Sarah Morton-Oswald

Background: Deprescribing, a proactive systematic approach to reducing or stopping medications, may lower adverse outcomes in older adults receiving dialysis. We evaluated the feasibility of an intervention to deprescribe potentially inappropriate medications, defined as medications whose risks often outweigh the benefits in older adults. Methods: In this non-randomized feasibility study in Durham, NC, study personnel reviewed charts to identify potentially eligible patients (age ≥55, active potentially inappropriate medication prescription, and appropriate for deprescribing) and generated deprescribing recommendations. Clinicians at participating dialysis clinics received recommendations for each patient. When clinicians agreed, they or study staff engaged patients in shared decision-making. For deprescribing attempts, the study provided taper plans, guidance on alternatives, and adverse drug withdrawal event monitoring. Feasibility outcomes included demand, limited efficacy, acceptability, and practicality. To assess patient acceptability, eligible patients were invited to participate in semi-structured interviews. Results: Among 632 charts reviewed, 85 patients were potentially eligible for deprescribing. After confirming eligibility and obtaining clinician agreement, 41 of the 85 patients were approached about deprescribing; 17 (41%) agreed to attempt deprescribing. Gabapentin was the most commonly deprescribed medication (n=15; 88%). Among those who attempted deprescribing, 7 (41%) experienced symptom recurrence, but none required unplanned healthcare use. Clinician responses were mixed: five of seven reported the intervention met their approval or seemed doable, but only two reported it fit within their usual workflow. Qualitative interviews highlighted that patients generally viewed the deprescribing discussions favorably but desired clearer explanations of the deprescribing rationale. Conclusions: This feasibility study demonstrates that deprescribing potentially inappropriate medications in older adults receiving hemodialysis is achievable, with good patient engagement, and no significant adverse drug withdrawal events. Clinician support was variable, with workflow integration as a key barrier. Improved workflow integration and strengthened shared decision-making processes are needed to support implementation in a future clinical trial.

Background: Long-term adherence to weight loss behaviors is challenging, as most individuals who achieve significant weight loss regain 1-2 kg per year. Financial incentives can reinforce weight-loss initiation and maintenance behaviors, but optimal strategies remain unclear. Objective: This paper describes the design, technical architecture, and operational workflow of Log2Lose, a 5-year, multisite randomized controlled trial testing different financial incentive strategies to promote weight loss and maintenance. We detail the platform’s integration with external devices, automated data collection, and adaptations to maintain intervention fidelity in the context of evolving technology and regulatory requirements. Methods: The Log2Lose platform collects daily weight and dietary data from cellular scales and fitness tracking applications, calculates weekly incentive eligibility, and sends automated feedback and motivational text messages. We summarize the technical adaptations, message delivery performance, data completeness, and the balance between automation and manual support required to ensure data integrity. Results: By the end of the study, 706 participants recorded 181,285 weights and 114,144 daily calorie entries. The platform sent 126,283 text messages and calculated 35,187 incentive payments, with 99.4% (34,976/35,187) processed automatically. Adaptations addressed device integration changes, application programming interface discontinuations, and new text messaging regulations. Despite automation, ongoing technical support was essential for resolving delivery errors, device issues, and data anomalies. Conclusions: Log2Lose demonstrated that large-scale, fully remote weight loss interventions can be implemented using consumer technology paired with a robust, adaptable platform. Success depended on flexible software design, continuous monitoring, and responsive technical support to navigate regulatory and technological changes. Log2Lose offers a practical model for processing remotely collected longitudinal dietary and weight data, providing valuable guidance for researchers, health care providers, and employers developing similar digital health interventions. Trial Registration: ClinicalTrials.gov NCT04770909; https://clinicaltrials.gov/study/NCT04770909

BACKGROUND Long-term adherence to weight loss behaviors is challenging, as most individuals who achieve significant weight loss regain 1-2 kg per year. Financial incentives can reinforce weight-loss initiation and maintenance behaviors, but optimal strategies remain unclear. OBJECTIVE This paper describes the design, technical architecture, and operational workflow of Log2Lose, a 5-year, multisite randomized controlled trial testing different financial incentive strategies to promote weight loss and maintenance. We detail the platform’s integration with external devices, automated data collection, and adaptations to maintain intervention fidelity in the context of evolving technology and regulatory requirements. METHODS The Log2Lose platform collects daily weight and dietary data from cellular scales and fitness tracking applications, calculates weekly incentive eligibility, and sends automated feedback and motivational text messages. We summarize the technical adaptations, message delivery performance, data completeness, and the balance between automation and manual support required to ensure data integrity. RESULTS By the end of the study, 706 participants recorded 181,285 weights and 114,144 daily calorie entries. The platform sent 126,283 text messages and calculated 35,187 incentive payments, with 99.4% (34,976/35,187) processed automatically. Adaptations addressed device integration changes, application programming interface discontinuations, and new text messaging regulations. Despite automation, ongoing technical support was essential for resolving delivery errors, device issues, and data anomalies. CONCLUSIONS Log2Lose demonstrated that large-scale, fully remote weight loss interventions can be implemented using consumer technology paired with a robust, adaptable platform. Success depended on flexible software design, continuous monitoring, and responsive technical support to navigate regulatory and technological changes. Log2Lose offers a practical model for processing remotely collected longitudinal dietary and weight data, providing valuable guidance for researchers, health care providers, and employers developing similar digital health interventions. CLINICALTRIAL ClinicalTrials.gov NCT04770909; https://clinicaltrials.gov/study/NCT04770909