Anxious about speaking in online classes and meetings? Here are 7 tips to make it easier

by Lesley Irvine, The Conversation

Credit: TommyStockProject/Shutterstock

Many parents and students are engaged in a daily routine of speaking to people via a camera on a computer, tablet or phone during COVID-19 restrictions. This often means finding a quiet place in order to ask a question, provide an answer or share an opinion with a virtual audience.

30 august 2020--Initial concerns about using video apps focused on privacy and equity issues.

Soon, new terms emerged such as Zoom fatigue. But an issue that has been less discussed is the role that nerves might play in these mediated sessions.

What is speaking anxiety?

For centuries, people have questioned their ability to speak in front of others. It's said the Roman orator Cicero (106-43BCE) turned pale and quaked before any speech he gave.

But it was in the 20th century that communication anxiety was studied in depth. It has been described by a number of different terms, including stage fright, unwillingness to communicate and communication apprehension.

Research suggests about one in five speakers experience high communication apprehension. This can make all speaking opportunities difficult.

Examples include speaking to a boss or teacher, contributing to a group discussion, or delivering a presentation. Public speaking anxiety is part of communication apprehension.

The prevalence of public speaking anxiety is well documented. It is complex (varying causes, indicators and treatment options), individual (affecting speakers differently) and unstable (changing levels of anxiety within and between presentations).

A focus on individual differences acknowledges that internal thoughts and feelings might not match external behavior. For example, a speaker who appears disengaged may actually feel a lack of control.

It is a tricky phenomenon. Some people can feel nervous the moment a speaking task is announced and, on the day of presentation, may rate themselves as more nervous than what an audience observes.

Nervous about the audience

It is the audience, and the potential for negative evaluation from that audience, that can make us feel anxious. And those listening can be physically or virtually present.

This brings us to the rather awkward situation of speaking to rows of little boxes on a screen in a video hook-up. Not only does this set-up limit broader non-verbal cues, but it also restricts general banter between participants.

On the plus side, this can make sessions more time-efficient, but it does tend to make conversations more stilted.

A perceived need to be visible is a contested area in online delivery. In educational settings, those who support "cameras on for everyone" suggest it helps to replicate usual classroom conditions, encourages discussion and ensures students are actually in attendance (not just logged on).

But it is important to consider the rationale behind making any feature mandatory. Participating via a video app is not the same as a live setting.

For a start, speakers rarely see themselves when talking to others. As a lecturer, seeing myself onscreen while speaking with a class can be distracting, especially when trying to look directly at the camera lens to maximize eye contact.

7 tips to make things easier

Whether running a business meeting or teaching a class, the following tips may help you to feel more comfortable speaking online:

1. provide an agenda ahead of time, which could include sending out some prepared questions for discussion
2. reduce uncertainty about participation by letting people know from the outset if there is any need or expectation to talk in a hook-up
3. use linking statements and signposts to keep everyone on track as other cues and clues may be absent (walking across a room to a computer), so it's important to let all participants know what you are doing and why (for example: "I'm going to check the chat box at the end of this point so feel free to add any questions as I go along.")
4. model good speaking practices, draw on simple structures to make your point and use language that is suitable for oral delivery
5. rethink the value of calling on someone randomly to contribute to a discussion, because if people are worried they may be asked to respond without notice, they may be less likely to engage overall
6. make decisions about the need for interaction (including break-out rooms) based on the type of session and number of participants, because needless interaction is not better than no interaction
7. plan for each online event rather than stick to a set of general rules. For example, is it always necessary for speakers to see each other onscreen? As most educators will tell you, just because a student is physically present that doesn't mean they are actively engaged.

Online tutorials, workshops and meetings are here to stay for the moment. To create safe, supportive and productive sessions, we need to build competent and confident speaking practices.

Acknowledging that speaking anxiety is common, and affects people in live and virtual settings, is a good place to start.

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Provided by The Conversation 

New at-home heart monitoring technique could reduce hospital visits and save lives

by Ben Robinson, University of Manchester

Credit: CC0 Public Domain

A simple new heart-monitoring technique has been developed to help people self-monitor their conditions at home without the need for hospital visits.

28 august 2020--University of Manchester researchers have developed a simple technique that allows people to monitor their own electrocardiogram (ECG) for a potentially life-threatening condition.

Previously people needed to have an ECG in hospital that was interpreted by a highly-trained expert. In new research published today in journal PLoS One, scientists show that if you apply color in the right way, people can easily monitor hospital-level health data themselves.

The "QT-interval" is the time it takes for the heart to depolarise and recharge itself. Many common medications, including some prescribed for depression and cancer, can cause this to lengthen. The longer it gets, the more likely you are to suffer from a life-threatening arrhythmia that can cause sudden death.

An ECG shows complex signal data representing the heart's electrical activity. It is vital for detecting cardiac pathologies, but extremely difficult to interpret, even for clinicians. Researchers at The University of Manchester have been working on a novel visualization technique that makes it straightforward for members of the general public to understand ECG data.

Dr. Caroline Jay from The University of Manchester said: "For decades we've assumed that only medical experts can interpret ECGs. We now have evidence that if you display an ECG in the right way, it can easily be interpreted by a patient. Here, we've shown that it is simple for lay people to understand when they might be at risk of long QT syndrome, which is important because it is caused by many common medications and can result in sudden death. Empowering people to understand and monitor their own ECG is a huge leap forward for public health, as it will reduce the number of times people have to go into hospital for routine check-ups, and ensure they get emergency medical attention as soon as they need it."

The newly developed technique works on a "single lead" ECG, which is the heart reading available on a smart watch. A spectrum of color is applied to the area under the ECG signal from blue to red. The more warm colors you can see, the greater the risk of long QT syndrome.Long QT syndrome often doesn't cause symptoms, so an ECG is the only way to pick it up. Self-monitoring is particularly useful when someone starts taking a new form of medication, as they will be able to contact their doctor as soon as they notice an issue.

The ability to accurately self-monitor conditions with confidence at home has the potential to ease the number of people requiring trips to hospital, which could be particularly useful during the COVID-19 pandemic.The technique is currently being used as the basis for a new Artificial Intelligence approach that can detect QT-interval lengthening automatically. Because the algorithm uses a data representation that humans find easy to visually understand, it is not just explainable from a technical perspective, but also intuitively understandable.

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More information: Alaa Alahmadi et al. Pseudo-coloring an ECG enables lay people to detect QT-interval prolongation regardless of heart rate, PLOS ONE (2020). DOI: 10.1371/journal.pone.0237854

Journal information: PLoS ONE 

Provided by University of Manchester 

 

Acedia: The lost name for the emotion we're all feeling right now

by Jonathan Zecher, The Conversation

Credit: CC0 Public Domain

With some communities in rebooted lockdown conditions and movement restricted everywhere else, no one is posting pictures of their sourdough. Zoom cocktail parties have lost their novelty, Netflix can only release so many new series. The news seems worse every day, yet we compulsively scroll through it.

27 august 2020--We get distracted by social media, yet have a pile of books unread. We keep meaning to go outside but somehow never find the time. We're bored, listless, afraid and uncertain.

What is this feeling?

John Cassian, a monk and theologian wrote in the early 5th century about an ancient Greek emotion called acedia. A mind "seized" by this emotion is "horrified at where he is, disgusted with his room … It does not allow him to stay still in his cell or to devote any effort to reading." He feels: "such bodily listlessness and yawning hunger as though he were worn by a long journey or a prolonged fast … Next he glances about and sighs that no one is coming to see him. Constantly in and out of his cell, he looks at the sun as if it were too slow in setting."

This sounds eerily familiar. Yet, the name that so aptly describes our current state was lost to time and translation.

Noonday demon

Etymologically, acedia joins the negative prefix a- to the Greek noun kēdos, which means "care, concern, or grief." It sounds like apathy, but Cassian's description shows that acedia is much more daunting and complex than that.

Cassian and other early Christians called acedia "the noonday demon," and sometimes described it as a "train of thought." But they did not think it affected city-dwellers or even monks in communities.

Rather, acedia arose directly out the spatial and social constrictions that a solitary monastic life necessitates. These conditions generate a strange combination of listlessness, undirected anxiety, and inability to concentrate. Together these make up the paradoxical emotion of acedia.

Evagrius of Pontus included acedia among the eight trains of thought that needed to be overcome by devout Christians. Among these, acedia was considered the most insidious.It attacked only after monks had conquered the sins of gluttony, fornication, avarice, sadness, anger, vainglory, and pride.

Cassian, a student of Evagrius, translated the list of sins into Latin. A later 6th century Latin edit gave us the Seven Deadly Sins. In this list, acedia was subsumed into "sloth," a word we now associate with laziness.

Acedia appears throughout monastic and other literature of the Middle Ages. It was a key part of the emotional vocabulary of the Byzantine Empire, and can be found in all sorts of lists of "passions" (or, emotions) in medical literature and lexicons, as well as theological treatises and sermons.

It first appeared in English in print in 1607 to describe a state of spiritual listlessness. But it's barely used today.

Making like monks

As clinical psychology has reclassified emotions and mental states, terms like "melancholy" can sound archaic and moralizing.

Emotional expressions, norms, and scripts change over time and vary between cultures. They mark out constellations of bodily sensations, patterns of thought and perceived social causes or effects.

Since these constellations are culturally or socially specific, as societies change, so do the emotions in their repertoire. With the decline of theological moralizing, not to mention monastic influence, acedia has largely disappeared from secular vocabularies.

Now, the pandemic and governmental responses to it create social conditions that approximate those of desert monks. No demons, perhaps, but social media offers a barrage of bad (or misleading) news.

Social distancing limits physical contact. Lockdown constricts physical space and movement. Working from home or having lost work entirely both upend routines and habits. In these conditions, perhaps it's time to bring back the term.

More than a label

Reviving the language of acedia is important to our experience in two ways.

First, it distinguishes the complex of emotions brought on by enforced isolation, constant uncertainty and the barrage of bad news from clinical terms like "depression" or "anxiety."

Saying, "I'm feeling acedia" could legitimize feelings of listlessness and anxiety as valid emotions in our current context without inducing guilt that others have things worse.

Second, and more importantly, the feelings associated with physical isolation are exacerbated by emotional isolation – that terrible sense that this thing I feel is mine alone. When an experience can be named, it can be communicated and even shared.

Learning to express new or previously unrecognized constellations of feelings, sensations, and thoughts, builds an emotional repertoire, which assists in emotional regulation. Naming and expressing experiences allows us to claim some agency in dealing with them.

As we, like Cassian's desert monks, struggle through our own "long, dark teatime of the soul," we can name this experience, which is now part of our emotional repertoire.

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Provided by The Conversation 

New frailty index to improve aged care outcomes

by South Australian Health and Medical Research Institute (SAHMRI)

Credit: Pixabay/CC0 Public Domain

A new frailty index, developed and validated by the SAHMRI-based Registry of Senior Australians (ROSA), is set to improve aged care and health outcomes for vulnerable older people.

25 august 2020--The frailty index project was led by ROSA and Flinders University Research Fellow Dr. Jyoti Khadka, who says the ability to measure frailty at a population level, especially when it is a pivotal time for older

Australians, should deliver broad benefits across the aged care sector.

"This index can accurately predict an individual's risk of death and the likelihood that they might need long-term residential aged care," Dr. Khadka said.

"This is extremely important information because frailty can be treated or prevented. Identifying risk enables timely treatment through relatively simple means such as diet and physical and mental exercises."

Medically, frailty is defined as a state of increased weakness and vulnerability to adverse health outcomes including falls, injuries, dependency, hospitalization, institutionalization and death.

Fellow research team member Professor Renuka Visvanathan, internationally recognized expert in geriatric medicine, says use of the index can be incorporated into the more than 186,000 aged care eligibility assessments currently performed each year by an aged care assessment team (ACAT).

"The assessment of a person's frailty at this important time in their aged care journey can be used to flag those who might benefit from additional support to lower their risk of adverse events like hospitalization," she said.

"There is increasing interest for assessment programs which use electronic systems such as our Australian aged care eligibility assessments, which is supported by My Aged Care. This can produce a frailty risk score by the end of an assessment with the older person."

Dr. Khadka says the frailty index is already proving highly valuable from a research perspective across several ROSA projects.

"For instance, a study recently published in the journal Bone used the index to demonstrate how frailty changes the risk of death, functional limitation and higher level of aged care following a hip fracture," he said.

The frailty index was developed using historical data involving more than 900,000 older Australians. The process behind its development was published in the Medical Journal of Australia.l

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More information: Jyoti Khadka et al. Development and validation of a frailty index based on Australian Aged Care Assessment Program data, Medical Journal of Australia (2020). DOI: 10.5694/mja2.50720

Provided by South Australian Health and Medical Research Institute (SAHMRI)

Surgical innovation promises better dialysis outcomes

by Brita Belli, Yale University

An illustration comparing the traditional approach to creating an arteriovenous fistulae in the arm to the scientists’ RADAR method. Credit: H. Bai et al., Science Translational Medicine (2020)

A new technique developed by a Yale-led research team improves blood flow in surgically made blood vessels used in dialysis, enables them to last longer, and results in fewer complications than the standard technique.

23 august 2020--The findings, based on work with hundreds of patients and supported by animal studies, appear in the Aug. 19 issue of Science Translational Medicine. 

Of more than 661,000 Americans with kidney failure, according to the National Institute of Diabetes and Digestive and Kidney Diseases, 468,000 are on dialysis, a method of filtering waste from the blood when the kidneys are damaged or fail. But the standard way of accessing a patient's blood flow has shortcomings the new technique overcomes.

Typically, vascular surgeons fashion a vein-to-artery arteriovenous fistula (AVF)—a larger, stronger blood vessel—by dividing a vein in the patient's wrist and joining it to the artery. This enhances blood flow and vein access for the two needles that route a patient's blood through the dialysis machine and back into the body. 

Yet the method, standard procedure for the last 50 years, has "the worst results of any procedure we do," said Yale School of Medicine's Dr. Alan Dardik, professor of surgery (vascular) and of cellular and molecular physiology, and senior author of the study.

Sixty percent of fistulas fail to mature, and only 50% are still usable a year later. For women, success rates are even lower, with just 40% of fistulas still usable at one year. 

Shear stress on vessels (colored regions) was lower in key spots in the new RADAR configuration (bottom row) than in the conventional vein-to-artery configuration (top row) in male rats. Credit: H. Bai et al., Science Translational Medicine (2020)

For the many cases in which the fistula can't be maintained, Dardik said, patients need an artificial graft, which has an even lower success rate.

"Eventually these patients can only receive dialysis with a catheter," he said, a procedure that carries increased risk of infection and death. Patients receiving dialysis by catheter have a 1.6 to 2.5 times higher mortality rate than those receiving dialysis by fistulas.

In the new surgical technique, known as radial artery deviation and reimplantation, or RADAR, surgeons essentially reverse the procedure, bringing the artery over to the vein. They also use a tourniquet instead of clamps to temporarily stop blood flow while operating. This requires less handling of the artery and vein than the traditional method and results in better blood flow and a more robust fistula.

"It works a heck of a lot better," said Dardik. 

Building on a 2016 pilot study of RADAR's effectiveness involving 53 patients, the new study examined 201 patients who had the novel artery-to-vein surgery and compared them with 73 who had the traditional vein-to-artery surgery.

At one year, 72.2% of the RADAR patients had viable fistulas, compared with 48.1% of traditional fistula patients. At three years, fistulas remained viable in 62.1% of RADAR patients versus 37.6% of patients with traditional fistulas.

Notably, the new procedure was just as successful for female patients as male patients. 

The researchers confirmed their findings in animal (rat) studies in which they created both artery-to-vein fistulas and vein-to-artery fistulas, and examined the differences. The results closely mirrored those for the human patients.

The animal studies also made clear why the new technique was more effective. Using CAT scans and ultrasound, researchers observed crucial differences in hemodynamics between the two surgical techniques. "The pattern of blood flow in the RADAR technique was better than the usual pattern of flow with the conventional technique," Dardik said.

Given the significant need for dialysis, Dardik said, the new technique offers a clear opportunity for improving patient outcomes through more robust fistulas and fewer procedures to maintain access and the related complications.

"Surgeons always want the best for their patients," he said, "and the RADAR procedure lets surgeons do their best."

More information: Hualong Bai et al. Artery to vein configuration of arteriovenous fistula improves hemodynamics to increase maturation and patency, Science Translational Medicine (2020). DOI: 10.1126/scitranslmed.aax7613

Journal information: Science Translational Medicine 

Provided by Yale University 

 

Doctor invents hybrid mask allowing ear, nose, and throat doctors to see more patients

by Troy Carter, TechLink

A VA medical staffer in Sacramento models a prototype of the new mask invented by Dr. Scott Fuller, director of Head & Neck Oncologyat the VA's Northern California Health Care System. Credit: Dr. Scott Fuller/VA

An otolaryngologist has developed a simple mask design that significantly improves safety during aerosol-generating activities of the head and neck. .

22 august 2020--Because of the pandemic, the number of patients Dr. Scott Fuller was seeing plummeted to one or two per day.

"I'd been sitting in my office quite a lot at that point in time, because we just weren't able to do anything," Fuller said in an interview on Friday. "We weren't able to see patients unless they were emergent patients in our clinic, and if we were seeing patients and had to do an endoscopy, we had to get into N95, goggles, face shields, all kinds of PPE."

Fuller specializes in head and neck cancer at the VA hospital in Sacramento. In late April, using scissors, he modified a surgical mask, installing a nasal tube and a transparent window for patients to wear. The new design now allows him to see a higher number of patients safely.

Fuller is now working to patent the invention and quickly transfer it to an industry partner who can begin its commercialization and mass production. After building a handful of his own prototypes, Fuller is now working with the VA's Human Engineering Research Labs in Pittsburgh, which recently sent him a shipment of advanced prototypes.

Federal law allows VA inventions to be licensed to businesses or entrepreneurs. Once licensed, an invention can be taken to market. Fuller is working with the VA Tech Transfer Program to submit a patent application and identify companies that have the ability to produce the mask for widespread use.

As the VA national partnership intermediary, TechLink is supporting the VA's outreach. Jonathan Baker, a senior technology manager at TechLink, has interviewed Dr. Fuller and is facilitating licensing conversations with companies.

A digital illustration of the mask prototype is shown. Credit: Courtesy VA

"It's a timely, useful invention with an existing market," Baker said. "Its simplicity makes it manufacturable and marketable."

Companies can now read Baker's summary of the technology and contact him directly.

Ear, nose, and throat doctors are, like others in the medical professions, at an increased risk of infection by the novel coronavirus, yet need to see patients who may or may not be carrying it. Viral particles can go airborne during endoscopic examinations in which a fiber-optic camera is inserted into the mouth or nose of a patient. The new mask's transparent window allows doctors to see the patient's nose or mouth during the procedure.

After an endoscopy, to completely clean an examination room, it has to be left empty for as long as three hours while the ventilation system changes out the air. Fuller's new mask eliminates the downtime by blocking any droplets or aerosol particles from going airborne. Additionally patients can put the mask on just as they would any other surgical mask before entering the exam room.

The mask also allows health care providers to safely reduce their PPE burn rate for routine endoscopic examinations. But most importantly, it allows doctors to see and treat their patients. "We have a lot of tools within our specialty that have been categorized as aerosol-generating," Fuller said. "This problem spans outside of COVID-19 to influenza and other respiratory maladies. But specifically, with COVID-19, I saw a shutdown, essentially, of our clinic and our ability to evaluate our patients."

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Provided by TechLink

 

One drink per day? Limit on men's alcohol consumption may become official US guideline

by Simone Jasper, The News & Observer (Raleigh, N.c.)

Credit: CC0 Public Domain

Men should restrict alcohol consumption to one drink each day, a group recommending new U.S. dietary guidelines says.

21 august 2020--That would be stricter than current guidance, which limits men to two drinks daily, according to the Centers for Disease Control and Prevention. Under the proposed change, men would be urged to stick to the same one-drink cap recommended for women.

"The fact that most existing evidence indicates increased risk of all-cause mortality among men drinking 2 drinks per day compared to 1 drink per day, and the possibility that no protection exists for low volume drinking on (cardiovascular disease), changing recommended limits to 1 drink daily for men is justified and should be strongly considered," the 2020 Dietary Guidelines Advisory Committee report said.

The proposal is among the suggestions under consideration for official U.S. dietary guidelines, which the government says are designed to help people make nutrition decisions.

Several of the recommendations, which the committee compiled into its July report, address drinking in moderation.

"Do not begin to drink alcohol or purposefully continue to drink because you think it will make you healthier," the report said in one of its suggestions.

Another recommendation urges "drinking less is generally better for health than drinking more."

In the United States, one drink is considered a 12-ounce beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor, according to the CDC.

Health officials last week said a public comment period about the advisory committee's report had ended. The document is expected to help the U.S. Departments of Agriculture and Health and Human Services develop 2020-2025 dietary guidelines by the end of the year, the government said.

The report comes as the CDC this month revealed about 5% of adults were heavy drinkers. That means they "consume an average of more than 14 alcoholic drinks per week for men or more than 7 drinks per week for women," according to a survey conducted in 2018.

Increased alcohol use has been recorded during the coronavirus pandemic. Researchers have said free time, stress and limited access to treatment could be behind the trend, McClatchy News reported.

But drinking more than recommended can come with risks, health officials warn.

"Heavy drinking is associated with an increased risk of alcohol use disorders, suicide, interpersonal violence, traffic injuries, liver disease, certain cancers and infectious diseases, and adverse birth outcomes in pregnant women," according to the CDC.

Task force examines role of mobile health technology in COVID-19 pandemic

by University of Massachusetts Amherst

Credit: CC0 Public Domain

An international task force, including two University of Massachusetts Amherst computer scientists, concludes in new research that mobile health (mHealth) technologies are a viable option to monitor COVID-19 patients at home and predict which ones will need medical intervention.

18 august 2020--The technologies—including wearable sensors, electronic patient-reported data and digital contact tracing—also could be used to monitor and predict coronavirus exposure in people presumed to be free of infection, providing information that could help prioritize diagnostic testing.

The 60-member panel, with members from Australia, Germany, Ireland, Italy, Switzerland and across the U.S., was led by Harvard Medical School associate professor Paolo Bonato, director of the Motion Analysis Lab at Spaulding Rehabilitation Hospital in Boston. UMass Amherst task force members Sunghoon Ivan Lee and Tauhidur Rahman, both assistant professors in the College of Information and Computer Sciences, focused their review on mobile health sensors, their area of expertise.

The team's study, "Can mHealth Technology Help Mitigate the Effects of the COVID 19 Pandemic?" was published Wednesday in the IEEE Open Journal of Engineering in Medicine and Biology.

"To be able to activate a diverse group of experts with such a singular focus speaks to the commitment the entire research and science community has in addressing this pandemic," Bonato says. "Our goal is to quickly get important findings into the hands of the clinical community so we continue to build effective interventions."

The task force brought together researchers and experts from a range of fields, including computer science, biomedical engineering, medicine and health sciences. "A large number of researchers and experts around the world dedicated months of efforts to carefully reviewing technologies in eight different areas," Lee says.

"I hope that the paper will enable current and future researchers to understand the complex problems and the limitations and potential solutions of these state-of-the-art mobile health systems," Rahman adds.

The task force review found that smartphone applications enabling self-reports and wearable sensors enabling physiological data collection could be used to monitor clinical workers and detect early signs of an outbreak in hospital or healthcare settings.

Similarly, in the community, early detection of COVID-19 cases could be achieved by building on research that showed it is possible to predict influenza-like illness rates, as well as COVID-19 epidemic trends, by using wearable sensors to capture heart rate and sleep duration, among other data.

Lee and Rahman, inventors of mobile health sensors themselves, reviewed 27 commercially available remote monitoring technologies that could be immediately used in clinical practices to help patients and frontline healthcare workers monitor symptoms of COVID-19.

"We carefully investigated whether the technologies could 'monitor' a number of obvious indicators and symptoms of COVID-19 and whether any clearance or certification from health authorities was needed," Lee says. "We considered ease of use and integration flexibility with existing hospital electronic systems. Then we identified 12 examples of technologies that could potentially be used to monitor patients and healthcare workers."

Bonato says additional research will help expand the understanding of how best to use and develop the technologies. "The better data and tracking we can collect using mHealth technologies can help public health experts understand the scope and spread of this virus and, most importantly, hopefully help more people get the care they need earlier," he says.

The paper concludes, "When combined with diagnostic and immune status testing, mHealth technology could be a valuable tool to help mitigate, if not prevent, the next surge of COVID-19 cases."

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More information: Catherine Adans-Dester et al, Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic?, IEEE Open Journal of Engineering in Medicine and Biology (2020). DOI: 10.1109/OJEMB.2020.3015141

Provided by University of Massachusetts Amherst 

 

Telehealth visits have skyrocketed for older adults, but some concerns and barriers remain

by University of Michigan

Key findings about the use of telehealth by older adults in 2020, compared with 2019. Credit: University of Michigan

One in four older Americans had a virtual medical visit in the first three months of the COVID-19 pandemic, most of them by video, a new telehealth poll finds. That's much higher than the 4% of people over 50 who said they had ever had a virtual visit with a doctor in a similar poll taken in 2019.

17 august 2020--Comfort levels with telehealth, also called telemedicine, have also increased. Back in 2019, most older adults expressed at least one serious concern about trying a telehealth visit. But by mid-2020, the percentage with such concerns had eased, especially among those who had experienced a virtual visit between March and June of this year.

Yet not all older adults see virtual care as an adequate substitute for in-person care, even in a pandemic, the National Poll on Healthy Aging findings show.

And 17% of people over 50 still say they have never used any sort of video conferencing tool for any reason, including medical care. While that's 11 percentage points lower than in the 2019 poll, that lack of experience or access could be a barrier to receiving care without having to leave home as the pandemic continues to surge in dozens of states.

Both the 2019 and 2020 polls were done for the University of Michigan's Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, U-M's academic medical center. Both involved a national sample of more than 2,000 adults aged 50 to 80.

"These findings have implications for the health providers who have ramped up telehealth offerings rapidly, and for the insurance companies and government agencies that have quickly changed their policies to cover virtual visits," says Laurie Buis, Ph.D., M.S.I., a health information technology researcher at U-M who helped design the poll and interpret its results. "Tracking change over time could inform future efforts, and highlights the need for much more research on concerns, barriers and optimal use of telehealth by older adults."

"This has been an extraordinary time for the telemedicine movement, and these poll results show just how powerful this 'trial by fire' has been," says Jeff Kullgren, M.D., M.P.H., M.S., associate director of the poll, health care researcher and a primary care provider who uses telehealth with his patients at the VA Ann Arbor Healthcare System. "But our data also highlight areas of continued concern for patients that need to be addressed."

COVID-19 impacts

The poll finds that 30% older adults had ever participated in a telehealth visit by June 2020, perhaps reflecting changes in insurance coverage that began to take effect before the pandemic. But the figure for March through June suggests that much of the movement to telehealth visits resulted from states mandating reductions in elective and non-emergency health care during the first months of the pandemic, as part of "stay home" public health requirements aimed at reducing the spread of the virus.

Nearly half of those who had had a telehealth visit said that they had had an in-person visit canceled or rescheduled by their health care provider between March and June, and 30% said that a virtual visit was the only option when they called to schedule an appointment.

Awareness about the special risks of COVID-19 among older adults may have also played a role, as 45% of respondents said the pandemic made them more interested in telehealth. The percentage was higher among those who had had a telehealth visit in the past. But only 15% of the poll respondents who had a telehealth visit said that fear of the virus led them to request a telehealth visit, whether for a new concern or in place of a previously scheduled visit.

Among those who had telehealth visit this past spring, 91% said it was easy to connect with their doctor. One-third had their visits via a video connection from their phone, and another third carried out the video visit on a tablet or computer. In addition, 36% had an audio-only visit by phone, which the 2019 poll did not ask about.

Key concerns by older adults about using telehealth to connect with medical providers. Credit: University of Michigan

Year-over-year change

The new poll asked older adults many of the same questions as the poll conducted in 2019. This allows for comparisons between the two years, such as the percentage who said:

• They feel very or somewhat comfortable with video conferencing technologies: 64%, up from 53% in 2019
• At least one of their health providers offer telehealth visits: 62%, up from 14%. They are interested in using telehealth to connect with a provider they had seen before: 72%, up from 58%
• They are interested in using telehealth for a one-time follow-up appointment after a procedure or operation: 63%, up from 55%
• They have concerns about privacy during a telehealth visit: 24%, down from 49%
• They are concerned they would have difficulty seeing or hearing the provider during a video visit: 25%, down from 39%

But there was almost no change in the percentage who said they would feel comfortable seeing a provider for the first time via a virtual visit (about one in three would), and the percentage who felt that the quality of care in a telehealth visit was not as good (about two-thirds).

Moving forward

Physician groups, insurers, professional societies and organizations including AARP are monitoring the situation with telehealth, and in some cases advocating for the temporary changes in Medicare and Medicaid payment policy, and other relevant regulations, to become permanent.

In June, AARP Research released a report about older adults' awareness of and attitudes toward telehealth. AARP has also published resources to help older adults and their caregivers use telehealth services.

"It's clear from this study and AARP's research that older adults are increasingly comfortable with telehealth and are willing to use technology to interact with their health providers," says Alison Bryant, Ph.D., senior vice president of research for AARP, says. "As the coronavirus pandemic continues, telehealth has been a useful tool for older adults to access health care from the safety of their own homes, but we must be mindful that not everyone can access these services."

Meanwhile, Buis is leading a new COVID-19-related telehealth research interest group as part of a broader IHPI initiative to evaluate the impacts and appropriate use of telehealth as well as barriers. Buis is an assistant professor in the U-M Department of Family Medicine, which has pivoted to virtual care for many primary care appointments along with the rest of Michigan Medicine.

The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 2,074 adults aged 50 to 80 who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have them.

 

Russia's coronavirus vaccine hasn't been fully tested, and approving it now risks side effects and false protection

by Kylie Quinn, Holly Seale, The Conversation

Credit: Pixabay/CC0 Public Domain

On Tuesday, Vladimir Putin announced Russia was the first country to register a vaccine offering "sustainable immunity" against SARS-CoV-2, the virus that causes COVID-19.

12 august--Developed by the Gamaleya Research Institute in Moscow, it's been registered with the Russian Health Ministry and approved for emergency use only.

But there are concerns it will soon be rolled out across the Russian population, far beyond emergency use. This has prompted discussion about the "race" towards a COVID-19 vaccine.

While speed is important, ensuring a vaccine is effective and safe is much more critical. The consequences of doling out a potentially unsafe and ineffective vaccine could be wide-reaching.

Data about the trials has not been published

The Gamaleya Research Institute announced it registered a SARS-CoV-2 vaccine with the Russian Health Ministry, the local regulatory body that determines which medicines can be used in Russia. This vaccine is called "Sputnik V" and the Institute has indicated it's approved for emergency use. An emergency use approval generally means a vaccine could be offered to people at very high risk of infection, such as health-care workers, but not the general civilian population.

The Institute had previously registered this vaccine for a Phase I/II trial (to assess safety and immune responses in humans), initially with just 38 people. Senior Russian officials said it induced a strong immune response and no "serious complications" in this trial. This isn't too surprising, as published data from human clinical trials for other similar vaccines have shown strong immune responses and no serious complications.

However, the data from the trial of Sputnik V has not been published and there is no data that indicates the vaccine would actually protect, as Phase III studies (requiring thousands of volunteers to demonstrate efficacy and detect rare side-effects) haven't been performed.

The Institute did announce a Phase III trial for Sputnik V will begin on August 12 in Russia and several other countries. However, many scientists (including Russian researchers) expressed concern the vaccine will soon be used in large civilian vaccination campaigns, which wouldn't usually be the case with an approval for emergency use.

What are the risks

If we go back to the analogy of a "race," we should stop thinking of vaccine development as the 100-meter sprint. Instead, think of it more like the pentathlon. In the pentathlon, each section the athlete completes contributes to their overall score and cannot be missed. If we try to run this race against COVID-19 without each section, we could end up with a vaccine which has not been properly tested, which could be unsafe and would be unethical. And then we all lose.

The risks of advancing into mass vaccination without proper testing are significant. If a vaccine is released but side-effects emerge, the consequences include both the health impacts and deterioration in trust from our community. If the vaccine does not protect individuals from infection, those who have been vaccinated could falsely believe they are protected.

Our system of methodical series of clinical trials has been designed, oftentimes with hard-won lessons, to avoid oversights and build essential data on safety, immunity and protection with vaccines.

As stated by the US Health and Human Services secretary, Alex Azar: "The point is not to be first with a vaccine. The point is to have a vaccine that is safe and effective for the American people and the people of the world."

Development takes time and we need to be realistic with our timelines and expectations.

Testing a vaccine is rigorous

When countries consider introducing a vaccine, the following information is examined:

• how safe is the vaccine?
• how well does the vaccine work?
• how serious is the disease the vaccine would prevent?
• how many people would get the disease if we did not have the vaccine?

This information is collected during each phase of the clinical trials (Phase I, II and III), with a particular focus on vaccine safety at each step. Developing this package of information can take years, but there have been cases when timelines were condensed.

For example, testing for an Ebola vaccine was condensed down to five years due to a critical need for a vaccine in the midst of ongoing epidemics. Regardless of this urgency, each clinical trial phase was still completed.

Phase III clinical trials are especially critical to assess safety in a large group of people, because certain rare side effects may not be identified in earlier, smaller trials. For example, if a vaccine-related side effect only occurred in one in every 10,000 people, the trial would have to enroll 60,000 volunteers to detect it.

In general, vaccines are more thoroughly tested than any other medicine. We administer vaccines to healthy people, so safety is the key priority, and we administer vaccines to large numbers of people, so rare side-effects must be identified.

What's in this vaccine?

This type of vaccine is called a viral vector. With viral vectors, we trick our immune system with a bait-and-switch; we take a harmless virus, modify it so it can't replicate, and include a target from the surface of the SARS-CoV-2 virus. The vaccine looks like a dangerous virus to the immune system, so the immune response is relatively strong and targeted against SARS-CoV-2, but the virus can't cause disease.

Sputnik V is unusual because it uses two different viral vectors, one after the other, in what we call a "prime boost." The first is called Ad26, which is similar to a COVID-19 vaccine being developed by Johnson&Johnson, and the second is called Ad5, which is similar to a COVID-19 vaccine being developed by CanSino Biologics. This prime boost should generate a relatively strong immune response, but we don't know for sure.

Viral vectors are also a relatively new technology. There have been a number of large clinical trials with viral vectors for HIV, Malaria, Tuberculosis and Ebola, but only one for Ebola has ever been approved for use in the general population.

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Provided by The Conversation