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Al Ammary F, Motter JD, Sung HC, Lentine KL, Sharfuddin A, Kumar V, Yadav A, Doshi MD, Virmani S, Concepcion BP, Grace T, Sidoti CN, Yahya Jan M, Muzaale AD, Wolf J. Telemedicine services for living kidney donation: A US survey of multidisciplinary providers. Am J Transplant 2022; 22:2041-2051. [PMID: 35575439 PMCID: PMC9543040 DOI: 10.1111/ajt.17093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers' practices and providers' attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow-up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out-of-state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Hannah C. Sung
- Department of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Asif Sharfuddin
- Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Vineeta Kumar
- Department of MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Anju Yadav
- Department of MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mona D. Doshi
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarthak Virmani
- Department of MedicineYale UniversityNew HavenConnecticutUSA
| | | | - Terry Grace
- Department of MedicineWake Forest Baptist HealthWinston‐SalemNorth CarolinaUSA
| | | | | | | | - Joshua Wolf
- Piedmont Transplant InstituteAtlantaGeorgiaUSA
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Dhakan DB, Maji A, Sharma AK, Saxena R, Pulikkan J, Grace T, Gomez A, Scaria J, Amato KR, Sharma VK. The unique composition of Indian gut microbiome, gene catalogue, and associated fecal metabolome deciphered using multi-omics approaches. Gigascience 2019; 8:giz004. [PMID: 30698687 PMCID: PMC6394208 DOI: 10.1093/gigascience/giz004] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/02/2018] [Accepted: 01/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Metagenomic studies carried out in the past decade have led to an enhanced understanding of the gut microbiome in human health; however, the Indian gut microbiome has not been well explored. We analyzed the gut microbiome of 110 healthy individuals from two distinct locations (North-Central and Southern) in India using multi-omics approaches, including 16S rRNA gene amplicon sequencing, whole-genome shotgun metagenomic sequencing, and metabolomic profiling of fecal and serum samples. RESULTS The gene catalogue established in this study emphasizes the uniqueness of the Indian gut microbiome in comparison to other populations. The gut microbiome of the cohort from North-Central India, which was primarily consuming a plant-based diet, was found to be associated with Prevotella and also showed an enrichment of branched chain amino acid (BCAA) and lipopolysaccharide biosynthesis pathways. In contrast, the gut microbiome of the cohort from Southern India, which was consuming an omnivorous diet, showed associations with Bacteroides, Ruminococcus, and Faecalibacterium and had an enrichment of short chain fatty acid biosynthesis pathway and BCAA transporters. This corroborated well with the metabolomics results, which showed higher concentration of BCAAs in the serum metabolome of the North-Central cohort and an association with Prevotella. In contrast, the concentration of BCAAs was found to be higher in the fecal metabolome of the Southern-India cohort and showed a positive correlation with the higher abundance of BCAA transporters. CONCLUSIONS The study reveals the unique composition of the Indian gut microbiome, establishes the Indian gut microbial gene catalogue, and compares it with the gut microbiome of other populations. The functional associations revealed using metagenomic and metabolomic approaches provide novel insights on the gut-microbe-metabolic axis, which will be useful for future epidemiological and translational researches.
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Affiliation(s)
- D B Dhakan
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - A Maji
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - A K Sharma
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - R Saxena
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - J Pulikkan
- Department of Genomic Science, Central University of Kerala, Periye Post, Kasargod, Kerala, 671316, India
| | - T Grace
- Department of Genomic Science, Central University of Kerala, Periye Post, Kasargod, Kerala, 671316, India
- Division of Biology, Kansas State University, 116 Ackert Hall, Manhattan, Kansas, KS 66506, USA
| | - A Gomez
- Microbiomics Laboratory, Department of Animal Science, University of Minnesota, 1988 Fitch Avenue, Minnesota, MN 55108, USA
| | - J Scaria
- Animal Disease Research & Diagnostic Laboratory, Veterinary and Biomedical Sciences Department, South Dakota State University, Brookings, South Dakota, SD 57007, USA
| | - K R Amato
- Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, Illinois, IL 60208, USA
| | - V K Sharma
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
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Jasper E, White M, Martin N, Grace T. 110 Operative and Burn Surge Capacity in a Major Metropolitan Area as Demonstrated By a Large Regional Disaster Exercise. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kelly D, Grace T, Golden D, Craig T, Breisch N, Hamilton R. Predictive Value of Sting Challenge. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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