A novel heart valve replacement method has been revealed that offers hope for the thousands of patients with rheumatic heart disease who need the procedure each year.

‘Over the past decade heart valve surgery has been revolutionised by transcatheter aortic valve implantation (TAVI),’ said lead author Dr Jacques Scherman, a cardiac surgeon in the Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa. ‘Heart valves are replaced or repaired via a catheter, obviating the need for open heart surgery or a heart-lung machine.’

He continued: ‘TAVI is only indicated in patients with calcific degenerative aortic valve disease, which is the most prevalent aortic valve pathology in developed countries. In developing countries, rheumatic heart disease still accounts for the majority of patients in need of a heart valve intervention.’
Rheumatic heart disease is caused by rheumatic fever, which results from a streptococcal infection. Patients develop fibrosis of the heart valves, leading to valvular heart disease, heart failure and death. In Africa alone there are around 15 million patients living with rheumatic heart disease of whom 100 000 per year might need a heart valve intervention at some stage of their life. The vast majority of these patients have no access to cardiac surgery or sophisticated cardiac imaging.

Dr Scherman said: ‘Inspired by the success of TAVI for calcific aortic valve disease, we developed a simplified TAVI device for transcatheter aortic valve replacement in patients with rheumatic heart disease.’
Currently available balloon expandable TAVI devices require the use of sophisticated cardiovascular imaging to correctly position the new valve. They also use a temporary pacemaker which allows the heart to beat so quickly that it stops blood circulating to the rest of the body (called rapid ventricular pacing).

Dr Scherman said: ‘Rapid ventricular pacing can only be tolerated for a short period and therefore limits the time available to do the implantation.’
The team in South Africa developed a novel TAVI device which is ‘non-occlusive’, meaning that there is no need to stop blood circulating to the body with rapid ventricular pacing. The device is also ‘self-locating’ and does not require sophisticated cardiac imaging for positioning.

The proof of concept study presented today tested the device in a sheep model. The investigators found that the device was easy to use and positioned the valve correctly, and the procedure could be performed without rapid ventricular pacing.

Dr Scherman said: ‘We showed that this new non-occlusive, self-locating TAVI delivery system made it easy to perform transcatheter aortic valve replacement. Using tactile feedback the device is stabilised in the correct position within the aortic root during the implantation. It also has a temporary backflow valve to prevent blood leaking backwards into the ventricle during the implantation of the new valve. All these factors together allowed for a slow, controlled implantation compared to the currently available balloon expandable devices.’

He added: ‘This simplified approach to transcatheter aortic valve replacement could be done in hospitals without cardiac surgery at a fraction of the cost of conventional TAVI. It has the potential to save the lives of the large numbers of rheumatic heart disease patients in need of valve replacement.’

European Society of Cardiology www.escardio.org/The-ESC/Press-Office/Press-releases/novel-heart-valve-replacement-offers-hope-for-thousands-with-rheumatic-heart-disease

Home-based telemental health for depression is well received by patients and delivers as good a quality of life as in-person visits, according to the results of a clinical trial in 241 depressed elderly veterans reported by investigators at the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center.

Depression affects 10 percent of Americans and is a leading cause of disability and mortality. And yet, only an estimated 56 percent of patients with depression seek treatment. Barriers to treatment include mobility issues, transportation costs, missed days of work, geographic isolation and fear of the associated stigma. By overcoming some of those barriers, proponents of telemental health say it could improve access to care for these patients.

Leonard E. Egede, M.D., director of the MUSC Center for Health Disparities Research and a Veterans Affairs physician, led a team of MUSC and VA Medical Center investigators, along with Christopher Frueh, Ph.D., director of clinical research at The Menninger Clinic and adjunct professor from Baylor College of Medicine.

‘This is the largest randomized clinical trial to date examining whether differences exist in patient perceptions, satisfaction, therapeutic alliance and quality of life between telemental health and same-room care,’ Egede said.

Male and female veterans aged 58 years and older who met the criteria for major depressive disorder, including Vietnam-era veterans, were eligible for enrollment in the trial. All participants received eight weeks of behavioural activation therapy and were randomly assigned to telemental health or in-person counselling. Behavioural activation reflects the notion that the patient’s activity plays a role in how the person feels and the goal of therapy is to reduce behaviours that promote depression.

Telemental health treatment sessions were delivered via in-home videoconferencing using a standard telephone line and did not require an internet connection. The 36-item Short Form Survey was used to assess quality of life and the Charleston Psychiatric Outpatient Satisfaction Scale was used to assess patient satisfaction. Scores on these scales did not differ significantly at 12-month follow-ups between veterans who received depression care via telemental heath and those who received in-person care.

Egede and colleagues had previously reported primary outcome and cost analysis results from this same trial of 241 depressed elderly veterans. In a 2015 Lancet Psychiatry article, Egede showed that telemental health was not inferior to same-room delivery in patients with a major depressive disorder for eliciting a treatment response. A treatment response was defined as a 50 percent decrease in depression symptoms at a 12-month follow-up appointment versus baseline and the absence of a diagnosis of major depressive disorder at a 12-month follow-up.

In an article published, Egede showed that the overall inpatient costs as well as outpatient and pharmacy costs for treating depression increase over time in elderly veterans, regardless of whether the treatment is delivered in person or via telemental health. This increase in cost is likely a result of the rising number of visits.

In conjunction with these earlier findings that primary outcomes and costs for telemental health are similar to those for in-person depression care, the report suggests that telemental health is a viable alternative to in-person visits because it delivers a similar quality of life and patient satisfaction.

EurekAlert www.eurekalert.org/pub_releases/2016-11/muos-ssh112316.php

Cardiac arrhythmia is a common complication following lung transplantation, and one that has a significant negative impact on long-term patient survival, reports a team of UPMC researchers in the largest study of its kind to date. The results provide critical information that will hopefully lead to better care of transplant recipients.
Arrhythmia, a rapid and irregular heartbeat, can lead to chest pain, stroke and heart failure. In addition, the blood-thinning drugs oft en used to treat atrial fibrillation, the most common type of arrhythmia, carry risks of heavy bleeding.
"Arrhythmias present a lot of challenges for both physicians and patients. After noticing this complication in many of our lung transplant recipients, we decided to investigate how often and when it was happening, as well as any risk factors," said lead researcher Jonathan D’Cunha, M.D., Ph.D., associate professor, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, and chief of Lung Transplantation, Department of Cardiothoracic Surgery, UPMC. "Now that we have a better understanding of these events, we can develop a standardized treatment plan, and better educate patients in advance."
Performing 70 to 100 lung transplants per year, UPMC is one of the leaders for this procedure in the US. In the new study, researchers examined the medical records of 652 UPMC patients who underwent a single or double lung transplant between 2008 and 2013. They found that about 30 percent of patients developed arrhythmia, most often during the first week following surgery. Risk factors for a postoperative arrhythmia included being older and having had a previous heart surgery.
Researchers also found transplant recipients who developed an arrhythmia were 1.6 times more likely to die within 5 years than those who didn’t, a finding Dr. D’Cunha attributed more to the potential complications of treating arrhythmia than the abnormal heart beats themselves.
"Our study suggests that we may need to treat patients with blood thinners only for a short amount of time-until they are out of the window of highest risk-which will hopefully improve long-term outcomes," Dr. D’Cunha explained.
In addition, because arrhythmia aft er lung transplant can be an anxiety-provoking experience for patients, the findings will allow surgeons to better prepare patients and families for what to expect.

University of Pittsburgh School of Medicine http://tinyurl.com/h3cerpp

For many patients, the uncertainty and stress that can come with cancer treatment is compounded by what is now known as ‘financial toxicity,’ the anxiety and distress that follow health care and medication expenses, often compounded by reduced ability to work.

A team of specialists have demonstrated how a survey can measure a patient’s risk for, and ability to tolerate, financial stress.

With data from 233 patients going through treatment for advanced cancers, the researchers showed that the COST (COmprehensive Score for financial Toxicity) questionnaire identified patients at financial distress, which was found to be a ‘clinically relevant patient-centered measure.’

‘As expected, we found a strong association between a patient’s use of health care resources and his or her sense of financial toxicity,’ said the study’s lead author Jonas de Souza, MD, MBA, a head-and-neck cancer specialist and health services researcher at the University of Chicago Medicine. ‘This is something we need to look for, to recognize early and make sure it does not become a barrier to care.’

More than two admissions to the hospital, for example, had a significant impact on a patient’s sense of financial toxicity. ‘This is reasonable,’ de Souza said. ‘Hospital care is much more expensive than office-based care. We now know that it also impacts a patient’s self-reported financial feelings.’

The research team kept the COST questionnaire short and simple. It includes 11 brief statements about costs, resources and concerns. For each question, patients were asked to circle one of five possible responses that help determine their level of concern.

Faced with statements such as: ‘I feel financially stressed,’ or ‘My out-of-pocket medical expenses are more than I thought they would be,’ patients had to choose the answer that best described their situation.

Financial toxicity questionsSample statements from the Comprehensive Score for Financial Toxicity (COST) tool questionnaire.
The questionnaires revealed several factors that were closely tied to financial toxicity. Employment status was at the top of the list, followed by household income, psychological distress, the number of hospital admissions, and race. African-American individuals tended to have more financial toxicity, on average, than Caucasians.

One surprise was the lack of a perceived financial benefit from participation in clinical trials. ‘Usually the maker of an innovative device or the company that supplies a new drug will pick up the costs related to the investigational drug,’ de Souza said. ‘But that did not reduce our patients’ sense of financial toxicity. We’ve added that to our model.’

The next step is to go back to our patients and understand the factors that drive financial toxicity for each kind of cancer,’ said de Souza. ‘Then we need to learn how to intervene. How can we help these patients, perhaps with financial counselors? And how can we decrease the costs of what we do to treat cancer overall and, at the same time, lessen the financial burdens that fall on the patient.

‘It’s important to note that the financial distress identified by the COST scale captures a unique set of stressors affecting patients above and beyond the physical and psychological strains of their disease,’ notes Lauren Hersch Nicholas, PhD, a health economist at the Johns Hopkins School of Public Health and member of the study team. ‘Being able to quantify this burden is an important step towards giving patients, their families and care team the information necessary to make the best treatment decisions for each patient’s situation.’

‘As society increasingly considers the costs incurred by patients with cancer as a side effect of treatment, instruments to measure financial toxicity should be patient centred, scientifically derived, and clinically relevant,’ the authors wrote. ‘It is time to start measuring and talking about the costs of care for patients as we would with any other side-effect,’ De Souza said.

Or, as the Irish mathematical physicist Lord Kelvin put it in 1883: ‘When you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.’

University of Chicago sciencelife.uchospitals.edu/2016/10/07/new-tool-for-cancer-patients-measures-the-stress-of-expenses/

Two major players in the monitor sector have joined forces. The medical monitors business of Panasonic Healthcare Co., Ltd. (‘Panasonic Healthcare’) became part of the EIZO Corporation in August 2016. The business transfer allows EIZO to combine the expertise of the two leading monitor solution manufacturers, especially for applications in medical imaging. The acquisition allows Karlsruhe-based EIZO GmbH to offer the entire product range of medical monitors for minimally invasive surgery, including 2D, 3D and 4K models.
EIZO had already announced the planned expansion of its business in the healthcare market with a particular focus on the field of operating rooms in a mid-term business plan in 2015. ‘Uncompromising quality and innovative products are EIZO’s strengths,’ said Peter Ziegler, Managing Director of EIZO GmbH in Karlsruhe. ‘Acquiring monitor solutions from Panasonic Healthcare lets us extend this offer into endoscopic image display.’
Panasonic Healthcare has been expanding its endoscopy monitor business since August 2010. Over the years, the company has built strong global partnerships with manufacturers in both endoscopy and OR integration. Panasonic Healthcare products are used in operating rooms around the world where they offer medical specialists outstanding colour settings and accurate colour reproduction. Michael Unger, formerly General Manager at Panasonic Biomedical Sales Europe B.V., sees the merger as a positive step for the future. ‘The many years of experience which EIZO and Panasonic Healthcare have accumulated in the area of imaging technology will provide surgeons with an entirely new level of quality and support in the operating room. As General Manager of Endoscopic Imaging for EIZO GmbH, I am delighted to continue supporting ongoing medical advances through the sale of our medical monitors.’

www.eizo.com www.panasonic-healthcare.com/global/