID-19 infection in health personnel caring for patients undergoing trauma surgery in low-resource environments.MethodsWe will conduct several searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials and over 30 other sources. The search results will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. This review will preferentially consider systematic reviews of experimental and quasi-experimental studies, as well as individual studies of such designs, evaluating the effect of different PPE on the risk of COVID-19 infection in HCWs involved in emergency trauma surgery. Critical appraisal of eligible studies for methodological quality will be conducted. Data will be extracted using the standardised data extraction tool in Covidence. Studies will, when possible, be pooled in a statistical meta-analysis using JBI SUMARI. The Grading of Recommendations, Assessment, Development and Evaluation approach for grading the certainty of evidence will be followed and a summary of findings will be created.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42020198267.

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