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Telehealth might be best as a supplement to office visits, not a replacement

The findings suggest that while patients 70 and older may well be capable of navigating the technical aspects of virtual doctor visits and are interested in communicating online with health-care professionals, their opinions on the effectiveness of the care they receive varied widely.



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With the pandemic, there has been a rise in the use of virtual appointments for patients seeking health care. A new study by Tufts researchers, however, suggests that for many older and chronically ill patients, telehealth appointments may be most effective when they augment in-person health-care visits rather than fully replace them.

The findings suggest that while patients 70 and older may well be capable of navigating the technical aspects of virtual doctor visits and are interested in communicating online with health-care professionals, their opinions on the effectiveness of the care they receive varied widely.

The study, which focused on older patients with serious and chronic kidney disease, found that not all patients were satisfied with telehealth. People of color, including patients who identified as Black, Native American, or Hispanic, or required additional accessibility features such as interpreters, were largely dissatisfied with telehealth.

Patients of color disproportionately suffer from chronic kidney disease and may more often contend with challenges associated with at-home care, such as inadequate space for home-dialysis and limited broadband access to support video-telehealth visits, said Keren Ladin, associate professor of occupational therapy and community health, who led the study.

Owing to historical and experienced discrimination, “we found that patients of color were less comfortable with telehealth and had more concerns about the quality of the care and being deprived of care in a telehealth setting than white patients did,” said Ladin.

Ladin said she was surprised by these findings, given that the study, which was recently published in JAMA Network Open, was conducted during the height of the COVID-19 pandemic.

“I thought people of color who were at higher risk would prefer to stay out of the health system for longer, but that was not what we found,” she said. Black patients also reported that telehealth appointments prevented them from connecting meaningfully with their doctors, contributing to feelings of mistrust.

“It was really striking,” said Ladin. “One woman told us, ‘I need to see the physician’s eyes to know that they were understanding me,’ underscoring that the persistent impacts of structural racism on health-care experiences of patients of color.”

The patients did appreciate that telehealth facilitated the ability of care partners such as family members to join them for appointments, something that has been limited during the pandemic. Beyond the comfort of accompanying patients, care partner participation can help improve treatment and adherence and patient education for older patients managing complex, chronic illnesses such as kidney disease, Ladin said.

Downsides from the Clinical Perspective

For clinicians, the low regard for telehealth appointments was more pronounced. A majority of the physicians interviewed remotely from Boston, Chicago, Portland (Maine), and San Diego equated telehealth with lower-quality care.

They could not, for example, conduct physical examinations and lab tests virtually, nor could they naturally build and maintain a personal rapport with chronic-disease patients. Patients, too, were worried about this.

“We heard loud and clear from clinicians that they felt that the human aspects of their job that they love so much—the communication with patients and those relationships—were fraught and damaged by this flat interaction style,” Ladin said. She conceded that although clinicians were generally dissatisfied with telehealth in its current form, most agreed that it did provide critical insight into a patient’s home, which was previously unavailable.

“Up until now, the patient’s home environment was really a black box,” Ladin said, “Whatever the patient said when they came into the office was accepted as truth.” During video visits, however, doctors are able to see patient’s homes, the exact medications they are taking, and interact directly with care partners. “That was a positive feature of these types of visits—more holistic care.”

To address the range of obstacles perceived by both patients and clinicians in the study, the researchers recommend doctors share detailed post-visit summaries with patients and care partners, leave time during virtual visits for patients to absorb difficult news, and inquire specifically after patients’ emotions in the absence of nonverbal cues. Structural inequalities require a longer-term but equally important investment beyond simple communication strategies.

“I wish I could say we are doing it perfectly in person, and that telehealth is the only challenge we’re facing,” said Ladin. “We’re not. We need to work on this both in person and for telehealth.”

She stressed the importance of increasing the availability of interpreters during virtual visits and a more diverse workforce throughout the medical training pipeline, including nurses and physician assistants.

“The type of community-building and relationship repair that need to happen in health care will go a long way in improving this aspect,” said Ladin. “Diversifying the health-care workforce is crucial.”

Many telehealth services will stay covered by Medicare through 2023, under current law. After that, the future of remote health care for older Americans remains uncertain. Much of it will depend on whether perceptions among these patients, and in particular those with chronic illness, are positive. For Ladin, the benefits are as clear as the drawbacks.

“At its best, maybe we are getting back to a more patient-centered approach,” she said. “But I would be cautious to use it as a replacement device. For older, complex patients, we want to strive for a balance between seeing somebody in person in the clinic most times and then occasionally seeing them onscreen.”

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McDonald’s Philippines poised for growth after strong 2022 finish

From its first store opening in Morayta, Manila in 1981, McDonald’s Philippines continues to uphold global food safety and quality standards in the preparation and service of its food whether through dine-in, take-out, Drive-Thru, or McDelivery.



McDonald’s Philippines achieved record-breaking sales in 2022, surpassing its pre-pandemic (2019) sales performance. 

Owned and operated by its Chairman and Owner Dr. George T. Yang and President and CEO Kenneth Yang— the quick service restaurant (QSR) giant attributes its performance not just to strong consumer mobility and post-pandemic behavior but to its continuous commitment to providing value for money, exciting limited-time menu offers, and an elevated omnichannel customer experience. 

“McDonald’s Philippines’ strong performance in 2022 wouldn’t have been possible if not for the trust and continuous support of our customers all over the country. As we aim to consistently improve how we serve McDonald’s favorites to every Filipino, we are equally committed to providing feel-good experiences to our people [crew and managers] who make it all happen in our stores, and in communities where we operate for many years to come,” said Kenneth Yang, President and CEO of McDonald’s Philippines. 

Feeling good, feeling safe

From its first store opening in Morayta, Manila in 1981, McDonald’s Philippines continues to uphold global food safety and quality standards in the preparation and service of its food whether through dine-in, take-out, Drive-Thru, or McDelivery.  

This was further strengthened during the pandemic as part of its M Safe program, introduced in 2020.  

The company doubledowned on food safety and quality efforts through continuous monitoring, and crew and manager training, which contributed to its thirdparty food safety audit results and customer perception scores on safety and trust.

Since the launch of M Safe, the company’s findings on ‘brand trust’ increased by 5.4% which contributed to increased dine-in guest count, lifting market share for McDonald’s in 2022.

Setting the standard for doing good 

McDonald’s takes pride in its global learning and development programs from Crew Training to Restaurant Leadership courses to its Digital Academy. As one of the biggest employers in the country, McDonald’s Philippines believes that everyone has the opportunity to grow and succeed in the company which starts by first having job security. McDonald’s is the first quick-service restaurant in the country to practice a direct hiring policy, providing regular employment to all its crew members. In 2022, McDonald’s Philippines hired more than 17,000 new employees in support of its new store openings—employing working students regardless of race, religion, gender, or sexual orientation. 

To date, the company has close to 60,000 employees in over 700 stores across the Philippines— with over 47,000 employees in Luzon, close to 6,000 employees in Visayas, and 5,000 employees in Mindanao.  

Serving meals with kindness 

McDonald’s also prioritizes its commitment to the communities where it operates. To serve meals to underserved families without access to food, McDonald’s Philippines launched the Kindness Kitchen, a flagship program of its charity of choice, Ronald McDonald House Charities (RMHC). 

In December 2022, Kindness Kitchen has served over 800,000 meals, a 33% increase from 600,000 meals served in May. The initiative aims to serve 1 million meals by the end of 2023. 

By continuously improving the quality of food, providing growth opportunities to its people, and creating a positive impact in communities, McDonald’s exemplifies always being a step ahead in upholding its commitment to world-class excellence. 

Yang reiterates, “It is these customers we serve, the people working in our restaurants and communities that we help that inspire and motivate us to be and do better. As many Filipinos continue to face challenges and recover from the pandemic, we want to be a place where they can experience feel-good moments. We want to be a company that Filipinos today and the future can trust.” 

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Shinagawa links partnership with Fujifilm Philippines Inc.

Shinagawa Diagnostic & Preventive Care Center takes this a step further and encourages preventive healthcare by offering more thorough and advanced examinations with the support of Fujifilm Philippines Inc.



Early detection of diseases can aid in saving lives, giving patients more time to seek effective treatments that help lessen and possibly cure their symptoms. Shinagawa Diagnostic & Preventive Care Center takes this a step further and encourages preventive healthcare by offering more thorough and advanced examinations with the support of Fujifilm Philippines Inc.

Committed to upholding high standard medical services, Shinagawa announces its partnership with Fujifilm Philippines Inc, an expert in prevention and diagnostics technology, in a signing ceremony today at Shangri-La The Fort. Through the collaboration, Shinagawa’s Diagnostic & Preventive Care Center acquires Fujifilm’s endoscopy equipment to conduct advanced testing for the gastrointestinal (GI) tract, which includes the esophagus, stomach, and small intestine. This helps identify emerging diseases, such as stomach ulcers, gastrointestinal disorders, lung problems, and possibly tumors. The technology eases the detection process as it can spot even the smallest abnormality using endoscopes that place minimal stress on the patient.  

“It is of utmost importance to conduct detailed examinations regularly to find diseases at an early stage, leading to preventive care. In particular, Fujifilm’s endoscopy equipment enables early detection of diseases that could not be found in advance by general medical checkups in the Philippines, and we believe this will lead to preventive medicine,” said Masako Uemori, President of Shinagawa LASIK and Aesthetics, Philippines.

Fujifilm Philippines Inc guarantees the prime condition and maintenance of equipment to ensure that all examinations produce in-depth results for more accurate diagnosis. The diagnostics technology company will also be conducting a series of training sessions for Shinagawa doctors and staff to fully regulate the use of the machines, assuring safe and accurate examinations. Through the synergy of Shinagawa’s Japanese-standard medical services and Fujifilm’s innovative healthcare equipment, improved quality of life, diagnosis, and prevention are now made more accessible.

The Shinagawa Diagnostic & Preventive Care will have its grand opening this April. Those who are interested in the center may check out Shinagawa’s official Facebook page @ShinagawaDiagnostic or the official website at to book an appointment. Shinagawa Diagnostic & Preventive Care Center is located at Ore Central Tower, BGC.

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Training breathing muscles could have longer lasting benefits than previously thought

The strength gains to the muscles from five weeks of inspiratory muscle training (a form of weight training to strengthen the muscles used to breathe) persist for five weeks after the training has stopped.



Training the breathing muscles (primarily the diaphragm which plays a vital role in breathing) could have longer lasting benefits than previously thought. The strength gains to the muscles from five weeks of inspiratory muscle training (a form of weight training to strengthen the muscles used to breathe) persist for five weeks after the training has stopped, according to new research published in Experimental Physiology.

Stronger breathing muscles may improve the distribution of blood flow during exercise, which allows a person to undergo physical activity for longer periods before tiring and becoming less breathless. Enhancing breathing muscle function can potentially help people manage and slow down the progression of chronic obstructive pulmonary disease (COPD), a group of lung conditions including emphysema and bronchitis. The disease is the third leading cause of death worldwide1 but is helped with pulmonary rehabilitation which can include inspiratory muscle training. Healthcare needs and the frequency of hospital visits depends on a person’s symptoms and how regularly they worsen. For people with weak breathing muscles, the training may help relieve the symptoms.

Muscles can lose function or weaken over time with disuse, particularly the respiratory muscles which may weaken faster than the other muscles in the body. The researchers from University of Waterloo, Canada foundthat the breathing muscles remain stronger after an equal amount of time without training, in this case five weeks. By observing similar muscle gains between weight training of the breathing muscles with that of the tibialis anterior (the muscle that runs down the front of the shin) indicates that the respiratory muscles can be trained like other skeletal muscles.  

Paolo Dominelli, University of Waterloo, Canada, a researcher on the study, said, “Inspiratory muscle training can be beneficial to people with breathing difficulties and can be part of pulmonary rehabilitation. Knowing the time frame before muscle function loss occurs could help inform treatment programs, determining how frequently an individual would need to train and the length of the programme.”

Inspiratory muscle training also caused a positive change to the respiratory muscle metaboreflex, a process where the body restricts the blood flow to the limbs when the breathing muscles tire. Typically during exercise when the limb muscles are working hard, the respiratory metaboreflex prioritises blood flow to the breathing muscles to ensure breathing is maintained. As a result, heart rate and blood pressure rise. However, inspiratory muscle training reduces the metaboreflex, which lowers the heart rate and blood pressure. Reducing the metaboreflex may improves a person’s endurance during exercise, meaning they can workout for longer before reaching exhaustion. The researchers found that the effects on the metaboreflex were preserved after five weeks in the absence of training.

Paolo Dominelli said, “By showing that the strength of the breathing muscles persisted, along with the retained reductions in the respiratory metaboreflex after five weeks without training suggests that the training itself may not need to be continuous. We would need to carry out subsequent clinical trails to test the appropriate frequency and length of training required to evaluate how long the health benefits persist.”

A group of 16 young healthy adults were randomly assigned into either the control group (seven male, one female) or the experimental group (six male, two female). Over 10-weeks their respiratory muscle strength and muscle strength of their lower leg (via the ability to flex the ankle upwards) were tested in a laboratory, and their blood pressure and heart rate were measured at pre-training (zero weeks), post-training (five weeks) and post-detraining (10 weeks) while their respiratory muscles were working hard to elicit the metaboreflex.

Over five weeks the experimental group performed inspiratory muscle training twice a day for five days a week. This was then followed by five weeks of undergoing normal physical activity but no inspiratory muscle training (post-detraining). The control group did not take part in inspiratory muscle training. All participants engaged in regularly physical activity (approximately three days per week) throughout the 10-week study period.

Paolo Dominelli cautions, “Firstly, our study was done in young healthy individuals who are not limited by their respiratory muscles. Follow-up studies needs to be completed in those with lung disease such as COPD. Secondly, the main limitation of the study was the duration of the detraining (no training) period. It was only for five weeks, the same amount of time as the training, where we did not see any decreases in breathing muscle strength. Further studies should extend the detraining phase to see if the reduction in the metaboreflex still persists with decreases in muscle strength.”

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