Elizabeth Russell-Minda

Age-related macular degeneration and low-vision rehabilitation: a systematic review

BACKGROUND Because of the prevalence and devastating consequences of age-related macular degeneration (AMD), a systematic review devoted to low-vision rehabilitation and AMD seems timely and appropriate. METHODS Several electronic databases were searched for studies from 1980 to 2006 involving individuals with low vision or visual impairment and rehabilitation interventions. Studies were assessed for quality and level of evidence. RESULTS The findings indicate that standard low-vision rehabilitation programs, conventional in-clinic assessments, and optical devices are effective ways of managing and living with vision loss. Areas of unmet need include determining which types of orientation and mobility programs and devices are most effective and developing methods of matching assistive technologies with the individuals visual and environmental requirements. INTERPRETATION Additional randomized controlled trials with similar intervention comparisons and outcome measures are needed to form stronger conclusions for the most effective low-vision rehabilitation interventions for individuals with AMD.

Health technologies for monitoring and managing diabetes: a systematic review.

Background: The primary objective of this review was to determine the strength of evidence for the effectiveness of self-monitoring devices and technologies for individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on specific health-related outcome measures. Self-monitoring devices included those that assist patients with managing diabetes and preventing cardiovascular complications (CVCs). A secondary objective was to explore issues of feasibility, usability, and compliance among patients and providers. Methods: Study criteria included individuals ≥14 years and youth (7–14 years) with T1DM or T2DM, intervention with a self-monitoring device, assessment of clinical outcomes with the device, literature in English, and ≥10 participants. Relevant published literature was searched from 1985 to 2008. Randomized controlled trials and observational studies were included. Data were extracted for clinical outcomes, feasibility and compliance methods, and results. Selected studies were independently evaluated with a validated instrument for assessing methodological quality. Results: Eighteen trials were selected. Predominant types of device interventions included self-monitoring of blood glucose, pedometers, and cell phone or wireless technologies. Feasibility and compliance were measured in the majority of studies. Conclusions: Self-monitoring of blood glucose continues to be an effective tool for the management of diabetes. Wireless technologies can improve diabetes self-care, and pedometers are effective lifestyle modification tools. The results of this review indicate a need for additional controlled trial research on existing and novel technologies for diabetes self-monitoring, on health outcomes associated with diabetes and CVCs, and device feasibility and compliance.

Remote Monitoring Technologies for the Prevention of Metabolic Syndrome: The Diabetes and Technology for Increased Activity (DaTA) Study

Objectives: Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. Research Design and Methods: The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. Results: Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. Conclusions: Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting.

Self-monitoring technologies for type 2 diabetes and the prevention of cardiovascular complications: perspectives from end users.

Background: The objective of this study was to explore facilitators and barriers to the adoption of self-monitoring devices in individuals with type 2 diabetes mellitus (T2DM). Methods: Individuals with T2DM who were currently using one or more devices to monitor their disease participated in focus groups. Transcripts of focus group meetings were coded into themes by two reviewers using NVivo qualitative software. Results: Twenty-eight adults with T2DM reported using a blood glucose meter, and almost half reported monitoring their blood pressure. Few individuals consistently monitored other aspects of their cardiovascular health. Four major themes impacting device use/disuse were identified: Knowledge gaps, relationships with health care providers, environment, and personal experience. Knowledge barriers included lack of information regarding diabetes and the associated risk of complications. Perceptions of inconvenience, pain, and financial restrictions were important factors influencing the adoption, use, and abandonment of self-monitoring devices. Community-run programs, as well as dieticians and pharmacists, were identified as important resources for accessing information related to T2DM. Conclusions: We identified the need for development of accessible and relevant education material; improved communication of disease-specific information between patients and providers, as well as providers and community resources; and strategies to improve the convenience and cost of monitoring devices.