Sara Karlovitch, Assistant Editor

Telemedicine can help limit the time spent in the emergency department (ED) and help hospitals with demand surges, according to a new study published in 

The coronavirus disease 2019 (COVID-19) pandemic has limited doctors’ offices and hospital visits to help ensure patient and care provider safety. Telemedicine can help bridge the gap rather than diminish the quality of care, according to the study. Additionally, overcrowding in EDs are a common problem in general, which can be costly for hospitals and impact patient experience.

Investigators looked at ED visits in New York from 2010 to 2014, comparing visits that utilized telemedicine versus those that did not.

Investigators found that telemedicine significantly reduces average length of stay. According to the study, this finding is partially driven by flexible resource allocation. Using telemedicine during ED surges can also reduce hospital stays and reduce patient wait times.

The majority (76%), of United States hospitals are already using telemedicine technologies.

"The current pandemic has shown hospitals the great promise of telemedicine application and hopefully the unexpected enrollment of such policies, alongside this research, can help get the process underway to help more health care facilities utilize this technology in [Eds] and elsewhere," study author Susan Lu, PhD said in a prepared statement.

"Policymakers can play a role as well by reducing regulatory barriers that inhibit more expansive use of telemedicine and by creating incentives that encourage hospitals to more broadly adopt telemedicine in emergency rooms,” said Lu.

Adopting telemedicine during ED surges would not increase costs, study authors say, nor would it increase the expense of care quality.

Utilizing telemedicine in the ER can reduce wait times and patient length of stay [News Release] October 16, 2020; West Lafayette, Indiana. 

https://www.eurekalert.org/pub_releases/2020-10/ifor-uti101620.php

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Investigators found that using telemedicine can improve patient experience. 

Study: Telemedicine Can Reduce Emergency Department Backlog, Wait Times

Lower doses of zinc are just as effective in treating childhood diarrhea while decreasing vomiting, according to a recent study published in 

While there has been a 90% decline in diarrhea-related deaths since 1980, approximately half a million children died of diarrhea in 2018. The World Health Organization currently recommends 20 mg of zinc for 10 to 14 days for children with acute diarrhea. Previous trials found that while this dosage decreases diarrhea, it increases vomiting, according to the study.

The randomized, multicenter study focused on 4500 children in Indian and Tanzania who were aged 6-59 months and had acute diarrhea. Each child was assigned 5 mg, 10 mg, or 20 mg of zinc sulfate for 14 days. According to the study, the 3 primary outcomes were a diarrhea duration of more than 5 days, the number of stools, and the number of vomiting within 30 minutes after zinc administration.

Children with diarrhea for more than 5 days was 6.5% in the 20 mg group, 7.7% in 10 mg group, and 7.2% in the 5 mg group, according to the study. The mean number of diarrheal stools was similar across all 3 groups. For the 20 mg group, the mean number of stools was 10.7, for the 10 mg group it was 10.9, and 10.8 in the 5 mg group. However, as the dosage of zinc decreased, so did the rate of vomiting within 30 minutes after administration. In the 20 mg group, 19.3% experienced vomiting within 30 minutes. For the 10 mg group, 15.6% had this adverse effect, and 13.7% of the 5 mg group experienced vomiting after administration.

“In our trial, we found that children with acute diarrhea receiving 5 mg or 10 mg per day of supplemental zinc had diarrhea outcomes similar to those in children receiving 20 mg but had less vomiting,” study authors wrote.

Investigators found that children in India appeared to benefit more from lower zinc doses with respect to vomiting than children in Tanzania. This may be due to several unmeasured factors, according to the study. For example, the Tanzanian children tended to be younger and more well-nourished compared to the Indian children in the study.

Dhingra, Usha, MA, MCA et al. Lower-Dose Zinc for Childhood Diarrhea — A Randomized, Multicenter Trial [Journal Article] The New England Journal of Medicine; September 24, 2020. DOI: 10.1056/NEJMoa1915905. Accessed September 24, 2020.

Lower doses of zinc provide similar results while reducing vomiting. 

Study: Lower Zinc Doses Effective For Childhood Diarrhea

A new study suggests that many medical professionals are not prescribing HIV prevention medications, even to patients at risk of contracting HIV.

Researchers at Vanderbilt University Medical Center surveyed 519 practitioners in 5 major cities who attended a continuing education course on HIV between March and May 2015. According to the study, published in 

 less than 10% of the more than 1 million people vulnerable to HIV are taking pre-exposure prophylaxis (PrEP).

“With a US policy goal to eradicate HIV by 2030, practitioners are central to ensuring the delivery of PrEP across care settings,” said study author Ashley Leech, PhD, in a statement.

Of the respondents, 70% were physicians, 9% were physician assistants, and 21% were nurse practitioners. The average age was 49 years old, with the majority identifying as female (57%) and white (58%).

 The majority of respondents said they had practiced independently for more than 10 years. Finally, 38% specialized in infectious disease, 27% in family medicine, 26% in internal medicine, and 9% in other specialties.

The survey found that internal medicine prescribers were 1.6 times more likely than infectious disease practitioners to prescribe PrEP, which the authors said was an indicator of the importance of internal and family medicine practitioners. These providers can play a major role in assessing and mitigating their patients’ risk of contracting HIV.

Leech noted that a possible explanation may be the longstanding confusion or disagreements between HIV experts and primary care practitioners over who should be responsible for prescribing PrEP. Age, years of training, and sex of the survey respondents were also significantly associated with prescribing experience.

The researchers also found that contrary to earlier beliefs, practitioners might be more willing to prescribe PrEP as a first clinical step for patients who inject drugs. However, they noted that more work is needed to effectively communicate with HIV-vulnerable groups and to reach individuals who could most benefit from PrEP.

“While a number of factors could impact PrEP prescribing, including patients’ low familiarity with the drug or practitioners’ lack of opportunity in offering PrEP, in order for the drug to be effective at eliminating HIV in the United States in the next 10 years, the proportion of prescribing needs to increase, with more effort placed on identifying risk across populations and clinical specialties,” Leech concluded.

Many practitioners are not prescribing HIV prevention medication, study finds [news release]. Vanderbilt University Medical Center; September 3, 2020. 

https://www.vumc.org/health-policy/HIV-preventive-medication-prescription-doctors

Leech AA, Christiansen CL, Linas BP, Jacobsen DM, et al. Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US. 

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238375

Internal medicine providers were 1.6 times more likely to prescribe PrEP than infectious disease practitioners.

Study: Just 54% of Practitioners Have Prescribed PrEP to HIV-Vulnerable Patients

People who received at least 1 flu vaccination are 17% less likely to develop Alzheimer disease over the course of their life, according to a new study by the University of Texas Health Sciences Center at Houston (UTHealth).

There are around 5.8 million people in the United States living with Alzheimer disease. Currently, there is no known treatment. Because of this, it is important to find ways of reducing the risk of Alzheimer disease.

The study was composed of 310,000 electronic health records collected through the Cerner Health Facts database, which is composed of over 600 hospitals and clinicals. The study authors hypothesized that the flu vaccine may introduce proteins needed to train the body to fight off the disease.

The study found that more frequent flu vaccinations and receiving them younger in age were associated with an even lower risk of developing Alzheimer disease. More research is still needed in order to determine how and why the flu vaccine works to prevent the condition.

"One of our theories of how the flu vaccine may work is that some of the proteins in the flu virus may train the body's immune response to better protect against [Alzheimer] disease…Providing people with a flu vaccine may be a safe way to introduce those proteins that could help prepare the body to fight off the disease. Additional studies in large clinical trials are needed to explore whether the flu shot could serve as a valid public health strategy in the fight against this disease,” said Albert Amran, the study’s first author and fourth-year medical student at McGovern Medical School at UTHealth, in a prepared statement.

Flu vaccine may reduce risk of Alzheimer's disease, new study shows [news Release]. Houston, TX; July 27, 2020: EurekAlert!. Accessed August 28, 2020

Flu vaccination may introduce proteins used by the body to learn how to fight Alzheimer disease later on. 

Author | Sara Karlovitch, Assistant Editor

Articles

Study: Telemedicine Can Reduce Emergency Department Backlog, Wait Times

Study: Lower Zinc Doses Effective For Childhood Diarrhea

Study: Just 54% of Practitioners Have Prescribed PrEP to HIV-Vulnerable Patients

Study Shows Flu Vaccine May Reduce Risk of Alzheimer Disease