Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews

There is considerable evidence that higher levels of screentime is associated with a variety of health harms for children and young people (CYP), with evidence strongest for adiposity, unhealthy diet, depressive symptoms and quality of life. Evidence for impact on other health outcomes is largely weak or absent. We found no consistent evidence of health benefits from screentime. While evidence for a threshold to guide policy on CYP screentime exposure was very limited, there is weak evidence that small amounts of daily screen use is not harmful and may have some benefits.

These data broadly support policy action to limit screen use by CYP because of evidence of health harms across a broad range of domains of physical and mental health. We did not identify a threshold for safe screen use, although we note there was weak evidence for a threshold of 2 hours daily screentime for the associations with depressive symptoms and with HRQOL. We did not identify evidence supporting differential thresholds for younger children or adolescents.

Any potential limits on screentime must be considered in the light of a lack of understanding of the impact of the content or contexts of digital screen use. Given the rapid increase in screen use by CYP internationally over the past decade, particularly for new content areas such as social media, further research is urgently needed to understand the impact of the contexts and content of screen use on CYP health and well-being, particularly in relationship to mobile digital devices.

The full article can be downloaded below.  

Paediatric physical activity and health: Moving towards a measure of quality

‪It is clear that physical activity, holistically, is linked with several positive factors through the life course. There exists a large evidence base for physical activity quantity, yet there has been little integration of physical activity qualities, and whilst quality is a nebulous term, recent developments in literature suggest it may be a viable measure in the characterisation of physical activity. The purpose of the study was to comprehensively review the development towards a measure of physical activity quality. ‪A review of literature was conducted using online databases: Web of Science, PubMed and Google Scholar. A narrative review was subsequently prepared on the topic and development of physical activity quality. ‪Quantitative assessment of movement quality shows promise in the evaluation and measurement of physical activity, particularly in relation to motor development, fundamental movement skills and body mass indices. ‪Whilst measures of movement quality display promise, this is a burgeoning field of research contributing to physical activity literature, and as such, these measures must be refined, developed and investigated further.

The full article can be downloaded below.  

Implementation of Behavioural and Medical Health Management Applications: Reducing High Intensity Medicaid Services Utilization for Individuals with Serious Mental Illness

Provider supporting, dynamic, self-service applications may deliver actionable information to support care management, quality of care, best practices, value based purchasing, and cost control for persons with Serious Mental Illness (SMI). Health analytics as a self-service (AaaS) can be provisioned in a streamlined way in LAN/WAN and cloud environments. These platforms can support Health Level 7, Version 3 (HL7 V3) CDA (Clinical Document Architecture) implementation guides and FHIR (Fast Health Interoperability Resources) for clinical documentation, messaging, and interoperability. Specifically, these can be implemented with Apache Spark® and Hadoop®, Google BigQuery®, Amazon Cloud MapReduce®, Microsoft SQL Server® with Azure®, IBM DB2® with Websphere®, Oracle RMDBS® with Cloud Applications/Platform Services, and many other platforms. Availability, functionality, and usability of such systems are critical for chronic care management for clients with SMI and chronic comorbid medical conditions. An application suite to improve behavioural and medical services was deployed in the community services division of South Beach Psychiatric Center (SBPC), a large state-run facility in New York, USA. As an exemplar of application effectiveness analysis, the association between the use of a Medicaid utilization application and changes in the use of two high intensity Medicaid-paid medical services, inpatient hospitalization and emergency room services, by a balanced panel of 416 patients, over a five-year period, was evaluated.

The full article can be downloaded below.  

What is the real ROI of Physician Compensation Management Technology?

A physician compensation technology platform can have profound impacts on health system operations, physician relationships (including turnover and retention), and even patient experience, delivering return on investment (ROI) in areas that organizations don’t typically consider technology as a means to mitigation. But how does that ROI translate into real returns, including quantifiable cost savings? Can such systems truly pay for themselves?

Answering these questions can pose a serious challenge. There are so many ways to peg ROI, especially when preferred performance indicators can differ by client based on geography, size, and organization type. Furthermore, ROIs are only as good as users successfully leveraging the system.

Yet, physician compensation technology has undeniably profound benefits that are well defined, and it’s straight-forward to translate operational and process improvements into actual dollars.

What is physician compensation software? This technology minimizes the manual processes of administering, measuring, and managing the performance of physician compensation plans. It automates the calculation and adjudication of physician compensation, provides real-time feedback to both administrators and physicians, and dramatically improves information transparency for all stakeholders.

In this paper, we assess the ways that organizations can “cost justify” such an investment in compensation management systems. We look at common challenges that medical groups experience and then detail the potential ROIs that they can reasonably expect from leveraging physician compensation technology.

The full Hallmark Healthcare Solutions paper can be downloaded below.  

  IBM exec on the ins and outs of securing internet of things devices in healthcare

The Internet of Things is a phenomenon with which healthcare CIOs, and just about everybody else, are by now quite familiar. Smartphones can control the lights in homes and manage security systems, for example. In healthcare, implanted medical devices can communicate with providers via the web.

But there's still a big learning curve ahead for IoT, especially with regard to security.

“Since data is the coin of the realm in healthcare, this phenomenon has been embraced by makers of medical equipment and has spurred innovation in a great many cases,” said Matthew Broomhall, CTO  of technology support services for healthcare at IBM. “If you contrast this to information technology as we understand it today, IT has had years to implement programs to protect IT assets and data.”

But while that has matured, the management and protection of the Internet of Medical Things is not yet at the same maturity level, he said. CIOs and CISOs now must accelerate programs to insure their medical devices are protected and therefore the data these devices generate and exchange.

The full Healthcare IT News article can be viewed at this link.  

Medical Marketing in the United States, 1997-2016

Medical marketing increased substantially from 1997 through 2016, especially DTC advertising for prescription drugs and health services. Pharmaceutical marketing to health professionals accounted for most spending and remains high even with new policies to limit industry influence. Despite the increase in marketing over 20 years, regulatory oversight remains limited.

The full article can be downloaded below.  

Cancer Statistics, 2019

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through  2015,  were  collected  by  the  Surveillance,  Epidemiology,  and  End  Results  Program;  the  National Program  of  Cancer  Registries;  and  the  North  American  Association  of  Central  Cancer  Registries.  Mortality  data,  available  through  2016,  were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer  cases  and  606,880  cancer  deaths  are  projected  to  occur  in  the  United  States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the  most  affluent  counties,  mortality  rates  in  the poorest  counties  were  2-fold  higher  for  cervical  cancer  and  40%  higher  for  male  lung  and  liver  cancers  during  2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting  the  opportunity  for  more  equitable  dissemination  of  effective  cancer  prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly  accelerate  progress  against  cancer. ​

The full article can be downloaded below.  

GE Healthcare, Vanderbilt University Medical Center Partner for Safer, More Precise Immunotherapy Cancer Treatment

GE Healthcare and Vanderbilt University Medical Center (VUMC) today announced a five-year partnership to enable safer and more precise cancer immunotherapies. Multiple diagnostic tools will be developed to help predict both the efficacy of an immunotherapy treatment and its adverse effects for a specific patient before the therapy is administered. This would allow physicians to better target immunotherapies to the right patients and avoid potentially damaging, ineffective and costly courses of treatments.

Immunotherapies use the immune system to recognize and attack cancer cells and can be more effective than traditional treatments, but response rates are often low and side effects can be severe. GE Healthcare and VUMC will retrospectively analyze and correlate the immunotherapy treatment response of thousands of VUMC cancer patients, with their anonymized demographic, genomic, tumor, cellular, proteomic and imaging data. They will then develop AI-powered apps that draw on this data to help physicians identify the most suitable treatment for each individual patient.

Simultaneously, GE Healthcare and VUMC will develop new positron-emission tomography (PET) imaging tracers, which together with the apps, will help physicians to stratify cancer patients for clinical trials. It currently takes an average of 12 years and costs almost $2bn to bring a drug to market. In many cases, inappropriate patients are recruited to participate in immunotherapy trials, incurring unnecessary expense and slowing down approvals of new therapies. It is hoped that the PET tracers will ultimately also be used to monitor the efficacy of immunotherapies in everyday practice.

The full press release can be viewed at this link from Business Wire.  

Laws Requiring the E-Prescribing of Opioids Have Gained Momentum, but Prescriber Adoption is Playing Catch Up

The SUPPORT for Patients and Communities Act, which Congress passed and President Trump signed into law in October, mandates the use of electronic prescribing of controlled substances (EPCS) for all controlled substances under Medicare Part D by January 1, 2021.

EPCS is a critical tool in the nation's response to the epidemic. It eliminates paper prescriptions, which can be stolen, forged or altered, and gives prescribers electronic access to a patient’s prescription history to help identify potential overuse or abuse. In addition, there are other benefits, including enhanced security, privacy and prescribing flexibility, as well as improved workflow efficiency for prescribers and pharmacists alike.

Policymakers clearly see the need to leverage EPCS in the fight against opioid abuse, as the continued acceleration of EPCS legislation at the state level demonstrates. In 2018, eight more states passed mandates--Arizona, California, Iowa, Massachusetts, New Jersey, Oklahoma, Pennsylvania and Tennessee—bringing the total number of states with EPCS mandates to 15. Of that total, the mandates in Arizona, New Jersey and Pennsylvania become effective in 2019—with Arizona’s beginning the very first day of the new year. Michigan and Illinois have now introduced EPCS bills, and industry experts expect nearly twenty more states to pursue similar legislation in 2019.

The full Surescripts article can be found at this link.  

Data Scientist Explains How AI's Seductive Power Can Mislead Biomarker Researchers

Today, I am writing about where the rubber squarely meets the road in AI and drug development: the use of algorithms to mine big data for informative patterns. In particular, I share what I believe is an extremely important, fairly critical, ultimately constructive perspective on the challenge of developing valid diagnostic biomarkers, presented by one of the most thoughtful data scientists I know, Imran Haque. 

The full Forbes article can be viewed at this link.