Among Those Eligible, Low Levels of Referrals for Cochlear Implants

Photo by Brett Sayles

A survey conducted in the UK found that people with severe to profound hearing loss who were eligible for cochlear implants were less likely to be referred if they lived in deprived areas and were male.

The study, published in PLOS Medicine, was carried out to determine the rates at which people in the UK with hearing loss were getting correctly referred for implants under the NHS, and where disparities might exist. Referrals were to be made on the basis of meeting pure tone audiometric threshold criteria.

Of 6171 participants in the survey who underwent the pure tone test and already did not have a cochlear implant, only 38% were informed of their eligibility and a mere 9% were actually referred for assessment.

Participants were less likely to be referred if they lived in more economically deprived areas and also within London, were male or were older. In addition to these factors, living in more remote areas, and being Black or Asian also reduced the likelihood of being informed of eligibility.

Lower odds of referrals in economically deprived areas is in line with data from both public and private healthcare sectors in Australia and the U.S.

The researchers also found that the presence of a “cochlear implant champion” increased the likelihood of discussions around cochlear implants but not referrals. That males were less likely to be referred or informed to were interpreted as stemming from men’s differences in health-seeking behaviour compared to women.

Limitations included the observational nature of the study, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups.

Probiotics plus Vitamin D may Boost Cognition in Schizophrenia

Photo by Michele Blackwell on Unsplash

Previous studies have questioned whether gut microbe imbalances and vitamin D deficiency may be linked to schizophrenia. New research published in Neuropsychopharmacology Reports now indicates that taking probiotics plus vitamin D supplements may improve cognitive function in individuals with the disease.

For the study, 70 adults with schizophrenia were randomised to take a placebo or probiotic supplements plus 400 IU vitamin D daily for 12 weeks. Severity of the disease and cognitive function were evaluated by tests called the Positive and Negative Syndrome Scale (PANSS) and the 30-point Montreal Cognitive Assessment (MoCA), respectively.

A total of 69 patients completed the study. The MoCA score increased by 1.96 units in the probiotic-containing supplement group compared with the placebo group. Also, the percentage of patients with MoCA scores of 26 or higher (indicating normal cognition) rose significantly in the intervention group. Between-group differences in PANSS scores were not significant.

“Probiotics may be a novel way to treat mental disorders by regulating gut microbiota,” said corresponding author Gita Sadighi, MD, of the University of Social Welfare and Rehabilitation Sciences, in Iran.

Source: Wiley

Microplastics Travel from the Gut to Other Organs

Photo by FLY:D on Unsplash

In a recent paper published in the journal Environmental Health Perspectives, University of New Mexico researchers found that microplastics – released by the breakdown of plastics in the environment – are having a significant impact on human digestive pathways, making their way from the gut and into the tissues of the kidney, liver and brain.

Eliseo Castillo, PhD, an associate professor in the Division of Gastroenterology & Hepatology in the UNM School of Medicine’s Department of Internal Medicine and an expert in mucosal immunology, is leading the charge at UNM on microplastic research.

“Over the past few decades, microplastics have been found in the ocean, in animals and plants, in tap water and bottled water,” Castillo, says. “They appear to be everywhere.”

Scientists estimate that people ingest 5 grams of microplastic particles each week on average – equivalent to the weight of a credit card.

While other researchers are helping to identify and quantify ingested microplastics, Castillo and his team focus on what the microplastics are doing inside the body, specifically to the gastrointestinal (GI) tract and to the gut immune system.

Over a four-week period, Castillo, postdoctoral fellow Marcus Garcia, PharmD, and other UNM researchers exposed mice to microplastics in their drinking water. The amount was equivalent to the quantity of microplastics humans are believed to ingest each week.

Microplastics had migrated out of the gut into the tissues of the liver, kidney and even the brain, the team found. The study also showed the microplastics changed metabolic pathways in the affected tissues.

“We could detect microplastics in certain tissues after the exposure,” Castillo says. “That tells us it can cross the intestinal barrier and infiltrate into other tissues.”

Castillo says he’s also concerned about the accumulation of the plastic particles in the human body. “These mice were exposed for four weeks,” he says. “Now, think about how that equates to humans, if we’re exposed from birth to old age.”

The healthy laboratory animals used in this study showed changes after brief microplastic exposure, Castillo says. “Now imagine if someone has an underlying condition, and these changes occur, could microplastic exposure exacerbate an underlying condition?”

He has previously found that microplastics are also impacting macrophages. In a 2021 paper published in Cell Biology & Toxicology, Castillo and other UNM researchers found that when macrophages encountered and ingested microplastics, their function was altered and they released inflammatory molecules.

“It is changing the metabolism of the cells, which can alter inflammatory responses,” Castillo says. “During intestinal inflammation – states of chronic illness such as ulcerative colitis and Crohn’s disease, which are both forms of inflammatory bowel disease – these macrophages become more inflammatory and they’re more abundant in the gut.”

The next phase of Castillo’s research, which is being led by postdoctoral fellow Sumira Phatak, PhD, will explore how diet is involved in microplastic uptake.

“Everyone’s diet is different,” he says. “So, what we’re going to do is give these laboratory animals a high-cholesterol/high-fat diet, or high-fibre diet, and they will be either exposed or not exposed to microplastics. The goal is to try to understand if diet affects the uptake of microplastics into our body.”

Castillo says one of his PhD students, Aaron Romero, is also working to understand why there is a change in the gut microbiota. “Multiple groups have shown microplastics change the microbiota, but how it changes the microbiota hasn’t been addressed.”

Castillo hopes that his research will help uncover the potential impacts microplastics are having to human health and that it will help spur changes to how society produces and filtrates plastics.

Source: University of New Mexico Health Sciences Center

Syphilis Rates are Spiking around the World

Colourised electron micrograph of Treponema pallidum, the bacteria that cause syphilis. Several spiral-shaped bacteria have been highlighted in gold. Credit: NIAID

By Biénne Huisman for Spotlight

Scientists worldwide are sounding the alarm at the return of syphilis, describing the comeback of the easily preventable infection as a huge public health failing – as an effective vaccine remains elusive.

Syphilis, one of the oldest known diseases, is making a resurgence worldwide. Top global scientists described this as a public health crisis and failure, given that the sexually transmitted infection (STI) – which can have dire and fatal consequences especially for newborn babies – is curable with early treatment.

The return of syphilis was under discussion at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI) where scientists, clinicians, and public health advocates gathered in Denver in March.

Addressing delegates in the Colorado Convention Centre, Professor Khalil Ghanem of Johns Hopkins University School of Medicine in Baltimore, noted a paucity of data – while syphilis continues to increase with “clinicians caring for patients with complex clinical presentations”. Ghanem was pointing out that there is little systematic information on how to manage cases of advanced syphilis, like neurosyphilis (syphilis in the central nervous system) and ocular syphilis (syphilis in the eyes).

Among some medical practitioners, syphilis is known as “the great imitator” due to its variable clinical manifestations that can mimic other diseases. In its severe forms, it can cause chronic multiple organ damage in adults. The infection can also be passed on from a mother to her baby during pregnancy resulting in congenital syphilis, causing premature birth, miscarriage, stillbirth, and birth defects. In most cases, however, the bacterial infection is transmitted sexually. Transmission can be prevented through the correct use of condoms.

According to the World Health Organization (WHO’s) latest available figures for congenital syphilis – dated 2016 – globally there were an estimated 661 000 congenital syphilis cases that year; including 143 000 stillbirths, 61 000 neonatal deaths (a newborn baby dying within seven days) and 109 000 surviving infants with a clinical diagnosis. Spotlight recently reported on a rise in sexually transmitted infections in Gauteng and in 2021 published an in-depth article on congenital syphilis in South Africa.

‘A failure of the healthcare system’

Epidemiologist Alex de Voux, from the University of Cape Town, moderated a session on syphilis at CROI. Speaking to Spotlight between sessions, an impassioned De Voux said the return of syphilis is “a failure of healthcare systems (in South Africa and abroad)  – because we have the tools, we know how to test for it, and we know how to treat it”.

She added: “The most extreme outcomes of congenital syphilis are stillbirths and neonatal deaths. We don’t even really understand the extent of longer term outcomes: neurological complications, skeletal deformations, impaired mental health development… And all these significant complications arise from an easily preventable infection. Remember, we use penicillin, which has been around for ages. The treatment hasn’t changed in all this time.”

Figures presented at CROI include from the Centers for Disease Control and Prevention in the United States, reporting a 76% increase in syphilis cases between 2013 and 2017. The WHO estimates that 7.1 million people between 15 and 49 years old were infected with syphilis in 2020. (See a WHO fact sheet on syphilis here.)

In 2018, at least 33 927 cases of syphilis were reported in 29 European Union member states, as recorded by the European Surveillance System (TESSy), at a rate of seven cases per 100 000 population. The reported syphilis rates were nine times higher in men than in women; showing a peak onset age of 25 to 45 years, in men.

Syphilis and HIV

One study presented at the conference surveyed 20 000 MSM (men who have sex with men) across ten cities in India, noting dramatic increases in syphilis in every city. It found syphilis was most prevalent in older MSM, pointing to a need for STI control efforts in this population. “Among people living with HIV, syphilis infection was associated with elevated (HIV) viral loads, raising concerns for transmission of HIV,” the study authors wrote.

Another study conducted in Cologne in Germany investigated 60 patients co-infected with syphilis and acute HIV. The study cites “rising co-infection rates and the unique interaction between these two sexually transmitted infections. Syphilis enhances HIV transmission and acquisition, while HIV accelerates the progression of syphilis…”

An ancient condition, the oldest artistic representation of syphilis is considered to be on a Peruvian jug dating back to the 16th century, depicting a mother suffering from syphilis holding a child. Famous people who had syphilis include Oscar Wild and Friedrich Nietzsche. [Read about the history of syphilis here]. Infections dropped sharply with the availability of penicillin in the 1940s.

However, over the past two decades scientists have reported an alarming spike in cases. This has been attributed by some to a drop in condom use. The reasons for a decrease in condom use is not clearly understood – one possible factor is a false sense of security given lower HIV transmission rates, effective HIV treatment, and the availability of HIV transmission prevention in the form of  pre-exposure prophylaxis (PrEP). PrEP contains a combination of two antiretroviral medicines which are highly effective at preventing HIV infection when taken as prescribed by someone not living with HIV, while not offering protection against other STIs like syphilis. Access to condoms may also be a factor. As Spotlight recently reported, the number of condoms distributed by the South African government has decreased dramatically over the last five years.

Sex partners

One study presented at CROI found: “The risk factors associated with acquired syphilis are sexual behaviour, serosorting (a strategy that involves selecting sexual partners of the same HIV status) among people living with HIV, multiple sexual partners, the use of PrEP to compensate for HIV risk behaviour, and social networking sites or mobile device apps to find sex partners.”

At the syphilis session at CROI, Dr Angélica Espinosa Miranda, STI unit coordinator at the Brazilian Ministry of Health, presented a talk titled “The Burgeoning Epidemic of Congenital Syphilis”. She emphasised “the underdiagnosis of syphilis in pregnancy, especially in regions with limited healthcare access”.

Miranda’s statement resonates with De Voux’s research in South Africa, which found congenital syphilis cases to be gravely underreported in the country. Congenital syphilis is a notifiable condition in South Africa, meaning that if a doctor delivers a baby believed to be infected they are required by law to report it to the National Institute For Communicable Diseases.  De Voux’s study relays how reported congenital syphilis cases in South Africa’s healthcare system between January 2020 and June 2022 – 36 cases for every 100 000 live births – were at least half the figure estimated by WHO scientists – thus bolstering the hypothesis that there is a high number of undiagnosed syphilis in South Africa.

Penicillin treatment

In her talk, Miranda added that ensuring that infected pregnant women receive timely and appropriate penicillin treatment is critical to preventing congenital syphilis. “Penicillin is the only effective treatment during pregnancy,” she said. “However challenges remain, such as limited healthcare access and penicillin shortages in some countries.”

When penicillin cannot be used (due to unavailability in a country or allergy in a patient) the WHO’s STI guidelines suggest using doxycycline 100mg twice daily orally for 30 days.

Penicillin shortages are a problem worldwide, and in South Africa too. “South Africa has also been affected by shortages of penicillin,” says De Voux. “In fact, often they will make sure that they keep stocks and prioritise pregnant women. So that means that sometimes other people who are infected with syphilis will get treated with something that’s much more burdensome. Instead of having penicillin injections, they will take oral tablets – doxycycline – which has these gastrointestinal side effects, so an upset stomach. You have to try minimise the side effects with f ood.”

Miranda stressed the need to invest in developing new strategies – antibiotics apart from penicillin – to treat syphilis. Meanwhile, epidemiologists agree that a vaccine for syphilis is important but that this scientific solution remains elusive.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

A Third of Women Experience Migraines Associated with Menstruation

Photo by Andrea Piacquadio

Of the nearly 20 million women who participated in a U.S. national health survey, one-third reported migraines during menstruation. The analysis was conducted by researchers at Georgetown University Medical Center and Pfizer, Inc., which makes a migraine medication.

Because of the underuse of medications to help treat or prevent menstrual migraines, investigators wanted to understand how common menstrual migraines were and which groups of women could most benefit from potential therapies. The study, presented April 16, at the American Academy of Neurology 2024 Annual Meeting in Denver, also revealed the most common medications taken by those women seeking to prevent menstrual migraines.

“The first step in helping a woman with menstrual migraine is making a diagnosis; the second part is prescribing a treatment; and the third part is finding treatments patients are satisfied with and remain on to reduce disability and improve quality of life,” says the study author, Jessica Ailani, MD, professor of clinical neurology at Georgetown University School of Medicine.

The researchers used the 2021 U.S. National Health and Wellness Survey to analyse responses from women who reported their current migraine treatments, frequency and disabilities via the Migraine Disability Assessment Test (MIDAS), a five-question survey. A migraine headache can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

“Discrepancies in the incidence of who gets migraine attacks associated with menses is likely due to premenopausal women having more regular menstrual cycles and thus more menstrual-related migraines,” says Ailani, also director of the MedStar Georgetown Headache Center at Medstar Georgetown University Hospital. “Additionally, as women move into their 40’s and become peri-menopausal, there tends to be a greater shift through the month in hormone levels also leading to frequent migraine attacks.”

The survey found that for all women during their menstrual periods, migraine attacks occurred as frequently as 4.5 times and that monthly only migraine headaches lasted 8.4 days, on average; 56.2 % of women had moderate-to-severe migraine-specific disabilities that ranked highest on the MIDAS scale.

When looking at treatments women in the survey used to help control their migraine symptoms, 42.4% used over-the-counter medications while 48.6% used prescription medications. Of the 63.9 % of women who used migraine treatments for acute symptoms, the most commonly used were triptans, a class of drugs developed in the 1990s to quiet overactive nerves associated with migraines and cluster headaches.

Sara’s story

Sara, a 38 year old mother of two, says her migraines are predictably and consistently worse during her period.

“It definitely disrupts my ability to go about my normal activities including at work,” Sara says. “I’m pretty lucky that I’m generally responsive to prescription medication, but I often still have to lie down for an hour or so while the medicine kicks in.”

Sara is being treated preventatively for migraines with Botox. She says over the past couple of months, she’s had a couple of migraines outside of when she gets her period, but that the headaches are definitely worse during menstruation.

“While I had my last period, I had a migraine every day for a week,” Sara says. “It’s starkly different [during menstruation].”

Prevention possibilities

Non-steroidal anti-inflammatory drugs (NSAIDs) are sometimes used as preventive medications for women with regular menstrual periods. In this study, 21.1% of women reported use of any migraine prevention medications or therapies.

“Preventive treatments are used less frequently than acute treatment for migraine,” Alaini said. “In my opinion, this is because preventive therapy is a long-term commitment by both a woman and her clinician to improving the disease process. Migraine is a life-long brain disease without a cure, and the goal of preventive therapy is to reduce disease burden and improve quality of life. Unfortunately, newer disease-specific treatments are costly, so generic older treatments are often used and come with greater side effects.”

Next steps

The researcher’s next steps involve looking at larger databases to see if they can mimic findings on a global scale. They want to determine if women with menstrual-related migraine are frequently turning to non-migraine treatments as was seen in around 53% of their current study group.

“As a headache specialist in the U.S., I know I can do better for women in my clinic, but what can be done for the millions of women who don’t get into a headache clinic? That is our true next step,” says Ailani. “If you have migraines related to your menstrual cycle, discuss this with your gynaecologist or neurologist. There are treatments that can help and if the first treatment tried does not work, do not give up.”

Source: Georgetown University Medical Center

Large Study Finds Antibiotics are Ineffective for Most Lower Respiratory Tract Infections

Photo by Robina Weermeijer on Unsplash

Use of antibiotics provided no measurable impact on the severity or duration of coughs, even if a bacterial infection was present, finds a large prospective study of people seeking care for lower-respiratory tract infections. The study by researchers at Georgetown University Medical Center and colleagues appeared in the Journal of General Internal Medicine.

“Upper-respiratory tract infections usually include the common cold, sore throat, sinus infections and ear infections and have well established ways to determine if antibiotics should be given,” says the study’s lead author, Dan Merenstein, MD, professor of family medicine. “Lower-respiratory tract infections tend to have the potential to be more dangerous, since about 3% to 5% of these patients have pneumonia. But not everyone has easy access at an initial visit to an X-ray, which may be the reason clinicians still give antibiotics without any other evidence of a bacterial infection. Plus, patients have come to expect antibiotics for a cough, even if it doesn’t help. Basic symptom-relieving medications plus time brings a resolution to most people’s infections.”

The antibiotics prescribed in this study for lower-tract infections were all appropriate, commonly used antibiotics to treat bacterial infections. But the researchers’ analysis showed that of the 29% of people given an antibiotic during their initial medical visit, there was no effect on the duration or overall severity of cough compared to those who didn’t receive an antibiotic.

“Physicians know, but probably overestimate, the percentage of lower-tract infections that are bacterial; they also likely overestimate their ability to distinguish viral from bacterial infections,” says Mark H. Ebell, MD, MS, a study author and professor in the College of Public Health at the University of Georgia. “In our analysis, 29% of people were prescribed an antibiotic, while only 7% were given an antiviral. But most patients do not need antivirals, as there exist only two respiratory viruses where we have medications to treat them: influenza and SARS-CoV-2. There are none for all of the other viruses.”

To determine if there was an actual bacterial or viral infection present, beyond the self-reported symptoms of a cough, the investigators confirmed the presence of pathogens with advanced lab tests to look for microbiologic results classified as only bacteria, only viruses, both virus and bacteria, or no organism detected. Very importantly, for those with a confirmed bacterial infection, the length of time until illness resolution was the same for those receiving an antibiotic versus those not receiving one –about 17 days.

Overuse of antibiotics can result in dizziness, nausea, diarrhoea and rash, along with about a 4% chance of serious adverse effects including anaphylaxis, which is a severe, life-threatening allergic reaction; Stevens-Johnson syndrome, a rare, serious disorder of the skin and mucous membranes; and Clostridioides difficile-associated diarrhoea. The World Health Organization considers antibiotic resistance to be a major an emerging threat.

“We know that cough can be an indicator of a serious problem. It is the most common illness-related reason for an ambulatory care visit, accounting for nearly 3 million outpatient visits and more than 4 million emergency department visits annually,” says Merenstein. “Serious cough symptoms and how to treat them properly needs to be studied more, perhaps in a randomized clinical trial, as this study was observational and there haven’t been any randomized trials looking at this issue since about 2012.”

Source: Georgetown University School of Medicine

Scientists Evaluate Old Epilepsy Drug for Glioma Prevention

Photo by Anna Shvets on Pexels

A drug used to treat children with epilepsy prevents brain tumour formation and growth in two mouse models of neurofibromatosis type 1 (NF1), according to a study by researchers at Washington University School of Medicine in St. Louis. NF1 is a genetic condition that causes tumours to grow on nerves throughout the body.

The findings lay the groundwork for a clinical trial to assess whether the drug, lamotrigine, can prevent or delay brain tumours in children with NF1. The study is published online in the journal Neuro-Oncology.

“Based on these data, the Neurofibromatosis Clinical Trials Consortium is considering launching a first-of-its-kind prevention trial,” said senior author David H. Gutmann, MD, PhD, professor of neurology. “The plan is to enrol kids without symptoms, treat them for a limited time, and then see whether the number of children who develop tumours that require treatment goes down.

“This is a novel idea, so we took it to an NF1 patient focus group,” Gutmann continued. “They said, ‘This is exactly what we’re looking for.’ A short-term treatment with a drug that has been used safely for 30 years was acceptable to them if it reduced the chance their children would develop tumours and need chemotherapy that might have all kinds of side effects.”

Optic gliomas, tumours on the optic nerve are the most serious type that those with NF1 get. Such tumours typically appear between ages 3 to 7. Though rarely fatal, they cause vision loss in up to a third of patients as well as other symptoms, including early puberty. Standard chemotherapy for optic gliomas is only moderately effective at preventing further vision loss and can affect children’s developing brains, resulting in cognitive and behavioural problems.

In a previous study, Gutmann and Corina Anastasaki, PhD, an assistant professor of neurology and the first author on the new paper, showed that lamotrigine stopped optic glioma growth in NF1 mice by suppressing neuronal hyperactivity. Intrigued, the Neurofibromatosis Clinical Trial Consortium asked Gutmann and Anastasaki to clarify the connection between NF1 mutation, neuronal excitability and optic gliomas; assess whether lamotrigine was effective at the doses already proven safe in children with epilepsy; and conduct these studies in more than one strain of NF1 mice.

In humans, NF1 could be caused by any one of thousands of different mutations in the NF1 gene, with different mutations causing different medical problems. Repeating experiments in multiple strains of mice was a way of gauging whether lamotrigine was likely to work in people regardless of the underlying mutation.

Anastasaki and Gutmann not only showed that lamotrigine worked in two strains of NF1 mice, they also showed that the drug worked at lower doses than those used for epilepsy, meaning that it was probably safe. Even better, they found that a short course of the drug had lasting effects, both as a preventive and a treatment. Mice with tumours and that were treated for four weeks starting at 12 weeks of age saw their tumours stop growing and even showed no further damage to the retinas. Mice that received a four-week course of the drug starting at 4 weeks of age, before tumours typically emerge, showed no tumour growth even four months after treatment had ended.

These findings have led Gutmann to suggest that a one-year course of treatment for young children with NF1, maybe between the ages of 2 to 4, might be enough to reduce their risk of brain tumours.

“The idea that we might be able to change the prognosis for these kids by intervening within a short time window is so exciting,” Gutmann said. “If we could just get them past the age when these tumours typically form, past age 7, they may never need treatment. I’d love it if I never again had to discuss chemotherapy for kids who aren’t even in first grade yet.”

Source: Washington University School of Medicine

AI Helps Clinicians to Assess and Treat Leg Fractures

Photo by Tima Miroshnichenko on Pexels

By using artificial intelligence (AI) techniques to process gait analyses and medical records data of patients with leg fractures, researchers have uncovered insights on patients and aspects of their recovery.

The study, which is published in the Journal of Orthopaedic Research, uncovered a significant association between the rates of hospital readmission after fracture surgery and the presence of underlying medical conditions. Correlations were also found between underlying medical conditions and orthopaedic complications, although these links were not significant.

It was also apparent that gait analyses in the early postinjury phase offer valuable insights into the injury’s impact on locomotion and recovery. For clinical professionals, these patterns were key to optimising rehabilitation strategies.

“Our findings demonstrate the profound impact that integrating machine learning and gait analysis into orthopaedic practice can have, not only in improving the accuracy of post-injury complication predictions but also in tailoring rehabilitation strategies to individual patient needs,” said corresponding author Mostafa Rezapour, PhD, of Wake Forest University School of Medicine. “This approach represents a pivotal shift towards more personalised, predictive, and ultimately more effective orthopaedic care.”

Dr. Rezapour added that the study underscores the critical importance of adopting a holistic view that encompasses not just the mechanical aspects of injury recovery but also the broader spectrum of patient health. “This is a step forward in our quest to optimize rehabilitation strategies, reduce recovery times, and improve overall quality of life for patients with lower extremity fractures,” he said.

Source: Wiley

Admin and Ethics should be the Basis of Your Healthcare AI Stratetgy

Technology continues to play a strong role in shaping healthcare. In 2023, the focus was on how Artificial Intelligence (AI),  became significantly entrenched in patient records, diagnosis and care. Now in 2024 the focus is on the ethical aspects of AI.  Many organisations including practitioner groups, hospitals and medical associations are putting together AI Codes of Conduct, with new legislation planning to be passed in countries such as the USA.

The entire patient journey has benefited from the use of AI, in tangible ways that we can understand. From online bookings, the sharing of information with electronic health records, keyword diagnosis, sharing of visual scans, e-scripts, easy claims, SMS’s and billing, are all examples of how software systems are incorporated into practices to facilitate a streamlined experience for both the patient and doctor. *But although 75% of medical professionals agree on the transformation abilities of AI, only 6% have implemented an AI strategy.

Strategies need to include ethical considerations

CompuGroup Medical South Africa, (CGM SA), a leading international MedTech company that has spent over 20 years designing software solutions for the healthcare industry, has identified one main area that seems to constantly be the topic for ethical consideration.

This is the sharing of patient electronic health records or EHR’s. On one hand the wealth of information provided in each EHR – from a patient’s medical history, demographics, their laboratory test results over time, medicine prescribed, a history of medical procedures, X-rays to any medical allergies – offers endless opportunities for real time patient care. On the other hand, there seems to be a basic mistrust of how these records will be shared and stored, no one wants their personal medical information to end up on the internet.

But there’s also the philosophical view that although you might not want your info to be public record, it still has the ability to benefit the care of thousands of people. If we want a learning AI system that adapts as we do, if we want a decision making support system that is informed by past experiences, then the sharing of data should be viewed as a tool and no longer a privacy barrier.

Admin can cause burnout

Based on their interactions with professionals, CGM has informally noted that healthcare practices spend 73% of their time dealing with administrative tasks. This can be broken down into 38% focusing on EHR documentation and review, 19% related to insurance and billing, 11% on tests, medications and other orders and the final 6% on clinical planning and logistics.

Even during the consultation doctors can spend up to 40% of their time taking clinical notes. Besides the extra burden that this places on health care practices, this also leads to less attention being paid to the patient and still requires 1-2 hours of admin in the evenings. (Admin being the number one cause of burnout in clinicians and too much screen time during interactions being the number one complaint by patients.)

The solution

The ability for medical practitioners to implement valuable and effective advanced technical software, such as Autoscriber, will assist with time saving, data quality and overall job satisfaction. Autoscriber is an AI engine designed to ease the effort required when creating clinical notes by turning the consultation between patient and doctor into a structured summary that includes ICD-10 codes which is the standard method of classification of diseases used by South African medical professionals    

It identifies clinical facts in real time, including medications and symptoms. It then orders and summarises the data in a format ready for import into the EHR, creating a more detailed and standardised report on each patient encounter, allowing for a more holistic patient outcome. In essence, with the introduction of Autoscriber into the South African market, CGM seeks to aid practitioners in swiftly creating precise and efficient clinical records, saving them from extensive after-hours commitments.

Dilip Naran, VP of Product Architecture at CGM SA explains: “It is clear that AI will not replace healthcare professionals, but it will augment their capabilities to provide superior patient care. Ethical considerations are important but should not override patient care or safety. The Autoscriber solution provides full control to the HCP to use, edit or discard the transcribed note ensuring that these notes are comprehensive, attributable and contemporaneous.”

Specific Nasal Cells Protect against COVID in Children

Legend of spirals: This image highlights the appearance of nasal cultures from older adults, revealing distinct spiral-like patterns that were absent in cultures grown from children. Credit: University College London

Important differences in how the nasal cells of young and elderly people respond to the SARS-CoV-2 virus, could explain why children typically experience milder COVID symptoms, finds a new study led by researchers at UCL and the Wellcome Sanger Institute.

The study, published in Nature Microbiology, focused on the early effects of SARS-CoV-2 infection on the cells first targeted by the viruses, the human nasal epithelial cells (NECs).

These cells were donated from healthy participants, including children (0–11 years), adults (30–50 years) and, for the first time, the elderly (over 70 years).

The cells were then cultured to regrow into the different types of nasal cells. Using single-cell RNA sequencing techniques that enable scientists to identify the unique genetic networks and functions of thousands of individual cells, the team identified 24 distinct epithelial cell types. Cultures from each age group were then either mock-infected or infected with SARS-CoV-2.

After three days, the NECs of children responded quickly to SARS-CoV-2 by increasing interferon (the first line of anti-viral defence), restricting viral replication. However, this early anti-viral effect became less pronounced with age.

The researchers also found that NECs from elderly individuals not only produced more infectious virus particles, but also experienced increased cell shedding and damage.

The strong antiviral response in the NECs of children could explain why younger people typically experience milder symptoms. In contrast, the increased damage and higher viral replication found in NECs from elderly individuals could be linked to the greater severity of disease observed in older adults.

Project lead, Dr Claire Smith (Associate Professor at UCL Great Ormond Street Institute of Child Health), said: “Our research reveals how the type of cells we have in our nose changes with age, and how this affects our ability to combat SARS-CoV-2 infection. This could be crucial in developing effective anti-viral treatments tailored to different age groups, especially for the elderly who are at higher risk of severe COVID-19.”

Co-Senior author, Dr Kerstin Meyer (Wellcome Sanger Institute), said: “By carrying out SARS-CoV-2 infections of epithelial cells in vitro and studying the responses with single cell sequencing, we get a much more detailed understanding of the viral infection kinetics and see big differences in the innate immune response between cell types.”

Children infected with SARS-CoV-2 rarely progress to respiratory failure, but the risk of mortality in infected people over the age of 85 remains high, despite vaccination and improving treatment options.

The research underscores the importance of considering age as a critical factor in both research and treatment of infectious diseases.

Co-senior author, Dr Marko Nikolic (UCL Division of Medicine), said: “It is fascinating that when we take away immune cells from nasal samples, and are only left with nasal epithelial cells grown in a dish, we are still able to identify age-specific differences in our body’s response to the SARS-CoV-2 between the young and elderly to explain why children are generally protected from severe COVID-19.”

Dr Smith added: “Understanding the cellular differences at the initiation of infection is just the beginning. We now hope to investigate the long-term implications of these cellular changes and test therapeutic interventions using our unique cell culture model. This ‘gold-standard’ system is only possible with the support of our funders and the willingness of participants to provide their samples.”

The team suggest that future research should consider how ageing impacts the body’s response to other viral infections.

Source: University College London