Psychosocial Implications of Prenatal Telehealth Genetic Counseling: A Systematic Review

Introduction: Telehealth is a growing service delivery model in clinical genetics and genetic counselling. Despite its popularity, telehealth genetic counseling (TGC) is often not incorporated into prenatal genetic services. Methods: A literature review was conducted to identify peer-reviewed, original research articles, that examined the psychosocial implications of prenatal TGC. The PubMed database was used with the following key terms: “Telehealth Genetic Counseling”, “Prenatal Genetics Telehealth” and “Telegenetics”. Results: The search returned 82 articles; only five articles assessed the psychosocial implications of prenatal TGC. The TGC delivery methods varied among studies, but results consistently revealed positive responses, most notably patient satisfaction. Conclusions: Further use and research of TGC are needed to better understand the social implications of this service delivery model for prenatal populations. This information is essential to guide clinical care for prenatal populations

Psychosocial Implications of Prenatal Telehealth Genetic Counselling: A Systematic Review

Introduction: Telehealth is a growing service delivery model in clinical genetics and genetic counselling. Despite its popularity, telehealth genetic counselling (TGC) is often not incorporated into prenatal genetic services. Methods: A literature review was conducted to identify peer-reviewed, original research articles, which examined the psychosocial implications (e.g. satisfaction) of prenatal TGC. Using the PubMed database, searches were conducted using the following key terms: “Telehealth Genetic Counselling”, “Prenatal Genetics Telehealth” and “Telegenetics”. Results: The search returned 82 articles; only five articles assessed the psychosocial implications of prenatal TGC. The TGC delivery methods varied among studies, but results consistently revealed positive responses, most notably patient satisfaction. Conclusions: Further use and research of TGC are needed to better understand the social implications of this service delivery model for prenatal populations. This information is essential to guide clinical care for prenatal populations

Benthic Microalgal Production at Stellwagen Bank, Massachusetts Bay, USA

Benthic microalgal chlorophyll a and production were measured at 3 sites at Stellwagen Bank, a cold temperate continental shelf habitat in Massachusetts Bay, USA, during August 1991. Benthic microalgal chlorophyll a averaged 39.8 Mg M-2, vs average integrated phytoplankton chlorophyll a of 25.9 mg m-2. Gross benthic microalgal production, measured by oxygen exchange in clear and opaque benthic chambers, averaged 20.9 mg C m-2 h-1. This production was supported by average daily light fluxes to the bottom that never exceeded 1 % of surface incident radiation and were as low as 4.7 μE M-2 s-1. These results indicate that benthic microalgal production can be spatially extensive and quantitatively important in continental shelf ecosystems

Total Body Photography and Sequential Digital Dermoscopy Imaging for Melanoma Surveillance in Patients Starting Natalizumab for Multiple Sclerosis

Introduction: Natalizumab is an integrin receptor antagonist that has been approved by the Food and Drug Administration to treat multiple sclerosis and Crohn’s disease. The drug has been linked to an increased risk of melanoma. This brief report highlights an innovative clinical approach for monitoring the skin of patients prescribed natalizumab. Methods: We include 2 cases from our skin oncology clinic and a literature review on the incidence of melanoma in patients prescribed natalizumab between 2004 and 2019. Results: In addition to our 2 cases, we found 193 reports of patients with melanoma who were prescribed natalizumab. We propose an innovative and proactive approach using total body photography and sequential digital dermoscopy imaging before starting and while treating patients with natalizumab. Discussion: Given the mechanism of action of natalizumab, many of the melanomas diagnosed likely arose from preexisting melanocytic nevi. Using total body photography before starting this high-risk medication and then sequential digital dermoscopy imaging will increase a dermatologist’s ability to recognize new and preexisting skin lesions that have evolved since the patient began taking natalizumab. Conclusions: Using the latest non-invasive technology to detect skin cancer supports systematic and objective monitoring of changing melanocytic growths in patients prescribed natalizumab, resulting in earlier detection of melanoma and greater cure rates

Stages of change in dietetics practice.

Registered dietitian nutritionists (RDNs) have provided nutrition counseling to patients and clients across practice settings for over 60 years. A major component of a RDNs work includes conducting nutrition assessments and providing nutrition interventions. RDNs must assess the “readiness” or stages of change for all patients and clients to provide appropriate interventions. The Transtheoretical Model (TTM), an integrative model of behavior change, uses stages of change to integrate the processes and principles of change across major theories of psychotherapy. At the core of the TTM is the stages of change construct, which suggests individuals change behaviors over time through a series of stages. While assessing stages of change and the provision of a stage-matched intervention in nutrition counseling is important, there is limited research surrounding the stages of change construct in dietetics practice. Thus, the purpose of this project is to first determine the extent to which RDNs are assessing stages of change in dietetics practice and how this assessment is being conducted, and then develop and validate a staging algorithm for healthy eating in the general population. Chapter Three is a descriptive study of nutrition professionals’ knowledge and use of the stages of change construct in dietetics practice. Chapter Four is a criterion validity study for the dietary stages of change algorithm. Results from the descriptive study revealed most nutrition professionals are familiar with the stages of change construct and are assessing stages of change. However, the methods differed, with the majority using open-ended questions during the patient interview. Assessing stages of change is appropriate and feasible in most practice settings, with low utility in acute care settings and pediatric populations. Results of the criterion validity study revealed a non-linear relationship between stages of change and total healthy eating index (HEI) scores. Mean total HEI-2015 scores were highest among those in precontemplation, suggesting the algorithm misclassified some individuals. However, mean total HEI-2015 scores increased linearly from contemplation to maintenance. These findings are promising and warrant further validity testing to refine this tool for clinical practice