FUJIFILM SonoSite is helping ultrasound users to assess the total cost of ownership for imaging equipment. Medical device warranties: Fine print, major total cost implications – a recently published report by the company’s Chief Operating Officer Rich Fabian – tackles the intricate details of warranties head-on, helping to clarify key considerations and unpack some of the hidden costs, for both patient care and financial planning. 
Warranties are intended to mitigate the risks related to ownership by allowing hospitals to control expenditure on training, servicing, repairs, replacement parts and software updates over the course of an instrument’s useful lifecycle. The two-page article is essential reading for procurement departments, helpfully examining how the appeal of generous multi-year warranties may be undermined by taking into account the exceptions mentioned in the fine print. For example, limitations on replacement parts can sometimes result in hospitals spending more on transducers than the cost of the original system. A key aim for buyers is to choose equipment in which the quality and durability are commensurate with the warranty offered. The mean time between instrument failures and the frequency of repairs is a critical factor to consider as downtime is costly, both in terms of patient care and delayed procedures. Raising awareness of these considerations will help ultrasound users to get the best value for money when purchasing a new clinical imaging system.
www.beckershospitalreview.com/finance/medical-device-warranties-fine-print-major-total-cost-implications.html

Patients in the UK who have survived critical illnesses requiring care in an intensive care unit (ICU) frequently report symptoms of anxiety, PTSD and/or depression, according to a study. Those reporting symptoms of depression after critical illness appear to be at a greater risk of death.
Researchers in our department led by Peter Watkinson investigated psychological disorders in a cohort of 4,943 of former ICU patients. They found that 46% of patients reported symptoms of anxiety, 40% reported symptoms of depression and 22% reported symptoms of PTSD, while 18% of patients in the study reported symptoms of all three psychological conditions.
To investigate possible links between treatment in an ICU and symptoms of psychological disorders, the authors asked a total of 4,943 patients who received treatment in one of 26 ICUs in the UK between 2006 and 2013, to complete a questionnaire on their symptoms of anxiety, depression and PTSD three months after discharge from ICU and again 12 months after discharge.
The authors found that patients who reported symptoms of depression were 47% more likely to die from any cause (all-cause mortality) during the first two years after discharge from the ICU than those who did not report these symptoms.
Dr Peter Watkinson said: ‘Our findings suggest that depression following care of a critical illness in the ICU may be a marker of declining health and clinicians should consider this when following up with former ICU patients.’
The authors caution that the generalisability of the results outside of the UK may be limited as the data was only collected from UK based patients. Furthermore, the observational nature of the study and its reliance of self-reported data mean that it does not allow for conclusions about cause and effect between ICU care and symptoms of psychological disorders.

Nuffield Department of Clinical Neuroscience
www.ndcn.ox.ac.uk/news/over-half-of-former-intensive-care-patients-in-the-uk-report-symptoms-of-psychological-disorders

A novel positron emission tomography (PET) imaging method shows promise for noninvasively pinpointing sites of inflammation in people with inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease.
Amanda C. Freise, PhD, first author of the study and a lecturer at UCLA, explains the research and its significance.
The U.S. Centers for Disease Control states that approximately three million Americans reported being diagnosed with IBD in 2015 (latest data). Managing patients with chronic bowel inflammation can be challenging, relying on symptoms and invasive procedures such as colonoscopy and biopsy.
In a mouse model of colitis, this study uses PET imaging with antibody fragment probes (immunoPET) to target a specific subset of immune cells, the CD4+ T cells, which are characteristic of IBD.
“CD4 immunoPET could provide a non-invasive means to detect and localize sites of inflammation in the bowel and also provide image guidance for biopsies if needed,” explains Anna M. Wu, PhD, professor of Molecular and Medical Pharmacology at UCLA and director of the UCLA Jonsson Comprehensive Cancer Center’s Cancer Molecular Imaging Program, who headed the project and collaborated with Jonathan Braun, MD, and Arion Chatziioannou, PhD, also of UCLA. She adds, “Assessment of CD4 infiltration could also potentially provide a means for detection of subclinical disease, before symptoms occur, and provide a readout as to the efficacy of therapeutic interventions.”
A zirconium-89 (89Zr)-labe7lled anti-CD4 engineered antibody fragment [GK1.5 cDb] was used for non-invasive imaging of the distribution of CD4+ T cells in the mice with induced colitis, and it successfully detected CD4+ T cells in the colon, ceca and mesenteric lymph nodes. The study demonstrates that CD4 immunoPET of IBD warrants further investigation and has the potential to guide development of antibody-based imaging in humans with IBD.
Wu points out that the ability to directly image immune responses could have wide applications, saying, “It could unlock our ability to assess inflammation in a broad spectrum of disease areas, including oncology and immune-oncology, auto-immunity, cardiovascular disease, neuroinflammation, and more. ImmunoPET is a robust and general platform for visualization of highly specific molecular targets.”

Society of Nuclear Medicine and Molecular Imaging
www.snmmi.org/NewsPublications/NewsDetail.aspx?ItemNumber=29170

The U.S. Food and Drug Administration last year  called for tougher warnings and “additional research” into a dye commonly used with standard MRIs.  The dye – a contrast agent – contains a metal called gadolinium. It made news recently after claims from actor Chuck Norris that its use during MRI scans seriously affected his wife’s brain.
Contrast agents are injected into the body during an MRI scan to enhance image quality.
Last year, Norris and his wife, Gena, filed a lawsuit against several medical companies alleging she fell ill after exposure to gadolinium during MRI scans.  The suit said Gena Norris was left weak, tired and suffering bouts of pain and burning sensations.
After reviewing available data, the FDA on Tuesday recommended that radiologists consider how much gadolinium might be left behind in a patient’s body when selecting a gadolinium-based contrast agent [GBCA] for an MRI.  The recommendation is especially important “for patients who may be at higher risk, such as those who may require repeat GBCA MRI scans to monitor a chronic condition,” explained Dr. Janet Woodcock, director of the agency’s Center for Drug Evaluation and Research.
Patients who are sent for an MRI should also now receive a medication guide outlining issues surrounding gadolinium, Woodcock added.
But for most patients, “gadolinium retention has not been directly linked to adverse health effects,” the FDA stressed. It also said “the benefit of all approved GBCAs continues to outweigh any potential risks.”
For now, the FDA says gadolinium agents have only one known health risk: A “small subgroup” of kidney failure patients has developed a rare skin condition that causes a painful thickening of the skin.
But gadolinium can linger in the body “for months or years after receiving the drug,” the agency said, noting more research is warranted. It is asking manufacturers of GBCAs to “also conduct human and animal studies to further assess the safety of these contrast agents.”
This was not the agency’s first warning on gadolinium. Preiously, an FDA panel had called for a warning to be added to the agents’ labels. The warning specifies that trace amounts of gadolinium may be retained in various organs, including the skin, bone and brain.
The big question remains, though: What, if any, are the harms?
Radiologists have used gadolinium-based agents for 30 years — totalling more than 300 million doses, said Dr. Vikas Gulani. He’s an associate professor of radiology at Case Western Reserve University in Cleveland.
But, Gulani explained, researchers have only recently discovered that trace amounts of the metal can be left behind in the brain.
One study on the issue was presented at the 2017 meeting of the Radiological Society of North America.
It involved nearly 4,300 older adults and found no evidence that gadolinium exposure was related to faster mental decline over several years, according to a team led by Dr. Robert McDonald, of the Mayo Clinic in Rochester, Minn.
“This study provides useful data that at the reasonable doses 95 percent of the population is likely to receive in their lifetime, there is no evidence at this point that gadolinium retention in the brain is associated with adverse clinical outcomes,” McDonald said.
So, “at this point,” Gulani said, “we are not aware of any harms from these agents being retained in the brain.”
Still, he added, the latest study does not rule out that possibility. There are open questions — including whether gadolinium exposure could be related to other neurological issues, such as movement problems.
Also, any theoretical risks from the agents have to be balanced against their proven benefit in improving MRI image quality.
However, there are cases where an MRI can be done without a contrast agent, Gulani said. “It’s reasonable for patients to ask their doctor whether it’s needed or not,” he added.

UPIhttps://tinyurl.com/y7xm6h6y

An automated text messaging system increases patient engagement with home-based exercise and promotes faster recovery after total knee or hip replacement surgery, reports a study.
Patients receiving timely texts showed improvement in several key outcomes, including fewer days on opioid pain medications, more time spent on home exercises, faster return of knee motion, and higher satisfaction scores, according to the research by Kevin J. Campbell, MD, of Rush University Medical Center, Chicago, and colleagues. “A chatbot that texts timely, informative and encouraging messages to patients can improve clinical outcomes and increase patient engagement in the early postoperative period after total joint replacement,” Dr. Campbell comments.
The randomized trial included 159 patients undergoing primary total knee or hip replacement. All received standard education, including instructions on home exercises after surgery.
In addition, one group of patients received a series of automated, physician-specific text messages. The pre-programmed texts provided recovery instructions along with encouraging and empathetic messages, personalized video messages from the surgeon, and brief instructional therapy videos. The texts were sent via a service called STREAMD; Dr. Campbell is the CEO and Co-Founder of STREAMD.
“The content of the text and video messages reinforced the perioperative instructions and were delivered to patients at the appropriate time based on their recovery progress,” the researchers write. Over the six-week period after surgery, patients in the text-message group received about 90 texts. The system did not accept inbound text responses from patients, although patients could access further information on topics they selected.
Patients who received automated texts performed their home exercises an average of 46 minutes per day, compared to 38 minutes in the standard-care group, a significant difference of nine minutes per day. The texted group had greater knee motion at three weeks’ follow-up, suggesting faster short-term recovery, but by six weeks, knee motion was similar between groups.
Patients in the text-message group stopped using opioid pain medications about 10 days sooner than those in the control group (22 versus 32 days). They also had higher mood scores and were more likely to say that their postoperative instructions were clear. Patients assigned to automated texts also made fewer phone calls to the surgeon’s office. There was a trend toward fewer emergency department visits as well, although this difference was not statistically significant.
There is growing interest in using text messages to increase patient engagement in recovery after surgery. But previous digital patient engagement platforms have not been widely adopted by either patients or healthcare providers.
This study provides evidence of improved outcomes when an automated text-message system makes daily contact with patients and provides them with relevant information and encouragement. Advantages include more time doing recommended home exercises, faster recovery of knee motion, and improved patient satisfaction.
The 10-day reduction in opioid use is a potentially important advantage, reducing the risk of persistent opioid use and other complications. “This finding could be related to improved patient education and to the encouraging and empathetic tone of the text and video messages,” Dr. Campbell comments. “It could also reflect improved mood scores and patients’ confidence in their ability to manage their recovery, which have been shown to be very effective pain relievers.”
The benefits of such an automated system could be especially important at a time when more patients are undergoing joint replacement surgery with less overall contact with the treatment team. “As we search for practical methods to engage patients, automated messages providing education, support, and encouragement create a natural and convenient way for patients to receive information, potentially improving key outcomes without placing extra time demands on the surgeon and staff,” Dr. Campbell concludes.

EurekAlerthttps://tinyurl.com/ycbrthu3