Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.
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Background: A paradigm shift in health care from illness to wellbeing requires new assessment technologies and intervention strategies. Self-monitoring tools based on the Experience Sampling Method (ESM) might provide a solution. They enable patients to monitor both vulnerability and resilience in daily life. Although ESM solutions are extensively used in research, a translation from science into daily clinical practice is needed. Objective: To investigate the redesign process of an existing platform for ESM data collection for detailed functional analysis and disease management used by psychological assistants to the general practitioner (PAGPs) in family medicine. Methods: The experience-sampling platform was reconceptualized according to the design thinking framework in three phases. PAGPs were closely involved in co-creation sessions. In the ‘understand’ phase, knowledge about end-users’ characteristics and current eHealth use was collected (nominal group technique – 2 sessions with N = 15). In the ‘explore’ phase, the key needs concerning the platform content and functionalities were evaluated and prioritized (empathy mapping – 1 session with N = 5, moderated user testing – 1 session with N = 4). In the ‘materialize’ phase, the adjusted version of the platform was tested in daily clinical practice (4 months with N = 4). The whole process was extensively logged, analyzed using content analysis, and discussed with an interprofessional project group. Results: In the ‘understand’ phase, PAGPs emphasized the variability in symptoms reported by patients. Therefore, moment-to-moment assessment of mood and behavior in a daily life context could be valuable. In the ‘explore’ phase, (motivational) functionalities, technological performance and instructions turned out to be important user requirements and could be improved. In the ‘materialize’ phase, PAGPs encountered barriers to implement the experience-sampling platform. They were insufficiently facilitated by the regional primary care group and general practitioners. Conclusion: The redesign process in co-creation yielded meaningful insights into the needs, desires and daily routines in family medicine. Severe barriers were encountered related to the use and uptake of the experience-sampling platform in settings where health care professionals lack the time, knowledge and skills. Future research should focus on the applicability of this platform in family medicine and incorporate patient experiences.
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Physical inactivity has led to an increase in the prevalence of lifestyle-related chronic diseases on a global scale. There is a need for more awareness surrounding the preventive and curative role of a physically active lifestyle in healthcare. The prescription of physical activity in clinical care has been advocated worldwide through the ‘exercise is medicine’ (E=M) paradigm. However, E=M currently has no position in general routine hospital care, which is hypothesized to be due to attitudinal and practical barriers to implementation. This study aims to create an E=M tool to reduce practical barriers to enforcing E=M in hospital care. Firstly, this project will perform qualitative research to study the current implementation status of E=M in clinical care as well as its facilitators and barriers to implementation among clinicians and hospital managers. Secondly, an E=M tool towards application of active lifestyle interventions will be developed, based on a prediction model of individual determinants of physical activity behavior and local big data, which will result in a tailored advice for patients on motivation and physical activity. Thirdly, the feasibility of implementing the E=M-tool, as designed within this project, will be investigated with a process evaluation, conducting a pilot-study which will integrate the tool in routine care in at least four clinical departments in two Dutch hospitals. This project will give insight in the current implementation status of E=M and in factors that influence the actual E=M implementation. Secondly, an E=M tool will be designed providing a tailored E=M prescription for patients as part of clinical care. Thirdly, an implementation strategy will be developed for implementation of the E=M tool in clinical practice. This project envisages an extensive continuation of research on the implementation of E=M, supports the mutual decision making process of lifestyle referral of clinicians and will provide insights which can be used to assist in implementing physically active lifestyle prescription in the medical curriculum.
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The continuous monitoring of health indicators in biofluids such as sweat, saliva, blood, and urine has great potential for preventive medicine. Techniques that continuously monitor biomarkers still remain a major technological challenge. Recently, a concept of dynamic biosensing was published that is based on mediator particles. Such mediator particles exhibit rapid switching between a bound and unbound state during interaction with a probing structure to which they are connected through a molecular tether (like a balloon on a string). Although the concept of using mediator particles for dynamics biosensing is very promising, the used detection method is not a viable solution as it is not miniaturizable. We propose to use a photonic ring resonator (RR) or Mach-Zender interferometer (MZI) as the probing structure in combination with a highly miniaturizable readout scheme. In this project, we perform preliminary experiments to prove that this photonic approach can be used for the detection of the mediator particles tethered to the photonic waveguide. To bridge the gap with the practical application by health professionals, we will enrich the envisioned solution through OnePlanet's OpenEd program. OpenEd aims to share technology and innovations (e.g. prototypes) with educational institutes (MBO, HBO) that want to further innovate their courses or work methods, such that current and future professionals are well prepared to work with new (digital) technologies. By presenting our use-case as a 'challenge' to teachers, students and practitioners, OpenEd also allows enriching the use-case by involving (future) health professionals that can provide feedback on - or further investigation of - the practical application of our new technology from the health professional's perspective.
