A study led by researchers at the University of Colorado Anschutz Medical Campus reveals that both patients and providers have more positive overall care experiences when the entire healthcare team is a part of bedside interdisciplinary rounds (BIDR).
The findings showed that BIDR, when the team meets at a patients’ bedside in the hospital to discuss care plans, helps build trust between patients and their healthcare providers and within healthcare teams by allowing everyone to observe and work together more closely. The study is out now in the Journal of General Internal Medicine.
“Traditional interdisciplinary rounds (IDR) consist of a clinical care team that coordinates a patient’s care together to help promote collaboration in hospitals. BIDR takes this process a step further by taking the team to the bedside and involving patients and their families,” said lead author Katarzyna Mastalerz, MD, associate professor of hospital medicine at University of Colorado School of Medicine. “BIDR transforms this traditional healthcare model by fostering trust through transparent communication, team collaboration and patient-centred care where every voice is heard, and every goal can be shared.”
The study interviewed 14 patients and 18 members of a interdisciplinary teams that included nurses, pharmacists and care coordinators.
Patients who participated in BIDR expressed positive feelings about being involved in their healthcare plans, which enhanced their trust in providers. Healthcare professionals reported improved respect and trust among colleagues, which contributed to better patient care.
While results were mostly promising, patients and providers said there is room for improvement to make the process more streamlined.
For example, some patients reported being uncomfortable due to the use of technical jargon and unclear communication regarding their treatment plans. Meanwhile, the providers said they faced challenges related to lack of supportive structures for interprofessional collaboration and lengthy presentations by physicians.
“To build effective BIDR, we suggest healthcare teams use transparency by sharing goals with patients, employing accessible patient-centred language, clearly delineating team roles for each team member, and actively addressing team input in real time” said Mastalerz. “With the professional siloes and hectic workflow that often characterise hospitals, it’s especially important for hospital leadership to recognise, support, and create opportunities for collaborative work by interprofessional teams.”
Johannesburg’s first general hospital was built on the “brow of the hill” in 1890. The building is now abandoned and derelict. (Photo: Courtesy of WRHI)
Hillbrow started out as Johannesburg’s first health hub in the late 1880s. It’s also been a suburb associated with pimps and prostitution, a middle finger to the Nationalist Party, and a key site of the HIV crisis. Today, it’s the forgotten flatlands of inner city decay … but in small pockets it stays true to its heritage of bringing healthcare to the city’s most overlooked.
Putting some distance between people and disease can sometimes be a smart idea. It’s what early Johannesburg town planners had in mind when they decided that the city’s first hospital should rise on the “brow of the hill”, looking north away from the gold-flushed, but malady-stricken, mining centre.
Johannesburg’s first general hospital opened in 1890. It was four years after Johannesburg was proclaimed a city under the Transvaal government with Paul Kruger at its head. With the hospital as an anchor in the suburb, Hillbrow would grow to become the health node of the city as it rushed into the new century with heady intentions to become a modern metropolis.
The Johannesburg General Hospital would treat miners arriving with crushed limbs and broken bodies from mining accidents, which were frequent. Other patients were admitted with respiratory illnesses and ruined lungs from breathing in silica dust as the angled reef under the Witwatersrand was drilled and crudely blasted for its yellow treasure.
From the shanties and old mining camps came those burdened with diseases of absent hygiene and sanitation and overcrowding. Typhoid, tuberculosis (TB) and dysentery were common. There would be malaria and smallpox. In 1905, the Rand Plague Committee published a report detailing outbreaks of pneumonic plague and bubonic plague in those first years of the new century. There would be waves of influenza as the “Spanish Flu” of 1918 swept through the country.
Author of Johannesburg Then and Now Marc Latilla writes that the first Johannesburg hospital located in Hillbrow was described as “lofty with handsome fireplaces”. He writes that the hospital had 130 beds for black and white patients. More wards would come with expansion plans, but so would racially segregated healthcare. By 1895, a separate wing would be built for black patients.
Tumult and gold fever
The new city was being constructed against a backdrop of tumult and gold fever. Social tensions, divisions, and politics were also always in play. In 1896, there would be the abortive Jameson Raid, an insurgency meant to usurp Kruger’s government. The raid failed but it would ratchet up tensions between the Afrikaners and the British till the outbreak of the South African War in 1899. The war continued till 1902. By the end of the decade, in 1910, the country would become a union, uniting the four old colonies of South Africa. In another four years, World War I would break out.
Medical and health historian Professor Catherine Burns, of the University of Johannesburg’s Department of Historical Studies, says a more textured history reveals a story of whose health priorities ranked higher in the young city.
Joburg’s first medical officer of health, Dr Charles Porter, arrived from Scotland and he would have looked at Johannesburg framed against his Glaswegian childhood. “He would have encountered Johannesburg mining slums with Glasgow on his mind – seeing the conditions of crippled children and terrible miasmas; and an atmosphere of steam and filth as people staggered from the mines,” says Burn.
But importing a system of healthcare would have its limitations. Burns points out that even as the Johannesburg General Hospital would count as modern advancement for medicine, the melting pot of people drawn to early Joburg brought with them vastly different beliefs on healing, on warding off sickness, and the meaning of wellness.
“Throughout the city – even today – we see the venerable men and women who seek out hilltops and high places to perform the rituals and prayers of healing and wellbeing. And of course many of these spots are in Hillbrow or Yeoville. It means we can’t flatten everything, ignoring the layers upon layers of health history in the city,” she says.
The melting pot was growing and “Hospital Hill” with it. The early part of the new century would see the establishment of facilities for nurses’ accommodation, a fever hospital, a children’s hospital, a mortuary, an operating theatre, nursing homes, maternity hospitals, medical research facility and a medical school. Most ominous was the establishment of the “non-European” hospital built to further entrench racially segregated healthcare.
Kathy Munro, emeritus professor and heritage expert with the Johannesburg Heritage Foundation, says of particular significance was that the first Johannesburg hospital was built on state owned land and with the intention of service. These were the nascent ideals of a public health service for the city. The hospital was run by the Catholic Church’s Holy Family Sisters until 1915.
The front and back view of Johannesburg’s first general hospital, featuring the prominent laundry chutes that spiralled down the building. (Photo: Ufrieda Ho/Spotlight)
Munro says: “You then had a clustering of private hospitals like the Florence Nightingale, the Colin Gordon and the Lady Dudley Gordon around the state hospital complex that ran from the top of the hill to the bottom. The South African Medical Research Institute, founded in 1912 and housed in a fine Herbert Baker building, also came up along Hospital Road.
“The health authorities would have had to deal with the fragmentation in society and the separated services for the Non-European hospital and a whites-only hospital,” she says.
By the time apartheid was written into the statute book with the Nationalist Party coming to power in 1948, Munro says segregation would further shape the distribution of medical services in the city in the way Wits University had to deploy its medical students across the city.
“One of the inadvertent consequences of the apartheid system was that the university’s medical faculty had to service many hospitals that were fragmented on the basis of race. But it also meant that more specialist professors in each discipline came to be stationed at these hospitals,” she says.
By the mid-1960s and the 1970s, Hillbrow as a health hub shifted. The new Johannesburg General Hospital – now Charlotte Maxeke Academic Hospital – would rise as a concrete hulk in Parktown in 1978 and the original Johannesburg Hospital was renamed the Hillbrow Hospital.
In these decades, Hillbrow also became the flatlands made up of residential highrises, distinct from the rest of suburbia. Its residents were mostly young European expat professionals, recruited to work in a South Africa that was in an era of economic boom. According to The Joburg Book, edited by Dr Nechama Brodie, the new arrivals from Europe boosted the white population in the country by 50% between 1963 and 1972.
Hillbrow was now a high density suburb with different pressures on health services. It was also a suburb, Brodie writes, that “acquired a cosmopolitan Bohemian character … and nurtured a subculture that incorporated elements of ‘swinging London’ and America’s hippie culture”.
Under the two iconic city landmarks of Ponte Towers and the Hillbrow Tower (Telkom Tower), Hillbrow was an unbounded playground, freer from the hang-ups of racial segregation and largely managing to evade the heavy hand of apartheid-era law enforcers and morality policing.
But by the mid-1980s, South Africa was in various States of Emergency and Hillbrow changed once again. White flight came on fast as more black people moved from the townships to Hillbrow, which was central, affordable and also anonymous. Hillbrow’s slide to urban decline came at the same time as the anxious steps towards democracy. Landlords absconded; the city council failed on upkeep, maintenance, and bylaw enforcement. Banks redlined the area, leaving Hillbrow to become an urban slum.
Professor Helen Rees, founder and executive director of the Wits Reproductive Health and HIV Institute (WRHI), picks up the story from the mid-1990s. She says: “I had set up the Institute in 1994 and it was at the same time when HIV was just exploding. We started out in Soweto but worked with a public clinic dedicated to treating sexually transmitted infections (STIs) on Esselen Street in Hillbrow.
“I remember one morning when I got to the clinic the queue stretched around the corner, with about 100 people waiting. Of course, what we hadn’t appreciated fully was that HIV was driving up the level of STIs hugely,” she says.
Hillbrow’s population included groups not easy to link to and retain on care. They were young people, migrants and sex workers. It was enlarging the HIV challenge, Rees says.
Rees didn’t baulk. She doubled down and decided that the WRHI should be located in Hillbrow, right next to the Esselen Street Clinic, one of the first clinics in the country to offer HIV testing.
Staying in Hillbrow means the WRHI has to invest in infrastructure, to have back-up for basics like water supply, generators, and security. These things are needed if the institute is to function as a global leader of science, innovation and research in fields like infectious and vaccine preventable diseases, sexual and reproductive health, antimicrobial resistance, and health in a time of climate change.
The Institute was involved in COVID-19 vaccine trials, studies of the CAB-LA HIV prevention injection, and now they are involved in research on Mpox vaccines and on trials of the experimental M72 tuberculosis vaccine.
WRHI sits at the heart of that which survives of the Hillbrow health precinct. The Shandukani Centre for Maternal and Child Health that opened to the public in 2012 is also here. Other WRHI facilities include a clinic for sex workers as well as a clinic for transgender people. Their neighbours are the Esselen Street Clinic, that endures in the distinctive Wilhelm B Pabst designed building from 1941, and the Hillbrow Clinic, that runs a 24-hour service. Along Hospital Street, the forensic pathology and national laboratory services still function.
Throbbing to a different pulse
But beyond the WRHI’s electric fencing and street corners monitored by private security, much of Hillbrow life throbs to a different pulse. Most noticeable is that one of the WRHI’s immediate neighbours is the condemned building of the one-time Florence Nightingale Maternity Hospital. The building is now a so-called dark building, simply not considered fit for life. The first Johannesburg Hospital stands derelict and abandoned, as does the chapel and the house the Catholic nursing sisters lived in when they tended to patients in the hospital.
And the Hillbrow streets live up to much of its bad reputation. It’s overcrowded with people and garbage. Drug users curl up slumped against urine-soaked concrete benches as hawkers are forced to retrieve water from the city’s smashed water pipes and it seems every bylaw is ignored.
Rees is clear though that WRHI, which marks its 30-year anniversary this year, is exactly where it needs to be. She says the coming needs for healthcare globally will focus on healthcare in slums and healthcare on society’s periphery because more people’s lives are precarious and more people will call slums home.
“The work we do is defined by the context and the needs of the population. But we have created a hugely professional context and run a state of the art institute,” she says. “You cannot do clinical research for the things that affect the majority of communities unless you’re actually working in those communities.”
It means some of WHRI’s budget does go into fixing things in their neighbours’ buildings – repairing pipes or cleaning up backyards turned to garbage dumps. It’s not technically their responsibility but it is a response that helps them remain a relevant and durable pillar. And in a place like Hillbrow, where so many people survive by transience and invisibility, something that holds firm a little longer can make a big difference.
Creative artwork featuring 3D renderings of respiratory syncytial virus (RSV)—a common contagious virus that infects the human respiratory tract – colourised as follows: (the viral envelope is purple, G- glycoproteins are light blue, and F-glycoproteins are orange). F-glycoproteins allow the virus to fuse with and infect human cells. Credit: NIAID/NIH
Since their introduction last year, researchers have been monitoring the real-world impact of the new respiratory syncytial virus (RSV) vaccines. In a recent commentary in The Lancet, Angela Branche, MD, an infectious diseases researcher at the University of Rochester Medical Center (URMC), details what has been learned during the vaccine’s first season.
“The evidence is clear; individuals should get vaccinated if they have conditions that place them at risk for severe disease. For older adults and those with chronic conditions, RSV should be considered as serious as the flu, and they should get vaccinated,” said Branche.
RSV is a significant cause of severe respiratory illness among older adults, especially those with underlying health conditions. Worldwide, RSV causes millions of infections, hundreds of thousands of hospitalisations, and tens of thousands of deaths annually in adults aged 60 and older. Older people with RSV are at higher risk of severe illness compared to those with influenza or COVID.
In 2023, the FDA approved three RSV vaccines for older adults. Studies have shown these vaccines to be effective, with the Pfizer, GSK, and Moderna vaccines preventing RSV pneumonia and bronchitis in more than 80% of participants.
A recent study published in The Lancet assessed the effectiveness of RSV vaccines using data from a large electronic health record network involving the Centers for Disease Control and Prevention (CDC) and multiple US healthcare systems. The study found that RSV vaccines were 80% effective in preventing hospitalisation, ICU admission, and death among adults aged 60 and older. Vaccine effectiveness was consistent across age groups, including those 75 and older, and among immunocompromised individuals. The study did not find evidence of waning vaccine protection within the season.
The uptake of the RSV vaccine in the 2023-2024 winter season was low, however. An estimated 24% of US adults aged 60 years and older received the vaccine, compared to influenza vaccination rates, which approach 50% each year for the same group. “Providers were not sure how to apply the shared clinical decision-making recommendations in the first season, and there remains a general lack of knowledge among the medical community and the public on what constitutes a risk for severe disease and who needs to be protected,” said Branche.
Based on these findings, the US Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that advises the CDC, updated guidelines in June 2024 to recommend RSV vaccination for all adults aged 75 and older, those 60 and older in long-term care facilities or with chronic and high-risk health conditions.
“This new data enabled the ACIP to make more definitive recommendations, which will build public confidence in the effectiveness of these vaccines and make implementation a lot easier for providers and pharmacies,” said Branche.
New research shows that vaccines that target multiple strains of the RSV virus, called bivalent vaccines, may provide longer protection. URMC infectious disease experts helped lead an international study of a bivalent RSV vaccine developed by Pfizer, the results of which were recently detailed in the New England Journal of Medicine. The vaccine effectively prevented severe RSV-related lower respiratory tract illnesses over two RSV seasons, with > 80% overall efficacy. The experimental vaccine was particularly effective in individuals aged 60-79.
In people with a rare condition called light chain amyloidosis, light chain proteins – which are a component of antibodies – mutate and build up in different organs. In new research published in The FEBS Journal, investigators have identified and characterised an antibody fragment that can bind to abnormal light chains to stabilise them and prevent their aggregation.
The findings could have an important clinical impact because the current prognosis for individuals with light chain amyloidosis is extremely poor, and current treatments, which rely on attacking the defective light chain–producing cells, are difficult to tolerate.
The results may also be applicable to other forms of amyloidosis, including Alzheimer’s disease.
“We are excited by this finding, which has potential to provide a much-needed treatment for people diagnosed with light chain amyloidosis,” said corresponding author Jillian Madine, PhD, of the University of Liverpool, in the UK.
Obesity and type 2 diabetes are risk factors for various malignancies, including pancreatic cancer, which has a high death rate. A new analysis in Diabetes/Metabolism Research and Reviews suggests that metabolic-bariatric surgery may lower the risk of developing pancreatic cancer in people with obesity, especially in those who also have type 2 diabetes.
In the systematic review and meta-analysis, investigators identified 12 relevant studies that explored the effects of metabolic-bariatric surgery on pancreatic cancer incidence, with a total of 3 711 243 adults with obesity. Surgery was associated with a 44% reduction in pancreatic cancer risk among individuals with obesity but without type 2 diabetes and a 79% risk reduction in those with both obesity and type 2 diabetes.
“Metabolic-bariatric surgery not only has beneficial effects on obesity and type 2 diabetes but also may play a crucial role in reducing the risk of pancreatic cancer in these individuals,” said corresponding author Angeliki M. Angelidi, PhD, of the Broad Institute of MIT and Harvard. “These findings underscore the need for further research to elucidate the underlying mechanisms and understand the full spectrum of health benefits of metabolic-bariatric surgery beyond weight loss.”
