Abundant disparities for women in medicine contribute to many women physicians considering leaving medicine. There is a strong financial and ethical case for leaders in academic medicine to focus on strategies to improve retention. This article focuses on five immediate actions that leaders can take to enhance gender equity and improve career satisfaction for all members of the workplace.
BACKGROUND Participating in physical activity and minimizing time spent sitting is an effective strategy for managing pain in older adults. Theory-based mHealth tools are integral to effective day-long physical activity interventions, but it is vital that mHealth tools undergo an iterative development process alongside members of the target population to ensure their uptake and use. OBJECTIVE We subjected a preliminary social cognitive smartphone application (Companion App) designed to promote day-long movement to a user centered design process with the assistance of low-active older adults with chronic multisite pain. The Companion App integrates ecological momentary assessments of pain, Fitbit activity monitor data, and smart weight scale data to provide real-time feedback on the relationships between movement, sitting, and pain and to facilitate goal setting and achievement. METHODS We recruited participants (N=5; 71.8 5.54 years old) sequentially to participate in a three-phase iterative design study. First, each participant received a brief orientation to physical activity, was exposed to the application, and engaged in a Think Aloud protocol. Use and usability issues were noted by study staff. The participant then used the app for one week in their daily lives, and then returned to provide feedback. Issues were identified from participant feedback, discussed with the study team, and modified before the next participant began the study. RESULTS Participant interviews yielded feedback in areas related to technology selection and operation, app design/form, and intervention clarity. Regarding technology, the use of the Fitbit activity monitor revealed no issues, but there were barriers to the use of the Fitbit Aria 2 scale, including incompatibility with a widely used home internet router. Switching to a cellular enabled scale alleviated this issue. With regard to form, modifications were made to several key interface elements in response to participant feedback to aid in clarity. Finally, initial participant experiences revealed the need to separate the intervention orientation from the technology orientation to minimize informational load. CONCLUSIONS Our brief user-centered design process produced key changes in our intervention orientation, the form and function of the Companion App, and the technologies that support the app. These are vital elements that are likely to hamper the perceived usefulness and utility of the Companion App in the context of a large trial and eventual public use. We recommend the conduct of such a process any time mHealth is used in research or medicine to account for changing populations and preferences. Moreover, publication of lessons learned can help to establish a foundation of knowledge for designing apps for underserved populations such as older adults. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT03377634
UNSTRUCTURED Abundant disparities for women in medicine contribute to many women physicians considering leaving medicine. There is a strong financial and ethical case for leaders in academic medicine to focus on strategies to improve retention. This article focuses on five immediate actions that leaders can take to enhance gender equity and improve career satisfaction for all members of the workplace.
The lack of empirical evidence documenting the pain experience of Black men may be the result of social messaging that men are to project strength and avoid any expression of emotion or vulnerability. This avoidant behavior however, often comes too late when illnesses/symptoms are more aggressive and/or diagnosed at a later stage. This highlights two key issues - the willingness to acknowledge pain and wanting to seek medical attention when experiencing pain.To better understand the pain experience in diverse raced and gendered groups, this secondary data analysis aimed to determine the influence identified physical, psychosocial, and behavioral health indicators have in reporting pain among Black men. Data were taken from a baseline sample of 321 Black men, >40 years old, who participated in the randomized, controlled Active & Healthy Brotherhood (AHB) project. Statistical models were calculated to determine which indicators (somatization, depression, anxiety, demographics, medical illnesses) were associated with pain reports.Results showed that 22% of the men reported pain for more than 30 days, with more than half of the sample being married (54%), employed (53%), and earning an income above the federal poverty level (76%). Multivariate analyses showed that those reporting pain were more likely to be unemployed, earn less income, and reported more medical conditions and somatization tendencies (OR=3.28, 95% CI (1.33, 8.06) compared to those who did not report pain.Findings from this study indicate that efforts are needed to identify the unique pain experiences of Black men, while recognizing its impact on their identities as a man, a person of color, and someone living with pain. This allows for more comprehensive assessments, treatment plans, and prevention approaches that may have beneficial impacts throughout the life course.
Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain.The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools.Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale.Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019.The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions.DERR1-10.2196/14525.
The COVID-19 pandemic altered how residency interviews occur. Despite 2 years of web-based interviews, these are still perceived as inferior to in-person experiences. Showcasing a program and location is critical for recruitment; however, it is difficult to highlight the program's location and community digitally. This article presents the authors' viewpoints on designing and implementing a virtual second look for residency applicants.Our objective was to host a web-based event to feature the benefits of living in Winston-Salem, North Carolina, for residency applicants, enhance recruitment efforts, and ensure a successful residency match. The goal was to cover topics that interested all applicants, highlight how Winston-Salem is a special place to live, involve current residents, and engage community members.Three programs-child neurology, neurology, and family medicine were chosen for a pilot virtual second look. All residency program directors' were asked to recommend community contacts and help identify residents and faculty who may serve as content experts on one of the topics in the panel discussions. A total of 24 community leaders from restaurants, venues, schools, and businesses were contacted, and 18 agreed to participate. The panel discussions included living in and raising a family in Winston-Salem, experiencing Winston-Salem arts and music, where to eat and drink like a local, and enjoying sports and outdoors in the area. The 2-hour event was hosted on Zoom. Postevent feedback assessments were automatically sent to each registrant through Research Electronic Data Capture (REDCap). This study was deemed exempt from Wake Forest University Health Sciences institutional review board review (IRB00088703).There were 51 registrants for the event, and 28 of 48 registrants provided postevent feedback, which was positive. The authors found in the MATCH residency results that 2 of 2 child neurology positions, 4 of 6 adult neurology positions, and 1 of 10 family medicine positions attended our second look event. One adult neurology resident who did not participate was an internal candidate. All respondents agreed or strongly agreed that the session was valuable, well organized, and met their expectations or goals. Furthermore, all respondents gained new information during this web-based event not obtained during their interview day.The virtual second look event for residency attendees featured the benefits of living in Winston-Salem, and the perspectives of current residents. Feedback from the session was overall positive; however, a top desire would be devoting more time for the applicants to ask questions directly to the community leaders and our resident trainees. This program could be reproducible by other institutions. It could be broadened to a graduate medical education-wide virtual second look event where all medical and surgical programs could opt to participate, facilitating an equitable opportunity for prospective applicants.
BACKGROUND Commercial wearable devices, which are often capable of estimating heart rate via photoplethysmography (PPG), are increasingly used in health promotion. In recent years, researchers have investigated whether the accuracy of PPG-measured heart rate varies based on skin pigmentation, focusing particularly on accuracy of such devices among users with darker skin tones. As such, manufacturers of wearable devices have implemented strategies to improve accuracy. Given the ever-changing nature of the wearable device industry and the important health implications of providing accurate heart rate estimates for all individuals no matter their skin color, it is imperative that studies exploring the impact of pigmentation on PPG accuracy are regularly replicated. OBJECTIVE We aimed to contrast heart rate readings collected via PPG using the Garmin Forerunner 45 in comparison with an ECG during various levels of physical activity across a diverse group of participants representing a range of skin tones. METHODS Heart rate data were collected from adult participants (18-64 years of age) at a single study session using the Garmin Forerunner 45 PPG-equipped smartwatch and the Polar H10 ECG chest strap. Skin tone was self-reported via the Fitzpatrick scale. Each participant completed two 10-minute bouts of moderate intensity walking or jogging separated by a 10-minute bout of light walking. RESULTS A series of mixed ANOVAs indicated no significant interaction between Fitzpatrick score and phase of the activity bout (i.e., rest at start, first intensity ramp-up phase, first steady-state phase, active rest, second ramp-up phase, second steady-state phase). Likewise, there was no significant main effect for Fitzpatrick score, though there was a significant main effect for phase, which was driven by greater ECG-recorded heart rate relative to PPG during the first ramp-up phase. CONCLUSIONS Our findings support prior research demonstrating no significant impact of skin tone on PPG-measured heart rate, with significant differences between PPG- and ECG-measured heart rate emerging during dynamic changes in activity intensity. As commercial heart rate monitoring technology and software continue to evolve, it will be vital to revisit the impact of skin tone and other individual-level factors on sensor accuracy, especially as new and more robust measures of skin tone are made accessible.
One's amount, intensity, and distribution of physical activity may have implications for whether it has positive or negative effects on pain and quality of life for older adults living with chronic pain. Thus, we investigated baseline patterns of stepping related to pain symptoms and health-related quality of life at baseline and over a 12-week follow-up period.
