Day: March 17, 2021

Categories : Gender Substance UseTags :

Alcoholic Liver Disease Is ‘Astronomical’ in Young Women

On By ModernMedia
Image by ds_30 from Pixabay

Rates of alcoholic liver disease are skyrocketing in young women, doctors in the US have warned. Much of it has to do with added pressures on women in the pandemic.

Alcoholic liver disease — including milder fatty liver and the permanent scarring of cirrhosis, as well as alcoholic hepatitis — are up 30% over the last year at the University of Michigan’s health system, said Dr Jessica Mellinger, a liver specialist there. Severe liver disease and cirrhosis can see survival rates as low as 10%.

The route by which liver disease develops varies according to the individual, although obesity, genetics and underlying health conditions play a role. Moderate consumption of alcohol, a glass or two of wine daily, is unlikely to contribute to it.

However, Dr Mellinger says that along with her colleagues, she has seen alcohol consumption edging upward, to a bottle of wine per day which results in increased risk of serious liver disease.

Since the beginning of the pandemic, no data on overall increases in serious alcoholic liver disease has yet been compiled by The Centers for Disease Control and Prevention. But, Dr Mellinger said, “in my conversations with my colleagues at other institutions, everybody is saying the same thing: ‘Yep, it’s astronomical. It’s just gone off the charts.’ “

The age demographic is also changing. “We’re seeing kids in their late 20s and early 30s with a disease that we previously thought was kind of exclusive to middle age,” she said.

The pressures of the COVID pandemic are partly to blame, and in many cases the extra burden is falling on women – who are already more susceptible to alcohol because they have a smaller water volume to distribute alcohol into and their bodies do less ‘first pass’ metabolism of alcohol in the stomach. Popular culture and advertising also encourages women to drink.

Psychological factors such as eating disorders and trauma from sexual abuse also fuel the disease.

“Whether this is early life sexual trauma or they are in a recent or ongoing abusive relationship, we see this link very, very closely,” said psychiatrist Dr Scott Winder, a clinical associate professor at the University of Michigan who treats liver disease patients. “Just the sheer amount of trauma is really, really tragic.”

The lack of overlap between the various fields in this complex relationship results in what he calls a “tragic gap”.

“The cultures of hepatology and the cultures of psychology and psychiatry are very disparate; we see patients very differently,” so physicians aren’t coordinating care, even when they should, he said.

Advanced liver disease may leave no other recourse than a liver transplant.
“Unfortunately, transplantation is finite,” said Dr Haripriya Maddur, a hepatologist at Northwestern University. “There aren’t enough organs to go around. What it unfortunately means is that many of these young people may not survive, and die very young — in their 20s and 30s. It’s horrific.”

Some people such as Jessica Duena, a teacher who was diagnosed with alcoholic hepatitis at 34, and was hospitalised several times following the death of her boyfriend from heroin, have managed to turn the disease around and are encouraging others to do the same. 

She wrote about her long-held secret in the Louisville Courier-Journal: “I’m Jessica, I’m the 2019 Kentucky State Teacher of the Year, I’m an alcoholic and I’ve been suffering in silence for years.”

She received hundreds of responses, mostly women like herself who were in similar circumstances.

“What I’ve noticed is quite a few of the women, typically, they were either educators, they were moms or they happened to be nurses or attorneys,” Duenas said. They poured their hearts out about the crushing and constant stress of kids, work and home life.

They also complained of the pressures outside the home. “Imagine being a teacher who gets evaluated on how your students do, given the situation today,” Duenas says. “I mean, that makes me want to drink for them, you know — like that’s a terrible pressure to be under.”

Duenas has started writing about the stories of such people who reach out to her on her website, www.bottomlesstosober.com.

Source: NPR

Categories : General InterestTags :

Heart Doctors’ Twitter Popularity Is Unrelated to Their Publications

On By ModernMedia
Phone with popular social media apps including Facebook and Twitter. Photo by Tracy Le Blanc from Pexels.

Having large numbers of widely cited publications has no bearing on the Twitter popularity of academics in the interventional cardiology community, a new study has found. 

The study, by Davide Capodanno, MD, PhD, Azienda Ospedaliero-Universitaria Policlinico “G Rodolico-San Marco” in Catania, Italy, and colleagues, found that academic impact through papers and citations, as calculated by the Hirsch index (or h-index) was found to be unrelated to whether or not academics were in the top quartile of Twitter followers (> 736 followers).

“Indeed, accounts generating a stream of valuable content are more likely to be followed. In addition, some accounts may take advantage of celebrity to amplify their success, in a kind of incremental cycle,” wrote the authors.
Rather, Twitter followers were defined by factors mostly related to time and effort spent on the platform.

Having abundant tweets (> 505 tweets, adjusted OR 16.39), along with individual charisma (‘Kardashian index’ >5, adjusted OR 8.66), were the most significant predictors. Large number of accounts user follows (> 309 following), tweet rate (> 2.6 tweets per week), a large cooperation network and being affiliated to the US were also predictive of the heart doctors’ Twitter popularity.

“Indeed, accounts generating a stream of valuable content are more likely to be followed. In addition, some accounts may take advantage of celebrity to amplify their success, in a kind of incremental cycle,” according to the authors.

Individual charisma per the ‘Kardashian index‘, which measures discrepancy between social media reputation and publication record, was not a significant factor in the rate at which someone amassed followers.

“In aggregate, our results suggest that a prediction rule for durable popularity on Twitter is to be active and generate valuable contents rather than relying on individual academic or social reputation,” Capodanno’s team concluded.

An earlier study had shown that the reverse was true; the more Twitter followers, the greater their academic standing.
Limitations include not being able to account for anonymous or pseudonym accounts, and the results may not be generalisable to the interventional cardiology community as a whole.

Source: MedPage Today

Journal information: D’Arrigo P, et al “Determinants of popularity and natural history of social media accounts in interventional cardiology” JACC Cardiovasc Interv 2021; DOI: 10.1016/j.jcin.2021.01.021.

Categories : Cancer PaediatricsTags :

Delaying Lumbar Puncture Cuts Relapse in Childhood Leukaemia

On By ModernMedia

Commencing chemotherapy several days before the first lumbar puncture for diagnosis and treatment of acute lymphoblastic leukaemia (ALL) may lower the risk of central nervous system (CNS) relapse in children, according to a study from St Jude Children’s Research Hospital and collaborators in China. 

“This study identified factors to help us predict and better manage the risk of CNS relapse that will be useful for treating ALL patients worldwide, in both resource-rich and resource-limited countries,” said corresponding author Ching-Hon Pui, MD, chair of the St. Jude Department of Oncology. Dr Pui pioneered paediatric ALL treatment that has achieved 94% long-term survival for St. Jude patients that did not receive brain irradiation.

Using an adapted paediatric protocol from St Jude Hospital, 7640 children and adolescents across 20 Chinese hospitals were enrolled in the trial. However, there was a great disparity across the hospital settings. For example, just three of the hospitals offered total intravenous anaesthesia for children undergoing spinal taps, while only two had flow cytometry for the diagnosis of leukaemia cells in cerebrospinal fluid.

The five-year overall survival rate was 91% for study patients, and the cancer-free survival rate was 80%, which is a dramatic improvement over previous clinical trials in China. But 1.9% of patients relapsed in the CNS alone, and in another 2.7% of patients the relapse involved the CNS. In comparison, a Canadian study reported a 6.6% rate for CNS-involved relapse in paediatric ALL patients followed over 10 years.

According to Dr Piu, in order to increase the survival rate of paediatric ALL patients requires identifying those at risk for CNS relapse, along with increasing their quality of life. Three factors reduced the risk of CNS relapse. First, commencing dexamethasone a few days before the spinal tap, prevents leukaemia cells entering the cerebrospinal fluid (CSF). Second, intravenous anaesthesia reduced bleeding risk during lumbar punctures, and improved  intrathecal therapy. Third, flow cytometry enables more accurate diagnosis of leukaemia cells in CSF, and reduced CNS relapse.

Source: Medical Xpress

Journal information: Jingyan Tang et al. Prognostic Factors for CNS Control in Children with Acute Lymphoblastic Leukemia Treated Without Cranial Irradiation, Blood (2021). DOI: 10.1182/blood.2020010438

Categories : Medical Research & TechnologyTags :

Telemedicine Is as Satisfactory as In-person Follow-Up for Knee Surgery

On By ModernMedia

Following arthroscopic knee surgery, patients are as satisfied with telemedicine follow-ups as they are with in-person follow-up, according to a new study published in The Journal of Bone & Joint Surgery.

“Patient satisfaction with overall care is equivalent between telemedicine and office-based follow-up after an arthroscopic meniscal surgical procedure in the immediate postoperative period,” wrote Christina P Herrero, MD, and colleagues of NYU Langone Health.

The study recruited 122 patients who underwent arthroscopic surgery on the meniscus in the knee, which is one of the most common orthopaedic surgical procedures. Of these patients, 88% had a removal of the meniscus (meniscectomy), with the rest undergoing meniscal repair procedures.
Patients were randomly assigned to either office-based or telemedicine follow-up, scheduled for 5 to 14 days postoperatively. During both types of follow-up visits, the surgeon spoke to the patient about the surgical findings, pain the patient might be experiencing, and the postoperative recovery period, as well as performing a physical examination that included range-of-motion testing.

The telemedicine follow-ups were performed using the patient’s home computer or mobile device via a telemedicine program that was compliant with privacy rules. Surgeons of course were unable to physically feel or touch the knee during telemedicine follow-ups. However they could still conduct a visual assessment of wound healing, drainage, and swelling. 

Overall satisfaction ratings were nearly identical between groups. The surveys showed average patient satisfaction scores (on a 0-to-10 scale) were 9.77 in office-based follow-up and 9.79 for telemedicine follow-up. In both groups, only about 20% of patients said they would have preferred the other type of visit. There was also similar improvement observed in pain scores between groups: from about 5 (out of a maximum of 10) on the day of the surgery to 3 at the follow-up visit.

Telemedicine has become all the more crucial in the COVID pandemic to minimise contact, but the levels of satisfaction shown indicate that it may be a promising standard mode of care in the future, especially for cases where access to physical follow-up consultation may be difficult for the patients. 

“Telemedicine may be a reasonable alternative to office-based follow-up after knee arthroscopy,” Dr Herrero and coauthors concluded. “[Our] study only evaluated the first postoperative visit, but future studies may benefit from expanding the use of telemedicine to longer-term follow-ups or to additional surgical procedures.”

Source: News-Medical.Net

Journal information: Herrero, C. P., et al. (2021) Patient Satisfaction Is Equivalent Using Telemedicine Versus Office-Based Follow-up After Arthroscopic Meniscal Surgery. The Journal of Bone & Joint Surgery. doi.org/10.2106/JBJS.20.01413.

Categories : GeneticsTags :

Whole Genome Sequencing Yields Diagnoses for Rare Diseases

On By ModernMedia

With the integration of whole genome sequencing in Swedish healthcare, some 1200 individuals with rare diseases have received a diagnosis, with novel disease genes discovered in the process.

“We’ve established a way of working where hospital and university collaborate on sequencing each patients’ entire genome in order to find genetic explanations for different diseases,” said first author Henrik Stranneheim, researcher at the Department of Molecular Medicine and Surgery, Karolinska Institutet. “This is an example of how precision medicine can be used to make diagnoses and tailor treatments to individual patients.”

The technology of large-scale whole genome sequencing to yield a person’s entire DNA, is not yet widely used in hospitals despite the technology becoming much more accessible over the last ten years. Whole genome sequencing has uncovered a great genetic variety among different populations, such as in South Africa, where a pilot study uncovered a high rate of novel variants in African populations.

Karolinska University Laboratory and the Clinical Genomics facility at SciLifeLab launched the Genomic Medicine Centre Karolinska-Rare Diseases (GMCK-RD) five years ago. Since then, the centre has sequenced the genomes of 3219 patients, which led to molecular diagnoses for 40% of them with rare diseases.

In addition to these, the researchers found pathogenic mutations in more than 750 genes and discovered 17 novel disease genes. 

“Clinical whole genome sequencing has had huge implications for the area of rare diseases,” explained corresponding author Anna Wedell, professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet. “Used in the right way, targeted at each patient’s specific clinical situation, new groups of patients can receive the right diagnosis and treatment in a way that hasn’t been possible before.”

Whole genome sequencing is challenging in part due to having to manage and interpret the millions of variations that exist within each invidual’s genome. In order to overcome this difficulty, the centre came up with a model that directs the initial analysis to pathogenic variants in genes relevant for that patient’s clinical symptomsIn this way, doctors play an important role in choosing which genetic analyses to run first.
Should the first assessment fail, the analyses are then broadened to more gene panels, which has uncovered new disease genes.

“For us to succeed with precision medicine, a multidisciplinary collaboration between health care and academia is essential,” said second corresponding author Anna Lindstrand, professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet and consultant at Karolinska University Hospital’s Department of Clinical Genetics. “Through these initiatives we combine clinical expertise with bioinformatic tools and together deliver accurate diagnoses and individualised treatments.”

Source: Medical Xpress

Journal information: “Integration of whole genome sequencing into a health care setting: High diagnostic rates across multiple clinical entities in 3219 rare disease patients,” Genome Medicine (2021). DOI: 10.1186/s13073-021-00855-5

Categories : HospitalsTags :

Optimised Scheduling Algorithm Cuts Delays for MRI Scans

On By ModernMedia

A team of researchers from Dartmouth Engineering and Philips have developed an optimised scheduling algorithm that significantly cuts the waiting time of patients for MRI at Lahey Hospital in Massachusetts, cutting overall associated costs by 23%.

“Excellence in service and positive patient experiences are a primary focus for the hospital. We continuously monitor various aspects of patient experiences and one key indicator is patient wait times,” said Christoph Wald, professor and chair, Department of Radiology, Lahey Hospital, Tufts University Medical School. With a goal of wanting to improve patient wait times, we worked with data science researchers at Philips and Dartmouth to help identify levers for improvement that might be achieved without impeding access.”

Exam waiting times can be stressful for patients, depending on the perceived value of the visit, and the associated costs of a delay to the patient.

Before the new algorithm, the average outpatient’s waiting time at the hospital was 54 minutes. The researchers found that the problem was a complicated scheduling system, which must cater to emergency room patients, inpatients, and outpatients; while other appointments are relatively inflexible, inpatient exams usually can be delayed if necessary.
“By analysing the patient data, we found that delays were prominent because the schedule was not optimal,” explained first author Yifei Sun, a Dartmouth Engineering PhD candidate. “This research uses optimisation and simulation tools to help the MRI centres of Lahey Hospital better plan their schedule to reduce overall cost, which includes patient waiting time.”

After identifying sources of delays, the researchers then created a mathematical model which optimised the length of each exam slot, and then worked in inpatient exams. Then they created an algorithm which cut down on the waiting time with its associated costs for outpatients, idle equipment time, employee overtime, and cancelled inpatient exams.

“This iterative improvement process did result in measurable improvements of patient wait times,” said Prof Wald. “The construction and use of a simulation model have been instrumental in educating the Lahey team about the benefits of dissecting workflow components to arrive at an optimised process outcome. We have extended this approach to identify bottlenecks in our interventional radiology workflow and to add additional capacity under the constraints of staffing schedules.”

The researchers believe that this solution may have great applicability, as the problem is common to mid-sized hospitals.

“We also provided suggestions for hospitals that don’t have optimisation tools or have different priorities, such as patient waiting times or idle machine times,” said Sun, who worked on the paper with her advisor Vikrant Vaze, the Stata Family Career Development Associate Professor of Engineering at Dartmouth.

Source: News-Medical.Net

Journal information: Sun, Y., et al. (2021) Stochastic programming for outpatient scheduling with flexible inpatient exam accommodation. Health Care Management Science. doi.org/10.1007/s10729-020-09527-z.