Intensive Care Units (ICUs), which provide the most expensive and invasive forms of care in a hospital setting, are being used too often for patients who don’t need that level of care, according to a new study by LA BioMed and UCLA researchers .
The researchers studied 808 ICU admissions from July 1, 2015 to June 15, 2016 at Harbor-UCLA Medical Center and found that more than half the patients could have been cared for in less expensive and invasive settings.
Of the patients in the study, 23.4percent were in need of close monitoring but not ICU-level care. Another 20.9percent of the patients were critically ill but unlikely to recover because they had underlying illnesses or severity of acute illness. For another 8percent, death was imminent or the same outcomes were expected in non-ICU care.
‘Our study found over 50percent of patients admitted to the ICU were categorized into groups suggesting that they were potentially either too well or too sick to benefit from ICU care or could have received equivalent care in non-ICU settings,’ said Dong W. Chang, MD, an LA BioMed researcher and the corresponding author for the study. ‘This research indicates that ICU care is inefficient because it is devoting substantial resources to patients who are less likely to benefit from this level of care. These findings are a concern for patients, providers and the healthcare system because ICU care is frequently invasive and comes at a substantial cost.’
The researchers added up the number of days each of the patients in the study spent in ICU and found nearly 65percent of the total number of days those patients spent in ICU were allocated to care that was considered discretionary monitoring, had a low likelihood of benefit despite critical illness or would have been manageable in non-ICU settings.
‘While this is a study of just one hospital and results may differ at other medical centres, we suspect that these characteristics of ICU utilization are commonplace and prevalent in many institutions,’ said Dr. Chang.
The researchers also noted that in other hospitals, the ICU may be the most appropriate level of care because the hospitals don’t have appropriate levels of care for those patients outside the ICU.
‘However, there is likely to be a subset of patients in which ICU care leads to unwanted, invasive care without significant clinical benefit,’ said Dr. Chang. ‘Refining our ability to identify these patients and developing approaches to improve ICU utilization for those patients are important steps to assure the best care for patients and the most efficient use of the healthcare system’s limited resources.’

LA BioMed http://tinyurl.com/ztppu5j

A medical device for Cystic Fibrosis (CF) sufferers which lessens their exposure to infections resulting in fewer doctors’ visits, reduced antibiotic usage and shorter hospital stays, is expected to be market ready within two years.
University of Limerick (UL) inventors recently secured funding for the new percussion device that helps remove mucus from the airways and will, they hope, greatly improve the quality of life for cystic fibrosis patients.
Ireland has the highest incidence of CF in the world and CF is the most common, fatal hereditary disease in the United States.
Professor Colum Dunne, who is Foundation Chair and Director of Research at UL’s Graduate Entry Medical School (GEMS), explained the background to the development of the product.
‘Patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary or lung function. One example that we have focused on here is the CF patient airway, which is defective in ciliary function; resulting, due to ineffective removal, in a mucus-rich environment favouring growth of bacteria. These bacteria include potential pathogens, associated with chronic infection, decreased lung function and accelerated respiratory disease’.

Currently, there are percussion-based chest physiotherapy devices on the market, but according to Professor Dunne, these ‘can sometimes become reservoirs for the bacteria that cause infections in Cystic Fibrosis patients’. Because the new device, SoloPep, is disposable, it poses no threat of reinfection.
‘In our research, we have observed that compliance with hygiene practices for reusable devices, by patient, is potentially poor. As such, despite even excellent compliance with prescribed antimicrobial regimens, the devices may become colonised with problematic or opportunistic pathogenic microbes,’ Professor Dunne outlined.

‘The devices may, therefore, function as a reservoir that does not come into contact with the antimicrobial agents. Subsequently, re-infection may occur post-antimicrobial cessation by microbes present in the reservoir. Therefore, there is a need to develop novel inexpensive, single-use devices,’ he added.

‘Ireland has the highest per capita incidence of Cystic Fibrosis globally. Because of this, it is reasonable to expect treatment innovations generated by Irish researchers and carers. In this case, our studies included patient involvement from the outset and allowed us to develop something that is truly technologically disruptive. The design of this new positive expiratory pressure (PEP) device is clever and focused on the end user from the beginning. It removes significant risk for patients by improving their microbiology hygiene and safety,’ Professor Dunne added.

Dr Leonard O’Sullivan from UL’s School of Design is co-principal investigator for this device.
‘SoloPEP is a good example of user-centred design and it will have a dramatic impact on the quality of life of cystic fibrosis patients in a sector with significant commercial opportunity,’ he said.
‘This product has the potential to improve the lives of Cystic Fibrosis and other patients. But for that to happen the product must actually be available to them,’ Professor Dunne concluded.

University of Limerick www.ul.ie/gems/news/new-cystic-fibrosis-device-reduce-antibiotic-usage

Tau PET is a new and promising imaging method for Alzheimer’s disease. A case study from Lund University in Sweden now confirms that tau PET images correspond to a higher degree to actual changes in the brain. According to the researchers behind the study, this increases opportunities for developing effective drugs.
There are several different methods of producing images showing the changes in the brain associated with Alzheimer’s disease. The tau PET method reveals the presence of a protein in the brain, tau, with the help of a gamma camera and a specially selected radioactive molecule (F-AV-1451).
Tau has an important function in assisting the transport of various substances within the brain’s nerve cells. People with Alzheimer’s disease have raised levels of tau, leading to accumulation of the protein in the brain cells and gradually to cell death.
Until now, no one has had precise knowledge of how well the new imaging method reproduces the actual changes in a brain affected by Alzheimer’s disease. The current case study, however, shows that image and reality match up well. The study has enabled researchers to compare tau PET images and brain tissue from the same person for the first time. The brain tissue came from a person who died having recently undergone examination with the new imaging method.
‘Tau PET can improve diagnosis, but above all, the imaging method can be of great significance in the development of new drugs to combat Alzheimer’s disease’, explains Ruben Smith, researcher at Lund University and physician at Skane University Hospital. He continues:
‘There are new candidate drugs which aim to reduce the accumulation of tau. The imaging method opens up opportunities to investigate the development of the disease at a detailed level, and to observe how tau aggregates are affected by the drugs.’
‘The person who was examined had a mutation which led to the same type of accumulation of tau in the brain as in Alzheimer’s disease. A single case study might seem insignificant, but since there are areas with a lot of tau stored and others with less tau in the same brain, it is sufficient to examine one person in order to verify whether the imaging method works’, explains Oskar Hansson, professor at Lund University and consultant at Skane University Hospital.
Interest from the research community in imaging methods focusing on tau is strong and growing. A reliable reproduction of tau protein in the brain is considered a more relevant marker and a better diagnostic tool than competing methods which are already in use.

Lund University http://tinyurl.com/hvbyfgw

Ottawa researchers have validated a rule that could safely take a third of chest pain patients in the emergency department off heart monitors, according to a study. Implementing this made-in-Ottawa rule could free up these monitored beds for sicker patients and reduce wait times.
‘Chest pain is one of the most common reasons people visit Canadian emergency departments, with around 800,000 visits a year,’ said Dr. Venkatesh Thiruganasambandamoorthy, lead author of the study and a scientist and emergency physician at The Ottawa Hospital and an assistant professor at the University of Ottawa.
About 70 percent of chest pain patients who come to the emergency department are put in beds with heart monitors in order to detect potentially dangerous arrhythmia. However, previous studies have shown that this condition is rare, with less than two percent of chest pain patients experiencing it during their stay.
This is why Ottawa researchers had previously developed a simple, highly sensitive tool to identify those patients who can be safely removed from heart monitors. According to the Ottawa Chest Pain Cardiac Monitoring Rule, patients can be removed if they have no current chest pain and there are no significant abnormalities in the electrocardiogram reading.
Patients are normally taken off the monitor after about eight hours, when they are discharged home. Applying this rule will allow patients to be taken off monitors much sooner. If implemented when they first arrive, the rule will allow them to be redirected to a non-monitored area of the emergency department.
To verify the rule, researchers observed chest pain patients in the emergency department. Then they tested whether the tool could accurately predict which patients had needed to stay on heart monitors because of irregular heartbeat.
They found that 15 of the 1,125 patients admitted to The Ottawa Hospital emergency departments for chest pain between November 2013 and April 2015 experienced irregular heartbeat during their eight-hour stay. The rule was able to predict with 100 percent accuracy the 15 patients who needed to stay on heart monitors. It also indicated that 36 percent of the 796 patients who were monitored during the study could have been safely removed from the monitors.
‘This rule now has the potential to take a large number of low risk chest pain patients off of heart monitors,’ said Dr, Thiruganasambandamoorthy. ‘We started using this rule in The Ottawa Hospital emergency departments a few months ago, and we’re watching the outcomes very closely. We have also spoken to several emergency departments across the country who are excited about bringing this rule into their hospitals.’

The Ottawa Hospital Research Institute http://tinyurl.com/j5dm7xl

A centuries-old herbal medicine, discovered by Chinese scientists and used to effectively treat malaria, has been found to potentially aid in the treatment of tuberculosis and may slow the evolution of drug resistance.

In a promising study led by Robert Abramovitch, a Michigan State University microbiologist and TB expert, the ancient remedy artemisinin stopped the ability of TB-causing bacteria, known as Mycobacterium tuberculosis, to become dormant. This stage of the disease often makes the use of antibiotics ineffective.

‘When TB bacteria are dormant, they become highly tolerant to antibiotics,’ Abramovitch said, an assistant professor in the College of Veterinary Medicine. ‘Blocking dormancy makes the TB bacteria more sensitive to these drugs and could shorten treatment times.’

One-third of the world’s population is infected with TB and the disease killed 1.8 million people in 2015, according to the Centers for Disease Control and Prevention.

Mycobacterium tuberculosis, or Mtb, needs oxygen to thrive in the body. The immune system starves this bacterium of oxygen to control the infection. Abramovitch and his team found that artemisinin attacks a molecule called heme, which is found in the Mtb oxygen sensor. By disrupting this sensor and essentially turning it off, the artemisinin stopped the disease’s ability to sense how much oxygen it was getting.

‘When the Mtb is starved of oxygen, it goes into a dormant state, which protects it from the stress of low-oxygen environments,’ Abramovitch said. ‘If Mtb can’t sense low oxygen, then it can’t become dormant and will die.’

Abramovitch indicated that dormant TB can remain inactive for decades in the body. But if the immune system weakens at some point, it can wake back up and spread. Whether it wakes up or stays asleep’ though, he said TB can take up to six months to treat and is one of the main reasons the disease is so difficult to control.

‘Patients often don’t stick to the treatment regimen because of the length of time it takes to cure the disease,’ he said. ‘Incomplete therapy plays an important role in the evolution and spread of multi-drug resistant TB strains.’

He said the research could be key to shortening the course of therapy because it can clear out the dormant, hard-to-kill bacteria. This could lead to improving patient outcomes and slowing the evolution of drug-resistant TB.

After screening 540,000 different compounds, Abramovitch also found five other possible chemical inhibitors that target the Mtb oxygen sensor in various ways and could be effective in treatment as well.

‘Two billion people worldwide are infected with Mtb,’ Abramovitch said. ‘TB is a global problem that requires new tools to slow its spread and overcome drug resistance. This new method of targeting dormant bacteria is exciting because it shows us a new way to kill it. ‘

Michigan State University msutoday.msu.edu/news/2016/ancient-chinese-malaria-remedy-fights-tb/