Thursday, January 19, 2023

For shared decision-making, telemedicine may be as effective as in-person appointments

Study shows general surgery patients who meet for first-time surgery consultations via telemedicine are satisfied with the quality of communication

Peer-Reviewed Publication

AMERICAN COLLEGE OF SURGEONS

Author video 

VIDEO: TELEMEDICINE MAY BE AS EFFECTIVE AS IN-PERSON APPOINTMENTS view more 

CREDIT: AMERICAN COLLEGE OF SURGEONS

Key takeaways

  • Shared decision-making: Large observational study found no difference in level of shared decision-making between patients receiving a first-time surgery consultation by telemedicine and those receiving in-person care.
  • Pros and cons: Patients and surgeons noted the convenience and usefulness of telemedicine visits, but also acknowledged challenges, including technical difficulties and lack of physical presence.
  •  Next steps: Future studies will map out when patients should and should not see their surgeons for virtual appointments.

CHICAGO (January 19, 2023): Telemedicine may be just as effective as in-person visits when it comes to shared decision-making and communication for patients undergoing a first-time surgery consultation, according to a study published as an “article in press” in the Journal of the American College of Surgeons (JACS) and presented at the  Southern Surgical Association 134th Annual Meeting in December 2022.

Telemedicine (also known as telehealth) has become an established part of patient care. However, its effectiveness to achieve proper shared-decision making between patients and clinicians—an essential part of quality care—had not been thoroughly studied previously. The Covid-19 pandemic necessitated a rapid expansion of the use of telemedicine visits, which allows patients and their healthcare teams to meet remotely through secure video-based platforms. It also makes specialty care, typically offered in cities, more accessible to patients living in rural areas.

“We see patients that live hours away. When the COVID-19 pandemic hit, it threw fuel on the fire of our telehealth program,” said study co-author Alexander T. Hawkins, MD, MPH, FACS, associate professor of surgery at Vanderbilt University Medical Center in Nashville, Tennessee. “Across the entire healthcare system, we now do about 20,000 telehealth visits a month. Previously, there had been concerns about whether we could effectively communicate with patients remotely, but we found that patients are just as satisfied with telehealth visits as in-person appointments.”

For the study, researchers compared video appointments with in-patient visits for level of shared decision-making and quality of communication, hypothesizing that telemedicine would be less effective. Researchers enrolled 387 patients participating in first-time visits between May 2021 and June 2022 at general surgery clinics across Vanderbilt University Medical Center in Nashville. 

Participants were categorized by type of visit: in-person or telemedicine. The aim was to evaluate the level of shared decision-making, as measured by a validated questionnaire called the collaboRATE Top Box score. Additionally, the 9-item Shared Decision-Making Questionnaire was used to assess patient satisfaction. An analysis of responses to open-ended questions about visits by both patients and surgeons was also performed.

Key findings

  • The study included 301 (77.8%) patients who underwent an in-person visit and 86 (22.2%) who underwent a telemedicine visit. The two groups had similar demographic backgrounds, including age, gender, employment status, and education.
  • Patients in both groups reported high levels of quality communication during these appointments.
  • In an adjusted analysis to account for various factors, levels of shared decision-making and quality of communication were similar between remote visits and in-person care. Telemedicine was not associated with less satisfactory communication when compared to in-person visits.
  • Patient responses to open-ended questions about their telehealth experience included positive statements about its convenience and usefulness. Negative comments about these visits included the inability to be physically present and experiencing technical difficulties. 

“I was surprised by the qualitative responses. I expected that telemedicine visits would result in an inferior quality of communication. While we did see that in some responses, we also saw some very positive perspectives on telemedicine visits both in terms of how the actual interaction went and the overall convenience of the process. Many patients really enjoyed having this as an option,” said study co-author Thomas Ueland, a third-year medical student at Vanderbilt University School of Medicine.

Since telehealth visits do not allow for in-office physical exams, there are situations when it’s not appropriate. To that end, some surgeons reported that telemedicine should be used for follow-up care, after they have already established the relationship, instead of for first-time consultations.

“We believe these results suggest that either method, in-person or telehealth, is appropriate. Ultimately, it very much depends upon what the surgeon and the patient think is the best way to communicate,” Dr. Hawkins said. “Going forward, we need to determine what is most appropriate for telehealth, and what is most appropriate for in-person visits. The data we generated in this study do give folks support, so that if they prefer telehealth appointments, they can be confident that they will not be sacrificing quality of communication or shared decision-making.”

Next, the research team will conduct more in-depth studies to identify a condition-by-condition guide for when telemedicine should be used, such as when patients are consulting for hernia surgery where a physical exam is required. For other patients, such as those needing follow-up care for routine operations, telehealth may be a viable option.

The major limitations of the study include the fact that the non-response rate from participants was more than 50 percent and that the patient population came mostly from middle Tennessee, southern Kentucky, and northern Alabama. These results may not apply to patients from other regions and of different demographic backgrounds.

Coauthors are Chetan V. Aher, MD, FACS; Timothy M. Geiger, MD, MMHC, FACS; Matthew D. Spann, MD, MMHC, FACS; Sara N. Horst, MD, MPH; Isabella V. Schafer; Fei Ye, PhD; Run Fan, PhD; and Kenneth W. Sharp, MD, FACS.

The study authors have no relevant disclosures to report.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health and the National Center for Advancing Translational Sciences.

Citation: Hawkins AT, Ueland T, Aher C, et al.  Shared Decision-Making in General Surgery: A Prospective Comparison of Telemedicine versus In-Person Visits. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000000538.

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About the American College of Surgeons 
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates a surgeon is a Fellow of the American College of Surgeons.  

The Journal of the American College of Surgeons (JACS) is the official scientific journal of ACS. Each month, JACS publishes peer-reviewed original contributions on all aspects of surgery, with the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.

Older adults benefit when health care providers and affordable housing sites partner

Research finds that seniors have lower rates of hospitalization and readmission

Peer-Reviewed Publication

HEBREW SENIORLIFE HINDA AND ARTHUR MARCUS INSTITUTE FOR AGING RESEARCH

Older adults benefit from enhanced partnerships between health care systems and affordable housing sites. These partnerships improve health care outcomes while reducing unnecessary spending and/or use, according to research published in the Health Services Research journal. 

The effect of the Right Care, Right Place, Right Time (R3) initiative on Medicare health service use among older affordable housing residents” study was designed to evaluate the R3 program of Hebrew SeniorLife, a Harvard Medical School-affiliated nonprofit. The report was coauthored by Tavares, J. Simpson, L. Miller, EA, Nadash, P. and Cohen, M. of the LeadingAge LTSS Center @UMass Boston.

Seniors living in sites with the R3 program had lower hospitalization rates, days, payments and readmissions than residents living in similar control sites.  This is the first study to document a decline in 30-day re-hospitalization rates among low-income senior housing residents who have access to place-based wellness teams, when compared to low-income seniors in buildings without this level of support.

R3 embeds a wellness nurse and coordinator in senior housing.  The place-based team efficiently conducts assessments and routine proactive check-in calls, risk stratifies the population based on established key risk factors, puts services in place to meet needs, partners with organizations to strengthen care coordination and communication, and tracks/trends data to drive and monitor results.

Hebrew SeniorLife developed R3 to address the disconnect between housing and health systems in order to improve the health and wellbeing of seniors. Partners, including emergency responders, health plans, area agencies on aging, and government agencies, were able to leverage congregate senior housing to achieve positive outcomes.

The research sought to determine the effect of this housing-based intervention on Medicare health service use among senior housing residents. R3 enrolled 400 participants across seven intervention sites, four operated by Hebrew SeniorLife and three operated by partner providers, including Milton Residences for the Elderly and WinnCompanies.

Program Impact

Researchers noted that: “The findings suggest that the combined focus on assessment, proactive outreach, and prevention (with special attention to high-risk individuals); coordination with off-site providers; and the strengthening of an ‘eyes-on’ culture, led to the positive results.”

“Both the comprehensive quantitative and qualitative analyses that we have undertaken demonstrate conclusively that the program is having a major and positive effect on residents and that health care payers also benefit from lower health care costs by having their members participate in the program,” said Marc A. Cohen, Co-Director of the LeadingAge LTSS Center at UMass Boston.  “The R3 program hits all success metrics.”

“This research demonstrates that R3 delivers much-needed health and quality-of-life improvements for residents of senior housing,” said Louis J. Woolf, president and CEO of Hebrew SeniorLife. “At the same time, R3 contributes to efforts that avoid unnecessary care and reduce costs for a system that is beset with labor challenges and struggling to provide both sufficient and affordable services.  We are encouraged by the fact that with this data, policy makers are giving serious consideration to the benefit of adopting R3-like programs across the Commonwealth.”

Researchers concluded: “Age-friendly health systems would do well to enhance partnerships with affordable housing sites to improve care and reduce service use for older residents.”

Funding and Recognition

This study was funded, in part, by Hebrew SeniorLife, which designed and piloted the R3 program and secured additional funding for the evaluation and intervention. Funders include the Massachusetts Health Policy Commission Health Care Innovation Investment and SHIFT Care Programs, Beacon Communities LLC, Boston Scientific Foundation, Coverys Community Healthcare Foundation, Enterprise Community Partners, Massachusetts Department of Housing and Community Development, and MassHousing. 

The Pioneer Institute 2017 Better Government Competition honored R3 with its Grand Prize and the John A. Hartford Foundation honored R3 with its 2021 Business Innovation Award.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, was founded in 1903 and today is a national leader dedicated to empowering seniors to live their best lives. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in DedhamNewBridge on the Charles, DedhamOrchard Cove, CantonSimon C. Fireman Community, RandolphCenter Communities of Brooklineand Jack Satter House, Revere. Hebrew SeniorLife also trains more than 1,000 future health care professionals each year, and conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a robust research portfolio whose NIH funding in 2021 places it in the top 10% of NIH-funded institutions. For more information about Hebrew SeniorLife, visit our website or follow us on our blogFacebookInstagramTwitter, and LinkedIn.

About LeadingAge LTSS

The LeadingAge LTSS Center @UMass Boston conducts research to help our nation address the challenges and seize the opportunities associated with a growing older population.  The LTSS Center is the first organization of its kind to combine the resources of a major research university with the expertise and experience of applied researchers working with providers of long-term services and supports (LTSS).

Warwick University will help Bolivia become the “energy cell of the world”

Historic agreement sees the university and Bolivia collaborate on lithium battery project and provide scholarships for Bolivian students

Business Announcement

UNIVERSITY OF WARWICK

Historic agreement sees the university and Bolivia collaborate on lithium battery project and provide scholarships for Bolivian students  

The University of Warwick is set to help Bolivia become a world leader in renewable energies and electric vehicles, thanks to a historic partnership on lithium battery research with the Bolivian Government.  

The partnership, funded by the UK’s Foreign Commonwealth & Development Office (FCDO), will help develop lithium’s application as a power source in everything from electric cars to mobile phones. 

Bolivia’s vast salt flats harbour an estimated 39 million tonnes of lithium reserve, positioning the country to be one of the world’s most important suppliers in the coming decades. The projects supports Bolivia’s ambition to provide 40% of the world’s supply of lithium by 2030.  It will see Bolivia be at the forefront of lithium value chain, lead to higher paying employment and industry and a transition away from simple extraction and exploitation of raw materials.   

Several master’s degree scholarships will also be offered to Bolivian students and the University’s Warwick Manufacturing Group will link up with Yacimentos de Lito Bolivianos, Bolivia’s lithium mining institution in a multi-year research project to improve the understanding and possibilities for lithium battery technology.  

David Rutley, Minister for the Americas and Caribbean at FCDO was present at the signing of the agreement and said: “This is a landmark partnership between Bolivia and Warwick – one of our great UK universities.  This collaboration will help unlock the possibilities of battery technology in a new era of clean energy. The partnership will also address the drawbacks associated with using fresh water in the extraction process – making the industry more sustainable and less environmentally damaging.”  

“This agreement demonstrates the potential for scientific and technological cooperation of our two great nations. It could help see Bolivia become the energy cell of the world.” 

Professor Mike Shipman, University of Warwick’s Pro-Vice- Chancellor (International), said: “We are excited to be partnering with the Ministry of Hydrocarbons and Energies and Yacimentos de Litio Bolivanos. This collaboration will draw on the University’s extensive expertise in battery technologies and build new capabilities in Bolivia and help the global transition to sustainable power solutions through innovative research and training”.  

 

DNA from domesticated chickens is tainting genomes of wild red junglefowl

Estimates suggest the wild birds have inherited 20% to 50% of their genomes from chickens

Peer-Reviewed Publication

PLOS

DNA from domesticated chickens is tainting genomes of wild red junglefowl 

IMAGE: RED JUNGLEFOWL ARE THE WILD ANCESTORS OF THE CHICKEN, AND THE TWO ARE KNOWN TO READILY ADMIX. IN THEIR STUDY, WU ET AL. FOUND EVIDENCE OF A LOSS IN WILD GENOTYPE IN THE RED JUNGLEFOWL ACROSS THE ANTHROPOCENE BY COMPARING CONTEMPORARY GENOMES WITH HISTORIC ONES FROM APPROXIMATELY A CENTURY AGO. IN THEIR NATIVE RANGE IN SOUTHEAST ASIA, FREE-ROAMING RED JUNGLEFOWL EXHIBIT DOMESTIC TRAITS INDICATIVE OF DOMESTIC INTROGRESSION INTO THE WILD POPULATION (SHOWN HERE). [PHOTO COURTESY OF YONG CHEE KEITA SIN] view more 

CREDIT: WU ET AL, 2023. CC-BY 4.0, HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/)

The red junglefowl – the wild ancestor of the chicken – is losing its genetic diversity by interbreeding with domesticated birds, according to a new study led by Frank Rheindt of the National University of Singapore published January 19 in the journal PLOS Genetics.

Humans domesticated the red junglefowl in tropical Asia somewhere between 3,000 and 10,000 years ago, but wild and domestic birds can still interbreed. This is a concern for red junglefowl conservation, because as wild populations acquire more DNA from chickens, they can lose their genetic diversity, potentially making them less resilient to changes in their environment.

In the new study, researchers contrasted whole genomes from 51 chickens and 63 junglefowl from across the wild bird’s natural range, to find signs of interbreeding. They saw that DNA from domesticated chickens is moving into wild junglefowl, and the scale of that movement has increased over recent decades. By comparing modern wild genomes to genomes of red junglefowl from approximately a century ago, the researchers estimate that the wild birds have inherited 20% to 50% of their genomes from domestic birds, depending on their location. The study also identified eight genes that differed greatly between domestic chickens and their wild ancestors, and which were likely key to developing the chicken as a livestock animal. These genes are involved in development, reproduction and vision.

The results of the study bring to light the ongoing loss of genetic diversity in the wild junglefowl, and the researchers suggest that efforts may be needed to protect its genome. Additionally, wild populations have value for agriculture because they can serve as a reservoir of genetic diversity that researchers can tap into to improve domesticated species – for example, finding genetic variants that make an animal more resistant to a particular disease. Losing that genetic diversity in red junglefowl may hinder scientists’ ability to safeguard one of humanity’s most important food sources.

The authors add: “Genomes of 100 year old birds show that modern wild junglefowl carry on average more domestic DNA than they used to. The wild genotype is an important reservoir of chickens’ genetic diversity and preserving it is critical.”

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In your coverage, please use this URL to provide access to the freely available article in PLOS Genetics:

http://journals.plos.org/plosgenetics/article?id=10.1371/journal. pgen.1010522

Press-only preview: https://plos.io/3WXmZNs

Contact: Frank Rheindt, dbsfre@nus.edu.sg

Image Caption: Red junglefowl are the wild ancestors of the chicken, and the two are known to readily admix. In their study, Wu et al. found evidence of a loss in wild genotype in the red junglefowl across the Anthropocene by comparing contemporary genomes with historic ones from approximately a century ago. In their native range in Southeast Asia, free-roaming red junglefowl exhibit domestic traits indicative of domestic introgression into the wild population (shown here). [Photo Courtesy of Yong Chee Keita Sin]

Image Credit: Wu et al, 2023. CC-BY 4.0, https://creativecommons.org/licenses/by/4.0/)

Image URL: https://plos.io/3W05Ph4

Citation: Wu MY, Forcina G, Low GW, Sadanandan KR, Gwee CY, van Grouw H, et al. (2023) Historic samples reveal loss of wild genotype through domestic chicken introgression during the Anthropocene. PLoS Genet 19(1): e1010551. https://doi.org/10.1371/journal.pgen.1010551

Author Countries: Australia, China, Germany, Singapore, Spain, UK, USA

Funding: MYW, GWJL, CYG were supported by the Singapore Ministry of Education under their MOE Tier 2 grant (A-0004777-00-00) awarded to FER. GF was supported by the Erasmus Mundus project EURASIACAT (ref. nr. 552067) coordinated by the University of Málaga. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Susan Hough honored by SSA for Public Communication and Support of International Earthquake Monitoring

Grant and Award Announcement

SEISMOLOGICAL SOCIETY OF AMERICA

Susan Hough 

IMAGE: SUSAN HOUGH view more 

CREDIT: PHOTO COURTESY OF SUSAN HOUGH

For her effective communication of science to the public and her work to establish and improve earthquake monitoring and hazard assessment worldwide, the Seismological Society of America (SSA) honors Susan Hough with the 2023 Frank Press Public Service Award.

Hough, a geophysicist and ground motions task leader at the U.S. Geological Survey, will receive the Press Award at the 2023 SSA Annual Meeting.

In her nomination of Hough for the award, USGS research geophysicist Morgan Page noted the multiple channels of communication that Hough has used during her career to share science, including newspapers, magazines, websites, television, and radio. Hough maintains an active Twitter account (@SeismoSue) that often provides quick information and context for earthquakes around the world as they happen.

Her books for the general public include Earthshaking Science: What we know (and don't know) about earthquakes (Princeton University Press, 2002), Finding Fault in California: An earthquake tourist's guide (Mountain Press Publishers, 2004), After the Earth Quakes: Elastic rebound on an urban planet (Oxford University Press, 2005), Richter's Scale: Measure of an earthquake, measure of a man (Princeton University Press, 2007), Predicting the Unpredictable: The tumultuous science of earthquake prediction (Princeton University Press, 2010), and The Great Quake Debate: The Crusader, the Skeptic, and the Rise of Modern Seismology (University of Washington Press 2022).

“In her books, not only does Sue distill complex scientific information in a clear and intelligible form for the general public, she layers it with history, context, and color – and her excitement for the scientific enterprise is contagious throughout,” said Page.

“Because of her expertise and ability to simply explain complex concepts,” Page added, “the media routinely specifically requests her for interviews.”

Not content to work only within the United States, Hough has also spent her career leading Office of Foreign Disaster (OFDA)—now part of the Bureau for Humanitarian Assistance-- and U.S. Agency for International Development (USAID)-supported projects responding to earthquakes around the world. She has helped to deploy immediate seismic monitoring, to train the next generation of earthquake scientists and to build scientific capacity in developing countries such as Haiti, Nepal and Burma (Myanmar).

Following the 2010 Haiti earthquake, for example, Hough worked to train researchers at the Haitian Bureau of Mines and Energy (BME) in seismometer installation and operation. The BME now independently maintains the first-ever national seismic network in Haiti and has an active earthquake outreach program with schools, public officials, and the media, partnering with the Haitian Faculté Des Sciences (FDS). The U.S. Geological Survey, with funding from USAID, continues to provide support for the network.

In their commendation for Hough, the Press Award committee noted that her “commitment to equity, diversity, and inclusion is manifest in her willingness to work with people at all levels of expertise across the globe to further their understanding of earthquakes.”

In support of the award, many of her colleagues spoke of Hough’s dedication to on-the-ground organizing and direct engagement with government and public officials in earthquake zones, winning the trust of the public and providing a roadmap for both immediate and future hazard assessment and resiliency.

Hough received her A.B. in geophysics in 1982 from the University of California, Berkeley and her Ph.D. in Earth sciences in 1987 from the Scripps Institution of Oceanography, University of California, San Diego.

The Frank Press Public Service Award honors outstanding contributions to the advancement of public safety or public information relating to seismology. This award may be given to any individual, combination of individuals, or organization.

POSTMODERN SPAGYRIC HERBALISM

Discovery of anti-cancer chemistry makes skullcap fit for modern medicine

Peer-Reviewed Publication

JOHN INNES CENTRE

Skullcap 

IMAGE: (SCUTELLARIA BARBATA) KNOWN IN CHINA AS BANZHILIAN view more 

CREDIT: PHIL ROBINSON

The evolutionary secrets that enable the medicinal herb known as barbed skullcap to produce cancer fighting compounds have been unlocked by a collaboration of UK and Chinese researchers.

The CEPAMS collaboration used DNA sequencing technology to assemble the genomic sequence of skullcap (Scutellaria barbata) known in China as banzhilian.

This gave researchers the genetic information - a microevolutionary history - required to identify how the plant produces the compound scutebarbatine A, which acts against a range of cancer cells.

Professor Cathie Martin, Group Leader at the John Innes Centre, and one of the authors of the study said, “We have found that the primary metabolite has activity against cancer cells but not non cancer cells which is especially important for an anti-cancer metabolite. Now we are looking to develop synthetic methods for producing more of the lead compound.”

In Traditional Chinese Medicine (TCM), to isolate medicinal chemistry from the plant, the herb is boiled in water for two hours and extract is dried to produce a powder and taken as a decoction (concentrated liquid).Now, with the knowledge of the genes that make up the biochemical pathway behind the anti-cancer activity of the herb, researchers are close to being able to synthesise larger quantities of compounds more rapidly and sustainably by using a host such as yeast.

The research which appears in the journal Molecular Plant is led by CEPAMS, a partnership between the John Innes Centre and the Chinese Academy of Science and supported by The Royal Society.

“This is a fantastic collaboration about developing interesting drug leads from natural resources and shows the practical value of focusing on the microevolution of a species” said Professor  Martin. 

The Skullcap genus has been used for centuries in TCM for treatment of different medical conditions. Clinical work has shown that preparations based on Scutellaria barbata during chemotherapy can reduce the risk of metastatic tumors.

CEPAMS Group Leader based at Shanghai Dr Evangelos Tatsis said, “Natural products have long been the lead compounds for the discovery of new drugs. By following the trail of the traditional Chinese plants, we can develop new anti-cancer medicines and this research marks a crucial step in that direction.”

Plant-based traditional medicines have long been used to provide leads for the new drug discovery, and plant natural products like vinblastine and taxol are used clinically as anticancer drugs.

TCM is one of the best catalogued systems with empirical information about the therapeutic properties of herbal remedies.

Anti-cancer drugs obtained from traditional Chinese medicine have higher efficacy than chemical synthetic drugs and with less toxic side effects. The genomes of medicinal skullcaps reveal the polyphyletic origins of clerodane diterpene biosynthesis in the family Laminiaceae, is published in Molecular Plant