Opinions on the Role of Telehealth in a Large Midwest Academic Health Center: A Case Study.

Introduction: Varying terms such as telemedicine, telehealth, and e-Health have increasingly been incorporated into medical education and clinical practice. While there is some variability in this adoption, our interest was in the opinions about the role these terms have in a large Midwestern academic health center (medical school and practice plan) in Cincinnati, Ohio.Materials and Methods: Two separate studies were conducted, one with medical students and the other with clinicians. Both studies were conducted at the University of Cincinnati. Two different questionnaires were sent to the two groups. The questionnaires were designed to solicit feedback on terminology, awareness, utilization, and perception. Several questions used a Likert scale to gauge knowledge in key areas.Results: Eighty-two medical students with an average age of 24.5 ± 2.3 years responded to the questionnaire. Most students were in their first or second year of medical school, and a majority had a Bachelor of Science degree (73.2%). A majority (84.2%) of the students indicated a knowledge of telehealth/telemedicine in clinical practice but were less likely to recommend its application. There were 155 clinician respondents, of whom the majority (95%) were primary care physicians. The majority of the respondents were more comfortable with the term telehealth rather than telemedicine. Most physicians felt that more training was needed and they expressed that management and organizational norms limited the adoption of telehealth and telemedicine.Conclusion: Two separate studies were conducted at a large Midwestern academic health center. Students and clinicians expressed awareness of the terminology and a need for more educational opportunities and training to further integrate these terms and concepts in both the educational and clinical arms of medicine.

Epigenetic profiling identifies novel genes for ascending aortic aneurysm formation with bicuspid aortic valves.

BACKGROUND:   Bicuspid aortic valves predispose to ascending aortic aneurysms, but the mechanisms underlying this aortopathy remain incompletely characterized.  We sought to identify epigenetic pathways predisposing to aneurysm formation in bicuspid patients. METHODS:   Ascending aortic aneurysm tissue samples were collected at the time of aortic replacement in subjects with bicuspid and trileaflet aortic valves.  Genome-wide DNA methylation status was determined on DNA from tissue using the Illumina 450K methylation chip, and gene expression was profiled on the same samples using Illumina Whole-Genome DASL arrays.  Gene methylation and expression were compared between bicuspid and trileaflet individuals using an unadjusted Wilcoxon rank sum test.   RESULTS:   Twenty-seven probes in 9 genes showed significant differential methylation and expression (P<5.5x10-4).  The top gene was protein tyrosine phosphatase, non-receptor type 22 (PTPN22), which was hypermethylated (delta beta range: +15.4 to +16.0%) and underexpressed (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10-5) in bicuspid patients, as compared to tricuspid patients.  Numerous genes involved in cardiovascular development were also differentially methylated, but not differentially expressed, including ACTA2 (4 probes, delta beta range:  -10.0 to -22.9%), which when mutated causes the syndrome of familial thoracic aortic aneurysms and dissections CONCLUSIONS:   Using an integrated, unbiased genomic approach, we have identified novel genes associated with ascending aortic aneurysms in patients with bicuspid aortic valves, modulated through epigenetic mechanisms.  The top gene was PTPN22, which is involved in T-cell receptor signaling and associated with various immune disorders.  These differences highlight novel potential mechanisms of aneurysm development in the bicuspid population.