Stacey Guy

Moving Beyond the Stigma: Systematic Review of Video Games and Their Potential to Combat Obesity

Increasing epidemic proportions of overweight children in the United States presents formidable challenges for education and healthcare. Given the popularity and pervasiveness of video gaming culture in North American children, the perfect opportunity arises to investigate the potential of video games to promote healthful behaviour. Our objective was to systematically review the literature for possible benefits of active and educational video games targeting diet and physical activity in children. A review of English-language journal articles from 1998 to 2011 using EMBASE and PubMed was conducted. Thirty-four studies concerned with children, video games, physical, and/or nutritional outcomes were included. Results of these studies that showed some benefit (increased physical activity and nutritional knowledge as a result of gaming) demonstrate the possibility of video games to combat childhood obesity—looking beyond the stigma attached to gaming.

Anticonvulsant medication use for the management of pain following spinal cord injury: systematic review and effectiveness analysis

Study design:Systematic review and effectiveness analysis.Objectives:Assess the effectiveness of anticonvulsants for the management of post spinal cord injury (SCI) neuropathic pain.Setting:Studies from multiple countries were included.Methods:CINAHL, Cochrane, EMBASE and MEDLINE were searched up to April 2013. Quality assessment was conducted using the Jadad and the Downs and Black tools. Effect sizes and odds ratios were calculated for primary and secondary outcome in the included studies.Results:Gabapentinoids, valproate, lamotrigine, levetiracetam and carbamazepine were examined in the 13 included studies, ten of which are randomized controlled trials. Large effect size (0.873–3.362) for improvement of pain relief was found in 4 of the 6 studies examining the effectiveness of gabapentin. Pregabalin was shown to have a moderate to large effect (0.695–3.805) on improving neuropathic pain post SCI in 3 studies. Valproate and levetiracetam were not effective in improving neuropathic pain post SCI, while lamotrigine was effective in reducing neuropathic pain amongst persons with incomplete lesions and carbamazepine was found effective for relief of moderate to intense pain.Conclusion:Gabapentin and pregabalin are the two anticonvulsants which have been shown to have some benefit in reducing neuropathic pain.

Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis

Objectives:To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI).Methods:Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to November 2014. Trials were included if (i) tDCS intervention group and a placebo control group were present; (ii) at least 50% of participants in the study had an SCI and there were at least three participants; (iii) participants were aged 18 years or older; and (iv) persistent pain for at least 3 months. Studies were excluded if: (i) the tDCS intervention group was compared with an active treatment group; (ii) there was insufficient reporting detail to enable pooling of data; and (iii) it was a nonclinical trial (that is, reviews, epidemiology, basic sciences). A standardized mean difference (SMD)±s.e. and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed or random effects model, as appropriate. Effect sizes were interpreted as: small >0.2, moderate >0.5, large >0.8.Results:Five studies met inclusion criteria of which four were randomized controlled trials and one was a prospective controlled trial. The pooled analysis found a significant effect of tDCS on reducing neuropathic pain after SCI post treatment (SMD=0.510±0.202; 95% CI, 0.114–0.906; P<0.012); however, this effect was not maintained at follow-up (SMD=0.353±0.272; 95% CI, −0.179 to 0.886; P<0.194). A reduction of 1.33 units on a 10-item scale was observed post treatment. No significant adverse events were reported.Conclusion:Meta-analytic results indicate a moderate effect of tDCS in reducing neuropathic pain among individuals with SCI; however, the effect was not maintained at follow-up. A mean pooled decrease of 1.33 units on a 10-item scale was found post treatment. Several factors were implicated in the effectiveness of tDCS in reducing pain. Due to the limited number of studies and lack of follow-up, more evidence is required before treatment recommendations can be made.

Data collection with iPhone Web apps efficiently collecting patient data using mobile devices

The use of mobile and ubiquitous computing devices is advantageous for collecting and sharing patient data at the bedside or in hospital waiting areas. iPhone web applications — or web apps — combine the power of Internet based solutions with the simplicity of multi-touch and gesture technology, all one portable device. Since many data collection platforms have moved to an online paradigm (or are in the process of doing so), a web app is an ideal solution. In this work, we show the advantages of using a web app for patient data collection, as an imaging engine, and for patient feedback and survey systems. This can be achieved by taking advantage of simple functions available on the iPhone OS when using an online collection platform.

Social Media: A Systematic Review to Understand the Evidence and Application in Infodemiology

Social media represents a new frontier in disease surveillance. Infoveillance allows for the real-time retrieval of internet data. Our objective was to systematically review the literature utilizing social media as a source for disease prediction and surveillance. A review of English-language conference proceedings and journal articles from 1999 to 2011 using EMBASE and PubMed was conducted. A total of 12 full-text articles were included. Results of these studies show the use of open-source micro-blogging sites to inform influenza-like-illness monitoring. These results inform recommendations for future research directions.

Evaluation of a Web-Based Patient Portal for Chronic Disease Management

Chronic disease directly affects more than 9 million Canadians. Efficient strategies are needed to cope with the demand on health care services and to increase patient adherence to treatment. Emerging web 2.0 technologies present viable options for patient engagement in health care. We undertook a pilot project to assess the feasibility of two chronic disease management patient portals. A total of 35 patients participated in the assessment. Portals were evaluated for participant expectations, motivations, usability, and recommendations for future iterations. Findings suggest the features of this portal were useful. Important issues to participants include access to their medical record, communication with health care professionals and other participants regarding topics of interest, keeping track of biometrics, and keeping up with the latest clinical studies.

Antidepressants Are Effective in Decreasing Neuropathic Pain After SCI: A Meta-Analysis

OBJECTIVE To systematically review and assess the effectiveness and safety of antidepressants for neuropathic pain among individuals with spinal cord injury (SCI). METHODS A systematic search was conducted using multiple databases for relevant articles published from 1980 to April 2014. Randomized controlled trials (RCTs) involving antidepressant treatment of neuropathic pain with ≥ 3 individuals and ≥ 50% of study population with SCI were included. Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohens d to calculate standardized mean difference, standard error, and 95% confidence interval for primary (pain) and other secondary outcomes was conducted. RESULTS Four RCTs met inclusion criteria. Of these, 2 studies assessed amitriptyline, 1 trazadone, and 1 duloxetine among individuals with neuropathic SCI pain. A small effect was seen in the effectiveness of antidepressants in decreasing pain among individuals with SCI (standardized mean difference = 0.34 ± 0.15; 95% CI, 0.05-0.62; P = .02). A number needed to treat of 3.4 for 30% or more pain relief was found by pooling 2 studies. Of these, significantly higher risk of experiencing constipation (risk ratio [RR] = 1.74; 95% CI, 1.09-2.78; P = .02) and dry mouth (RR = 1.39; 95% CI, 1.04-1.85; P = .02) was found amongst individuals receiving antidepressant treatment compared to those in the control group. CONCLUSIONS The current meta-analysis demonstrates that antidepressants are effective in reducing neuropathic SCI pain. However, this should be interpreted with caution due to the limited number of studies. Further evaluation of long-term therapeutic options may be required.

Analysis of treatment compliance of patients with diabetes

The prevalence of diabetes is increasing worldwide. Despite the advances in evidence based therapies, patients with diabetes continue to encounter ongoing morbidity and diminished health-related quality of life. One of the reasons for the diminished benefit from therapy is medication noncompliance. Considerable evidence shows that a combination of therapeutic lifestyle changes (increased exercise and diet modification) and drug treatment can control and, if detected early enough, even prevent the development of diabetes and its harmful effects on health. However, despite the fact that type-2 diabetes is treatable and reversible with appropriate management, patients frequently do not comply with treatment recommendations. In this paper, we use a combination of Expectation Maximization (EM) clustering and Artificial Neural Network (ANN) modeling to determine factors influencing compliance rates, as measured in terms of medication possession ratio (MPR), among patients prescribed fixed dose combination therapy for type 2 diabetes.

An inclusive, online Delphi process for setting targets for best practice implementation for spinal cord injury

RATIONALE, AIMS, AND OBJECTIVES The Spinal Cord Injury Knowledge Mobilization Network is a pan-Canadian community of practice composed of seven rehabilitation hospitals. The goal of this network is to utilize implementation science processes to facilitate the adoption of best practice in spinal cord injury (SCI) rehabilitation. In addition to selecting specific practices for implementation, a key aspect of effective implementation is the engagement of stakeholders in decision-making processes. To achieve this, the network utilized a Delphi process to reach consensus on two pressure ulcer prevention and management practices to be implemented in SCI inpatient rehabilitation. A diverse, multidisciplinary panel of clinicians, researchers, sponsoring agency representatives, and persons with SCI participated in this process. METHOD An online Delphi process was conducted in order to prioritize pressure ulcer prevention and management best practice recommendations and performance indicators for implementation. The process was conducted in six stages: (1) steering committee selection; (2) identification and selection of evidence; (3) participant selection and recruitment; (4) survey development; (5) identification of voting criteria; and (6) five rounds of voting. RESULTS The Delphi process resulted in the selection of two best practices: (1) comprehensive risk assessment and (2) education for pressure ulcer prevention and management in persons with SCI. CONCLUSIONS In this Delphi process, a large expert panel achieved consensus on best practice recommendations and associated performance indicators for implementation. This process was undertaken as a first step towards optimization of service delivery and outcomes for persons with SCI across Canada.

Advancing research and clinical care in the management of neuropathic pain after spinal cord injury: Key findings from a Canadian summit

ABSTRACT Background: Optimal management of neuropathic pain (NP) is essential to enhancing health-related quality of life for individuals living with spinal cord injury (SCI). A key strategic priority for the Ontario Neurotrauma Foundation (ONF) and Rick Hansen Institute (RHI) is optimizing NP management after SCI. Aims: A National Canadian Summit, sponsored by ONF and RHI, was held to develop a strategic plan to improve NP management after SCI. Methods: In a one-day meeting held in Toronto, Ontario, a multidisciplinary panel of 18 Canadian stakeholders utilized a consensus workshop methodology to (1) describe the current state of the field, (2) create a long-term vision, and (3) identify steps for moving into action. Results: A review of the current state of the field identified strengths including rigourously developed evidence syntheses and practice landscape documentation. Identified gaps included limited evidence on NP hindering recommendation development in evidence syntheses, absence of a national strategy, care silos with limited cross-continuum connections, limited consumer involvement, and limited practice standard implementation. The panel identified key themes for a long-term vision to improve the management of SCI NP in Canada, including establishing an integrated collaborative network; standardized care and outcome evaluation; education; advocacy; and directing resources to innovative solutions. The panel identified the next step as prioritization of areas that will have the greatest impact in a 5-year time frame. Conclusion: A strategic plan outlining a long-term vision to improve management of NP after SCI in Canada was developed and will inform future activities of the sponsors.