Month: March 2021

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.

Categories : Hospitals Mental HealthTags :

Burnout is Highly Prevalent in Healthcare Workers in Cape Town

On By ModernMedia
Image by Free-Photos from Pixabay

Among Cape Town healthcare workers, burnout is highly prevalent, and worsened by the fear of infection, said City spokesperson Priya Reddy.

A year after the breakout of COVID in the Western Cape, the provincial department of health also reported significant levels of burnout among its health-care workers, especially in doctors, nurses and support staff.

Reddy said: “Burnout is highly prevalent as a result of exposure to trauma, loss, grief and compassion fatigue, and is exacerbated by the high levels of anxiety for fear of contracting the virus.”

However, she said: “The presence of Covid-19 has not diverted health-care workers from their primary responsibilities, thus the pandemic added additional levels of care and caution to the way they work and required a major adjustment.”

In response, the City has made available a number of employee assistance programmes (EAP) and wellness interventions to all employees, including City health-care workers and those supporting them in their different functions. The City is also providing workshops on burnout, compassion fatigue and resilience, and making proactive interventions to deal with stress and anxiety.

The provincial health department reported that between October and December last year, 2832 employees accessed the employee health and wellness programme. Work related problems, trauma, COVID related challenges, family challenges and relationships issues were the most common problems presented during this time.

In his review of the pandemic ‘s year in the province, provincial department of health head, Dr Keith Cloete said: “The department recognised the immense impact the pandemic has had on its staff and has initiated intentional healing and grieving sessions with our front-line workers and managers.”

“The department also recognised the need for staff to rest and recuperate, and in between the two waves we encouraged and granted staff to take leave so they can spend some time with family members,” Dr Cloete added.

SA Society of Psychiatrists (Sasop) board member Dr Renata Schoeman said: “Because people on the verge of burnout feel the need to keep going even though they are exhausted and in a state of relentless overwork, by the time they consult a health professional, burnout has often already become depression or anxiety disorder.”

She added: “Avoiding burnout is a classic case where prevention is better than cure, and lifestyle is the most effective preventative strategy. Improving your emotional and mental fitness, as well as physical fitness, helps to build resilience which means you can handle stress better and cope with setbacks.”

A survey of burnout in India found that 52.8% of respondents reported pandemic-related burnout, compared to 26.9% for work-related burnout. Burnout risk was increased by 1.64 for doctors and by 5 for support staff.

Source: IOL

Categories : Ethics and LawTags :

‘Re-Emphasise Ethical Foundation of Medicine’, ACP Urges

On By ModernMedia

As healthcare services struggling under COVID are bought out by private equity, the American College of Physicians says that it is important to prioritise duty to the patients.

“Today, changing practice dynamics place greater focus on the business aspects of medicine,” the authors wrote in a position paper in the Annals of Internal Medicine. “Although employment or consolidation within larger organisations may not be problematic per se, physicians, regardless of practice setting, should challenge business concerns that are placed above the best interests of patients.”

Practices are often bought out by private equity firms that invest in them and introduce cost-cutting measures to increase market share, and then sell them on to make a profit. This results in pressures to generate financial returns at the ultimate expense of patient care.

“This desire to sell the practice soon after acquisition can create the incentive to sell off parts of the practice or undertake drastic short-term cost-cutting measures, including staff layoffs, to make a potential sale more attractive,” the authors wrote. “Insurance companies may further narrow their networks or restrict patient access to only their employed physicians.”

One example the authors cited was that of Hahnemann University Hospital in Philadelphia, which was shuttered just a year after being bought out by a for-profit corporation. This left patients without access to medical care, and some 570 medical residents and fellows were left with an uncertain future.

The authors also cautioned that private equity firms could also limit Medicaid and Medicare patients due to more complex needs and lower reimbursement. These are government medical schemes that cover lower-income individuals. Medicaid alone covers 1 in 5 Americans.
Value-based payment, the authors noted, is supposed to promote high-quality care, but there are many concerns such as influencing patient choice and creating affordability barriers to treatment. Extrinsic, financial incentives may compete with the intrinsic desire to help patients. They also noted that referral-based payment is subject to similar ethical concerns. Meanwhile, time spent with patients needs to be valued, they wrote, as this is needed to ensure effective communication, examination and to express compassion.

“The challenges to care and medical practice during and after the COVID-19 pandemic underscore the need to reemphasise the ethical foundation of medicine,” the authors wrote. “Looking anew at the environment in which care is delivered, physicians should lead in ensuring that business relationships explicitly recognise and support the fundamental and timeless commitments of physicians and medicine to patients.”

Source: MedPage Today

Journal information: DeCamp M, et al “Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices: A Policy Paper From the American College of Physicians” Ann Intern Med 2021; DOI: 10.7326/M20-7093.

Categories : Diseases, Syndromes and ConditionsTags :

Key Cellular Defence Functions Found for Heparanase

On By ModernMedia

A recent study has shown that there is a poorly understood protein, heparanase (HPSE), that is in fact a key regulator of cellular innate defence systems. High levels of HPSE are linked to cancer metastasis. 

Cellular innate defence systems are an array of built-in mechanisms that are common to species throughout evolution. These can be spurred into action by the presence of pathogens or environmental toxins and dysfunctional cells that may build up over time in the body. A clearer understanding of the interplay between these different processes has the potential to open up a whole new range of multi-target drugs to treat a wide range of conditions and diseases.

Researchers from the University of Illinois Chicago (UIC) used a systems approach to track changes in important components in cells and mice that have been genetically engineered to lack HPSE.

In this collaborative multidisciplinary study, Agelidis and coauthors for the first time demonstrated that HPSE is a mediator for antiviral immunity, proliferative signals and cell death.

“HPSE has been long known to drive late-stage inflammatory diseases yet it was once thought that this was primarily due to enzymatic activity of the protein breaking down heparan sulfate, a sugar molecule present in chains on the surface of virtually all cells,” Agelidis said.

While their study largely focussed on mechanisms of pathogenesis of herpes simplex virus (HSV-1), these findings hold a range of implications for treating diseases that involve the dysregulation of HPSE, including cancer, atherosclerosis and autoimmune disorders.

Source: Medical Xpress

Journal information: Alex Agelidis et al, Disruption of innate defense responses by endoglycosidase HPSE promotes cell survival, JCI Insight (2021). DOI: 10.1172/jci.insight.144255

Categories : COVIDTags :

WHO and Health Experts Back AstraZeneca Vaccine

On By ModernMedia
Woman receiving an injection in the upper arm. Photo by Gustavo Fring from Pexels.

Although a number of EU countries have halted the use of the AstraZeneca vaccine, the company along with a number of health experts insist that it is safe.

AstraZeneca said in a statement on Monday that there were 15 deep vein thrombosis (DVT) events and 22 pulmonary embolism (PE) cases among 17 million people in the EU and UK who have received at least one AstraZeneca vaccine dose.    

“This is much lower than would be expected to occur naturally in a general population of this size and is similar across other licensed COVID-19 vaccines,” the pharmaceutical company said.

The company pointed out that in the clinical trials, “even though the number of thrombotic events was small, these were lower in the vaccinated group. There has also been no evidence of increased bleeding in over 60 000 participants enrolled.”

The European Medicines Agency (EMA) reiterated that there is no indication that the vaccine was responsible for these adverse events. The organisation is currently reviewing the vaccine, and more information is expected in its monthly safety report due during the week. They are currently scheduled to meet on Tuesday.

There are however concerns that slowing the pace of vaccinations will result in more lives lost and fuel vaccine hesitancy.

“I do worry that some people will not be able to differentiate between an unrelated or coincidental VTE [venous thromboembolism] occurrence (due to DVT/PE being so common in the general population) and a causative relationship,” Stephan Moll, MD, of the division of haematology at the University of North Carolina at Chapel Hill, said to MedPage Today.

WHO chief scientist Soumya Swaminathan, MD, noted that it has happened before: Norway early on raised concerns about deaths among the elderly getting vaccinated, but then clarified it was only the expected rate of death.

She pointed out that of the 300 million-odd doses of all COVID vaccines administered globally, not one death has been documented as having been caused by vaccination, “We do not want people to panic. We would for the time being recommend that countries continue vaccinating with AstraZeneca.”

Canada, meanwhile, has said that it will continue to use the AstraZeneca vaccine. The company is likely to seek emergency use authorisation from the United States for its jab when it clears its Stage III clinical trials in that country.

“This does not necessarily mean these events are linked to vaccination, but it’s routine practice to investigate them,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at a press briefing Monday. “It shows that the surveillance system works and effective controls are in place.”

Source: MedPage Today

Categories : AgeingTags :

Telomere Lengthening May Treat Renal Fibrosis

On By ModernMedia

A new study has shown that it may be possible to treat renal fibrosis, an age-related disease, by lengthening telomeres.

Previous research had shown it was that lengthening telomeres successfully treated pulmonary fibrosis and infarctions in mice.

Renal fibrosis is the leading cause of kidney failure, treatable only with dialysis. Moderate renal fibrosis is present in some 11% of people over 65, and is a predictor of the severity of renal failure. Telomeres are proteins at the end of chromosomes that maintain genetic integrity during cellular division. They shorten over time, eventually to the point where they are too short for cells to divide, becoming senescent. Telomere lengthening, eg through hyperbaric oxygen therapy, has been suggested as a way to reverse many age-related declines.

While short telomeres were by themselves not enough to cause renal fibrosis, the researchers found that mice with short telomeres developed it when they were exposed to small amounts of toxin, mimicking the environmental toxins people are exposed to over their lives. Mice that also lacked a certain protein needed for telomere function, Trf1, developed renal fibrosis, showing that telomeres are indeed involved in proper kidney function.

Since genes involved in epithelial-to-mesenchymal transition are overexpressed in patients with kidney failure, the researchers looked for this in mice with short telomeres. And “we found that short telomeres induce changes in the expression of genes involved in EMT.”

As a final demonstration of the importance of telomeres in kidney fibrosis, the authors cultured kidney cells in which they expressed the gene for the telomerase enzyme, which elongates telomeres. In these cells with restored telomeres, the epithelial-to-mesenchymal transition program returned to normal, and the cells regained their healthy, pre-fibrosis appearance.

“As short telomeres accumulate with ageing in the organism, it is tempting to speculate that pathological EMT programmes associated with ageing, such as cancer and different types of tissue fibrosis, may be originated at least in part by the presence of short telomeres,” the authors conclude.

Source: News-Medical.Net

Categories : Neurology PaediatricsTags :

Early Interventions May Improve Infant Brain Health

On By ModernMedia
Image by Raman Oza from Pixabay

At the Cognitive Neuroscience Society’s (CNS) annual meeting, researchers from the University of Minnesota presented their work on early interventions to ameliorate negative effects on infant brain health.

Their two interventions consist of using engineered gut microbes for antibiotic-exposed infants and the other is a choline supplement to treat infants exposed to alcohol in the womb.

Dr Gale’s new research shows that infants with different compositions of gut bacteria process auditory and visual stimuli differently during memory tasks. “These results raise the possibility that gut bacteria are involved in the development of brain function,” she said.

The study compared the brain activity of infants who received antibiotics within their first month of life to those who did not. Using EEG, the researchers recorded a type of electrical activity called event related potentials (ERPs) in the infants’ brains in response to either their mother’s voice or a stranger’s voice – a “recognition memory” that can be assessed in preverbal infants before any behavioral changes are apparent. This has been shown to be an effective assessment of many aspects of cognitive development.

“Recognition memory is one of the earliest types of explicit memory to develop and is known to be dependent on medial temporal lobe structures, including the hippocampus, the brain region affected by microbiome perturbation in animal models,” explained Dr Cheryl Gale, of the University of Minnesota.

The ERP measurements of infants exposed to antibiotics showed an abnormal response to their mother’s voices compared to those unexposed.
While antibiotics were associated with impact on brain function, a causal relationship could not be established. “We don’t yet know if there is a definitive cause and effect relationship between microbes and brain function in human infants, but future research will hopefully be able to shed light on this,” Gale says.

The work raises the prospect of creating engineered microbes as an early life intervention. “Infancy is a critical time window for brain development, when therapeutic interventions can have effects for the life-course,” Gale said.

The other study was on foetal alcohol exposure, which is still a widespread problem, involved in some 8 in 1000 births worldwide, resulting in serious cognitive consequences. Dr Jeff Wozniak became aware of a lack of neural imaging studies in this very high-need population.

“So I became interested in using some of the tools that we had available here at the University of Minnesota to do high-quality imaging of brain structure and function in this understudied population to learn something about how the brain is altered by prenatal alcohol exposure at the earliest stages of development,” he said.

Together with colleagues, they identified a number of pathways by which alcohol impacts the foetus, such as interfering with the myelination of nerves. The researchers came up with a treatment: choline, an essential nutrient. This has been used in a number of double-blind, placebo-controlled clinical trials in 2-5 year olds with foetal alcohol exposure.
Children receiving choline early in life showed higher non-verbal intelligence, higher visual-spatial skill, higher working memory ability, better verbal memory, and fewer behavioral symptoms of attention deficit hyperactivity disorder (ADHD) than those in the placebo group.

“The further back you go and do your intervention, the more leverage you have to alter the developmental trajectory of that particular child,” Dr Wozniak said. “So that was the exciting thing about bringing those children back and looking at their development and seeing much larger choline versus placebo effects in cognitive functions like working memory and even behavioural differences in terms of ADHD.”

Source: News-Medical.Net

Categories : COVID General InterestTags :

Have COVID Restrictions Eroded The Right to Dissent?

On By ModernMedia
Image by Niek Verlaan from Pixabay

An article in The Guardian explores how the COVID pandemic and its restrictions have also may have caused an erosion in the institutions of democracy around the world.

On Saturday, a vigil at Clapham Common in the UK for Sarah Everard, a woman believed to have been murdered by a police officer, was broken up by police in a heavy-handed manner which drew widespread criticism.
Defending the Metropolitan police’s handling of the situation, assistant commissioner Helen Ball argued the force had to act “because of the overriding need to protect people’s safety” from COVID. In 2020, Black Lives Matter protestors were criticised for their actions in the first waves of the pandemic, but their actions did not cause a spike in infections. Indeed, the protests may have helped deter the spread of COVID due to their deterring people from going to restaurants and other forms of social gatherings.

While the Clapham Common event was not on the same scale, it is possible that even very large and boisterous protests are not ‘super-spreader’ events. And, according to the human rights organisation Liberty, they can be performed safely. For example a socially distanced rally was held in Tel Aviv in April last year against the Israeli prime minister, Benjamin Netanyahu, where thousands of people,   each in their own space, separated by two metres, were able to shout and wave banners.

“Protest is the lifeblood of a healthy democracy, and it’s critical that we can all stand up to those in power, and make our voices heard,” said Lana Adamou, a lawyer at Liberty. “Safe, socially distanced demonstrations are perfectly possible, and it is the duty of the police to facilitate them, not block them. The current restrictions should be interpreted compatibly with our rights enshrined in the Human Rights Act.”

However a report published by Carnegie Europe in January observed that human rights are being eroded in the name of public health, with many governments using the pandemic as a pretext to crack down on dissent.

“While governments have claimed that they were imposing measures to tackle the pandemic, these measures often have been contradictory and have excessively restricted the right to peaceful assembly,” the report said, saying that while economic activities were enabled, large protests were still prohibited. In Sweden large groups were allowed to congregate in restaurants and at sporting events, but public gatherings and protests involving more than eight people were banned. It also noted that police used tactics such as kettling, a controversial tactic where police corral protestors into tight groups before arresting them, which can increase the spread of infection.

These restrictions have forced some campaigners to become creative in their protests. In the Netherlands, climate activists filled a square in front of the Dutch parliament in the Hague with 1000 shoes from all over the country. In Croatia, a civil society movement staged balcony protests against the governance of the mayor of Zagreb.

What campaigners in some countries will be asking is whether or not the pandemic has eroded the right to dissent, and to what extent will mass public protests be allowed to return once the COVID threat has passed.

Source: The Guardian

Categories : COVIDTags :

‘3 Feet’ Social Distancing Rule Being Considered by US

On By ModernMedia

Data that suggest a ‘three feet’ social distancing rule is under consideration, according to Dr Anthony Fauci, the foremost infectious disease expert in the US.

To control COVID transmission, the World Health Organization recommends social distancing at one metre (3.3 feet), and a three feet distance used in some schools in the US is based on this. When asked about the new report on a CNN programme on Sunday, Dr Fauci agreed the data appeared to indicate that three feet is sufficient.   

While the Centers for Disease Control and Prevention do not currently recommend a rule change, Dr Fauci said that the report is being reviewed by them.

“What the CDC wants to do is accumulate data, and when data shows ability to be three feet, they will act accordingly,” Dr Fauci said, adding that its director, Dr Rochelle Walensky, was aware of the new research, with the CDC also conducting its own studies. “I don’t want to get ahead of official guidelines,” he added.

The researchers, who controlled for community rates of coronavirus in their analysis, concluded that lower physical distancing policies can safely be adopted in school settings, as long as other measures like universal masking are in place.

The study compared COVID infection rates among staff and students across 242 school districts in the state of Massachusetts, and found that schools with a three feet social distancing rule did not have a significantly different rate of transmission compared to those with the standard six feet rule.

However, there is a limitation to COVID monitoring in school-aged populations. While children may be infected as readily from COVID, they are less likely to develop illness from COVID, and so they are also less likely to get tested.

Source: NY Times

Categories : COVID TransplantsTags :

COVID Vaccination in Immunosuppressed Patients Produces Weak Response

On By ModernMedia

An article by Dorry Segev, MD, PhD for MedPage Today reveals poor results for COVID vaccination in immunosuppressed patients, with concerning implications. 

Dr Segev professor of surgery and epidemiology and associate vice chair of surgery at Johns Hopkins University School of Medicine and Bloomberg School of Public Health.

Dr Segev and colleagues launched a national study of vaccine immune responses in immunosuppressed solid organ transplant recipients. Among 436 COVID-naïve participants who received their first mRNA vaccine dose, only 17% of them mounted detectable antibodies to SARS-CoV-2.  The researchers also found that those taking anti-metabolites (eg, mycophenolate or azathioprine) were less likely to develop antibody responses, with 8.75% with detectable antibody found in those taking anti-metabolites versus 41.4% in those not taking them.

“Naturally, we were disappointed to see these findings, as we were hoping to be able to tell our immunosuppressed patients that the vaccines seemed to work well for them. Given this observation, the CDC should update their new guidelines for vaccinated individuals to warn immunosuppressed people that they still may be susceptible to COVID-19 after vaccination,
Dr Segev wrote. 

The current CDC guidelines are worded in a way that suggests vaccination translates into immunity, Dr Segev pointed out, but the study demonstrates that for most transplant recipients, as well as other immunosuppressed patients that the vaccine does not automatically confer immunity. This could also be a concern for the some 37.9 million people around the world living with HIV, although the effects of achieving viral suppression with antiretroviral therapy have so far not been well investigated in relation to COVID. Vaccine trials so far have not had sufficient numbers of participants living with HIV to draw any conclusions.

Notably, their previous research did show that rates of COVID infection and mortality were not greater for immunosuppressed transplant patients. 
Dr Segev noted that there are some implications for immunosuppressed patients; firstly, that they should at the very least receive the second dose of their vaccination (the current research is only on the effects of the first dose), and secondly, immunosuppressed patients should be aware that they may not necessarily be immunised after receiving a vaccination. They should speak to their provider about an antibody test to determine if the immunisation has been achieved.

The researchers are continuing to investigate other aspects of immune response besides antibodies, such as T and B cells, and are also looking at other vulnerable populations.

Source: MedPage Today