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This waveform representation of a conversation between patient and physician in an exam room was later coded to show who was speaking, and for how long, at each point in the conversation. The longer colored bars represent speaking turns (doctor with gold, patient with pink). The shorter bars are interjections, and the black bars are silences that occurred within or between speaking turns. Medical student Josef Bartels analyzed the waveforms to determine which silences resulted from the physician having to enter electronic data, and which silences represented meaningful connections.
Silence can indicate deep connections between physician, patient
As described in this newsletter recently, Josef Bartels, a medical and public health student at the School of Medicine and Dentistry, discovered that 47 percent of the silences (two seconds or more) that occurred during conversations between oncologists and their patients seemed to be associated with entering or accessing data on an exam room computer.
While analyzing the computer-associated silences, Bartels noted that there were other silences — not computer-related — that were markers for a deeper sense of connection between physician and patient. These silences had a particular "fingerprint" when coders plotted who was talking on waveform representations of the conversations.
Bartels showed how analyzed patterns of speaking turns (see illustration above) were markers for times when, for example, physicians were really connecting with their patients by responding to their concerns, and when both patient and physician were "really in sync."
"You tend to get shorter and shorter speaking turns (by the physician or patient), and overlapping vocalizations in the conversation, and lots of little 'continuers' — short, affirmative 'uh-huhs' that show both speakers are really engaged in the conversation," Bartels said.
Computers can be programmed to identify different speakers and analyze the rhythm of their conversations; Bartels is exploring whether such programs could be developed to evaluate patient/physician conversations — to measure "engagement" in patient/physician conversations, and the extent to which "computer-centered" communication and many other factors might affect the frequency and intensity of these vocal patterns that seem to represent engagement and presence.
Whatever the findings, larger, unanswered questions remain, Bartels added. For example, what is the physician's role? New technologies provide ever more accurate data for evidence-based decisions to improve patients' health. Can physicians focus on that and still protect a doctor-patient relationship built on communication and the physical exam that provides meaning to both patient and physician? And to what extent should a specialist such as an oncologist, for example, be trained to not only keep up with the latest biomedical advances in the field, but also be trained to be "emotionally engaged and present" — to be an empathic witness to the sometimes unrelieved suffering that human beings experience?
Do you have an interesting photo or other image that helps illustrate your research? We would like to showcase it. Send a high resolution jpg or other version, along with a description of what it shows, to bmarcotte@ur.rochester.edu.
O'Donoghue promoted to associate vice president
Kelley O'Donoghue has been promoted to Associate Vice President for Human Subject Protection at the University of Rochester.
"She brings incredible energy and leadership to the position," said Robert Clark, Senior Vice President for Research. "We are very fortunate to have her."
O'Donoghue, who has served as director of the office since 2012, will continue to direct activities related to the review of all biomedical, social and behavioral research involving human subjects at the University and elsewhere by any faculty member, employee or student.
The Office for Human Subject Protection (OHSP) is responsible for the day-to-day administration and oversight of the University's Human Research Protection Program (HRPP), which involves high-level coordination with a wide range of offices, committees and senior managers to ensure the preservation of the rights and the physical and psychological well being of subjects involved in research.
The position is responsible for oversight and support of the Research Subjects Review Board (RSRB) and for the operation of activities and programs that directly support the RSRB, specifically Research Education & Training and Research Quality Improvement (audit).
(Next week: O'Donoghue talks about the resources her office provides for investigators, study coordinators and other study team members engaged in human subject research at the University.)
Grotz awarded literary translation fellowship
Jennifer Grotz, Professor of English and the Director of the University's translation studies program, has been awarded a Literary Translation Fellowship by the National Endowment for the Arts (NEA). Grotz is one of 20 fellows awarded an arts grant for a translation project by the NEA in 2016, selected from a pool of more than 90 applicants. Her fellowship will support the English translation of several poems by the Polish writer Jerzy Ficowski as part of a collaboration with poet and translator Piotr Sommer.
"Receiving a fellowship from the National Endowment for the Arts is truly one of the highest forms of affirmation a writer or artist can aspire to," said Grotz. "Not only am I grateful for the support this fellowship gives me as a translator, I'm also tremendously grateful for the time it will give me to translate an essential body of work by a major 20th-century writer still almost completely unknown in the United States." Read more here.
New genomic network's database will help cancer researchers
The Wilmot Cancer Institute is joining the OmniSeq Genomic Network, an organization of institutions being formed to help define the future of advanced genomic diagnostics for cancer. Through this network, Wilmot and Roswell Park Cancer Institute (RPCI) in Buffalo — the state's two largest cancer care and research institutions outside New York City — will collaborate and expand genomic testing for cancer across the Finger Lakes and western New York region. The network, which will create a database of genomic profiles of tumors, will also provide opportunities for research.
The database will include tumors' genomic profiles, which therapies were used and the outcomes of treatment, in some cases. With this information, the members of the network will help advance genomics in cancer care. In addition, researchers will be able to analyze the data to learn more about cancer genomes and the influence of gene mutations. Read more here.
CTSI seeks repositories, datasets for Research Resource Catalog
The University's Clinical and Translational Science Institute is gathering information to populate the new Research Resource Catalog. The catalog is a searchable directory of information about biomedical specimen repositories and research datasets available at the University of Rochester. Other types of research resources will be added over time. If you have a specimen repository, culture collection, or dataset that you would be willing to include in the database, click here to enter the item.
Introducing a new faculty member
Richard F. Dunne has joined the Wilmot Cancer Institute faculty full time after completing fellowships at Wilmot in recent years. As a member of the Division of Hematology/Oncology, Dunne will work with gastrointestinal tumors. Dunne graduated from SUNY Downstate College of Medicine in Brooklyn in 2009 and then came to the University of Rochester Medical Center, where he completed his residency, chief residency and a two-year fellowship. Dunne plans to conduct research in pancreatic and biliary cancers, looking specifically at weight and muscle loss, issues that affect more than 70 percent of GI cancer patients. "Pancreatic cancer is one of the biggest challenges that we face as oncologists," Dunne said. "Treatments need to be improved. It's a cancer we're finding affects friends, family members and there's still a lot of work that needs to be done."
UR research in the news
A recent study from the Heart Research Follow-Up Program at the Medical Center found a link between medications used to treat attention deficit hyperactivity disorder, or ADHD, and increased risk of cardiac issues in young patients with a heart rhythm disorder called Long QT Syndrome. The study, published in the Journal of Cardiovascular Electrophysiology, identified a strong link between ADHD medications and increased fainting spells — and potentially death — in Long QT Syndrome patients. "ADHD medications seem to be harmful in Long QT Syndrome patients and this is something that has not been investigated before. Prior studies of ADHD medication safety were mainly conducted in healthy individuals", says Valentina Kutyifa, Research Assistant Professor of Cardiology and Heart Research and author of the study. While ADHD drugs may pose an increased risk to patients with Long QT Syndrome, Kutyifa and colleagues suggest further studies are needed to confirm their findings. "The take home message for clinicians who are currently taking care of Long QT Syndrome patients is that ADHD medication should be prescribed only when symptoms clearly require therapy, and we suggest close follow up and starting with the lowest possible dose and then slowly titrating up." Read more here.
A small number of testicular cancer patients — about 11 in 6,909 — died of cardiovascular disease in their first year after diagnosis and treatment with chemotherapy, in stark contrast to no elevated risk of deaths among nearly 8,100 men treated initially with surgery alone, according to a Wilmot Cancer Institute study. "Although our findings need to be confirmed, it's important that oncologists recognize any type of increased risk of death, even if it is quite rare, and apply evidence-based clinical practice guidelines for prevention and treatment of complications," said Chunkit Fung, Assistant Professor of Medicine (Hematology/Oncology). The small increase in absolute risk of death might be due to cisplatin-based chemotherapy, which also has been shown in previous studies to boost cardiovascular complications in long-term survivors of testicular cancer. Research suggests that cisplatin-based chemotherapy may induce acute blood vessel injury and that testicular cancer itself may be a high-risk condition for blood clots. Read more here.
Joan Adamo, Associate Director for Regulatory Support Services, and Scott Steele, Associate Professor of Public Health Sciences, Director (Operations) of the Rochester Center of Excellence for Data Science, and Director of Government and Academic Research Alliances, recently published an article in the Clinical and Translational Science Journal that identifies 11 thematic areas of training that contribute to regulatory science, a new and burgeoning field defined by the FDA as "the science of developing new tools, standards, and approaches to assess the safety, efficacy, quality and performance of FDA-regulated products." Some examples of the Regulatory Science competencies include regulatory policies and process, research ethics, drug discovery and development, clinical trials, post-marketing and compliance, and communication. This work was done in collaboration with other Clinical and Translational Science Award institutions. Future plans include developing a training network by identifying which academic institutions have expertise in the various thematic training areas, creating opportunities to share training amongst institutions and providing experiential learning opportunities in the training areas. In the future, "investigators will be able to pick and choose training topics related to regulatory science that will bolster the work they do in their field of expertise", says Adamo. Adds Steele: "A key element to advancing regulatory science and translational science is enabling research and educational collaborations across FDA, NIH, industry, academia and foundations." Read more here.
PhD dissertation defense
Nandini Kar, Geosciences, "The Cenozoic Evolution of the Northern Central Andean Plateau and its Tectonic Significance." 9:30 a.m., Friday, Aug. 14, Hutchison 229. Advisor: Carmala Garzione.
Mark your calendar
Aug. 20: Share issues, barriers and potential solutions to enhance research coordination, SCORE meeting, noon to 1 p.m., SRB 1.416.
Aug. 20: LGBT Patients: Addressing Disparities and Health Care Needs, John Cullen, Research Associate Professor of Surgery and coordinator of outreach, Susan B. Anthony Center. Noon to 1 p.m., Helen Wood Hall Auditorium (1-304).
Sept. 30: Industry Consulting: Part One, Karl Kieburtz, CTSI director. Noon to 1 p.m., Helen Wood Hall Auditorium (1-304). Part of the series on Good Advice: Case Studies in Clinical Research, Regulation, and the Law.
Oct. 15-16: NIH Regional Seminar on Program Funding and Grants Administration, San Diego, CA. Click here for more information and registration.
Please send suggestions and comments to Bob Marcotte. You can see back issues of Research Connections, an index of people and departments linked to those issues, and a chronological listing of PhD dissertation defenses since April 2014, by discipline.
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