Emergence of High Pathogenicity Avian Influenza Virus H5N1 Clade 2.3.4.4b in Wild Birds and Poultry in Botswana

Numerous outbreaks of high-pathogenicity avian influenza (HPAI) were reported during 2020–2021. In Africa, H5Nx has been detected in Benin, Burkina Faso, Nigeria, Senegal, Lesotho, Namibia and South Africa in both wild birds and poultry. Botswana reported its first outbreak of HPAI to the World Organisation for Animal Health (WOAH) in 2021. An H5N1 virus was detected in a fish eagle, doves, and chickens. Full genome sequence analysis revealed that the virus belonged to clade 2.3.4.4b and showed high identity within haemagglutinin (HA) and neuraminidase proteins (NA) for viruses identified across a geographically broad range of locations. The detection of H5N1 in Botswana has important implications for disease management, wild bird conservation, tourism, public health, economic empowerment of vulnerable communities and food security in the region.     

Collaborative mental health care: A narrative review

The Collaborative Care model is a systematic strategy for treating behavioral health conditions in primary care through the integration of care managers and psychiatric consultants. Several randomized controlled trials have demonstrated that Collaborative Care increases access to mental health care and is more effective and cost efficient than the current standard of care for treating common mental illnesses. Large healthcare systems and organizations have begun to adopt Collaborative Care initiatives and are seeing improved treatment outcomes and provider and patient satisfaction. This review discusses current research on the effectiveness and cost-efficiency of Collaborative Care. In addition, this paper discusses its ability to adapt to specific patient populations, such as geriatrics, students, substance use, and women with perinatal depression, as well as the significance of measurement-based care and mental health screening in achieving improved clinical outcomes. Current data suggests that Collaborative Care may significantly improve patient outcomes and time-to-treatment in all reviewed settings, and successfully adapts to special patient populations. Despite the high upfront implementation burden of launching a Collaborative Care model program, these costs are generally offset by long term healthcare savings.     

Establishing a telemedicine program for interventional radiology: a study of patient opinion and experience

PURPOSEThe coronavirus disease 2019 (COVID-19) pandemic forced healthcare officials to implement new policies, such as the use of virtual consultations over office-based medical appointments, to reduce the transmission of the virus. The purpose of this study was to quantitatively compare patients’ experiences with virtual outpatient telemedicine encounters at a single academic institution in interventional radiology (IR) and in-person visits during the course of the COVID-19 pandemic.METHODSThe TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were used to survey patients’ satisfaction with both in-person and virtual office visits.RESULTSNinety respondents (38 in-person and 52 virtual) acknowledged numerous benefits of virtual visits versus in-person office visits including reductions in time, cost, and potential viral transmission risk during the COVID-19 pandemic. No statistically significant difference was noted, based on a Likert scale from 1 to 7, between in-person and virtual visits (all P > .05) for scheduling-related factors. No statistically significant difference was noted in any of the MCCS subscales between the 2 cohorts with regard to medical information communication (all P > .05). A majority of patients with virtual encounters (82.7%) stated that it was easy to obtain an electronic device for use during the telemedicine visit, and 73.1% of patients felt that setting up the telemedicine encounter was easy.CONCLUSIONSThis study demonstrates that telemedicine is an acceptable alternative to in-office appointments and could increase access to IR care outside of the traditional physician–patient interaction. With telemedicine visits, patients can communicate their concerns and obtain information from the doctor with noninferior communication compared to in-person visits.

Main points

• In a pilot telemedicine program for interventional radiology clinic visits at a tertiary care hospital, the experience of telemedicine encounters was not inferior to in-person visits.
• There was no significant difference in patient experience and satisfaction between in-person and virtual encounters.
• There was no significant difference in the transmission and understanding of information between in-person and virtual encounters.

Telemedicine is an efficient and cost-effective service “that seeks to improve a patient’s health by permitting a two-way, real-time interactive communication between the patient and the physician at a distant site,” according to the Centers for Medicare and Medicaid Services (CMS).¹ With improvements in real-time audiovisual communications technology and secure high-speed internet access over the past several decades, the practice of telemedicine has evolved to augment and even replace traditional face-to-face medical visits. This has translated into improved accessibility to high-quality medical care for a wide variety of patient populations.In recent years, telemedicine has been shown to improve care logistics and increase the geographic reach of healthcare providers, which is more important than ever in the current environment of specialty care centralized in higher volume urban medical centers.^2,3 The benefits of telemedicine include improved clinical efficiency, increased access for patients in underserved areas to specialty care, reduction in transportation time and costs, as well as increased patient satisfaction.^4-11 Telemedicine has proven useful for a variety of patient appointments (e.g., initial consultations, preoperative evaluation, postoperative checks, and long-term follow-ups) in a broad range of healthcare settings (e.g., primary care, specialty care, stroke care, and physician-to-physician consultation between academic institutions or networks of rural community clinics).^7-15 However, despite this progress, telemedicine had previously not been broadly adopted due to regulatory hurdles and inflexible payment structures until coronavirus disease 2019 (COVID-19).¹⁶The pandemic forced healthcare systems to implement new practice workflows to mitigate the spread of severe acute respiratory syndrome coronavirus-2. Various governing bodies and associations instituted guidelines resulting in the cancelation of elective, non-emergent appointments and procedures. However, a large cohort of patients remained who suffered from time-sensitive ailments that required urgent consultation, evaluation, and medical procedures, making cancellation impossible.In order to continue to deliver care to these patients and reduce both patients’ and healthcare workers’ exposure to the virus, clinical assessments shifted to a virtual platform. Furthermore, CMS authorized a rule stating that virtual telemedicine visits would be temporarily reimbursed at the same rate as face-to-face visits to incentivize the use of telemedicine and thus reduce viral transmission rates.¹⁷ These changes were welcomed by healthcare personnel and patients alike. Additionally, the use of telemedicine allowed for continued routine care of the elderly or high-risk patients who would otherwise have been hesitant to seek face-to-face care in the midst of the pandemic.Telemedicine is a relatively new endeavor for many providers in a variety of specialties. Although various guidelines and recommendations have been published, there are few studies of telemedicine utilization in the practice of interventional radiology (IR).^18-33 The aim of this study was to evaluate patients’ experiences with the newly implemented COVID-19 era telemedicine in IR at a single tertiary care academic center.     

Impact of anticoagulation and antiplatelet therapy on dialysis catheter fibrin sheath formation

PURPOSEFibrin sheaths are a significant cause of dialysis catheter dysfunction. This study aimed to determine the role of anticoagulation, antiplatelet medications, and other factors in delaying fibrin sheath formation.METHODSAn institutional review board-approved retrospective review of all patients treated for tunneled dialysis catheter fibrin sheaths from January 2014 to January 2020 was undertaken. All catheters were symmetric tipped, 14.5 F in diameter, and placed via the internal jugular vein. Seventy patients with venographically confirmed fibrin sheaths that developed after de novo catheter placement were identified. Recurrent fibrin sheaths were excluded. The impact of anticoagulation and antiplatelet therapy, as well as statin therapy, catheter side (right or left), hematocrit, platelet count, prothrombin time (PT), and international normalized ratio (INR), on the time to fibrin sheath formation was determined.RESULTSPatients on anticoagulation had a longer median catheter implantation time of 109.2 days (interquartile range (IQR): 29.3-178.5 days) compared to 80.7 days (IQR: 28.0-168.6 days) among patients not on anticoagulation. Catheter dwell time among patients taking antiplatelet therapy was 86.0 days (IQR: 31.5-160.7 days) versus 74.4 days (IQR: 27.5-202.4 days) for patients not on antiplatelet medication. Patients taking statins versus those not taking statins had median catheter dwell times of 97.5 days (IQR: 27.5-138.5 days) and 62.4 days (IQR: 29.9-259.6 days), respectively. Time to fibrin sheath formation was not significantly associated with hematocrit (P  = .16), platelet count (0.12), PT (P  = .51), or INR (P  = .74).CONCLUSIONAnticoagulation has no significant benefit in delaying sheath formation in patients with tunneled dialysis catheters. Hematologic and coagulation parameters at the time of catheter placement were also not associated with catheter dwell time.

Main points

• Tunneled dialysis catheter dwell time was not significantly longer with anticoagulation, antiplatelet or statin therapy.
• There is no association between baseline coagulation profile and clinically significant fibrin sheath formation.

Tunneled dialysis catheters are frequently the initial access for patients requiring dialysis.^1,2 According to the United States Renal Data System, 80% of end-stage renal disease patients require a catheter when starting dialysis. At 90 days after the start of dialysis, 68.5% of patients are still reliant on catheters.³Fibrin sheaths are a significant cause of catheter dysfunction. Increased catheter infection risk and persistent bacteremia are also associated with fibrin sheaths.⁴ Studies have demonstrated fibrin sheaths can develop within 24 hours of catheter placement and may affect up to 47% of catheters.^5,6 When thrombolytic treatment fails, patients have to undergo additional procedures to exchange the catheter, disrupt the sheath, or strip the sheath, which contribute to patient morbidity.^7-10Prevention of fibrin sheath formation would be expected to have a beneficial impact on satisfactory dialysis maintenance. Placing patients on anticoagulation is a potential strategy that may decrease the risk for catheter dysfunction secondary to fibrin sheaths.¹¹ The aim of this study is to determine whether anticoagulation, antiplatelet medication, or other factors may influence the rate of fibrin sheath development in patients with tunneled dialysis catheters.     

Weakened untuned gain control is associated with schizophrenia while atypical orientation-tuned suppression depends on visual acuity

Perceptual distortions are core features of psychosis. Weakened contrast surround suppression has been proposed as a neural mechanism underlying atypical perceptual experiences. Although previous work has measured suppression by asking participants to report the perceived contrast of a low-contrast target surrounded by a high-contrast surround, it is possible to modulate perceived contrast solely by manipulating the orientation of a matched-contrast center and surround. Removing the bottom-up segmentation cue of contrast difference and isolating orientation-dependent suppression may clarify the neural processes responsible for atypical surround suppression in psychosis. We examined surround suppression across a spectrum of psychotic psychopathology including people with schizophrenia (PSZ; N = 31) and people with bipolar disorder (PBD; N = 29), first-degree biological relatives of these patient groups (PBDrel, PSZrel; N = 28, N = 21, respectively), and healthy controls (N = 29). PSZ exhibited reduced surround suppression across orientations; although group differences were minimal at the condition that produced the strongest suppression. PBD and PSZrel exhibited intermediate suppression, whereas PBDrel performed most similarly to controls. Intriguingly, group differences in orientation-dependent surround suppression magnitude were moderated by visual acuity. A simulation in which visual acuity and/or focal attention interact with untuned gain control reproduces the observed pattern of results, including the lack of group differences when orientation of center and surround are the same. Our findings further elucidate perceptual mechanisms of impaired center-surround processing in psychosis and provide insights into the effects of visual acuity on orientation-dependent suppression in PSZ.     

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco

In this study, we consider the patient, provider, and public health repercussions of San Francisco’s (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020–2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.     

Assessment of patients’ perceptions towards embryo disposition after donation of embryos to a research biobank

Purpose To explore perceptions towards embryo disposition among patients donating excess embryos to a research biobank.MethodsCross-sectional study of survey responses collected as part of enrollment in a research biobank. Patients are asked questions regarding the difficulty of their disposition decision, their alternative disposition choice if donation to research was not available, quality of the counseling they received, and if additional counseling throughout their treatment would have been beneficial. Survey responses use 5-point Likert scales, with “1” being lowest/least and “5” being highest/most.ResultsA total of 157 men and 163 women enrolled in the biobank. Median scores for difficulty of disposition decision were 3 for females and 2 for males, and for quality of counseling, the median scores were 4 for females and 3 for males. Seventy percent of patients would have chosen to discard their excess embryos had donation to research not been an option. Statistical analyses showed no significant difference in responses based on variations in race, religion, sexual orientation, and infertility diagnoses. Concordance of responses within heterosexual couples was tested and found to be poor to moderate.ConclusionsAssessing patients’ perceptions towards embryo disposition after donation of their excess embryos to a research biobank affords a unique perspective. The difficulty of the disposition decision, the tendency to discard embryos in the absence of a means for donation to research, and the poor agreement between heterosexual partners highlight the importance of donation to research as an accessible disposition option and the need for a personalized approach to counseling and consenting for embryo disposition.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-022-02659-x.Keyword: Embryo disposition     

Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals

ObjectiveFederated learning (FL) allows multiple distributed data holders to collaboratively learn a shared model without data sharing. However, individual health system data are heterogeneous. “Personalized” FL variations have been developed to counter data heterogeneity, but few have been evaluated using real-world healthcare data. The purpose of this study is to investigate the performance of a single-site versus a 3-client federated model using a previously described Coronavirus Disease 19 (COVID-19) diagnostic model. Additionally, to investigate the effect of system heterogeneity, we evaluate the performance of 4 FL variations.Materials and methodsWe leverage a FL healthcare collaborative including data from 5 international healthcare systems (US and Europe) encompassing 42 hospitals. We implemented a COVID-19 computer vision diagnosis system using the Federated Averaging (FedAvg) algorithm implemented on Clara Train SDK 4.0. To study the effect of data heterogeneity, training data was pooled from 3 systems locally and federation was simulated. We compared a centralized/pooled model, versus FedAvg, and 3 personalized FL variations (FedProx, FedBN, and FedAMP).ResultsWe observed comparable model performance with respect to internal validation (local model: AUROC 0.94 vs FedAvg: 0.95, P = .5) and improved model generalizability with the FedAvg model (P < .05). When investigating the effects of model heterogeneity, we observed poor performance with FedAvg on internal validation as compared to personalized FL algorithms. FedAvg did have improved generalizability compared to personalized FL algorithms. On average, FedBN had the best rank performance on internal and external validation.ConclusionFedAvg can significantly improve the generalization of the model compared to other personalization FL algorithms; however, at the cost of poor internal validity. Personalized FL may offer an opportunity to develop both internal and externally validated algorithms.