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Tag: Story Ideas: Medicine

  • Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

    Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

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    Newswise — SAN FRANCISCO — Although people with opioid use disorder (OUD) are significantly more likely to overdose or have a complication after major surgery than those without the disorder, using medications for the treatment of OUD before surgery may eliminate that extra risk, suggests a large, first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Patients with OUD who didn’t use an OUD medication (such as buprenorphine or methadone) were over four times more likely to overdose after having surgery, yet those who used evidence-based OUD medication before surgery were essentially at no greater risk than those who didn’t have OUD, according to the study. Taken orally, OUD medications reduce withdrawal and cravings and prevent opioids from producing the feeling of euphoria that drives addiction.

    “We know that OUD treatments are very effective in helping to prevent relapse, overdose and death in nonsurgical patients, but our research is the first to show that they also may be remarkably effective in at-risk patients facing surgical stress and recovery pain that often is addressed with opioids,” said Anjali Dixit, M.D., MPH, a pediatric anesthesiologist at Stanford University, California. “This is helping us learn more about how to optimally treat OUD patients so that their surgical and post-surgical pain is well-controlled, while also making sure we are minimizing their risk of relapse and overdose.”

    Researchers analyzed 4,030,032 surgeries performed between 2008 and 2020 from the Merative MarketScan Commercial Database, a nationwide sample of data from patients with both employer-sponsored and Medicare Advantage insurance. The analysis reviewed overdoses and other complications (such as OUD-related hospitalization or infection) that occurred in the three months after surgery for the 25 most common surgeries, including knee and hip replacement, hysterectomy and gallbladder removal.

    Of the over 4 million surgeries, 26,827 were performed on patients who had a history of OUD, 9,699 (36%) of whom used OUD medications in the month before surgery and 17,128 (64%) who did not. OUD patients who did not use OUD medications were 4.2 times more likely to overdose or have an OUD-related infection or hospitalization than those who did not have the disorder, according to the study. OUD patients who used OUD medications did not experience a statistically different risk of opioid-related adverse events compared to those who did not have the disorder.

    As many as 7.6 million people in the U.S. live with OUD, according to research, and that number continues to grow. Only 20% of people with OUD currently use OUD medications, said Dr. Dixit. She noted the number of people in the study who used OUD medications was likely higher, because they had access to commercial insurance and therefore, better access to care. The researchers also want to look at other populations such as those on Medicaid, because they may be sicker and have less access to care.

    “The national efforts to increase access to OUD medications is good news for people with OUD, including those who need surgery,” said Dr. Dixit. “The next step is to determine if a particular medication or regimen is better than another.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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    American Society of Anesthesiologists (ASA)

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  • Two easy fixes could reduce bleeding after cesarean delivery

    Two easy fixes could reduce bleeding after cesarean delivery

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    Newswise — SAN FRANCISCO — Two simple solutions could help prevent severe bleeding (postpartum hemorrhage) after cesarean delivery, suggests research presented at the ANESTHESIOLOGY® 2023 annual meeting. As the leading cause of maternal mortality in the U.S. at the time of birth, postpartum hemorrhage is more common after cesarean deliveries than vaginal births.

    Both solutions help address uterine atony, which causes up to 80% of postpartum hemorrhage. Uterine atony is when, after delivery, the uterus remains soft and weak instead of contracting to compress the blood vessels that had been attached to the placenta. One solution involves infusing a medication to help the uterus contract after delivery. The other is an early warning system that prompts an assessment of how well the uterus is contracting after delivery to quickly alert the health care team when a woman is at risk for heavy bleeding and requires treatment.

    “Bleeding during a cesarean delivery is a high-stakes, high-risk situation, and when it occurs, the obstetrics and anesthesia teams must work together to rapidly prevent and treat ongoing bleeding,” said James Xie, M.D., lead author of the early warning study and clinical assistant professor of anesthesiology, perioperative and pain medicine at Stanford University, California. “Studies have shown that rapid recognition and management are essential to improving outcomes.”

    “The ultimate goal is to decrease maternal mortality and morbidity,” said Jessica Ansari, M.D., M.S., senior author for both studies and an obstetric anesthesiologist at Stanford University. “Recent estimates show a new mother dies of postpartum hemorrhage about every seven minutes, mostly in low-resource settings. If our findings can be confirmed in larger studies, it could transform the way we prevent and treat postpartum hemorrhage.”

    Calcium chloride infusion

    The researchers looked at using calcium chloride to help prevent bleeding in women with uterine atony because it is inexpensive, simple, safe and doesn’t require refrigeration like other treatments. Consequently, it can be used even in very low-resource settings, where women are much more likely to die from pregnancy-related bleeding. They found that calcium chloride reduced the amount of bleeding that patients experienced during their cesarean delivery by nearly a measuring cup (more than 200 mL).

    The double-blind, randomized, controlled trial included 120 women who required a cesarean delivery after labor with an oxytocin infusion (which increases contraction of the uterus during labor), placing them at much higher risk of suffering from uterine atony and bleeding after the birth. Researchers randomly assigned 60 women to receive 1-gram infusions of calcium chloride and 60 women to receive a placebo. The infusion was administered slowly after the baby was delivered, and the study was blinded, meaning the patients and their doctors were unaware if they received calcium or the placebo. Of the women who received the placebo, 57% had postpartum hemorrhage and 15% required a blood transfusion, while 40% of those who received calcium chloride had postpartum hemorrhage and 8.3% required a blood transfusion.

    The last Food and Drug Administration-approved drug to treat uterine atony was released in 1979.

    “New treatments to treat uterine atony are desperately needed,” said Alla Yarmosh, M.D., lead author of the study and clinical assistant professor in anesthesiology at Stanford University. “This is the first time an infusion of calcium chloride has been studied as a possible treatment to help the uterus contract after cesarean delivery and decrease bleeding in those patients. If our findings are confirmed by larger studies, it would be an easy technique for institutions to implement since anesthesiologists run infusions during surgery regularly.”

    Early warning system

    For the early warning study, researchers created an alert that pops up on the anesthesiologist’s electronic health record (EHR) module two minutes after the baby is marked as delivered, asking for a uterine score from 1-10. The anesthesiologist prompts the obstetrician to assess the uterine tone (by manually feeling it) and provide the score, which the anesthesiologist records. Scores of 6 or lower mean the uterus is not contracting well and the woman is at higher risk for postpartum hemorrhage.

    This real-time communication that a woman is at risk alerts the treatment team, which can then determine the best solution. Physicians can give the woman medications to help the uterus contract better or put stitches or balloons in the uterus to compress the vessels to prevent further bleeding, said Dr. Xie. They also can anticipate and prepare for hemorrhage, which can be addressed by giving the woman medications to stabilize blood clotting or ordering blood products to be ready for transfusion.

    The study assessed more than 1,000 consecutive cesarean deliveries by 70 different obstetricians over eight months. The uterine tone score was assessed three times for each patient and was documented reliably; two minutes after delivery (recorded 87% of the time), seven minutes after delivery (recorded 97% of the time), and 12 minutes after delivery (recorded 98% of the time). At 12 minutes, 179 women (18%) had scores of 6 or lower, meaning they were at higher risk for severe bleeding. Of those with scores of 6 or lower, 77% experienced hemorrhage, 46% experienced major hemorrhage and 25% needed a blood transfusion.

    “Our research shows that this simple scoring system is a very meaningful, easy way to ensure that if the uterus is contracting poorly and there is a risk of hemorrhage, it will be recognized by their health care team early,” said Dr. Xie. “In the future we can further refine models that predict when women are at high risk of bleeding around the time of delivery to help physicians be prepared to manage bleeding caused by poor uterine tone.”

    The United States has the highest maternal mortality rate among high-income countries.

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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    American Society of Anesthesiologists (ASA)

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  • AI Pain Recognition System Could Help Detect Patients’ Pain Before, During and After Surgery

    AI Pain Recognition System Could Help Detect Patients’ Pain Before, During and After Surgery

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    Newswise — SAN FRANCISCO — An automated pain recognition system using artificial intelligence (AI) holds promise as an unbiased method to detect pain in patients before, during and after surgery, according to research presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Currently, subjective methods are used to assess pain, including the Visual Analog Scale (VAS) — where patients rate their own pain — and the Critical-Care Pain Observation Tool (CPOT) — where health care professionals rate the patient’s pain based on facial expression, body movement and muscle tension. The automated pain recognition system uses two forms of AI, computer vision (giving the computer “eyes”) and deep learning so it can interpret the visuals to assess patients’ pain.

    “Traditional pain assessment tools can be influenced by racial and cultural biases, potentially resulting in poor pain management and worse health outcomes,” said Timothy Heintz, B.S., lead author of the study and a fourth-year medical student at the University of California San Diego. “Further, there is a gap in perioperative care due to the absence of continuous observable methods for pain detection. Our proof-of-concept AI model could help improve patient care through real-time, unbiased pain detection.”

    Early recognition and effective treatment of pain have been shown to decrease the length of hospital stays and prevent long-term health conditions such as chronic pain, anxiety and depression.

    Researchers provided the AI model 143,293 facial images from 115 pain episodes and 159 non-pain episodes in 69 patients who had a wide range of elective surgical procedures, from knee and hip replacements to complex heart surgeries. The researchers taught the computer by presenting it with each raw facial image and telling it whether or not it represented pain, and it began to identify patterns. Using heat maps, the researchers discerned that the computer focused on facial expressions and facial muscles in certain areas of the face, particularly the eyebrows, lips and nose. Once it was provided enough examples, it used the learned knowledge to make pain predictions. The AI-automated pain recognition system aligned with CPOT results 88% of the time and with VAS 66% of the time.

    “The VAS is less accurate compared to CPOT because VAS is a subjective measurement that can be more heavily influenced by emotions and behaviors than CPOT might be,” said Heintz. “However, our models were able to predict VAS to some extent, indicating there are very subtle cues that the AI system can identify that humans cannot.”

    If the findings are validated, this technology may be an additional tool physicians could use to improve patient care. For example, cameras could be mounted on the walls and ceilings of the surgical recovery room (post-anesthesia care unit) to assess patients’ pain — even those who are unconscious — by taking 15 images per second. This also would free up nurses and health professionals — who intermittently take time to assess the patient’s pain — to focus on other areas of care. The researchers plan to continue to incorporate other variables such as movement and sound into the model.

    Concerns about privacy would need to be addressed to ensure patient images are kept private, but the system could eventually include other monitoring features, such as brain and muscle activity to assess unconscious patients, he said.

     

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook and follow ASALifeline on Twitter and use the hashtag #ANES23.

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    American Society of Anesthesiologists (ASA)

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  • More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist

    More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist

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    Newswise — SAN FRANCISCO — Patients who had common procedures performed outside of the operating room (OR) were more likely to go home instead of to a long-term care facility when they were discharged from the hospital if their sedation was administered or directed by an anesthesiologist, rather than by a physician who is not a trained anesthesiologist, according to a first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Patients who need catheters placed in a vein, angiograms (X-ray of the blood vessels), image-guided biopsies and many other procedures typically are treated in the interventional radiology (IR) suite instead of the OR and given sedation. Sedation is a type of anesthesia that relieves anxiety, controls pain and discomfort, and sometimes makes them fall asleep. One in 10 patients admitted to the hospital requires an IR procedure and many are at increased risk for complications due to health issues or having more complex procedures.

    The study was the first to directly compare the hospital discharge outcomes of patients who received sedation administered by an anesthesiologist, or by a nurse anesthetist under the direction of an anesthesiologist, to the discharge outcomes of patients whose sedation was administered or directed by a physician who was not an anesthesiologist, such as a radiologist or cardiologist. Anesthesiologists are physicians who are experts in ensuring the safety and comfort of patients undergoing surgery and other procedures and are highly trained in critical care to manage medical emergencies if there is a complication. 

    “We focused on patients undergoing IR procedures as they often have health issues such as heart disease or diabetes and some of the procedures are high risk,” said Matthias Eikermann, M.D., Ph.D., senior author of the study and chair of the department of anesthesiology at Montefiore Medical Center, Bronx, New York. “We found anesthesiologists add value to patients undergoing interventional radiology procedures. That’s especially true for complex neurovascular procedures such as angiograms for the treatment of aneurysms or the creation of an arteriovenous (AV) fistula, a connection between an artery and a vein, for people on dialysis and those that typically take longer than an hour.”

    In the study, 9,682 patients had sedation in the IR suite and 1,639 (16.93%) were discharged from the hospital to a long-term care facility (such as a nursing home) because of complications that they may be more likely to experience due to their disease. Anesthesiologists have the training to identify these complications early and address them.

    Of those who were not discharged home, 1,429 (87%) had their sedation administered or directed by a physician who was not an anesthesiologist, often with the assistance of a nurse, and 210 (13%) had their sedation administered or directed by an anesthesiologist.

    “The anesthesiologist is not just providing sedation, but life support for the patient during the entire procedure,” said Dr. Eikermann. “The difference in outcomes is because anesthesiologists are trained to identify early complications and treat them immediately. Physicians who are not anesthesiologists are not trained to do that.”

    Anesthesiologists administered or directed sedation for higher-risk patients, such as those with more health issues or who had more invasive procedures. Despite being at higher risk, the patients who received sedation administered or directed by an anesthesiologist were nearly 70% more likely to be discharged home than those whose sedation was administered or directed by a physician who was not an anesthesiologist.

    “Increasingly, high-risk patients are undergoing procedures outside of the OR,” said Vilma Joseph, M.D., MPH, FASA, co-author of the study and director of procedural sedation at Montefiore Medical Center. “The presence of physician anesthesiologists as part of the anesthesia care team model has been associated with improved outcomes.”

    “Patients should know that they can ask for an anesthesiologist if they are concerned about excessive pain, anxiety or their safety during diagnostic procedures,” said Dr. Eikermann. “Our research suggests rethinking anesthesia assignments to ensure anesthesiologists provide sedation when patients are at higher risk due to their health or are having more complex, longer or more-invasive procedures.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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    American Society of Anesthesiologists (ASA)

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  • Johns Hopkins School of Nursing Professor Bonnielin Swenor Named Inaugural Endowed Professor of Disability Health and Justice

    Johns Hopkins School of Nursing Professor Bonnielin Swenor Named Inaugural Endowed Professor of Disability Health and Justice

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    Newswise — Johns Hopkins School of Nursing Professor Bonnielin Swenor, PhD, MPH, BS, also founder and director of the Johns Hopkins Disability Health Research Center, has been named the inaugural Endowed Professor of Disability Health and Justice.

    “Dr. Bonnielin Swenor is an incredible researcher, scientist, and educator with an unrelenting drive to ensure that people with disabilities are able to thrive,” says JHSON Dean Sarah Szanton, PhD, RN, FAAN. “Her installation as an endowed chair formally acknowledges the impact her career has made, and our trust in all there is to come.”

    “Dr. Swenor and the Center are committed to training the next generation of disability equity researchers, including researchers with disabilities,” says Jermaine Monk PhD, MSW, MS Mgmt, MA Th, MA, Associate Dean of Diversity, Equity, Inclusion, and Belonging. “That is so important to build into nursing education as we prepare the next generation of nurses.”

    The chair was funded by the estates of Ms. Charlotte B. Lockner, School of Nursing alumna from the Class of 1955; Mr. Ralph S. O’Connor, University Trustee and Krieger School of Arts and Sciences alumnae from the class of 1951; and Antoinette Delruelle and Joshua L. Steiner, along with The Maryland E-Nnovation Initiative Fund Authority.

    Today more than 27 percent of American adults have a disability, and yet people with disabilities still face many barriers to health, equity, and inclusion.

    With that in mind, the Endowed Professorship of Disability Health and Justice was established to push scientific discovery and develop innovative, evidence-based strategies to foster inclusion of people with disabilities into the workforce.

    Dr. Swenor founded and directs the Johns Hopkins Disability Health Research Center, which is home to experts across disciples who test and collaborate on data-driven approaches to reduce disability inequity. It officially moved to the School of Nursing in 2022 when Dr. Swenor joined the faculty. The professorship will fund Dr. Swenor and the Center to develop novel tools that inform policy and integrate artificial intelligence (AI) and other technologies into new disability health tools.

    “I am honored to be the inaugural Endowed Professor of Disability Health and Justice,” says Dr. Swenor. “We aim to shift the paradigm from ‘living with a disability’ to ‘thriving with a disability’ and maximize the health, equity, and participation of people with disabilities.”

    Through this endowed chair, Dr. Swenor and the Johns Hopkins Disability Health Research Center will have significant impact on our ability to build up activism and visibility in the disability community.

    ***

    Located in Baltimore, the Johns Hopkins School of Nursing is a globally-recognized leader in nursing education, research, and practice. In U.S. News & World Report rankings, the school is No. 1 nationally for its DNP program and No. 2 for its master’s. In addition, JHSON is ranked as the No. 3 nursing school in the world by QS World University. The school is a five-time recipient of the INSIGHT Into Diversity Health Professions Higher Education Excellence in Diversity (HEED) Award and a four-time Best School for Men in Nursing award recipient. For more information, visit www.nursing.jhu.edu.

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  • Black Patients More Likely to Perceive Racial Bias From Orthopaedic Surgeons

    Black Patients More Likely to Perceive Racial Bias From Orthopaedic Surgeons

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    Newswise — October 9, 2023 – Black patients report more difficulties relating to their orthopaedic surgeon and are more likely to perceive bias from their surgeon, as compared with White patients, reports a study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

    “Black patients were six times more likely to report difficulty relating to their surgeon and 14 times more likely to report perceived racial bias compared with their White counterparts,” according to the survey study by Marsalis Brown, MD, of University Hospitals – Cleveland Medical Center, and colleagues. The research also shows race- and gender-related differences in patient preferences for orthopaedic surgeons with specific characteristics.

    Survey shows racial differences in patient experiences

    The study evaluated patients’ experiences, perceptions, and preferences related to diversity in orthopaedic surgery. The survey included 349 patients seen at orthopaedic clinics within the authors’ health system. About 80% of respondents were White and 18% were Black; only about three percent were Hispanic.

    The results showed differences in patient experiences between racial groups. Black patients were more likely to report difficulties relating to their orthopaedic surgeon, as compared with White patients: 11.48% versus 2.29%. Black patients were also much more likely to perceive racial bias from their surgeon: 5.17% versus 0.37%.

    Patients perceived low levels of diversity within orthopaedic surgery (average rating of 2.5 out of 10) with only a small difference between Black and White patients (2.10 versus 2.57). Black patients ranked race as a more important factor to consider when selecting a surgeon: average rating 3.49 compared with 1.45 for White patients.

    Women report more difficulty relating to their orthopaedic surgeon

    Women were about five times more likely to report difficulty relating to their surgeon. Although male and female patients had similar perceptions of diversity in orthopaedic surgery, women placed more importance on their surgeon’s gender.

    The study also found some differences according to patient income and education, with more-educated patients perceiving lower diversity among surgeons. That perception is consistent with the slow rate of change in representation of racial and ethnic minorities and women in orthopaedic surgery, which lags behind other surgical specialties.

    The findings are especially important in light of recent studies, which have shown that diversity leads to higher patient satisfaction, greater adherence to recommended treatment, and improvement in the patient-physician relationship. “Despite the ongoing education reforms to encourage increased diversity during trainee selection, the impact of such efforts is yet to manifest as changes in patient perceptions in current practice settings,” Dr. Brown and coauthors write. They discuss the critical need for reforms early in medical education, including early exposure to orthopaedic surgery, improving access to mentors, and steps to improve retention through each educational level.

    Read Article [ Patient Preferences and Perceptions of Provider Diversity in Orthopaedic Surgery ]

    Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

    ###

    About The Journal of Bone & Joint Surgery

    The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.

    About Wolters Kluwer

    Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

     Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,900 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

    For more information, visit www.wolterskluwer.com, follow us on LinkedIn, Twitter, Facebook, and YouTube.

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  • Tunable “Affibodies” Offer a New Approach to Healing Bone Fractures

    Tunable “Affibodies” Offer a New Approach to Healing Bone Fractures

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    Newswise — Instead of bulky metal plates and screws, bone fractures might someday be healed via targeted, controlled delivery of a specialized bone-growth protein.

    University of Oregon researchers have developed a system to get that protein to the site of injury and release it gradually over time. Their approach uses small proteins called affibodies, which can be specially engineered to grab onto specific other proteins and release them at different rates.

    The team reports their results in a paper published June 28, 2023 in Advanced Healthcare Materials.

    Healing is a complex biological process, with many different proteins at the site of injury aiding in regeneration. “This initial proof of concept shows we can release things at different rates, like other proteins, to mimic how the bone would naturally regenerate,” said Jonathan Dorogin, a graduate student in Marian Hettiaratchi’s lab who led the design. Hettiaratchi is an assistant professor in the UO’s Phil and Penny Knight Campus for Accelerating Scientific Impact.

    One of these many healing-related proteins is bone morphogenetic protein-2, or BMP-2. Early in development, it helps bones form. And when someone breaks a bone, cells around the site of the fracture secrete this protein to help new bone grow. Recently, scientists and doctors have been interested in giving patients infusions of BMP-2 as a treatment to hasten healing.

    But BMP-2 is so powerful that it can easily lead to off-target effects, causing bone growth where it’s not wanted and leading to unexpected complications.

    Hettiaratchi and her colleagues have been trying to develop a more controlled strategy. Affibodies piqued the lab’s interest as a possible solution because they’re small and relatively simple to engineer, Hettiaratchi said. These molecules are cousins to antibodies, immune system molecules that selectively latch onto bacteria or viruses. But affibodies’ pared-down size makes them easier to generate in the lab. And because they’re engineered to be highly specific to the proteins they’re sticking to, there’s less risk of them interacting with other things they’re not supposed to in the body.

    The team screened a set of affibodies by testing how well they stuck to BMP-2, looking for molecules that would stick solidly but still release the protein under the right conditions. As candidate for further testing, they picked one affibody that stuck to BMP-2 more strongly, and another that had a weaker connection.

    They linked those affibodies with a squishy material called a hydrogel, which is often used as a delivery vehicle in the body for BMP-2 and similar treatments. Then, they tested how the whole package behaved in a liquid solution that mimics the environment inside the body.

    Adding affibodies to the hydrogel made it release BMP-2 more slowly than an affibody-free hydrogel, the researchers found. And changing up the affibodies could alter the rate of release, too.

     “Our innovation has been to control when the protein comes out,” Dorogin said.  

    In collaboration with colleagues in the lab of Knight Campus researcher Parisa Hosseinzadeh, the team also used machine learning to better understand how the affibodies were interacting with BMP-2.

    Hettiaratchi and Dorogin anticipate the work will be most useful for severe or complex fractures, where there’s a higher likelihood of a bone not healing correctly. They’ve filed a patent for the design of this BMP-2 delivery strategy, and are moving on to further testing with the hopes that someday, this tunable approach could be used in human patients. 

    They see affibodies as far more than just a platform for BMP-2 delivery, though. Healing is complicated, and the natural process involves a cascade of different molecules rushing to the site of injury at different times and in different quantities.

    Hettiaratchi ultimately envisions an affibody-based system that could deliver many healing-related proteins to the site of an injury, each one tuned to come in at a specific rate depending on when it’s needed during the healing process.

    “BMP-2 was a great protein to start with, because we knew it would be clinically relevant,” Hettiaratchi said. “But the long-term goal is to apply this to many things in the clinic.”

     – By Laurel Hamers, University Communications

    This research is funded in part by the Department of Defense and the National Institutes of Health. The team also received a pilot grant from the Collins Medical Trust.

    About the Knight Campus 
    The Phil and Penny Knight Campus for Accelerating Scientific Impact is a hub of discovery and innovation where teams of world-class bioengineers and bioscientists are driving groundbreaking scientific research and providing an innovative approach to technical training, professional development, and entrepreneurship. Made possible by a $500 million lead gift from Penny and Phil Knight in 2016 and a second $500 million gift in 2021, the Knight Campus is home to several research centers of excellence and offers a Ph.D. in bioengineering, a bioengineering minor and an accelerated master’s degree program with multiple industry focused tracks. 

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  • Yelp Reviews of Plastic Surgeons – What Factors Affect Positive and Negative Ratings?

    Yelp Reviews of Plastic Surgeons – What Factors Affect Positive and Negative Ratings?

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    Newswise — July 27, 2023 – How many stars would you give your plastic surgeon? An analysis of Yelp reviews identifies a wide range of surgeon-and practice-related factors that influence whether plastic surgery patients leave positive or negative reviews, reports the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

    “Our study also identifies some sources of bias that may affect patients’ perceptions of their care – although the plastic surgeon’s gender or race doesn’t appear to affect the overall quality ratings,” comments senior author Brent R. DeGeorge, MD, PhD, of University of Virginia, Charlottesville.

    Multiple factors affect five-star versus one-star ratings

    The researchers analyzed 5,210 Yelp reviews of plastic surgery provider practices from 49 cities across the United States. Reviews were coded for the presence of positive and negative themes. Surgeon and practice-related factors associated with positive or negative ratings were identified, including the effects of the physician’s race and gender.

    80% of reviews included in the analysis were five-star reviews, indicating the highest level of patient satisfaction. Another 13.5% were one-star reviews, reflecting the lowest patient satisfaction. Two- to four-star ratings accounted for only about six percent of reviews.

    In positive reviews, the most frequently mentioned surgeon-related factors were the surgical outcomes achieved, the physician’s temperament, the physician’s competency and knowledge, and physician-patient communication.

    “Patients with positive experiences emphasized having results that looked natural and matched the look they had discussed with the physician prior to surgery,” Dr. DeGeorge and colleagues write. “Patients felt most comfortable with physicians who gave thorough explanations of the procedures beforehand, often spending several hours over multiple consultation sessions.”

    Plastic surgeons can learn from online reviews to improve the patient experience

    In adjusted analyses, positive physician factors associated with higher Yelp ratings were surgical outcomes, physical exam/procedures, injectable outcomes, competency and knowledge, and temperament. Negative mentions of the same factors were linked to lower Yelp ratings, along with cost consciousness.

    On analysis of practice-related factors, interactions with office staff and issues related to scheduling significantly affected whether patients left positive or negative reviews. Additional negative practice-related factors included billing/insurance issues and wait times. The study “corroborates the results of past studies, which have found that practice factors such as wait time and courtesy of registration staff were correlated with a patient’s likelihood to highly rate a practice,” according to the authors.

    Yelp ratings were not significantly associated with the physician’s race or gender. While that’s an encouraging finding, the researchers note some differences in both positive and negative factors related to race and gender. “Further research is needed to identify the effect of patient characteristics on their ratings and reviews of providers,” Dr. DeGeorge and colleagues write.

    While noting some limitations of the study – including the inherent subjectivity of online ratings – the researchers believe their analysis lends new insights into the range of physician and practice-related factors influencing patient perceptions of quality of care. Dr. DeGeorge and coauthors conclude: “Plastic surgeons can learn from patient ratings and reviews to develop initiatives to improve the patient experience and learn more about general biases held by patients as the field becomes more diverse.”

    Read [The Ratings Game: Demographic and Practice Factors Affecting Yelp Ratings of Plastic Surgeons]

    Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

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    About Plastic and Reconstructive Surgery

    For over 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

    About ASPS

    The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

    About Wolters Kluwer

    Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

    Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

    For more information, visit www.wolterskluwer.com, follow us on LinkedIn, Twitter, Facebook, and YouTube.

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  • Loyola Medicine Improves Health Equity by Increasing Access to Kidney Transplants for Patients with Obesity

    Loyola Medicine Improves Health Equity by Increasing Access to Kidney Transplants for Patients with Obesity

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    Newswise — MAYWOOD, IL – Diabetes and high blood pressure are among the primary causes of renal failure. They also contribute to obesity which poses a major obstacle to qualifying for a transplant, particularly for minority communities disproportionately affected by obesity. Fortunately, minimally invasive robotic surgical technology can improve access for patients who might otherwise be ineligible for a kidney transplant. Loyola Medicine’s advanced robotic surgery program makes it one of the few hospitals in the country to offer kidney transplantation to patients with obesity.

    Raquel Garcia-Roca, MD, surgical director of the kidney, pancreas and living donor kidney transplant programs, said, “in the majority of the transplant centers, not only here in Chicago, but nationwide, there is limited access to transplantation when the patient’s body mass index is above 35, an indication of obesity.” Patients with high BMIs are typically ruled ineligible for transplantation due to the increased risk of complications that comes with obesity and its comorbid conditions, including increased infection rates.

    However, the advanced technology of robotic surgery allows surgeons to operate using keyhole surgery, which improves outcomes with faster recovery and reduced infection risk compared with open surgery. “Most transplant centers will ask potential kidney recipients to lose weight before they can get a transplant,” said Garcia-Roca. “This can be difficult for patients who already have limited dietary options due to their renal disease and whose condition often makes it hard to exercise. Loyola is one of the very few centers in the nation that has not included obesity as a limitation for transplantation.”

    Dr. Garcia-Roca says the ability to provide transplants for patients with obesity helps improve health equity in minority communities disproportionately affected by obesity. According to the CDC, non-Hispanic Black adults had the highest age-adjusted prevalence of obesity (49.9%), followed by Hispanic adults (45.6%) and non-Hispanic White adults (41.4%).

    Loyola’s ability to perform transplants for patients with obesity proved to be lifesaving for Israel Sanchez, a patient with end-stage renal failure. When Sanchez was a child living in Mexico, he developed an infection that damaged his kidneys. At age 12, he came to the United States, and at 21 years old, he was told he would need a kidney transplant and hemodialysis in the next few years.

    At 216 pounds, and having experienced lifelong symptoms, Sanchez thought there were no further options. But five years after he began dialysis, he sought treatment at Loyola Medicine. With a BMI of 42, he might have been turned away from another center, but was able to receive a transplant at Loyola. Sanchez described finding out about the transplant as one of the happiest days of his life. “I felt, this is unbelievable,” said Sanchez. “This is probably a dream. This is impossible that it’s happening to me.”

    Sanchez also said he felt most comfortable with Loyola because so many people on the transplant team spoke Spanish. More than half of Loyola Medicine’s abdominal transplant team are Spanish speakers, including surgeons, nurses, social workers and transplant coordinators of Hispanic origin. Dr. Garcia-Roca said, “we also work around a lot of the barriers to access that make it very difficult for members of the Hispanic community to reach a transplant center.”

    Since his surgery and recovery, Sanchez has lost around 30 pounds. He says he’s motivated to eat healthier and has the energy to work out and take walks outside. “It’s things that I haven’t experienced that people take for granted that I want to do,” Sanchez said. “I’m just grateful for this opportunity that I have to experience a life that I never experienced.”

    Dr. Garcia-Roca is encouraged by his progress. “Israel has made huge, huge changes in his life and lost a lot of weight. This is all super beneficial because he will maintain a very good, healthy condition for this new kidney to continue to work for a very long time.”

    To watch a video about Israel Sanchez’s journey and robotic transplant technology at Loyola, click this link. B-roll of Mr. Sanchez and Dr. Garcia-Roca is available to download here. B-roll with additional conversations in Spanish is available here.

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    Loyola Medicine

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  • Mobile Network Data, an Efficient Method for Assessing the Spread of Epidemics

    Mobile Network Data, an Efficient Method for Assessing the Spread of Epidemics

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    Newswise — The onset of the COVID-19 pandemic in March 2020 forced governments around the world to take measures to prevent its spread among the population and, thus, reduce the number of fatalities as a result of the virus. A few months later, as mobility restrictions and confinements were gradually lifted, states decided to launch tracking apps that citizens could download to their cell phones to find out if nearby contacts were infected with COVID. However, for these apps to be truly effective they require a large number of people to have them installed on their devices, and they also involve certain privacy risks.

    Now an IMDEA Networks research team led by Elisa Cabana (Postdoc researcher) and Nikolaos Laoutaris (Research Professor), in collaboration with Andra Lutu (Teléfonica Research) and Enrique Frías-Martínez (Camilo José Cela University), has carried out a study in which they propose a method that uses mobile network data to detect possible hospitalizations due to COVID-19 and obtain the corresponding epidemic risk maps. The paper “Improving epidemic risk maps using mobility information from mobile network data” will be published at the ACM SIGSPATIAL conference in November 2022.

    Cabana explains that the main advantage of the proposed solution is that, unlike Contact Tracing, “the data is already available at the operator and progress is faster. You don’t need to have GPS enabled and an application downloaded.” “When you have mobile data connected, your device connects to a cell tower that identifies your location radius. And that’s how you study the spatio-temporal mobility of people,” she adds. Another plus point is that the method works with anonymized data and can be run on the operator’s premises under its standard security provisions.

    According to Laoutaris, the method works as follows: “We check the location of a phone late at night and if it is not connected to the usual phone towers it was connected to in the pre-pandemic era, we see if it was connected to a tower near a hospital that is receiving COVID patients. If it does, the person who owns the cell phone is labeled as potentially hospitalized. The method also includes filters to eliminate false positives, such as people who live near or work in hospitals.

    As indicated in their study, mobile network data can be exploited to understand the dynamics of urban mobility and its impact on the spread of contagious diseases such as cholera, and also to predict the risk of viruses such as dengue, Zika or malaria, or other new ones that may emerge in the future.

    The team has applied their methods to an anonymized dataset of more than 2 million cell phones, collected by a mobile network provider located in London, UK, during the months of March and April 2020. They have concluded that this method yields a 98.6% agreement with public records of patients admitted to National Health Service (NHS) hospitals.

    Phases of the data collection process

    In the first phase, the research group describes the algorithm for detecting possible COVID hospitalizations from the mobile network data, as well as the parameters involved. The second phase consists of validating these data by checking the cases reported by London hospitals to the National Health Service and comparing them with those obtained with the proposed method. Finally, in the third phase, they analyze the mobility pattern of each person detected as hospitalized during the two weeks prior to their hospitalization day. With this information, they obtain dynamic and detailed risk maps that change over time and thus more accurately capture the distribution, evolution and intensity of the disease.

    Compared to census-based maps, their risk maps indicate that the areas at highest risk are not necessarily the most densely populated and can change from day to day. In addition, they have observed that hospitalized people tend to have a higher average mobility than non-hospitalized people.

    Elisa Cabana stresses that the most relevant result of her research is precisely the risk maps, since they not only allow the evolution of an epidemic to be visually analyzed, but can also be very beneficial for different sectors of society. “At the individual level, representing each area with a more or less intense color, which can vary over time, depending on a risk measure, is useful because it can help people to take additional protective measures, at each time and place. For emergency teams and decision-makers, it would help to assess the level of stress in the health system, as well as the severity and intensity of spread, and the advantages or disadvantages of certain decisions (use of masks, quarantine, vaccination). In general, the spatio-temporal information extracted from mobile network data, and the tools we develop with that information, can benefit both individuals and the policies and important decisions being developed against existing and future epidemics,” she concludes.

    E. Cabana, A. Lutu, E. Frias-Martinez, N. Laoutaris, “Improving Epidemic Risk Maps Using Mobility Information from Mobile Network Data,” ACM SIGSPATIAL’22.(extended abstract, full versionat SpatialEpi’22 workshop).

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    IMDEA Networks Institute

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