Medical Education Column, Creating a High-Yield Guide to Lifestyle Medicine for Medical Students and Healthcare Professionals.

Despite their inclusion as first-line therapy for many chronic diseases, lifestyle interventions are often de-emphasized in medical education and fail to make it into the repertoire of non-lifestyle medicine trained clinicians. We sought to address this gap in medical education by creating a concise pocket guide to lifestyle medicine that lends itself to use in the face-to-face clinical setting. With input from lifestyle medicine experts, the guide was created by medical students for medical students as well as other healthcare professionals for use in a variety of clinical settings. In this article we share our process of creating the guide, initial feedback, and future directions.

The effect of vertical load placement on metabolic rate during loaded walking in humans.

We examined the effects of vertical load placement on the metabolic cost of walking. Twelve healthy participants walked on a treadmill with 13.8 and 23.4 kg loads in both high and low vertical positions. Metabolic rate was measured using respirometry. While load position had no effect on the net metabolic rate for the 13.8 kg load, the net metabolic rate with the 23.4 kg load was significantly reduced by 4.3% in the high vertical load position compared to the low vertical load position. Loads carried higher on the trunk were also associated with increased forward trunk lean that reduced the load gravitational moment arm in the sagittal plane suggesting that reduction of fore-aft upper body torques is an energy-saving mechanism during loaded walking. Practitioner Summary: Load placement within a backpack affects the biomechanics of load carriage. We experimentally tested the metabolic cost of high and low load placement during walking and found the high position to be less costly with large loads. Loading high may be the optimal technique for carrying heavy backpacks.

Incorporation of Patient-Reported Outcomes Measurement Information System to assess quality of life among patients with breast cancer initiating care at an academic center.

BACKGROUND: Symptom burden and reduced quality of life (QOL) are considerable hurdles in oncology. The authors used the Patient-Reported Outcomes Measurement Information System (PROMIS), which assesses physical and psychosocial health, to establish a mean symptom burden, examine potential drivers, and characterize severe symptom burden in breast cancer patient subgroups with the goal of characterizing stage IV patient QOL and triaging patients to individualized supportive care services. METHODS: New patients at the University of California San Francisco Breast Care Center received questionnaires with 8 PROMIS domains: depression, anxiety, fatigue, sleep-related impairment, sleep disturbance, cognitive function, cognitive abilities, and physical function. PROMIS values were scored with the HealthMeasures service and were compared by age, cancer stage, and educational status. RESULTS: Stage IV patients with breast cancer (n = 169) reported higher depression and fatigue and worse cognitive function, cognitive abilities, and physical function than patients with stage 0 to III disease (n = 2577). As age increased, cognitive function impairment, depression, anxiety, and sleep-related symptoms decreased. More educated patients showed better physical function and less severe sleep disturbance and fatigue. Across all subgroups, patients with high anxiety had the greatest probability of worse symptom burden and function in other domains. CONCLUSIONS: This study provides an additional set of PROMIS population estimates across breast cancer demographic groups. The analysis of a large stage IV population reinforces that metastatic patients have impaired QOL across multiple domains. Because anxiety emerged as a potential driver of impaired QOL in other domains, earlier interventions to reduce anxiety could improve QOL overall. These analyses will help to determine appropriate thresholds of intervention. LAY SUMMARY: Patients receiving treatment for breast cancer can experience decreased quality of life. This study characterized differences in self-reported quality of life among patients of different ages, with different stages of cancer, and with different educational backgrounds. This study also examined the effect of decreased quality of life in one area (eg, anxiety) on another area (eg, difficulty in sleeping). Patients who were younger, had not attended college or technical school, or had stage IV cancer tended to have worse quality of life. Patients who had high levels of anxiety also tended to have high levels of impairment in other areas.