Source:http://news.ntu.edu.sg/pages/newsdetail.aspx?URL=http://news.ntu.edu.sg/news/Pages/NR2018_Nov21.aspx&Guid=af569264-037b-4792-a22c-6ca2fa43e059&Category=News+Releases Reviewed by James Ives, M.Psych. (Editor)Nov 21 2018Analysis of doctor-patient conversations to help shape design of future specialists’ communication trainingA joint study by researchers from Nanyang Technological University, Singapore (NTU Singapore) and clinicians at Tan Tock Seng Hospital (TTSH) has yielded insights into how doctors can better communicate the value of clinical investigations to patients.The research team is one of the first groups in Singapore to use Conversation Analysis, a method for studying social interaction, in a hospital setting.In Conversation Analysis, video recordings of interactions in an authentic setting are transcribed verbatim. Researchers analyse the verbal and non-verbal aspects during each person’s turn to talk, paying attention to context and identifying recurring patterns of interaction.This micro-analysis is richer in insights compared to retrospective interviews and surveys commonly used in health communication studies. Researchers can subsequently give clinicians specific recommendations in terms of what to say, and how to say it at a specific point, in order to enhance the communication process.For example, when addressing a patient’s concern about pain during a procedure, just explaining the use of anaesthetics may not be enough to reduce the fear. Instead, the doctor can share what his past patients said about their experience.The research outcomes are expected to shape the design of medical communication modules for training of future urologists in TTSH.The study which involved an analysis of 150 doctor-patient conversations at TTSH’s Urology clinics was led by Professor Luke Kang Kwong Kapathy and Assistant Professor Lim Ni Eng, both from NTU School of Humanities, in collaboration with Adjunct Assistant Professor Png Keng Siang, Senior Consultant, Department of Urology, TTSH.”Conversation Analysis is a fresh look into communication in healthcare which doctors were not previously exposed to. We are excited that our day-to-day doctor-patient interactions can shed so much insight through the use of this novel approach,” said Adjunct Asst Prof Png Keng Siang.”Current medical education already includes communication training, but we want to go a step further in looking at the actual interactions in the clinics. Studying the languages, responses and social psychology in the clinical setting gives us insights on what makes patients more receptive to doctors’ recommendations, which may lead to patients being more willing to go through necessary tests and increased patient satisfaction,” said Prof Luke, who is the Chair, School of Humanities, and Associate Dean (Research), College of Humanities, Arts, & Social Sciences at NTU.Related StoriesAre physical examinations by family doctors still needed?How to get a cheaper prescription before leaving the doctor’s officeNew app created to help people reduce exposure to anticholinergic medicationsRicher insightsThe study involved filming 150 first-visit consultations at TTSH urology clinics. A preliminary study involving 50 patients and three urology consultants started in July 2016.From the initial findings, a larger study involving 100 patients and clinicians from the urology department was conducted from mid-2017 to mid-2018. Patients had given their written consent to participate in this research project, which was approved by National Healthcare Group’s ethics review board.A common reason for patients to be referred to Urology clinics is the presence of blood in urine. As this can be caused by various reasons, a first-visit consultation often involves the recommendation of various diagnostic procedures, in order to pinpoint the exact cause behind the symptom. These tests may consist of a urine test, renal ultrasound, as well as cystoscopy which involves running a thin tube with lens to the bladder through the urethra.Recurring scenarios include patients’ expression of fear towards cystoscopy, and apprehension towards going through multiple tests. To enhance the communication process, doctors can be more aware of patients’ subconscious signs of fear. To patients who may view the tests as being optional, they can also explain upfront that all the tests are needed to pinpoint the exact cause behind the symptoms, before going into test details.NTU’s Asst Prof Lim said, “Our study also brings up the question of how much patients know or do not know about the various medical procedures when they enter the clinic. How this knowledge affects patients’ interaction with doctors and their decision-making process can be further studied.”Throughout 2018, the research team had presented their findings at several international conferences such as the Singapore Public Health & Occupational Medicine Conference, the International Symposium on Healthcare Communication, and the Global Health Histories Seminar jointly organised by the World Health Organisation and Sri Lanka’s government.NTU and Tan Tock Seng Hospital have been collaborating in advancing patient care through their engagement in the Lee Kong Chian School of Medicine and Health City Novena.The NTU team is part of a medical humanities research cluster at the university, which looks at the linguistic, social and cultural aspects of medical practice.Other ongoing projects by the same team include enhancing communication in TTSH’s Ophthalmology clinics and in the training of medical students. The researchers also aim to apply Conversation Analysis in palliative care in future.
Reviewed by Alina Shrourou, B.Sc. (Editor)Apr 2 2019Research at St. Jude Children’s Research Hospital has identified a genomic risk factor associated with stroke in childhood cancer survivors. The findings were announced today at a press conference as part of the American Association for Cancer Research annual meeting in Atlanta.This investigation draws on whole genome sequencing and other data gathered longitudinally through the St. Jude Lifetime Cohort (SJLIFE) study. The purpose of SJLIFE is to learn about the health of adult survivors of childhood cancer and to reduce the late effects of childhood cancer treatments.”Long-term survivors of childhood cancer are known to be at an increased risk of stroke, which is often attributed to their prior cancer treatment,” said first author Yadav Sapkota, Ph.D., of the St. Jude Department of Epidemiology and Cancer Control. “But we observed variation in risk that suggested there may be an underlying genetic component.”To study the risk of stroke, Sapkota and his colleagues focused on 686 childhood cancer survivors in the cohort treated with cranial radiation therapy. Higher doses of radiation have been previously correlated with risk of stroke. However, the researchers wanted to understand why some patients treated with high doses do not experience a stroke, while other patients do even when they are treated at lower doses.”This is one of the first studies to evaluate the genomic underpinnings of stroke in such a robust cohort,” Sapkota said. “Ultimately our findings help determine who is at a greater risk so we can intervene on modifiable lifestyle and other factors that are known to affect the risk of stroke.”The genomic data generated through this research is freely available to researchers on the St. Jude Cloud platform, a data-sharing resource pioneered by St. Jude and available to the global research community. St. Jude Cloud is one of the world’s largest repositories of pediatric genomics data and offers a suite of unique analysis tools and visualizations.Related StoriesTrends in colonoscopy rates not aligned with increase in early onset colorectal cancerUsing machine learning algorithm to accurately diagnose breast cancerStudy reveals link between inflammatory diet and colorectal cancer riskKey findings from the study include: In addition to the dose level of cranial radiation therapy that increases stroke risk up to 11 fold, variants on a chromosomal region called 5p15.33 increase risk approximately three-fold overall. This result suggests that testing for variants of 5p15.33 may be useful for identifying patients who, when treated with cranial radiation therapy, will be at a high risk of stroke as adults. This is the first study to link the chromosomal region with an increased risk of stroke. These variants in 5p15.33 are found to elevate stroke risk approximately five-fold among childhood cancer survivors treated with intermediate dose (25-50 Gray) of cranial radiation therapy. This suggests that among those treated with cranial radiation therapy, 5p15.33 may modify the effect of the treatment on stroke risk. The researchers replicated the finding in two independent groups of survivors from SJLIFE, consisting of survivors of African ancestry who received cranial radiation therapy and survivors of European descent who did not receive cranial radiation therapy. Results of the replication analysis suggest that a combination of cranial radiation therapy and genetic factors can greatly increase childhood cancer survivors’ risk for developing stroke. Source:https://www.stjude.org/media-resources/news-releases/2019-medicine-science-news/aacr-genetic-study-identifies-risk-factor-for-stroke-among-cancer-survivors.html This research is included in a poster session to be held Wednesday, April 3, 2019, as part of the AACR meeting. Additionally, SJLIFE is one of the projects for which the St. Jude Survivorship Research Team was awarded the 2019 AACR Team Science Award. To date, through SJLIFE, more than 4,300 survivors and 580 control cases have undergone comprehensive evaluations of cardiac, reproductive, neuromuscular, neurocognitive and psychosocial functions. read more
Despite best efforts by rheumatologists and patients to find an effective arthritis treatment and management strategy, there are still many patients who seek additional relief for chronic symptoms. It’s alarming that so many arthritis patients use medical marijuana and cannabidiol products in the absence of high quality evidence about their safety, effectiveness, and appropriate dosing. This underscores the urgent need to conduct randomized, controlled trials to study their effectiveness at addressing symptoms common to arthritis as well as their potential to interact with other medications. Moreover, it’s concerning that patients may not be discussing their use of these products to augment or replace other arthritis treatments with their health care team.”W. Benjamin Nowell, Ph.D., Director of Patient-Centered Research at CreakyJoints and an ArthritisPower co-principal investigator and poster author Jun 20 2019On June 13, CreakyJoints®, a Global Healthy Living Foundation patient community, will present a poster at the Annual European Congress of Rheumatology (EULAR 2019) meeting in Madrid, Spain. Two additional abstracts were accepted for publication.The poster titled, “Patients’ Perceptions and Use of Medical Marijuana,” found that more than half (57.3%) of arthritis patients (N=1,059) have reported trying marijuana (THC) and/or cannabidiol (CBD) products for a purpose they perceived as medical. Of those who use THC regularly for medical reasons 62 percent reportedly use THC at least once daily. Among the most commonly cited reasons for stopping use were illegality (31.2%) of THC and cost (32.5%) of CBD. Despite those barriers, most participants who tried THC or CBD said that it improved their symptoms (THC= 97.1%, CBD=93.7%) and/or their condition (THC= 96.1%, CBD=93.1%). Pain and sleep disturbance were the main symptoms participants sought to relieve with these products and many used them in lieu of prescribed or over-the-counter medications. Related StoriesStill-to-be-approved drug proves to be new option for treating active rheumatoid arthritisResearchers develop NO-scavenging hydrogel for treatment of rheumatoid arthritisPromising methods for early detection and treatment of rheumatoid arthritisThe survey found that only two-thirds (64.6%) of participants reported telling their HCP about their THC or CBD use and of those more than half did not receive any information from their healthcare provider about safety, effectiveness or dosing, possibly because such little research is available. Of those that did receive advice, most reported that their HCP did not consider their use of THC or CBD when making other treatment changes. Whether they had used THC or CBD for medical reasons or not, most patients (THC=65.5%, CBD=55.6%) expressed wanting more information about them, including on their effectiveness and interaction with other medications from their health care provider or online educational resources.Utilizing the ArthritisPower® research registry, which now includes more than 19,000 consented participants, the 77-item survey included 1,059 participants who were ≥ 19 years old, lived in the United States, and reported physician-diagnosed rheumatoid or musculoskeletal disease. The survey also required participants to report their current health status (NIH PROMIS Global Health), use and perceptions of THC/CBD, and related information needs. The complete survey results are available in the poster, upon request.Overview of CreakyJoints data at EULAR 2019 Patients’ Perceptions and Use of Medical Marijuana Identifier: THU0644 Poster presentation: June 13, 2019 at 11:45 a.m. CET The Patient Experience: A Process Evaluation of a Pilot Pragmatic Using Remote Monitoring of Symptoms Identifier: AB1284, published abstract Patient Preferences for the Use of Digital Tools and Social Media in Diet and Exercise Interventions Identifier: AB1222, published abstract Source:CreakyJoints read more