The American Society for Gastrointestinal Endoscopy (ASGE) has issued
A new angiographic analysis of the CHAMPION PHOENIX trial examined the incidence and impact of stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI).
CHAMPION PHOENIX was a prospective, double-blind, active-controlled trial which randomised 11,145 patients to receive intravenous cangrelor or oral clopidogrel administered at the time of PCI. In a previous analysis presented at TCT 2013 and published in the Journal of the American College of Cardiology, cangrelor significantly reduced periprocedural and 30-day ischemic events in patients undergoing PCI.
In this new analysis, an independent core laboratory (CRF) blinded to the treatment performed the angiographic analysis of 10,939 of the randomised patients. Stent thrombosis was defined as the occurrence of either intraprocedural ST (IPST) or ARC defined ST (definite or probable). Adverse events were adjudicated by an independent clinical events committee.
ST occurred in 120 patients (1.1 percent) at 48 hours and in 175 patients (1.6 percent) at 30 days. The occurrence of ST at 48 hours and 30 days was associated with a marked increase in 30-day mortality (OR [95%CI] = 15.3 [8.6, 27.2], p<0.001; and 55.2 [36.6, 83.3] p<0.001, respectively). IPST, ARC acute ST (=24 hrs), and ARC subacute ST (1-30 days) occurred in 89 (0.8 percent), 32 (0.3 percent), and 60 (0.5 percent) patients respectively. Each type of ST was also associated with an increase in 30-day mortality (IPST: 17.4 [8.4, 36.1], p<0.001, ARC acute ST: 43.3 [18.1, 103.5], p<0.001, ARC sub-acute ST: 189.1, [107.9, 331.4], p<0.001). 'Regardless of the exact type of stent thrombosis, it remains associated with a high rate of death,' stated Deepak L. Bhatt, MD, MPH, Executive Director of Interventional Cardiovascular Programs at Brigham and Women
Pancreatic cancer is a particularly devastating disease. At least 94 percent of patients will die within five years, and in 2013 it was ranked as one of the top 10 deadliest cancers.
This prototype of a microfluidic device has both curved and straight channels for transporting tissue biopsies. The silicon material is lightweight, flexible and transparent.
Routine screenings for breast, colon and lung cancers have improved treatment and outcomes for patients with these diseases, largely because the cancer can be detected early. But because little is known about how pancreatic cancer behaves, patients often receive a diagnosis when it
Scripps Whittier study shows potential for improving glycemic control in Latinos
An oral capsule that vibrates as it moves through the digestive tract has shown notable promise as a non-pharmacological treatment for constipation, according to new research presented today at Digestive Disease Week (DDW). In the pilot study, the vibrating capsule was found to nearly double the weekly bowel movements of patients suffering from chronic idiopathic constipation (CIC) and constipation predominant irritable bowel syndrome (C-IBS).
‘Despite the widespread use of medication to treat constipation, nearly 50 percent of patients are unsatisfied with the treatment either because of side effects, safety concerns about long-term use, or the fact that it simply doesn
As the effectiveness of anaesthesia, pain management and rehabilitation continues to improve, more orthopaedic procedures are being done on an outpatient basis. In a new research study same-day total joint replacement (TJR) patient outcomes were comparable to those of patients admitted to the hospital and staying at least one night following surgery. However, readmission rates, although statistically ‘non-significant,’ were higher for outpatient procedures. In a related study, a very low complication rate (.23 percent) was found in a review of more than 28,737 hand and upper extremity surgeries at an outpatient speciality clinic.
‘Our study supports the view that outpatient surgery can offer patients and physicians options for safe, cost-effective surgical care, offering improved patient comfort, increased efficiency and low complication rates.’
Many surgeons are now performing TJR as a same day procedure, with patients discharged within 24 hours of surgery. Outpatient TJR has ‘the potential benefit to cut costs and improve patient satisfaction,’ however, concerns for patient recovery, as well as increased Medicare scrutiny and financial penalties for unplanned hospital re-admissions within 30 days of surgery, is deterring some doctors and hospitals from routinely performing outpatient surgeries, said David N. Vegari, MD, a Philadelphia orthopaedic surgeon and lead author of the study, ‘Implications of Outpatient vs. Inpatient Total Joint Arthroplasty on Hospital Readmission Rates.’
In the study, researchers reviewed outcomes for 235 patients who underwent either outpatient (137 patients) or inpatient (98 patients) total knee or total hip replacement surgery between September 2010 and May 2011. Patients receiving outpatient surgery had a body mass index (BMI) =40 kg/m
Scientists from The University of Manchester
Surgical decision making for sick, elderly patients should be orchestrated by a multidisciplinary team, including the patient, his or her family, the surgeon, primary care physician, nurses and non-clinicians, such as social workers, advocates Laurent G. Glance, M.D., in a perspective piece published.
For this group of patients, surgery can be very risky. Glance, professor and vice-chair for research in the Department of Anesthesiology at the University of Rochester School of Medicine and Dentistry believes a more patient-centred, team-based treatment approach would lead to higher quality care that matches the values and preferences of the sickest patients.
Usually, patients undergo a one-on-one consultation with their surgeon, who is frequently solely responsible for most of the decision making and management surrounding a possible surgical procedure. However, this traditional approach has potential pitfalls. For example, patients may not always be presented the full range of treatment options, such as medical treatment, less invasive surgical options, or watchful waiting.
‘Evaluating treatment options, formulating recommendations and articulating the benefits and risks to patients comprehensively require more than a well-informed or experienced surgeon,’ noted Glance, who is also a professor of Public Health Sciences and a cardiac anaesthesiologist at UR Medicine
A new methodology for rapidly measuring the level of antibiotic drug molecules in human blood serum has been developed, paving the way to applications within drug development and personalised medicine.
The study, describes the exploitation of a sensor for measuring the concentration of effective antibiotics in blood, giving an indication of their efficiency against disease causing pathogens, for instance multidrug resistant hospital ‘superbugs’.
This development could potentially give a far greater understanding of the effectiveness of drug dosages required for different individuals, reducing potential toxic effects, allowing personalised treatment for patients and leading to new insights into optimal clinical regimes, such as combination therapies.
When effective, antibiotic molecules impose cellular stress on a pathogen’s cell wall target, such as a bacterium, which contributes to its breakdown. However, competing molecules in solution, for example serum proteins, can affect the binding of the antibiotic to the bacterium, reducing the efficacy of the drug. Serum proteins bind to drugs in blood and, in doing so, reduce the amount of a drug present and its penetration into cell tissues.
As the amount of antibiotics that bind to serum proteins will vary between individuals, it is extremely valuable to be able to determine the precise amount of the drug that is bound to serum proteins, and how much is free in the blood, in order to be able to accurately calculate the optimum dosage.
Existing biosensors on the market do not measure cellular stress, however, the nanomechanical sensor exploited by a group of researchers from the London Centre for Nanotechnology (LCN) at UCL, the University of Cambridge, the University of Queensland and Jomo Kenyatta University of Agriculture and Technology, can accurately measure this important information even when antibiotic drug molecules are only present at very low concentrations.
The researchers coated the surface of a nanomechanical cantilever array with a model bacterial membrane and used this as a surface stress sensor. The sensor is extremely sensitive to tiny bending signals caused by its interactions with the antibiotics, in this case, the FDA-approved vancomycin and the yet to be approved oritavancin, which appears to deal with certain vancomycin-resistant bacteria, in the blood serum.
This investigation has yielded the first experimental evidence that drug-serum complexes (the antibiotics bound to the competing serum proteins) do not induce stress on the bacteria and so could provide realistic in-vitro susceptibility tests for drugs and to define effective doses which are effective enough but less toxic to patients.
In the future, the researchers believe that with a suitably engineered surface probe, this sensor could be paired with customised drug delivery for anaesthetics, anti-cancer, anti-HIV and antibacterial therapies.
The lead author of the study, Dr. Joseph W. Ndieyira of the LCN, said ‘This discovery represents a major advance in our fundamental understanding of the pathways between chemical and mechanical signals in a complex media, such as blood serum, and how this information can be used to tune the efficacy of drugs and to minimise the potential toxic side effects.’
EurekAlert
Since late January, Healthcare Informatics Solutions and Services is a new business group within Philips’ Healthcare sector that offers hospitals and health systems the customized clinical programs, advanced data analytics and interoperable, cloud-based platforms necessary to implement new models of care.
Building off a proven track record in improving the health of aging and at-risk populations, Healthcare Informatics Solutions and Services will partner with healthcare providers to improve access, lower cost and enhance quality across the continuum of care, from screening and diagnosis, to treatment and monitoring, and finally after care at home.
“Healthcare systems today are changing the way they operate, how decisions are made and how patients receive care,” said Deborah DiSanzo, chief executive officer, Philips Healthcare. “This requires a significant overhaul of complex organizations, as well as the associated actionable data about each patient population they serve. As we continue to expand the tools, analytics, consulting and support, we are paving the way for providers to transition into more integrated, collaborative care.”
Healthcare Informatics Solutions and Services will be led by Jeroen Tas, who previously served as the chief information officer of Philips, and will represent the next step in the evolution of Philips, responding to increasing demand by major health systems worldwide.
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