Royal Philips and a consortium of leading European healthcare regions, companies, universities and hospitals* have announced the start of the first large scale care coordination and telehealth programme in the European Union to support tens of thousands of people living with chronic conditions. The three-year ACT@Scale programme will collect and analyse the health outcome and economic impact data for large populations of chronic patients and elderly people to develop, test and consolidate best practice’ care coordination and telehealth programmes that can be replicable and successfully rolled out across the European Union. The programme aims to reach more than 75,000 patients in the United Kingdom, the Netherlands, Spain and Denmark by 2019.
‘Today, 70 percent of Europe’s healthcare budget is spent on patients living with chronic conditions, largely a result of Europe’s aging population and rapidly changing care needs,’ said Jeroen Tas, CEO Connected Care and Health Informatics, Philips. ‘The ACT@Scale programme will provide the evidence needed to successfully deliver a seamless patient experience with better outcomes at lower cost.’
The five participating healthcare regions are all in the process of rolling out innovative care coordination and telehealth services. Within the ACT@Scale programme, they will share an agreed and standardized data set including programme outcomes such as the number of patients included, (re)hospitalizations, duration of hospitalizations and mortality rates. They will also assess economic impact factors such as cost per patient and the impact on hospitals income models. This data is to support the development of new and sustainable business models. Next to this, patient satisfaction scores are measured and the degree to which connected technology empowers people and affects health outcomes.
The regions involved comprise Catalonia (Spain), which has developed programmes to support nursing homes, reduce hospital re-admissions, manage complex cases and promote physical activity; Southern Denmark (Denmark), which is rolling out a telehealth programme to deliver psychiatric treatment; Northern Ireland (UK), which has remote telemonitoring programmes to support COPD and diabetes patients, and manage maternal obesity; Northern Netherlands (The Netherlands), with programmes to provide specialist support for COPD, asthma and heart failure patients, and connect healthcare and community services for chronic disease patients; and the Basque Country (Spain), which is rolling out programmes to support older people with complex health and social care needs, plus telehealth services for chronic heart failure patients.
‘Telehealth and coordinated care services may offer the elderly and otherwise frail individuals the ability to maintain their independence for longer and enjoy a significantly better quality of life, but they also involve significant changes to the healthcare system and the recipients’ ability to self-manage,’ said Professor Erik Buskens, Professor of Medical Technology Assessment at University Medical Center Groningen (UMCG). ‘ACT@Scale will allow us to determine the most cost-effective ways of implementing those changes while also maximizing the benefits for Europe’s ageing population.’
The ACT@Scale scientific consortium members comprise of University Medical Center Groningen (The Netherlands), Aristotle University of Thessaloniki (Greece), City University London (UK), Universitatsklinikum Wurzburg/Klinikum der Bayerischen Julius-Maximilians-Universitat (Germany), University of Hull (UK), Kronikgune-Centre for Research Excellence in Chronicity (Basque Country, Spain), Hospital Clinic of Barcelona (Spain) and Philips. It is anticipated that the first preliminary findings will be available from the end of Q4, 2016.
ACT@Scale builds on the successful ACT programme, a two-and-a-half year study (2013 – 2016) that looked into the results of European integrated care programmes. Thousands of interviews were conducted with participating patients and care providers. These learnings on success factors are applied to significantly grow the ACT@Scale healthcare regions’ coordination and telehealth programmes. The programme is part of the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), an initiative from the European Commission under its Innovation Union strategy, and aims to increase the average healthy lifespan by two years by 2020.

www.philips.com

Scientists of Tomsk State University have changed the physical and chemical properties of zeolites (aluminosilicates of calcium and sodium) by mechanical and thermal influence. After these studies, scientists will be able to create a portable device for haemodialysis – blood filtration from toxic products of metabolism in the case of renal insufficiency.

Of course now there are analogues of traditional devices for haemodialysis, but with all of them, the procedure must be performed in a hospital setting, so people are tied to their place of residence. And with the new device, they will be able to go even on long trips. Haemodialysis can be done at home and in an emergency situation, – said Alexander Buzimov, co-author of the study.
Zeolite gives out and absorbs moisture well. To increase this capacity, we had to find a way to increase the specific surface area.
The natural zeolite is a solid mineral, so it is important to find the technology of chopping in order to increase its surface area – said Alexander Buzimov. Its changing under the influence of mechanical processing allows control of varying the properties of zeolites.
TSU scientists compared the synthetic zeolite SAPO-34 to natural zeolite from the Tokay deposits in Hungary. They exposed the minerals to thermal and mechanical treatment in a ball mill and found that the specific surface area of the synthetic zeolite had decreased and area of the natural had increased. There had been a change in the mineral composition of natural zeolite.
Now scientists want to combine zeolites with nano-ceramic material developed by the Institute of Strength Physics and Materials Science of RAS and create a composite sieve, which will be the basis for the future haemodialysis device. The device will connect to a shunt, which is implanted under the skin of the patient. The blood will circulate through the composite sieve and will be cleaned. The scientists plan to get the new material from zeolite and nanoceramics in a year, and in two years to create the first device.

Tomsk State University en.tsu.ru/news/tsu-has-changed-the-properties-of-a-mineral-needed-for-hemodialysis/

Twice as many patients with non-serious injuries, such as fractures or neck strain, are undergoing CT scans in emergency departments at California hospitals, according to a UCSF-led study, which tracked the use of the imaging from 2005 to 2013.
While CT scans enable clinicians to swiftly pinpoint life-threatening conditions, exposure to its ionizing radiation is associated with an increased risk of cancer. According to a 2009 report by the FDA, a single CT scan may be associated with a fatal cancer in one in 2,000 patients.
In the study, researchers at UCSF and Stanford studied more than 8 million adult patient visits at 348 state hospitals, using data from the California Office of Statewide Health Planning and Development. These patients had been discharged after being seen in emergency departments for injuries such as minor falls or low-impact vehicle accidents. The study found that 3.51 percent of patients underwent at least one CT scan in 2005, versus 7.17 percent in 2013.
‘The reasons for this increase are multifactorial,’ said senior author Renee Hsia, MD, professor of emergency medicine and health policy at UCSF. ‘They range from defensive medicine practices, the superior diagnostic accuracy of CT scans compared with X-rays, to their increased availability and convenience in emergency departments, and the demand to expedite discharge of patients.’
The authors noted that CTs were more likely to be ordered in hospitals that were designated high-level trauma centres. Some 39 percent of those in the study were ordered at level I and II trauma centres, compared with 3 percent at low-level centres.
‘This may reflect an underlying work culture largely centred around the management of severely injured patients, guided by standard trauma CT protocols, and also the fact that level I and II trauma centres see sicker patients,’ the authors wrote in their paper.
Also disproportionately visible were patients between the ages of 18 and 24, ‘those at greatest risk for radiation,’ wrote the authors, as well as those over 45. ‘With the aging of the U.S. population, physicians may be influenced toward greater advanced imaging even in the case of low-mechanism injuries, given the atypical presentations and more serious pathology that older adults may have,’ said Hsia.
The authors reported an upswing in the use of CTs from 2005 to 2009, followed by a gradual decline to 2011 – reflecting awareness of overuse – which was preceded by a resurgence from 2011 to 2013 that almost reached the zenith of 2009.
‘The message for both patients and physicians is that there are long-term risks associated with radiation exposure and there may be situations where imaging is not definitively warranted or beneficial,’ said Hsia.

University of California – San Francisco http://tinyurl.com/hp4525h

Researchers and physicians have grappled with the role of ‘adjuvant,’ or post-surgery, chemotherapy for patients with early-stage colon cancer, even for cancers considered high risk. Now researchers from the University of Illinois at Chicago have found an association between the use of adjuvant chemotherapy in stage 2 colon cancer and improved survival – regardless of a patient’s age or risk, or even of the specific chemotherapy administered.

The American Cancer Society estimates that more than 95,000 people in the U.S. will be diagnosed with colon cancer this year, making it the third-most common cancer diagnosis in men and women in the U.S. It is the second-leading cause of cancer-related deaths.

Adjuvant chemotherapy has long been proven to help patients fighting advanced colon cancer. However, its benefit for patients with stage 2 colon cancer remains unknown, and current clinical guidelines only recommend that physicians discuss this treatment option with stage 2 patients whose cancer is considered high-risk and likely to return after surgery.

‘The results of this study are exciting, and certain aspects not entirely expected,’ says lead author Dr. Ajay Maker, associate professor of surgery in the UIC College of Medicine and director of surgical oncology for the Advocate Creticos Cancer Center. ‘For many years, studies have included, but not focused on, stage 2 colon cancer patients. This study, which looks at the largest group of stage 2 colon cancer patients to date, set out to better understand the role of adjuvant chemotherapy in treating patients that are fighting this specific type and stage of cancer.’

Medical Center.
This research was funded in part by the the National Cancer Institute, one of the National Institutes of Health, under grant K08CA190855.

University of Illinois at Chicago news.uic.edu/adjuvant-chemotherapy-in-early-stage-colon-cancer-may-improve-survival

By identifying new compounds that selectively block mitochondrial respiration in pathogenic fungi, Whitehead Institute scientists have identified a potential antifungal mechanism that could enable combination therapy with fluconazole, one of today’s most commonly prescribed fungal infection treatments. The approach could also prevent the development of drug resistance.

‘Our research adds weight to the idea that effective antifungal drugs can target even those mitochondrial proteins that are highly conserved in humans and fungi, and that this could be a way to make a broad spectrum antifungal combination therapy that would be less susceptible to resistance,’ says Benjamin Vincent, a former graduate student in Whitehead Member Susan Lindquist’s lab who is now a scientist at Yumanity Therapeutics.

Fungi cause bothersome diaper rashes, oral thrush, athlete’s foot, and vaginal yeast infections, but they are also responsible for life-threatening infections in the immune-compromised, including patients receiving transplants, people with HIV/AIDS, cancer patients, and the elderly. Severe invasive fungal infections have a mortality rate of 30-50% and cause an estimated 1.5 million deaths worldwide annually.

Doctors rely on three main drug classes-the azoles (e.g., fluconazole), the echinocandins, and amphotericin-to treat these severe infections, but often with limited success. Many strains of pathogenic yeast, such as Candida albicans (C. albicans) can develop resistance to these drugs. Although combining therapies is a potent method to combat drug resistance in bacteria, antifungal drugs often perform poorly when used in combination due to their complex pharmacology and antagonistic antifungal mechanisms. When used individually, current antifungal drugs can have significant toxicities that are markedly enhanced when the drugs are used in combination.

‘Pharmaceutical companies are abandoning the development of antifungals,’ says Lindquist, who is also a Howard Hughes Medical Institute investigator and a professor of biology at MIT. ‘Fungi are much more similar to us than bacteria, so it is hard to find agents that attack them but not us.’

To identify new potential antifungals that could be combined with fluconazole, a team of Whitehead and MIT scientists screened 300,000 compounds, selecting one with the most apparent potential-Inz-1-for further study. Their work is described online this week in the journal Cell Chemical Biology.

Inz-1 inhibits the growth of C. albicans in media lacking glucose but only partially impairs growth when glucose is present, indicating that Inz-1 interferes with mitochondrial function. Indeed, the researchers determined that Inz-1 targets the cytochrome B protein required for mitochondrial production of ATP. The authors then worked with synthetic chemist Jean-Baptiste Langlois in the laboratory of Stephen Buchwald in the MIT Department of Chemistry to iteratively synthesize and test analogs of Inz-1 to improve its properties. This work led to Inz-5, which exhibited dramatically improved potency and selectivity for fungal cytochrome B. Although cytochrome B is highly conserved across humans and many pathogenic fungi, including Cryptococcus neoformans, Aspergillus fumigatus, and Rhizopus oryzae, Inz-5 exploits important differences in the amino acid sequence of the protein that enable selectivity for fungi.

Because the compound is metabolized too rapidly for study in mice, the team mimicked its effects by knocking out cytochrome B in C. albicans and infecting mice with this mutant strain. Overall, the cytochrome B knock-out strain is much less virulent, and mice infected with it survive much longer than those with the wild-type strain. Curiously, the mutant yeast seems to cause more infections in the brain and central nervous system than unaltered C. albicans. Treatment with fluconazole effectively clears infection caused by this mutant, indicating that combination antifungal therapy could be highly effective when one of the agents targets mitochondrial respiration.

Not only does hitting cytochrome B disable C. albicans’ virulence, but the fungus’s altered mitochondrial function means that the yeast is unable to adapt to the nutrient-deprived conditions present within the host, particularly inside macrophages. Instead of punching its way out of a macrophage that has engulfed it, the yeast remains trapped and loses its fight against the immune system.

Although Inz-1’s therapeutic promise is limited by its poor stability in animals, the compound proves that conserved cellular processes can be viable targets for selective antifungal therapeutics and could provide targets for effective combination antifungal therapy.

Whitehead Institute wi.mit.edu/news/archive/2016/disrupting-mitochondrial-function-could-improve-treatment-fungal-infections