Cardiovascular disease pervades Appalachia, yet many Appalachians live far from any heart and vascular specialist. Follow-up doctor’s visits in the weeks after cardiovascular surgery can involve hours-long drives down narrow, winding roads.
A recent study led by Albeir Mousa, a professor in the West Virginia University School of Medicine, suggests telemedicine may improve these patients’ satisfaction with their postoperative care as well as their quality of life.
With telemedicine, a healthcare provider can use a computer, tablet or other electronic device to remotely evaluate their patients’ symptoms, diagnose illnesses or injuries, and prescribe treatments. They can also field their patients’ questions.
The 30 participants in Mousa’s study were recovering from vascular surgery. In each case, the surgeon made an incision in the patient’s groin to access the arteries that needed rebuilding or rerouting. Whether the incisions healed without complications was the study’s focus.
Sixteen patients received tablets with Enform—a telemedicine app developed by TeleMed 2020 Inc.—that facilitated communication with nurses managing their care. As part of an in-home monitoring kit, patients also received thermometers, blood pressure cuffs, scales and devices to measure blood oxygen saturation levels.
Each day, patients who had been discharged from the hospital weighed themselves, took their temperature, measured their pulse and blood pressure, and determined their blood oxygen levels using the Enform app. They completed a wellness and symptom tracking quiz that included questions like “How is your pain today?” Each week they answered satisfaction and emotional wellness questions as well. These data, along with photos of the surgical incision sites that patients captured with the app—were made available to the patients’ care team.
Care managers, in turn, logged into the telemedicine platform daily to review the information patients had submitted from their homes. Cares managers received notifications of abnormalities, such as blood pressure spikes and fevers. Based on the information they gathered, the care managers intervened, answered patients’ questions about symptoms or wound care, called in prescriptions, scheduled appointments with physicians, and modified care plans based on consultations with the medical director.
Meanwhile, the other 14 participants had standard-of-care treatment. They received no monitoring equipment, tablet or telemedicine app.
After 30 days, the researchers made a number of comparisons between the two groups. For example, were wound infections more common in one group than the other? Did one group require more hospital readmissions? How did members of each group rate their own well-being? Were they happy with the postoperative care they received?
Hospital-readmission and wound-infection rates did not differ significantly between groups. The researchers attribute this fact to the study’s small sample size. But patients in the telemedicine group scored better on measures of their physical function, mental health and role limitations due to physical health problems. In addition, the vast majority of patients who used the app found it intuitive to use. Using a five-point scale to measure ease of use, 91 percent of patients gave it a score of 4 or 5. A similar percentage of patients said the app enriched the quality of care they received.
Likewise, the telemedicine patients’ scores on quality-of-life assessments surged more dramatically between the study’s beginning and end.
Patients assigned to the telemedicine group lived an average of 60 miles from their vascular care center. Almost a third of them lived more than 77 miles away and had to drive for two to three hours to get there.
“Telemedicine would save a lot of headache in Appalachia—in areas where people don’t even have the money to get in the car to get to the hospital,” said Mousa, who teaches surgery at the WVU Health Sciences Charleston Campus.
He envisions that, one day, patients will be able to download a cell phone app that provides these telemedicine services. That way, they won’t even need a tablet. “Each household has at least one cell phone, and most likely, it’s a smartphone.”
“You’re getting the same service,” he said, “but with a very minor hassle for the patient and the physician.”

West Virginia University
medicine.hsc.wvu.edu/News/Story?headline=wvu-researchers-find-telemedicine-may-increase-patients-satisfaction-with-their-medical-care

Nowadays, tumours inside the complex central nervous system remain one of the most challenging cancers to diagnose.
Different from conventional brain-imaging techniques, nearinfrared (NIR) fluorescence imaging demonstrates particular merits including being non-hazardous, offering fast feedback, and having higher sensitivity.
A research team led by Prof. ZHENG Hairong from the Shenzhen Institutes of Advanced Technology (SIAT) of the Chinese Academy of Sciences, in collaboration with Prof. LIU Bin from the University of Singapore, reported the first NIR-II fluorescent molecule with aggregation-induced-emission (AIE) characteristics for dual fluorescence and photoacoustic imaging.
Fluorescence imaging in the second NIR window (NIR-II), compared with the first NIR window (NIR-I), exhibits salient advantages of deeper penetration and higher spatiotemporal resolution, owing to further reduced photon scattering, absorption, and tissue autofluorescence in biological tissues.
Scientists designed a new donor-acceptor (D-A)-tailored NIR-II emissive AIE molecule, and formulated dots showed a high NIR-II fluorescence quantum yield up to 6.2%, owing to the intrinsic aggregation-induced emission nature of the designed molecule.
The AIE dots have been successfully used for dual NIR-II fluorescence and NIR-I photoacoustic imaging for precise non-invasive brain-tumour diagnosis. Based on the same dots, the experiments revealed that NIR-II fluorescence imaging showed a high resolution.
Meanwhile, NIR-I PA imaging intrinsically exhibited higher penetration depth than that of NIR-II fluorescence imaging, which allowed clear delineation of tumour depth in the brain.
The synergetic bimodal imaging with targeting c-RGD-decorated bright AIE nanoparticles showed precise brain-tumour diagnosis with good specificity and high sensitivity, which yielded a high S/B of 4.4 and accurately assessed the depth of tumour location inside brain tissue.
The study demonstrates the promise of NIR-II AIE molecules and their dots in dual NIR-II fluorescence and NIR-I photoacoustic imaging for precise brain cancer diagnostics.

EurekAlert
www.eurekalert.org/pub_releases/2018-06/caos-nmh060818.php

Testing women for the presence of sexually transmitted infections (STIs) only at the urogenital site will miss approximately 20% of STIs in women who report having receptive anal intercourse, a STD surveillance network study indicates.
“As an obstetrician-gynecologist, I thought it would be interesting to analyse data from women who report having receptive anal intercourse and see what the rates of chlamydia and gonorrhea might be,” Eloisa Llata, MD, MPH, Centers for Disease Control and Prevention, Atlanta, Georgia, said in podcast prepared by the journal, Obstetrics & Gynecology.
“We found that about one in five women who reported having receptive anal intercourse will only be infected at the rectal site, so if we only screen women with a urine-based approach, we are going to miss these women and the opportunity to stop transmission,” she added.
“So this study underscores the need to ascertain a comprehensive sexual history for all patients, male and female, in order to identify risky behaviours and to test accordingly,” Llata emphasized.
The researchers collected and analysed data from the STD Surveillance Network involving 10 state and local health jurisdictions for all visits between January 2015 and December 2016.
The researchers included 94,094 visits made to STD clinics in five jurisdictions in the analysis.
A total of 7.4% of women presenting for care during a 2-year interlude reported having receptive anal intercourse.
Some 94.1% of women were tested for Chlamydia trachomatis at the urogenital site, whereas 94.5% were tested for Neisseria gonorrhea at the same site.
Fewer women, at 76.9%, were tested for the same two STIs at the rectal site.
C trachomatis positivity was 9.1%, and N gonorrhea positivity was 5.4% among women tested only at the genital site.
Results differed among women who were tested only at the rectal site. In this subgroup of women, C trachomatis was detected in 26.7% of samples and N gonorrhea in 6.1% of them.
Investigators then identified infection rates for each of the two STIs separately in women who were tested at both the genital and rectal sites.
Analysis of this subgroup of women found that 10.4% of women tested positive for C trachomatis; of these, 20.9% of women were positive for the infection at the genital site only, whereas 58.6% of women tested positive at both the genital and rectal sites.
Another 20.5% of women were positive for C trachomatis only at the rectal site.
For women who were tested at both the genital and rectal site for N gonorrhea, 4.5% of women had been infected with the STI.

MedScapehttps://tinyurl.com/y7hayez8

An innovative technique that uses mammography to determine the biological tissue composition of a tumour could help reduce unnecessary breast biopsies, according to a new study.
Mammography has been effective at reducing deaths from breast cancer by detecting cancers in their earliest, most treatable stages. However, many women are called back for additional diagnostic imaging and, in many cases, biopsies, for abnormal findings that are ultimately proven benign. Research estimates this recall rate to be more than 10 percent in the United States.
“The callback rate with mammography is much higher than ideal,” said the study’s first author, Karen Drukker, PhD, research associate professor from the Department of Radiology at the University of Chicago. “There are costs and anxiety associated with recalls, and our goal is to reduce these costs but not miss anything that should be biopsied.”
Dr. Drukker and colleagues recently studied a new technique called three-compartment breast (3CB) imaging. John Shepherd, PhD, currently at the University of Hawaii in Honolulu, and his team developed 3CB while he was at the University of California in San Francisco. By measuring the water, lipid and protein tissue composition throughout the breast, 3CB might provide a biological signature for a tumour. For instance, more water in the tumour tissue might indicate angiogenesis.
For the study, the researchers acquired dual-energy mammograms from 109 women with breast masses that were suspicious or highly suggestive of a malignancy immediately prior to biopsy. The ensuing biopsies showed 35 masses to be invasive cancers, while the remaining 74 were benign.
3CB images were derived from the dual-energy mammograms and analysed along with mammography radiomics developed by Maryellen L. Giger, PhD, and her team at the University of Chicago for use in computer-aided diagnosis on breast images.
The combination of 3CB image analysis and radiomics improved the positive predictive value in breast masses deemed suspicious. The combined method improved positive predictive value from 32 percent for visual interpretation alone to almost 50 percent, with an almost 36 percent reduction in biopsies. The 3CB-radiomics method missed one of the 35 cancers, for a 97 percent sensitivity rate.
“These results are very promising,” Dr. Drukker said. “Combining 3CB image analysis with mammography radiomics, the reduction in recalls was substantial.”
Dr. Drukker said the combined 3CB-radiomics approach has the potential to play an increasingly prominent role in breast cancer diagnosis and perhaps also screening. She noted that 3CB can easily be added to mammography without requiring extensive modifications of existing equipment.
“The patient is already getting the mammography, plus we get all this extra information with only a 10 percent additional dose of radiation,” she said.

Radiological Society of North Americahttps://tinyurl.com/ychyg9wa