It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, July 13, 2023
Schmidt Marine Technology Partners announces recipients of $3.5 million global sustainable fisheries initiative
10 organizations receive grants to develop tools to improve fishing practices worldwide
SAN FRANCISCO—Schmidt Marine Technology Partners, a program of the Schmidt Family Foundation, has awarded $3.5 million in grants to ten organizations and universities in seven countries for the development of new tools and innovations that will improve the sustainability of global fisheries, the program announced today.
“Tens of millions of jobs around the world depend on fisheries, and seafood is the primary protein source for 3 billion people,” said Wendy Schmidt, president and co-founder of the Schmidt Family Foundation. “The innovators chosen to receive these grants are ensuring that fishers and fisheries—and by extension all of us who rely on them—are secure and sustainable worldwide.”
Although more investors are funding ocean technology today than in years past, developers need considerable early-stage support to advance from an idea to wide use of a technology. The sustainable fisheries initiative—to which Schmidt Marine has committed $2 million in new funding, with partners Oceankind and Builders Initiative contributing the additional $1.5 million—aims to address that gap.
“Increasing the sustainability of fisheries is challenging, but we think that both technology and philanthropy have important roles to play,” said Mark Schrope, director of Schmidt Marine Technology Partners. “We try to take a realistic approach by focusing on solutions that offer significant benefits not just for the environment, but also for the fishers themselves.”
The 10 projects selected for grants—ranging from $150,000 to $500,000—seek to reduce bycatch, prevent illegal fishing, improve data collection on fisheries and fish populations, and increase the transparency of a fish’s journey from ocean to table. A team of seven expert advisers and additional tech reviewers from nonprofits, government, and industry helped evaluate proposals from a pool of 200 applications from 20 countries across six continents. Schmidt Marine selected grantees based on the environmental benefits of their proposed ideas, as well as their incorporation of sound fisheries science and management principles, and, where applicable, the practical appeal of the new technologies to fishers.
The funding recipients are:
Katchi Technologies (Yarmouth, Nova Scotia, Canada): An alternative trawling net outfitted with a cable-mounted system that ensures the net stays open and is automatically controlled to prevent contact with the seafloor. The system also reduces drag by an estimated 30%, which in turn further reduces carbon emissions, fuel costs and bycatch while also increasing fisher safety.
Trygg Mat Tracking (Oslo, Norway): Data-rich and easy-to-use software that enables countries to make quick and informed decisions on who can enter their ports and what to target in their inspections to stop illegal fish landings.
Abalobi (Cape Town, South Africa): Development and deployment of software that integrates fishing data with processing plant data to provide ocean-to-market tracking that helps prevent illegal fishing and connects small businesses to larger markets.
University of Haifa, work led byRoee Diamant, Ph.D. (Haifa, Israel):A “swarm” of low-cost underwater autonomous robots that coordinate for better acoustic detection and size estimation of fish populations.
Centro de Ciencas do Mar (Center for Marine Science) (Faro, Portugal): A redesigned fishing net, developed in partnership with fishers, that could reduce bycatch in certain squid and other fisheries by 40%, reducing net damage and protecting sensitive habitats.
Cornell University, work led by Aaron Rice, Ph.D., (Ithaca, N.Y.)in partnership with Marc Dantzker, Ph.D. of Fisheye Acoustics(Arlington, Va.): A new autonomous audio/video technology that allows researchers to identify fish species based on the specific unique sounds they emit. With this information, inexpensive passive acoustic monitoring techniques will be better able to track and estimate fish populations for conservation, sustainability and research.
Allen Institute for AI (AI2), in association withOcean Aero (Gulfport, Miss.) and ThayerMahan (Groton, Conn.): Tools to improve the detection, interdiction and prosecution of illegal, unreported, and unregulated (IUU) fishing activities. The integration of AI driven detections from Skylight AI and a modified ThayerMahan acoustic system into the TRITON—an environmentally powered Autonomous Underwater and Surface Vehicle (AUSV)—promises a revolutionary approach to securing our oceans against IUU fishing.
Arizona State University, work led by Jesse Senko, Ph.D., (Tempe, Ariz.): Low-cost lights, powered by solar energy, that easily hook on to fishing nets and reduce bycatch of threatened species including sea turtles and sharks.
Wildaid Marine (San Francisco, Calif.): An app that provides accurate fishing and vessel data to rangers to help them deter illegal fishing in marine areas and better protect marine wildlife and the coastal communities that depend on them.
Fishtek Marine (Devon, England): An evaluation of the effectiveness of multiple bycatch reduction tools such as a shark-repellent device for longline fishing.
About Schmidt Marine Technology Partners Schmidt Marine Technology Partners supports scientists, engineers and entrepreneurs in developing technologies that restore ocean health. Schmidt Marine is one of two grant-making and investment programs of the Schmidt Family Foundation, founded by Eric and Wendy Schmidt. For more information, visit schmidtmarine.org.
About the Schmidt Family Foundation Established in 2006 by Eric and Wendy Schmidt, the Schmidt Family Foundation works to restore a balanced relationship between people and planet. Through grantmaking and investments, the foundation partners with communities around the world in working for renewable energy, resilient food systems, healthy oceans and the protection of human rights. The foundation makes grants and impact investments through two programs: 11th Hour Project and Schmidt Marine Technology Partners.
MEDICINE
Home blood pressure monitoring saves lives, cuts costs, and reduces healthcare disparities
New research in the American Journal of Preventive Medicine confirms that regular self-testing better controls hypertension, especially among underserved patients
Ann Arbor, July 13, 2023 – Expanding home blood pressure monitoring among US adults with hypertension could substantially reduce the burden of cardiovascular disease and save healthcare costs in the long term, according to a new study in the American Journal of Preventive Medicine, published by Elsevier. The results of the study show that expanding home monitoring has the potential to address pervasive health disparities facing racial and ethnic minorities and rural residents because it would reduce cardiovascular events among US adults.
Co-lead investigator Yan Li, PhD, Professor, School of Public Health, Shanghai Jiao Tong University School of Medicine, explained, “Our study is among the first to assess the potential health and economic impact of adopting home blood pressure monitoring among American adults with hypertension. We found that it facilitates early detection, timely intervention, and prevention of complications, leading to improved control and better health outcomes.”
Analyzing data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), investigators projected that implementing home blood pressure monitoring, as opposed to traditional clinic-based care, could result in a reduction of myocardial infarction (MI) cases by 4.9% and stroke cases by 3.8% over 20 years.
Non-Hispanic Blacks, women, and rural residents had more averted cardiovascular events and greater cost savings related to adopting home blood pressure monitoring compared to non-Hispanic Whites, men, and urban residents. Adopting home blood pressure monitoring in rural areas would lead to a potential reduction of 21,278 MI cases per one million people compared to 11,012 MI cases per one million people in urban areas. Rural residents tend to have a higher prevalence of hypertension and uncontrolled hypertension than urban residents and often face additional barriers in accessing primary care services.
Estimating healthcare cost parameters based on actual healthcare payment data from the Medical Expenditure Panel Survey (MEPS), researchers projected an average of 4.4% per person annual savings and an average of $7,794 in healthcare costs per person over a span of 20 years in this population due to home blood pressure monitoring adoption and the subsequent reduced cardiovascular disease cases. Previous economic evaluations of home blood pressure monitoring have primarily focused on local health systems or conducted short-term, small-scale randomized controlled trials.
Hypertension -- systolic blood pressure (BP) greater than 130 mmHg or a diastolic BP greater than 80 mmHg or being on medication for it -- is a pressing public health challenge in the US, with significant implications for the development of heart disease and stroke and leads to substantial healthcare costs. Traditional clinic monitoring, the common method for BP measurement and hypertension diagnosis, has a number of drawbacks: Patients may not visit clinics often enough to pick up the problem, and when they do, accuracy may be compromised by the “white coat” (high office BP but normal BP on home measurements) or “masked” (normal/high normal BP in the office but elevated at home) effects.
Home blood pressure monitoring eliminates these impediments and provides more comprehensive and accurate data compared to sporadic measurements obtained during clinic visits. Yet, the highly effective practice has not been widely adopted in the US because of inadequate health insurance coverage, lack of investment in preventive services, and limited health promotion efforts provided by primary care physicians. However, the landscape has changed between 2020 and 2022 when home blood pressure monitoring attracted increasing attention due to healthcare disruptions caused by the COVID-19 pandemic.
Co-lead investigator Donglan Zhang, PhD, Associate Professor, Center for Population Health and Health Services Research, New York University Long Island School of Medicine, commented, “Given that almost half of all adults in the US (47%) are affected by high blood pressure, and considering the persistent health disparities in cardiovascular health, it is very important to advocate for the widespread adoption of effective and cost-saving strategies. Home blood pressure monitoring empowers patients to take a more active role in managing their chronic conditions. Our findings provide compelling evidence for healthcare systems and payers supporting the broader implementation of this intervention.”
ARLINGTON, Va. (July 11, 2023) — Five medical societies have published a set of recommendations for operationalizing strategies for infection prevention in acute care settings that account for conditions within the facility, including the culture and communications style of teams, hospital policies, resources available, leadership support and staff buy-in.
“There is no best way to implement a practice, but implementation need not be overly complex,” said Joshua Schaffzin, MD, a pediatric infectious disease physician and a senior author of Implementing Strategies to Prevent Infections in Acute Care Settings published as a new section of the Compendium, a set of guidelines for infection prevention. “This new section is a compilation of a number of options and practical tools you can use to find your best way to implement successfully. It’s a way to take the Compendium from paper to bedside to improve practices for patient safety.”
The new chapter summarizes seven models for implementing other Compendium recommendations for preventing common healthcare-associated infections. It is meant to help bridge the “knowing-doing” gap, a term that describes why healthcare practices often diverge from published evidence to prevent infections that harm patients.
The complexity of healthcare systems makes it difficult for healthcare teams to implement best practices in infection prevention. Understanding factors that promote and hinder adoption within a given setting is an important step to identifying the best framework to deploy in that setting.
“Spending time listening and exploring your context, including local factors such as operational support, informatics resources, familiarity and experience, willingness to change, and safety, is of tremendous value and will guide you to success,” Schaffzin said. “People are rarely eager to change. It’s ok to be discouraged, but don’t give up.”
Schaffzin compared establishing new infection prevention strategies to convincing a young child to try a new food. Sometimes it’s easy, and other times you have to try different tactics, but you can’t force new behaviors.
“Studies in implementation science make it clear that identifying effective interventions is a necessary first step before transferring them into real-world settings in an intentional process,” said Kavita Trivedi, M.D., Director of Clinical Guidance and Communicable Disease Controller at the Alameda County Public Health Department in California and the lead author of the chapter. “Here we provide the reader with the resources to think about implementation and evaluate the contextual determinants of behavior in order to design more successful, customized interventions.”
Implementing Strategies to Prevent Infections in Acute Care Settings is a new section to the Compendium, first published in 2008. The Compendium is sponsored by the Society for Healthcare Epidemiology (SHEA) and is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of several organizations and societies with content expertise. It is a multiyear, highly collaborative guidance-writing effort by over 100 experts from around the world.
An update of strategies to prevent catheter-associated urinary tract infections will be published in coming weeks. The societies also recently updated strategies for preventing methicillin-resistant Staphylococcus aureus infections, Clostridioides difficile infections, surgical site infections, central line-associated bloodstream infections, ventilator and non-ventilator associated pneumonia and events, and strategies to prevent healthcare-associated infections through hand hygiene.
Each Compendium article contains infection prevention strategies, performance measures, and approaches to implementation. Compendium recommendations are derived from a synthesis of systematic literature review, evaluation of the evidence, practical and implementation-based considerations, and expert consensus.
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About Infection Control & Hospital Epidemiology Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 24th out of 94 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
About the Society for Healthcare Epidemiology of America (SHEA)
The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online atshea-online.org,facebook.com/SHEApreventingHAIsandtwitter.com/SHEA_Epi.
JOURNAL
Infection Control and Hospital Epidemiology
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Implementing Strategies to Prevent Infections in Acute Care Settings
ARTICLE PUBLICATION DATE
11-Jul-2023
Caesarean birth injury rates have risen for mums and babies but training and a new device could change that
IMAGE: FETAL PILLOW. IMAGE REPRODUCED COURTESY OF COOPER SURGICAL, INC.view more
CREDIT: BJOG: AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY
Over 34% of women in Australia have a caesarean birth, and a significant proportion of these happen in late labour when the fetal head is deep in the mother’s pelvis and can be impacted which makes delivering a baby challenging and poses serious risks to both the mother and the baby.
It’s estimated the baby’s head is wedged, known as impacted fetal head (IFH) in around 10% of all emergency caesarean births (CB). This makes it difficult for the doctor to get their hand below the baby’s head to deliver it, which leads to longer delivery times.
Recent statistics show that while the majority of babies born following IFH sustain minor damage, 2% of these infants die or suffer serious injuries with lifelong consequences.The NHS Resolution report in the UK states that 9% of avoidable brain injuries at birth are caused by impacted fetal head (IFH).
Complications for the mother include increased blood loss, an increased risk of infection, bladder and urinary tract damage, uterine tears that require repair and may cause issues in subsequent pregnancies, or even a hysterectomy. While complications for the baby include lacerations and bruising to the head and face, skull fractures, and haemorrhages, there have also been reports of eye injuries.
A Scientific Impact Paper published in BJOG: an International Journal of Obstetrics & Gynaecology by the Royal College of Obtsetricians & Gynaecologists in the UK and Professor Annette Briley at Flinders University has reported a significant rise in cases of IFH injuries in recent years, with maternity staff implementing varied approaches and no consensus regarding the definition or training regarding management to help deliver the baby during CB.
Approaches to managing this obstetric emergency include having an assistant push the baby's head up during birth, delivering the baby feet first, using an inflatable balloon device (Fetal Pillow) designed to elevate the baby’s head, and administering medication to relax the mother’s womb.
However, this scientific impact paper reviewed the available evidence, concluding there is currently no consensus on the best approach for these risky cases.
Various manoeuvres and some devices have been introduced to help with the delivery of the baby in this situation, but to date there is no consensus on which is best for mothers and babies or the training required for staff managing this emergency situation.
Most commonly, an assistant is asked to push up from below, although some evidence suggests reverse breech extraction may be associated with better outcomes. A UK-wide survey reported that more than half of obstetric registrars did not feel confident performing reverse breech extraction, and fewer than one in 10 are familiar with the Patwardhan technique.
"The aim of this scientific impact paper was to examine all the current available evidence regarding different manoeuvres and devices currently in use to manage IFH, with the results integrated into the findings of a systematic review commissioned by the National Guideline Alliance (UK)," says research co-author and midwife at Flinders University, Dr. Annette Briley.
The researchers say key steps need to be taken to improve standards:
• High-quality adequately powered RCTs comparing techniques to manage and prevent IFH are required. (Those currently available have significant weaknesses.) • A universally accepted definition of IFH would facilitate future research and education. • Women and their partners need to inform research around the language and management of IFH. • The development and implementation of an evidence-based multi-professional educational package would lead to consistent management of this obstetric emergency. • More research is required around the efficacy and cost-effectiveness of the Fetal Pillow
Dr Briley says the data clearly shows that there has been a significant rise in caesarean sections in late labour and associated cases of IFH-related injuries in recent years, and further education is needed to develop consistent management of this obstetric emergency.
"We’ve reviewed the existing evidence on strategies to identify, prevent, and manage the IFH during births to provide guidance and recommendations that improve outcomes for mothers and babies when this potentially serious complication occurs. It’s essential that clinicians use the best evidence to inform care for women and babies, including the optimal techniques to reduce the potentially devastating complications associated with IFH."
Dr Briley is also part of a research team developing and evaluating the Tydeman tube, an innovative single-use, hollow silicone tube inserted to elevate the baby’s head. Its designed to minimise applied pressure to the head and reduce any suction effect once access has been achieved.
"A minimal number of Tydeman Tubes have been used clinically; further research in a clinical setting, compared with appropriately trained and executed manual disimpaction, is required to investigate its efficacy and safety before use."
JOURNAL
International Journal of Obstetrics and Gynaecology
Management of Impacted Fetal Head at Caesarean Birth
Chagas Disease is also
underdiagnosed in Spain
A new study of nearly 3,000 Latin Americans who visited the Hospital Clinic over 17 years shows that 47% were infected with the parasite that causes the disease, and more than 10% had heart lesions
A high percentage of people from Latin America are infected with the parasite that causes Chagas disease. This is the conclusion of an analysis of nearly 3,000 people from countries where the disease is endemic and who attended the International Health Service at Barcelona’s Hospital Clinic, over a 17-year period. The study, published in PLOS Neglected Tropical Diseases, was led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by "la Caixa" Foundation.
Nearly 7 million people in the world are estimated to be infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Although the vector that transmits the parasite (the kissing bug) is endemic in 21 Latin American countries, the parasite has spread globally due to migratory flows. In non-endemic countries, the parasite can be transmitted vertically, from mother to child or, less commonly, through blood or organ donations. In 30-40% of cases, the infection ends up damaging the heart and digestive system, causing Chagas disease.
"It is therefore recommended that Latin Americans arriving in the country be tested in order to treat them if they are infected and, in the case of women of childbearing age, to prevent the vertical transmission of the parasite," explains Irene Losada, coordinator of the Chagas Initiative and first co-author of the study, along with Pedro Laynez-Roldán, ISGlobal researcher and physician at the ClÃnic’s International Health Service.
This retrospective study describes one of the largest samples of people at risk of infection in a non-endemic country: 2,820 Latin Americans, the vast majority from Bolivia, who attended the International Health Service of the Hospital Clinic of Barcelona between 2002 and 2019. Of the total number of people analysed, almost half (47%) were infected with T. cruzi and 17% had heart lesions typical of the disease. Although in most cases an electrocardiogram was sufficient to detect the lesions, an echocardiogram was needed in 10% of cases. "These results reinforce the importance of echocardiograms in the initial assessment of patients with T. cruzi infection," says Laynez-Roldán.
An underdiagnosis problem
The authors note that many people arriving from highly endemic regions of Latin America, such as Bolivia, had never been tested before. "The infection is clearly under-diagnosed even in Spain, one of the European countries with the highest diagnostic coverage," warns Maria Jesús Pinazo, last author of the study, former researcher at ISGlobal and currently at DNDi.
The majority of the cases are women of working age, reflecting the migratory flows of recent years, which allows for better targeting of screening and prevention programmes.
Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement
ARTICLE PUBLICATION DATE
13-Jul-2023
U$ FOR PROFIT MEDICINE
New UCF study examines insurance barriers to access opioid addiction medication
While insurance coverage of some forms of buprenorphine has improved over the years, researchers say coverage of new, more effective forms of the medication is lacking
IMAGE: BARBARA “BASIA” ANDRAKA-CHRISTOU IS AN EXPERT IN HEALTH SERVICES, HEALTH POLICY AND SUBSTANCE-USE DISORDER TREATMENT. PHOTO CREDIT: BLAKE OSTINGview more
CREDIT: PHOTO CREDIT: BLAKE OSTING, UNIVERSITY OF CENTRAL FLORIDA
By Danielle Hendrix ’15
ORLANDO, July 13, 2023 – In 2021, more people died from opioid overdoses in the U.S. than any other year in history, according to data from the U.S. Centers for Disease Control and Prevention.
However, a new University of Central Florida study recently published in Health Affairs shows that one of the most effective medications for treating opioid addiction is one of the least covered by insurance plans often used by patients with substance use disorder.
Researchers found that although most plans covered the immediate-release sublingual form of buprenorphine, extended-release buprenorphine injections were covered by less than half of commercial plans and less than a fifth of Medicare Advantage Plans. Furthermore, while most Medicaid plans did cover it, more than a third presented a barrier by requiring prior authorization before prescription.
The study’s lead author, Barbara “Basia” Andraka-Christou, says her key passion in research is trying to understand how to expand access to these life-saving treatments.
"Approximately 20% of people actually use buprenorphine or another similar medication called methadone for treatment of opioid-use disorder,” she says. “Most people don't get any treatment, or if they do get treatment, they're getting something that's less effective. Unfortunately, there have been a lot of barriers to accessing it, and some of those have been either lack of insurance coverage or various prior-authorization requirements.”
Buprenorphine can be prescribed by any clinician licensed by the Drug Enforcement Administration and comes in two overall forms: an oral immediate release version that is taken daily or a monthly extended-release intramuscular injection. Since some of the oral versions of the medication are available in generic form, they tend to be the cheaper option. The injection is newer and still under patent, making it the more expensive option.
How the Research Was Performed
Andraka-Christou, an associate professor in the School of Global Health Management and Informatics at UCF, teamed up with Thuy Nguyen from the University of Michigan, W. David Bradford from the University of Georgia and Kosali Simon from Indiana University to examine Medicaid, Medicare Advantage and commercial insurance formulary files to compare insurance-imposed restrictions for buprenorphine from 2017-21.
They studied factors like insurance coverage, prior-authorization requirements, and other potential access barriers like step therapy and quantitative limits across commercial providers, Medicaid, and Medicare.
“Medicaid covers about a third of people in the U.S. with opioid-use disorder and Medicare covers both the elderly and disabled populations,” she says. “That’s important because among older Americans, the rates of opioid overdoses have also been increasing. Because people flow in and out of different types of insurance, it’s very important to look at all insurance sectors.”
What Andraka-Christou and her team found were stark differences in coverage and prior authorization barriers depending on the form of buprenorphine requested. Nearly all plans covered at least one form of immediate-release buprenorphine in 2021, and prior-authorization requirements and quantity limits gradually decreased for immediate-release buprenorphine.
The intramuscular, extended-release injection was subject to the most variance by insurer type. Their research determined that Medicare and commercial insurance were less likely to cover the cost of the buprenorphine injection — with only 46% of commercial plans and 19% of Medicare Advantage plans covering it — as compared to Medicaid. On the other hand, most Medicaid plans covered the extended-release version in 2021, although 37% still required prior authorization.
Despite the oral version now being largely covered by insurers, Andraka-Christou says there is a downside in that it’s easier for opioid-use disorder patients to relapse if they skip doses. With the monthly intramuscular injection, that is less likely to happen.
“The reason prior-authorization requirements are a problem is that someone with an addiction may have a short window of time during which they're willing to go and get treatment,” Andraka-Christou says. “From a public health standpoint, it’s very important to not have prior-authorization requirements for these types of medicines. The injection is also very expensive because it's still on patent, so those requirements probably exist to cut costs. However, if someone had to wait days for the injection and has an overdose in that timeframe, then it might be less costly to not require prior authorization.”
The barriers related to the oral version of buprenorphine have been a topic of conversation in U.S. healthcare for a while, but Andraka-Christou’s team found that prior-authorization requirements for oral versions are minimal today compared to 10 years ago. With this new finding, she urges researchers, advocates and policymakers to shift their attention to the intramuscular injection version and work on addressing those barriers.
“I think providing access to life-saving treatment needs to be a priority for policymakers and community advocates, and that’s where my passion comes from,” Andraka-Christou says. “The fact is that we have this ongoing, horrific crisis, but we also have tools like buprenorphine and methadone that could cut the risk of overdose deaths in half if they weren’t so underused. State lawmakers could help lead this effort by requiring insurers to cover extended-release buprenorphine without prior authorization.”
Researcher Credentials
Andraka-Christou received both her juris doctorate and doctorate in law and social science from Indiana University Bloomington. She joined UCF’s School of Global Health Management and Informatics, part of UCF’s College of Community Innovation and Education, in 2017. Her areas of expertise include health services, health policy and substance-use disorder treatment. Much of her research on the evolving opioid epidemic is summarized in her book The Opioid Fix: America’s Addiction Crisis and the Solution They Don’t Want You to Have (Johns Hopkins University Press, 2020).
IMAGE: UVA HEALTH'S BRUCE SCHIRMER, MD (LEFT), AND ADISHESH K. NARAHARI, MD, WARN THAT A "BROKEN PIPELINE" OF FUNDING FOR SURGEON-SCIENTISTS COULD HARM PATIENT-CARE INNOVATION.view more
CREDIT: COURTESY ADISHESH K. NARAHARI, MD
Surgeons who also conduct important biomedical research are struggling to obtain research funding, and that “broken pipeline” could spell extinction for surgeon-scientists and slow innovations for patients if something isn’t done, a team of UVA Health experts warns.
Researchers led by Bruce Schirmer, MD, of UVA's Department of Surgery, found that surgeon-scientists often succeed in obtaining research support early in their careers but then are much less likely than peers in internal medicine to translate that into ongoing research funding.
The reasons for this are complex, Schirmer and colleagues say in a new scientific paper, but include the heavy clinical demands surgeons face and the ongoing need to maintain and refine their skills. This often leaves them with little time to compete for research funding and to conduct research that would ultimately benefit patients.
That, Schirmer and colleagues warn, could have dire implications for the future.
“Surgeons have been responsible for many of the significant advancements in treatments of diseases, especially those of the cardiovascular, digestive, neurologic, endocrine, pulmonary and urologic systems, as well as most types of cancer. Lack of ongoing funding for surgical research could limit such contributions in the future,” Schirmer said. “These data should be a wake-up call to the surgical community to reconsider when research is optimally performed during surgical training and how resources to subsequently support it can be best secured.”
Surgical Research Funding
Schirmer and his team looked at research grants obtained by trainees in both surgery and internal medicine. They found that trainees obtained F32 grants from the National Institutes of Health to support dedicated research at similar rates, but the internal medicine trainees were almost six times more likely to parlay that later into R01 grants, the NIH’s oldest and most competitive funding mechanism. The internal medicine researchers were also five times more likely to obtain a career development K-award from the NIH.
The researchers label the discrepancy a “shocking drop-off” and say it represents a “major problem” for the surgical specialty.
“Surgeons are struggling to find funding, and many of them are not able to obtain funding despite trying for 10 years. Surgeon-scientists have made many advances in biomedical research in fields such as transplantation, oncology and diabetes,” said UVA Health surgery intern Adishesh K. Narahari, MD, PhD, the first author of the new scientific paper. “In short, surgeons need to apply for funding early and become proficient at navigating the biomedical research world. Otherwise, we may see a decrease in innovation and lack of new solutions to not only surgical problems but many areas of biomedical research.”
Narahari, Schirmer and their collaborators say swift action is needed and have formulated recommendations to address the problem. These suggestions include:
Develop alternate grant-funding mechanisms to support surgeon-scientists;
Establish programs at individual institutions to support surgical residents who wish to do research;
Encourage surgeons to do research by evaluating surgeon-scientists using different job-performance metrics than surgeons who do not do research.
If steps aren’t taken, the UVA researchers warn, surgical research will suffer.
“We hope this paper sparks a movement to encourage the development of surgeon-scientists through curricular, programmatic and supportive mechanisms that foster those highly interested in such career paths to be most productive and successful,” Schirmer said. “We hope those who oversee surgical education and training will strongly consider these findings.”
Findings Published
The researchers have published their findings in the scientific journal Annals of Surgery. The team consisted of Narahari, Anirudha S. Chandrabhatla, Emily Fronk, Simon White, Shreya Mandava, Hannah Jacobs-El, J. Hunter Mehaffey, Curtis G. Tribble, Mark Roeser, John Kern, Irving L. Kron and Schirmer.
Narahari was supported by NIH grant F30CA236370.
To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog.
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