Navigating the health-care system is not easy, but you’re not alone.
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Hello, dear reader!
This is my first column for Healthy Debate as a Patient Navigator. This column will be devoted to providing patients with information to help them through their journey with the health-care system and answering your questions.
Here’s a bit about me: I have been a patient partner at The Ottawa Hospital and Ottawa Hospital Research Institute since 2017, and have joined a variety of governance boards that work on patient and caregiver engagement such as the Patient Advisors Network, the Ontario Health East Region Patient and Family Advisory Council and the Equity in Health Systems Lab.
My journey as a patient partner started much before 2017 though. When I was a teenager, I was diagnosed with a cholesteatoma, a rare and chronic disease that causes the development of fatty tumors in the middle ear. I have had multiple surgeries to try to fix it but will need regular follow-ups to monitor whether the tumor returns. Because of this, I also live with an invisible disability since I have essentially become functionally deaf in one ear and often rely on a hearing aid when I navigate the world.
Having undergone three surgeries in my adolescent years, it was my experience undergoing surgery for an acute hand and wrist injury following a jet ski accident as an adult that was the catalyst for my decision to become a patient partner. There was an intriguing contrast between how I was cared for at two different health-care institutions, my age being the deciding factor at which hospital I went to (a children’s hospital or an adult one).
The most memorable example was how, as a teenager or child, you were never left alone before surgery, and nurses and staff took all the time necessary to comfort me and answer my (and my family’s) questions. I also remember how right before putting me to sleep, the whole staff initiated a surgical pause and introduced themselves and explained to me what their role was during my surgery.
None of that happened as an adult. I was left in a hallway while the operating theater was prepared, anxious and alone with staff walking by not even batting an eye. My questions felt like an annoyance to the care team; as soon as I was wheeled onto the operating room table, the anesthetist quickly put me to sleep. I didn’t even have the time to see who else was there.
Now don’t get me wrong: I am incredibly appreciative with the quality of care I received, but it was the everyday interactions with the care teams that I felt could be improved. And so, while I was recovering from that surgery, I looked for a way to help other patients and the hospital improve its care. I discovered the hospital’s patient engagement program, applied, and the rest is history!
Since then, I have worked on a host of patient-centered policy and research projects and fervently advocate that surgical teams adopt a more compassionate approach with patients before and after surgery.
I’d be happy to talk a bit more about my journey if you ask, but with that out of the way … Welcome to our first patient navigator column about patient engagement.
Conceptualizing the continuum of Patient Engagement
In the context of Canadian health care, patient engagement is a multifaceted concept that involves active collaboration between patients, caregivers, health-care providers and researchers. It involves patients and caregivers as active contributors in decision-making processes, health-care services and medical research. Though the concept is not new, the paradigm shift toward patient engagement in Canada started around 2010.
I like to conceptualize the different levels of patient engagement as a measure of the strength of the relationship between patients and their interlocutors – whether it’s a healthcare provider, administrator or researcher – charted against the duration of the engagement or the scope of input required from the patient.
Defining different levels of Patient Engagement
Following the continuum, let’s begin by defining different levels of patient engagement. Bear in mind that these definitions can vary from one organization to another but are useful in generally labelling the level of patient engagement a project has achieved (or wishes to achieve).
Patient involvement: If the strength of the relationship between patients and their interlocutors is minimal and not time consuming or too onerous, then perhaps it can be categorized as patient involvement. This applies to many instances of transactional engagement.
Patient advisory/consulting: Right in the middle of our continuum, patients can find themselves engaging in patient advisory or consulting work, where projects are limited in scope and duration or complexity, and the relationship is not as profound as a partnership.
Patient partnership: The stronger the relationship is between the patient and their interlocutor, and the longer the engagement activity lasts or how much input the patient is providing, the more this situation can be categorized as patient partnership. It is the inverse of patient involvement.
Examples of the different levels of Patient Engagement
Let’s pretend you are accompanying a loved one to an appointment to manage a kidney disease, requiring them to undergo dialysis treatment. We’ll use this scenario to exemplify what label could be used to describe the level of engagement.
Patient involvement: In our case, if your loved one – or you – fills out a satisfaction or feedback survey about your experience in the waiting room and all that needed to be done was to hand it back to the clerk or care team, then, at a basic level, you could likely label this interaction as a form of patient involvement. It can also involve open consultations around a design of a new look and feel for a hospital, or the understandability of a survey or communications product. Interactions with the care team, administrators or researchers are minimal and often transactional.
Patient advisory/consulting: If your loved one was asked for more detailed information about survey results over the course of a few meetings, this could represent patient advisory/consulting. This could mean that patients meet with program administrators and care providers and share their insights on how things can be improved. It essentially involves patients providing advice to health-care institutions from the perspective of patients, their family members and caregivers.
Patient advisors or consultants are often appointed by hospitals or academic institutions to offer insights at multiple stages of health-care delivery and research. They can help pilot an initiative based on that feedback or evaluate whether the new solutions are working. Often patient advisors are engaged in smaller-term individual projects and meet with the project team as regularly as required.
Patient partnership: Going above and beyond patient advisory, if patients have built a trusting relationship with their care team or administrators, they could feel comfortable enough to partner with them and initiate a project of their own. This could be for a project in which they study a different form of treatment to improve patient-centered outcomes (like the time it takes to feel “normal” following a session); it could be working together to identify and remove barriers for other patients that need to access that type of care. These projects are not fulfilled overnight, but require a collaborative, longstanding and trusting relationship between patients and health-care providers, administrators or researchers. It ensures that patients, regardless of severity or chronicity of their illness, can meaningfully contribute their experiences to aid in improving patient care, or develop or implement policies, pilots or research projects from start to finish.
It is leveraging that lived and living experience to its full extent and having the patient partner involved as an equal voice in the decision-making process for a project – over many months, usually – that the engagement could be labeled a partnership.
Last words
The point of this column will be to answer or explore issues or questions related to patient engagement, health communications or even provide some thoughts on how to handle a particular situation.
I would be happy to collect your questions and feedback at any time, which will help inform future columns. Just email me at max@le-co.ca or connect with me on social media (Linked In, X / Twitter).
It’s not easy to navigate our health-care systems, but you are not alone.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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Forget Ringing the Button for the Nurse. Patients Now Stay Connected by Wearing One.
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HOUSTON — Patients admitted to Houston Methodist Hospital get a monitoring device about the size of a half-dollar affixed to their chest — and an unwitting role in the expanding use of artificial intelligence in health care.
The slender, battery-powered gadget, called a BioButton, records vital signs including heart and breathing rates, then wirelessly sends the readings to nurses sitting in a 24-hour control room elsewhere in the hospital or in their homes. The device’s software uses AI to analyze the voluminous data and detect signs a patient’s condition is deteriorating.
Hospital officials say the BioButton has improved care and reduced the workload of bedside nurses since its rollout last year.
“Because we catch things earlier, patients are doing better, as we don’t have to wait for the bedside team to notice if something is going wrong,” said Sarah Pletcher, system vice president at Houston Methodist.
But some nurses fear the technology could wind up replacing them rather than supporting them — and harming patients. Houston Methodist, one of dozens of U.S. hospitals to employ the device, is the first to use the BioButton to monitor all patients except those in intensive care, Pletcher said.
“The hype around a lot of these devices is they provide care at scale for less labor costs,” said Michelle Mahon, a registered nurse and an assistant director of National Nurses United, the profession’s largest U.S. union. “This is a trend that we find disturbing,” she said.
The rollout of BioButton is among the latest examples of hospitals deploying technology to improve efficiency and address a decades-old nursing shortage. But that transition has raised its own concerns, including about the device’s use of AI; polls show the public is wary of health providers relying on it for patient care.
In December 2022 the FDA cleared the BioButton for use in adult patients who are not in critical care. It is one of many AI tools now used by hospitals for tasks like reading diagnostic imaging results.
In 2023, President Joe Biden directed the Department of Health and Human Services to develop a plan to regulate AI in hospitals, including by collecting reports of patients harmed by its use.
The leader of BioIntelliSense, which developed the BioButton, said its device is a huge advance compared with nurses walking into a room every few hours to measure vital signs. “With AI, you now move from ‘I wonder why this patient crashed’ to ‘I can see this crash coming before it happens and intervene appropriately,’” said James Mault, CEO of the Golden, Colorado-based company.
The BioButton stays on the skin with an adhesive, is waterproof, and has up to a 30-day battery life. The company says the device — which allows providers to quickly notice deteriorating health by recording more than 1,000 measurements a day per patient — has been used on more than 80,000 hospital patients nationwide in the past year.
Hospitals pay BioIntelliSense an annual subscription fee for the devices and software.
Houston Methodist officials would not reveal how much the hospital pays for the technology, though Pletcher said it equates to less than a cup of coffee a day per patient.
For a hospital system that treats thousands of patients at a time — Houston Methodist has 2,653 non-ICU beds at its eight Houston-area hospitals — such an investment could still translate to millions of dollars a year.
Hospital officials say they have not made any changes in nurse staffing and have no plans to because of implementing the BioButton.
Inside the hospital’s control center for virtual monitoring on a recent morning, about 15 nurses and technicians dressed in scrubs sat in front of large monitors showing the health status of hundreds of patients they were assigned to monitor.
A red checkmark next to a patient’s name signaled the AI software had found readings trending outside normal. Staff members could click into a patient’s medical record, showing patients’ vital signs over time and other medical history. These virtual nurses, if you will, could contact nurses on the floor by phone or email, or even dial directly into the patient’s room via video call.
Nutanben Gandhi, a technician who was watching 446 patients on her monitor that morning, said that when she gets an alert, she looks at the patient’s health record to see if the anomaly can be easily explained by something in the patient’s condition or if she needs to contact nurses on the patient’s floor.
Oftentimes an alert can be easily dismissed. But identifying signs of deteriorating health can be tough, said Steve Klahn, Houston Methodist’s clinical director of virtual medicine.
“We are looking for a needle in a haystack,” he said.
Donald Eustes, 65, was admitted to Houston Methodist in March for prostate cancer treatment and has since been treated for a stroke. He is happy to wear the BioButton.
“You never know what can happen here, and having an extra set of eyes looking at you is a good thing,” he said from his hospital bed. After being told the device uses AI, the Montgomery, Texas, man said he has no problem with its helping his clinical team. “This sounds like a good use of artificial intelligence.”
Patients and nurses alike benefit from remote monitoring like the BioButton, said Pletcher of Houston Methodist.
The hospital has placed small cameras and microphones inside all patient rooms enabling nurses outside to communicate with patients and perform tasks such as helping with patient admissions and discharge instructions. Patients can include family members on the remote calls with nurses or a doctor, she said.
Virtual technology frees up on-duty nurses to provide more hands-on help, such as starting an intravenous line, Pletcher said. With the BioButton, nurses can wait to take routine vital signs every eight hours instead of every four, she said.
Pletcher said the device reduces nurses’ stress in monitoring patients and allows some to work more flexible hours because virtual care can be done from home rather than coming to the hospital. Ultimately it helps retain nurses, not drive them away, she said.
Sheeba Roy, a nurse manager at Houston Methodist, said some members of the nursing staff were nervous about relying on the device and not checking patients’ vital signs as often themselves. But testing has shown the device provides accurate information.
“After we implemented it, the staff loves it,” Roy said.
Serena Bumpus, chief executive officer of the Texas Nurses Association, said her concern with any technology is that it can be more burdensome on nurses and take away time with patients.
“We have to be hypervigilant in ensuring that we are not leaning on this to replace the ability of nurses to critically think and assess patients and validate what this device is telling us is true,” Bumpus said.
Houston Methodist this year plans to send the BioButton home with patients so the hospital can better track their progress in the weeks after discharge, measuring the quality of their sleep and checking their gait.
“We are not going to need less nurses in health care, but we have limited resources and we have to use those as thoughtfully as we can,” Pletcher said. “Looking at projected demand and seeing the supply we have coming, we will not have enough to meet demand, so anything we can do to give time back to nurses is a good thing.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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New research suggests intermittent fasting increases the risk of dying from heart disease. But the evidence is mixed
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Kaitlin Day, RMIT University and Sharayah Carter, RMIT University
Intermittent fasting has gained popularity in recent years as a dietary approach with potential health benefits. So you might have been surprised to see headlines last week suggesting the practice could increase a person’s risk of death from heart disease.
The news stories were based on recent research which found a link between time-restricted eating, a form of intermittent fasting, and an increased risk of death from cardiovascular disease, or heart disease.
So what can we make of these findings? And how do they measure up with what else we know about intermittent fasting and heart disease?
The study in question
The research was presented as a scientific poster at an American Heart Association conference last week. The full study hasn’t yet been published in a peer-reviewed journal.
The researchers used data from the National Health and Nutrition Examination Survey (NHANES), a long-running survey that collects information from a large number of people in the United States.
This type of research, known as observational research, involves analysing large groups of people to identify relationships between lifestyle factors and disease. The study covered a 15-year period.
It showed people who ate their meals within an eight-hour window faced a 91% increased risk of dying from heart disease compared to those spreading their meals over 12 to 16 hours. When we look more closely at the data, it suggests 7.5% of those who ate within eight hours died from heart disease during the study, compared to 3.6% of those who ate across 12 to 16 hours.
We don’t know if the authors controlled for other factors that can influence health, such as body weight, medication use or diet quality. It’s likely some of these questions will be answered once the full details of the study are published.
It’s also worth noting that participants may have eaten during a shorter window for a range of reasons – not necessarily because they were intentionally following a time-restricted diet. For example, they may have had a poor appetite due to illness, which could have also influenced the results.
Other research
Although this research may have a number of limitations, its findings aren’t entirely unique. They align with several other published studies using the NHANES data set.
For example, one study showed eating over a longer period of time reduced the risk of death from heart disease by 64% in people with heart failure.
Another study in people with diabetes showed those who ate more frequently had a lower risk of death from heart disease.
A recent study found an overnight fast shorter than ten hours and longer than 14 hours increased the risk dying from of heart disease. This suggests too short a fast could also be a problem.
But I thought intermittent fasting was healthy?
There are conflicting results about intermittent fasting in the scientific literature, partly due to the different types of intermittent fasting.
There’s time restricted eating, which limits eating to a period of time each day, and which the current study looks at. There are also different patterns of fast and feed days, such as the well-known 5:2 diet, where on fast days people generally consume about 25% of their energy needs, while on feed days there is no restriction on food intake.
Despite these different fasting patterns, systematic reviews of randomised controlled trials (RCTs) consistently demonstrate benefits for intermittent fasting in terms of weight loss and heart disease risk factors (for example, blood pressure and cholesterol levels).
RCTs indicate intermittent fasting yields comparable improvements in these areas to other dietary interventions, such as daily moderate energy restriction.
So why do we see such different results?
RCTs directly compare two conditions, such as intermittent fasting versus daily energy restriction, and control for a range of factors that could affect outcomes. So they offer insights into causal relationships we can’t get through observational studies alone.
However, they often focus on specific groups and short-term outcomes. On average, these studies follow participants for around 12 months, leaving long-term effects unknown.
While observational research provides valuable insights into population-level trends over longer periods, it relies on self-reporting and cannot demonstrate cause and effect.
Relying on people to accurately report their own eating habits is tricky, as they may have difficulty remembering what and when they ate. This is a long-standing issue in observational studies and makes relying only on these types of studies to help us understand the relationship between diet and disease challenging.
It’s likely the relationship between eating timing and health is more complex than simply eating more or less regularly. Our bodies are controlled by a group of internal clocks (our circadian rhythm), and when our behaviour doesn’t align with these clocks, such as when we eat at unusual times, our bodies can have trouble managing this.
So, is intermittent fasting safe?
There’s no simple answer to this question. RCTs have shown it appears a safe option for weight loss in the short term.
However, people in the NHANES dataset who eat within a limited period of the day appear to be at higher risk of dying from heart disease. Of course, many other factors could be causing them to eat in this way, and influence the results.
When faced with conflicting data, it’s generally agreed among scientists that RCTs provide a higher level of evidence. There are too many unknowns to accept the conclusions of an epidemiological study like this one without asking questions. Unsurprisingly, it has been subject to criticism.
That said, to gain a better understanding of the long-term safety of intermittent fasting, we need to be able follow up individuals in these RCTs over five or ten years.
In the meantime, if you’re interested in trying intermittent fasting, you should speak to a health professional first.
Kaitlin Day, Lecturer in Human Nutrition, RMIT University and Sharayah Carter, Lecturer Nutrition and Dietetics, RMIT University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Enjoy Bitter Foods For Your Heart & Brain
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When Bitter Is Better
A good general rule of thumb for “does this food contain a lot of healthy polyphenols?” is:
“is this (edible) plant bitter/astringent/pungent”?
If it is, it’s probably rich in polyphenols:
Deciphering the role of bitter and astringent polyphenols in promoting well-being
…which is why it’s no surprise that black coffee and bitter chocolate score highly, as do hot peppers and even garlic.
See also: Our Top 5 Spices: How Much Is Enough For Benefits?
Even fruits, generally considered something sweet to eat, often contain more polyphenols when they are bitter—many berries are great examples of this!
Read more: Goji Berries: Which Benefits Do They Really Have?
You can read more about the science of this here:
Sensory Nutrition and Bitterness and Astringency of Polyphenols
Important for multiple reasons (including heart and brain health)
Polyphenols have many benefits, and they’re most well known for their heart-healthy properties, but their antioxidant effect (and other mechanisms) also means these foods are generally neuroprotectants too:
The science of this is not all as obvious as you might think!
It is reasonable to expect “ok, this has antioxidant effect, so it will reduce oxidative damage to brain cells too”, and while that is true (and yes, polyphenols do cross the blood-brain barrier), they also help in other ways, including through the gut:
What if I don’t like bitter/astringent/pungent foods?
If you do not have a medical condition that proscribes them (do check with your doctor if unsure), the best advice is to simply eat them anyway, and your tastes will adapt.
It will also help if you avoid sweet foods (though this too is also a good general rule of thumb!), as this will move the balance of where your brain’s “set range” is for “good taste”.
Bonus tip: dark chocolate (80%+ cocoa if possible, 95% if you can get it) and chilli peppers go great with each other. Here’s an example of a chilli chocolate product on Amazon; it’s 70% cocoa (which is not bad, but could be better). You might be able to get a higher percentage locally, especially if you ask your local chocolatière, or make it yourself!
Enjoy!
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Cardiac Failure Explained – by Dr. Warrick Bishop
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The cover of this book makes it look like it’ll be a flashy semi-celebrity doctor keen to sell his personalized protocol, along with eleventy-three other books, but actually, what’s inside this one is very different:
We (hopefully) all know the basics of heart health, but this book takes it a lot further. Starting with the basics, then the things that it’s easy to feel like you should know but actually most people don’t, then into much more depth.
The format is much more like a university textbook than most pop-science books, and everything about the way it’s written is geared for maximum learning. The one thing it does keep in common with pop-science books as a genre is heavy use of anecdotes to illustrate points—but he’s just as likely to use tables, diagrams, callout boxes, emboldening of key points, recap sections, and so forth. And for the most part, this book is very information-dense.
Dr. Bishop also doesn’t just stick to what’s average, and talks a lot about aberrations from the norm, what they mean and what they do and yes, what to do about them.
On the one hand, it’s more information dense than the average reader can reasonably expect to need… On the other hand, isn’t it great to finish reading a book feeling like you just did a semester at medical school? No longer will you be baffled by what is going on in your (or perhaps a loved one’s) cardiac health.
Bottom line: if you’d like to know cardiac health inside out, this book is an excellent place to start.
Click here to check out Cardiac Failure Explained, and get to the heart of things!
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Fitness Freedom for Seniors – by Jackie Jacobs
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Exercise books often assume that either we are training for the Olympics, and most likely also that we are 20 years old. This one doesn’t.
Instead, we see a well-researched, well-organized, clearly-illustrated fitness plan with age in mind. Author Jackie Jacobs offers tips and advice for all levels, and a progressive week-by-week plan of 15-minute sessions. This way, we’re neither overdoing it nor slacking off; it’s a perfect balance.
The exercises are aimed at “all areas”, that is to say, improving cardiovascular fitness, balance, flexibility, and strength. It also gives some supplementary advice with regard to diet and suchlike, but the workouts are the real meat of the book.
Bottom line: if you’d like a robust, science-based exercise regime that’s tailored to seniors, this is the book for you.
Click here to check out Fitness Freedom for Seniors, and get yours!
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Superfood Soba Noodle Salad
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This Japanese dish is packed with nutrients and takes very little preparation time, involving only one cooked ingredient, and a healthy one at that!
You will need
- 8 oz dried soba noodles
- ½ bulb garlic, finely chopped
- 2 tbsp avocado oil
- 2 tsp soy sauce
- ¼ cucumber, cut into thin batons (don’t peel it first)
- ½ carrot, grated (don’t peel it first)
- 6 cherry tomatoes, halved (you wouldn’t peel these, right? Please don’t)
- ½ red onion, finely sliced (ok, this one you can peel first! Please do)
- 1 tbsp chia seeds
- 1 tsp crushed red chili flakes
- Garnish: fresh parsley, chopped
Method
(we suggest you read everything at least once before doing anything)
1) Cook the soba noodles (boil in water for 10 mins or until soft). Rinse with cold water (which lowers the glycemic index further, and also we want them cold anyway) and set aside.
2) Make the dressing by blending the garlic, avocado oil, and soy cauce. Set it aside.
3) Assemble the salad by thoroughly but gently mixing the noodles with the cucumber, carrot, tomatoes, and onion. Add the dressing, the chia seeds, and the chili flakes, and toss gently to combine.
4) Serve, adding the parsley garnish.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Rice vs Buckwheat – Which is Healthier? ← soba noodles are made from buckwheat, which by the way is also a good source of rutin, which can strengthen blood vessel walls against damage, reducing the risk of atheroma
- Cucumber Extract Beats Glucosamine & Chondroitin… At 1/135th Of The Dose?!
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Chia: The Tiniest Seeds With The Most Value
Take care!
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