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11 years, 9 months ago

Is intervention in the armed conflict appropriate?

Henry Dowlen
Directory:
Health Policy
Tags:
civil warfare
Emergency Medicine
Health IT
low intensity conflict
Neurosurgery
Orthopedics
trauma
traumatic brain injury
Warzone medicine
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joined 11 years, 10 months ago

Chiara Recchi

Senior Research Associate
Directory:
Cancer
Expertise:
cancer cells
cell biology
EUTROC
intracellular trafficking
OPCML
ovarian cancer
tumour suppressors

Chiara Recchi graduated cum laude in Italy with a Master in the laboratory of Cesare Montecucco at the University of Padova. She then moved to France at the Pasteur Institute in the group of Brigitte Gicquel, where she obtained her PhD in Microbiology for her work on the virulence factors of Mycobacterium tuberculosis.

Later, she extended her interest to cell biology and she trained as a postdoc in the laboratory of Philippe Chavrier at the Curie Institute in Paris. Here she became involved in the study of intracellular trafficking and how this controls the metastatic properties of cancer cells.

She thus continued working in this field when in 2007 she moved to London, where she became research associate at the Imperial College in Miguel Seabra’s group. Here she developed her own project combining her expertise in intracellular trafficking with the lab’s experience in Rab proteins. This led to one of the first descriptions of Rab27a as key to tumour progression.

She now leads the Tumour Suppressor Group at the Ovarian Cancer Action Research Centre, directed by Hani Gabra, at Imperial College London.

Her main focus is to understand how the tumour suppressor protein OPCML controls trafficking and signalling of Receptor Tyrosine Kinases in ovarian cancer.


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11 years, 10 months ago

Improving the management of diabetes

HealthPad
Directory:
Diabetes
Tags:
commentary
diabetes
healthcare expenditure
mobile technology
rich media
self-management
 
Keen to discover the effectiveness of short healthcare videos as a communication tool for patients, Dr. Seth Rankin, the managing partner of Wandsworth Medical Centre, London, emailed his patients living with diabetes short videos about their condition, and surveyed their opinions afterwards, which we report.
 
The clinicians
"Healthcare information in video format distributed directly to patients' mobiles is a more effective way to educate people living with diabetes, and propel them towards self management with an eye to slowing the onset of complications," says Rankin.    

According to Dr. Sufyan Hussain,an endocrinologist and lecturer from Imperial College, London, Clinical Lead on the Wandsworth project,  "Despite accounting for 10% of the NHS budget and 8% of UK's population diabetes healthcare systems still need considerable improvement, particularly in management, strategy and infrastructure. Communicating important health information via video, can help significantly to improve the quality of care and efficiency in an over burdened healthcare system."
 
Patient survey
 
During the six- week project, over 50% of diabetes patients opened the emails sent, and watched the information videos about their condition.
  • 75% of respondents say that they would like to have more reliable information to help them to manage their diabetes
  • 44% regularly search the Internet for healthcare information about diabetes, and 20% are undecided
  • Only 9% say that they can differentiate between good and bogus online healthcare information about diabetes
  • 68% found the video information they received by email helpful
  • 21% regularly visit Diabetes UK website
  • 71% want GPs to provide more healthcare information via email
  • 50% prefer to receive healthcare information about diabetes in video format, and 23% are undecided
  • 71% believe it's important to access healthcare information about diabetes at anytime, from anywhere and on any device.
It's important for me to quickly access premium and reliable healthcare information about my condition at anytime, from anywhere and on any device
NICE relaxing guidelines
These findings, if indicative of patient views, are significant. Recently, the National Institute of Health and Care Excellence (NICE) issued new draft guidelines to make more people eligible for weight-reduction surgery. According to NICE, such surgery would reduce the debilitating complications associated with type 2 diabetes.

Until now, people with type 2 diabetes only could be considered for weight loss surgery at a BMI of 35. The new guidance could mean that more than 850,000 people could be eligible for a stomach-reduction surgery if their doctors think they are suitable.

A costly therapy
Over the past five years, there has been a significant increase in the number of people receiving weight loss surgery. According to the UK's Health and Social Care Information Centre's latest report: in 2012-13, about 8,000 people received stomach-reduction surgery for potentially life threatening obesity when other treatments failed.

A mounting body of evidence suggests such surgery improves symptoms in around 60% of patients, which in turn, may result in a reduction in people taking their type 2 diabetes medications, and even in some cases needing no medication at all.

Stomach-reduction surgery, which costs between £3,000 and £15,000, does not mean that type 2 diabetes has been cured, and there are raised concerns that the NHS will not be able to afford the treatment, even if there are savings in the longer term. Furthermore, an irreversible procedure that does have surgical risks attached to it does not make it an attractive option for everyone. 
 
Takeaways
"We know about the escalation of the diabetes burden. We know that established therapies, diets and lifestyles could effectively reduce the burden of diabetes. And yet the burden shows no signs of slowing. IF patient data from the Wandsworth Medical Centre are indicative of the situation more generally, we should seriously consider the way doctors communicate with patients. Doing 'more of the same' is not the answer. We need to find new innovative solutions to engage, interact and motivate as many people as possible," says Dr. Hussain.

 

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11 years, 10 months ago

Making Sense of Individualised Molecular Data in Gynaecological Cancer

Hani Gabra
Directory:
Cancer
Tags:
AKT
biomarker
ca
CARIS
gynaecological cancer
individualised molecular data
ovarian cancer
platinum resistance
platinum sensitivity

Pr Gabra - ICACT 2014 (2.8 MB)
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11 years, 10 months ago

What is a Data Science Institute?

Ioannis Pandis
Directory:
Healthcare
Tags:
Data
Science
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joined 11 years, 10 months ago

BritPACT

British Psoriatic Arthritis Consortium
Directory:
Rheumatology
Expertise:
dermatology
Psoriatic Arthritis
Translational research

The British Psoriatic Arthritis ConsorTium has been created to bring together people with an interest in psoriatic arthritis.

its mission is to facilitate and advance research and best practice in psoriatic arthritis in the United Kingdom.

Its main goals are:

  • To bring together UK individuals with an interest in PsA
  • To create a UK infrastructure to undertake studies in PsA
  • To collaborate in studies improving knowledge and outcome in PsA
  • To develop and execute research ideas in PsA
  • To engage with ARUK clinical study group to facilitate research in PsA
  • To engage with the Translational Research Partnerships in PsA
  • To collaborate with BRIT-SPA
  • To collaborate with GRAPPA
  • To engage with relevant dermatology stakeholders
  • To develop and disseminate knowledge around PsA and comorbidities 
  • To ensure patient and public involvement at all levels

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joined 11 years, 10 months ago

Axel Walther

Consultant Medical Oncologist
Directory:
Cancer
Expertise:
cancer risk
colon cancer
EUTROC
genetic markers
ovarian cancer

Dr Axel Walther is a medical oncologist and Director for Research in Oncology at University Hospitals Bristol. He is the co-lead for the Cancer Research Theme at the University of Bristol.

He completed his undergraduate degree at Cambridge University followed by Medical School at Oxford University. He trained at the Hammersmith, Middlesex and Royal Marsden Hospitals and obtained his PhD from University College London.

His research interests are genetic markers of cancer risk and outcome, and he has collaborated in the discovery of several low-penetrance colon cancer susceptibility loci, thought to make up part of the inherited risk of colon cancer. Dr Walther has presented these findings at global conferences, published in and reviewed articles for high-impact journals and contributed to textbooks on cancer.


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11 years, 10 months ago

Weight loss and health benefits

HealthPad
Directory:
Weight Management
Tags:
commentary
diabetes
heart disease
obesity
overweight
physical activity
physical inactivity
weight loss
weight loss surgery
 
 
The UK's National Institute for Health and Care Excellence (NICE) recently recommended that primary care doctors should identify people eligible for state-funded slimming classes run by private companies, such as Weight Watchers, an American company that offers various products and services to assist weight loss and maintenance.

UK facts
Obesity costs NHS England £5.1bn a year
25% of adults in England are obese
42% of men & 32% of women are overweight
A BMI of 30-35 cuts life expectancy by up to four years
A BMI of 40 plus cuts life expectancy by up to 10 years

Lose weight and save millions
NICE suggests that health professionals should raise the issue of weight loss in a "respectful and non-judgmental" way, by measuring their body mass index (BMI) to identify people who are eligible for referral for lifestyle weight management services. BMI is a person's weight in kilos divided by their height in meters squared.

About 25% of UK adults are obese with a BMI over 30 and 74% are overweight with a BMI above 25. Just a 3% reduction in weight could extend life expectancy, and reduce the risk of Type2 diabetes, high blood pressure and heart disease.

NICE argues that the cost of funding private weight loss programs for overweight people would be outweighed by the benefits. For example, preventing just a 1% increase in obesity would save the UK government nearly £100 million a year.
 
Lifestyle change rather than yo-yo dieting
In a recent study published in The Lancet Diabetes and Endocrinology, researchers suggest that weight loss at any age in adulthood is worthwhile and even transitory weight loss is beneficial to health.
 
The research examined the impact of lifelong patterns of weight change on cardiovascular risk factors in a group of 1,273 British men and women, followed since their birth in March 1946. It concluded that the longer a person is overweight the greater their propensity of cardiovascular problems in latter life and the greater risk of diabetes.
 
According to the lead author Professor John Deanfield from University College, London, "Our study is unique because it followed individuals for more than 60 years, and allowed us to assess the effect of modest, real-life changes in adiposity. . . .  Losing weight at any age can result in long-term cardiovascular health benefits, and support public health strategies."
 
Professor Mike Kelly, the director of the centre for public health at NICE, said the guidelines were about lifelong change rather than yo-yo dieting, when the weight is piled back on after initial success.

He stressed the importance of achievable goals: "We would like to offer an instant solution and a quick win . . .  but realistically it's important to bear in mind this is difficult. It's not just a question of 'for goodness sake pull yourself together and lose a stone'; it doesn't work like that. People find it difficult to do  . . it takes resolve, it takes encouragement."
 
mHealth proven support for weight management
Scott Lonnee, a bariatric dietitian at St George's Hospital, London echoes Kelly's sentiment, "Sensible lifestyle changes, which include sustained dietary changes and physical exercise can have significant healthcare benefits. Planning is important, and there are simple techniques to help individuals lose weight, which include, setting realistic and achievable targets, keeping diaries of what you eat and what exercise you take."
 
Research commissioned by Weight Watchers, and recently published in the American Journal of Medicine, suggests that losing weight is significantly easier and more effective when individuals have access to online support, compared to weight loss among those who tried to lose weight on their own.
 
Takeaways
Pro-active mHealth strategies can help to change the way health professionals interact with patients. Information, guidance and support regularly sent to the mobiles of overweight individuals to help them lose weight and engage in lifestyle changes would save lives, prevent the onset of disease and save NHS England millions of pounds. Why is it not being done?   
 
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11 years, 10 months ago

Where does it hurt?

HealthPad
Directory:
Health Policy
Tags:
affordable healthcare
affordable quality healthcare
commentary
Devi Shetty
healthcare expenditure
quality healthcare
telemedicine
 
 
What does the nephew of the 41st American President and the cousin of the 43rd have in common with an Indian doctor?

They're both passionate about using new technologies to provide high quality healthcare at affordable cost.

Bush and Shetty
Jonathan Bush, a relative of two former American Presidents, is the co-author of Where Does it Hurt? which calls for a healthcare revolution to give patients more choices, and affordable quality care.

A former Army medic and ambulance driver, Bush is the cofounder and CEO of athenahealth, one of the fastest growing American cloud-based service companies, which handles electronic medical records, billing, and patient communications for more than 50,000 US health providers.

Dr Devi Shetty is a brilliant heart surgeon, and veteran of more than 30,000 operations. However, his growing international reputation rests less on his medical skill, and more on his business brain. He wants to do for healthcare what Henry Ford did for the motorcar: "make quality healthcare affordable."

Shetty is the founder and chairman of Narayana Health, and by thinking differently to traditional healthcare providers, he's built, India's largest private hospital group comprised of 23 hospitals in 14 Indian cities.
 
Shetty practices what Bush preaches
Bush suggests that the only way America will provide convenient quality healthcare at affordable cost, is if doctors do what they're trained to do, others perform routine services for less: for example, nurse-intensivists relieve surgeons from ICUs, and most importantly, if healthcare entrepreneurs are encouraged to tap into the transformative power of the marketplace.

For the past 15 years Shetty has been practicing what Bush is now preaching.  Narayana Health provides high quality healthcare, with compassion at affordable cost on a large scale. For instance in 2013, its 1,000-bed specialist heart hospital in Bangalore alone, performed a staggering 6,000 operations, half of them on children. By contrast, in the same year, Great Ormond Street Hospital in London performed less than 600.

In addition to hospitals, Shetty has developed a telemedicine practice, which reaches 100 facilities throughout India and more than 50 in Africa. Narayana Health is also India’s largest kidney-care provider. Shetty has started a micro-insurance program backed by the government that enables three million farmers to have health coverage for as little as US$2 in annual premiums. Over the next five years, Shetty plans to grow Narayana Health four times its present size and become a 30,000-bed hospital chain.
 
Healthcare change will come from developing nations
Bush says, the only way to build a flourishing health marketplace that everyone wants and can afford is for Americans to demand more from their health providers, and accept greater responsibility for their own health.

This will not happen, and Shetty explains why.
 
Shetty argues that the greatest advances in healthcare will not come from wealthy nations like the US and UK, but from developing nations. Rapidly changing technologies provide opportunities for developing nations to leapfrog wealthy nations, which are encumbered by entrenched and aging technologies.
 
Hospitals in developing countries with few advanced procedures can quickly leapfrog world-class hospitals such as those in the US and the UK, says Shetty. Instead of slowly replacing aging technologies, they can quickly implement innovative operational designs, and state-of-the-art technologies, which gives them a competitive advantage.  
 
Narayana Health City Cayman
This is what Shetty has done in the Cayman Islands. Backed by Ascension, the largest private health network in the US, and the Cayman government, which has designated a 200-acre site for the development of Narayana Health City Cayman.
 
 The first phase, which opened in February 2014, is a 104-bed tertiary hospital, which provides surgeries for less than half the average US price, with quality outcomes that match or exceed the very best US hospitals.  Narayana Health City Cayman is expected to develop into a 2000-5000-bed conglomeration of JCI accredited multiple super speciality hospitals in a single campus providing affordable healthcare to thousands.
 
Takeaway
Americans will have access to high quality healthcare at affordable cost, but it won’t happen in the way that Bush anticipates. Grand Cayman is only a 30minute flight from Miami.
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11 years, 10 months ago

Patient centred diabetes care

HealthPad
Directory:
Diabetes
Tags:
commentary
diabetes management
diabetes prevention
healthcare expenditure
smartphone technology
type 1 diabetes
type 2 diabetes
 
It's a travesty!

Health professionals don't effectively use mHealth strategies to proactively engage and support people living with diabetes. This failure destroys the lives of millions and unnecessarily increases healthcare costs by billions. This is a travesty.

Health information online
In the UK and US the majority of people living with diabetes and pre-diabetes have smartphones, which they use on a daily basis to send and receive information, purchase goods, bank, educate and socialize. Notwithstanding, 80% of health professionals still provide information for the management of diabetes in paper pamphlets, and the majority of diabetes care information on websites is digitalised paper pamphlets. Such communications strategies, cost millions, and fail to slow the progression of the condition.

Epidemic
Here's evidence, which suggests that current healthcare communications strategies are failing. Recent UK data released by the NHS show that people diagnosed with diabetes has increased significantly over the past decade. Today, 6% of UK adults are registered as diabetic, and an estimated 0.85 million people have diabetes without knowing it. In 2013 there were 163,000 new diagnoses: the biggest annual increase since 2008.

A 2014 study reported in the British Medical Journal revealed that the prevalence of pre-diabetes in England has tripled in eight years, from 11.6% in 2003 to 35.3% in 2011, which puts immense pressure on NHS finances. It's projected that by 2025, five million people will have diabetes in the UK.

The situation in the US is similar. Results of a 2014 study published in the Journal of the American Medical Association, show that there was a significant increase in diabetes between 2001 and 2009, and warns of a growing epidemic that could strain the American health-care system.
 
Diabetes UK report
Governments and charities are good at describing the burden of diabetes, but poor at introducing and promoting effective mHealth strategies to reduce the burden. In a 2014 Diabetes UK report, Barbara Young, the charity's CEO says, "The NHS is spending an eye watering amount on diabetes (£10 billion annually), but the money isn't being used effectively." Those who are diagnosed late or don't receive timely care can suffer complications such as kidney and nerve damage, which costs the NHS billions.

The Report emphasises the importance of better education on how to manage diabetes, and stresses that a staggering 80% of the £10 billion the NHS spends on diabetes goes on treating complications, which may have been prevented if patients had received more effective information about the condition.

If nothing changes, the Report suggests, by 2035 diabetes will cost the NHS £17billion a year, and thousands of diabetics will suffer unnecessary complications.

Online managed care systems
Where's the leadership to help change the situation?  There's evidence to suggest that when mHealth strategies are used in the management of diabetes, they slow the progression of the condition, propel self-management, and significantly reduce the costs of care.

For example, Professor Shahid Ali, a UK practicing GP and Head of Digital Health, University of Salford, has developed and implemented a mHealth system, which enhances the quality of diabetes care, while substantially reducing costs and increasing the efficiency of health professionals. 
 
In the US, Welldoc a successful technology company, founded in 2005 by an endocrinologist, provides  a mHealth solution for people living with diabetes, which coordinates diabetes care, propels self-management and achieves long-term adherence.
 
Professor Gordon Moore from Harvard University Medical School has developed a managed care system that embeds the clinical, behavioural and motivational aspects of diabetes care into any handheld device. It's like, Moore says, "having your doctor in your pocket".
 
Notwithstanding, governments and agencies responsible for enhancing the quality of care for people living with diabetes are failing to bring such tried-and-tested mHealth solutions to their attention.
 
Takeaways
According to Diabetes UK's, we, "know what needs to happen":
  • "More focus on ensuring that people know about diabetes
  • Provision and promotion of effective self-management
  • Integrated care planned around the needs of the individual
  • Effective promotion of lifestyle change."
But, how many more people living with diabetes have to endue unnecessary progression of their condition, and devastating complications, which cost health systems billions, before health professionals abandon their costly and ineffective communications systems and embrace cheaper and more effective mHealth strategies?  
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