Pilot Study of a Mobile Phone Chatbot for Medication Adherence and Toxicity Management Among Patients With GI Cancers on Capecitabine.

PURPOSE: Capecitabine is an oral chemotherapy used to treat many gastrointestinal cancers. Its complex dosing and narrow therapeutic index make medication adherence and toxicity management crucial for quality care. METHODS: We conducted a pilot study of PENNY-GI, a mobile phone text messaging-based chatbot that leverages algorithmic surveys and natural language processing to promote medication adherence and toxicity management among patients with gastrointestinal cancers on capecitabine. Eligibility initially included all capecitabine-containing regimens but was subsequently restricted to capecitabine monotherapy because of challenges in integrating PENNY-GI with radiation and intravenous chemotherapy schedules. We used design thinking principles and real-time data on safety, accuracy, and usefulness to make iterative refinements to PENNY-GI with the goal of minimizing the proportion of text messaging exchanges with incorrect medication or symptom management recommendations. All patients were invited to participate in structured exit interviews to provide feedback on PENNY-GI. RESULTS: We enrolled 40 patients (median age 64.5 years, 52.5% male, 62.5% White, 55.0% with colorectal cancer, 50.0% on capecitabine monotherapy). We identified 284 of 3,895 (7.3%) medication-related and 13 of 527 (2.5%) symptom-related text messaging exchanges with incorrect recommendations. In exit interviews with 24 patients, participants reported finding the medication reminders reliable and user-friendly, but the symptom management tool was too simplistic to be helpful. CONCLUSION: Although PENNY-GI provided accurate recommendations in >90% of text messaging exchanges, we identified multiple limitations with respect to the intervention's generalizability, usefulness, and scalability. Lessons from this pilot study should inform future efforts to develop and implement digital health interventions in oncology.

A Culinary Medicine Elective for Clinically Experienced Medical Students: A Pilot Study.

Purpose: Culinary medicine, a combination of nutrition science and the culinary arts, is an emerging approach for teaching nutrition to medical students and improving their competence in counseling patients with diet-associated diseases. Data are, however, lacking on the impact of culinary medicine courses directed at clinically experienced students. This study reports initial outcomes of a pilot nutrition and culinary medicine course targeting 4th-year medical students. Methods: An elective course on culinary medicine was offered to 4th-year medical students at the Perelman School of Medicine, comprising seven disease-focused sessions, with a final capstone session. Students read primary literature for each session. Individual sessions consisted of culinary literacy, cooking, and a case discussion led by physicians and registered dietitians. In addition, students participated in a nutrition education initiative in a local high school. Students completed pre-and postcourse surveys that evaluated perceived nutrition knowledge and counseling skills and personal dietary choices, and included free-text options for qualitative comments. Results: Thirty-one 4th-year medical students participated in three offerings of the course in 2018 and 2019. There was strong student enthusiasm for the course as (1) all the available slots for each course offering were filled within 2 h of an e-mail announcement to the students; (2) student attendance was consistently very high; and (3) student feedback about the course was uniformly positive. Students reported significant increases in their confidence regarding (1) knowledge of pertinent nutrition information; (2) discussing nutrition with patients; and (3) ability to impact patient behavior through counseling (p < 0.001). Qualitative comments suggested that students were contemplating or implementing changes in their dietary habits and food choices. Conclusion: A culinary medicine course for clinically experienced medical students may improve perceived nutrition knowledge and increases confidence in counseling patients with diet-associated diseases.

A Randomized Trial to Encourage Healthy Eating Through Workplace Delivery of Fresh Food.

PURPOSE: This study aimed to increase the consumption of home-cooked meals among employees at a large urban worksite through a fully subsidized Community Supported Agriculture (CSA) program. DESIGN: Randomized trial. SETTING: Worksite in a large northeast city. PARTICIPANTS: Employees were recruited through flyers, e-mail listservs, and outreach from departmental administrators (n = 60). INTERVENTION: Intervention participants received 8 biweekly fresh food deliveries through a CSA program. They also received cooking education and support. Control participants received usual employee benefits. MEASURES: Consumption of meals prepared at home was the primary end point. Increased consumption of fresh fruits and vegetables was the secondary end point, and food insecurity was an exploratory end point. ANALYSIS: Poisson regression was used to assess mean differences in weekly consumption of home-cooked meals. To assess differences in fruit and vegetable consumption and food insecurity, binary logistic regression was used to estimate odds ratios. RESULTS: Compared to the control group, intervention participants consumed 29% more home-cooked meals per week (P < .01). Fruit and vegetable consumption also increased among intervention participants. The odds of at least twice-daily fruit consumption were 3.8 times higher among intervention participants than among controls, and the odds of at least twice-daily vegetable consumption were 6.2 times higher among intervention participants than among controls. Compared to control participants, intervention participants experienced a statistically significant 89% reduction in the odds of reporting food insecurity at follow-up, when controlling for baseline food insecurity. Participants reported perceived intervention benefits, including the opportunity to experiment with new, healthful foods without financial risk, as well as the social value of sharing recipes, food, and related conversation with colleagues. CONCLUSION: The study demonstrated the feasibility and potential positive effects of a subsidized workplace CSA program, augmented with cooking education and support.

Curing-light intensity and depth of cure of resin-based composites tested according to international standards.

BACKGROUND: Several factors control the light curing of a resin-based composite: the composition of the composite, the shade of the composite, the wavelength and bandwidth of the curing light, the distance of the light from the composite, the intensity of the curing light and the irradiation time. The authors investigated the depth of cure of several shades of five brands of resin-based composites when irradiated via light in the 400- to 515-nanometer wavelength bandwidth at the International Organization for Standardization, or ISO, recommended intensity of 300 milliwatts per square centimeter. The resin-based composites were irradiated for the times recommended by the products' manufacturers. METHODS: The authors used a curing light adjusted to emit 300 mW/cm2 in the 400-nm to 515-nm wavelength bandwidth to polymerize five samples of each composite brand type and shade. They measured depth of cure using a scraping method described in the ISO standard for resin-based composites. Depth of cure was defined as 50 percent of the length of the composite specimen after uncured material was removed by manual scraping. The authors determined a mean from the five samples of each composite brand and shade. RESULTS: Thirteen (62 percent) of 21 composite materials met the ISO standard depth-of-cure requirement of 1.5 millimeters. Six of the eight remaining materials met the depth-of-cure requirement when the authors doubled the irradiation time recommended by the product manufacturers. CONCLUSIONS AND CLINICAL IMPLICATIONS: Curing lights with an intensity of 300 mW/cm2 appear to effectively cure most resin-based composite materials when appropriate curing times are used, which, in some cases, are longer than those recommended by the manufacturers. Dentists should verify the depth of cure of a composite material as a baseline measure, and then check depth of cure periodically to confirm light and material performance. The ISO depth-of-cure measurement method can be used for this purpose.