Accurately detecting a rare but devastating cause of blindness in premature babies can be done as effectively with telemedicine as with traditional, in-person eye exams, a study suggests. This is believed to be the first study to directly compare the two approaches.
The finding could enable more blindness-preventing treatment for infants born in rural and other areas where there are few ophthalmologists trained to detect the condition, called retinopathy of prematurity, or ROP. Musician Stevie Wonder went blind due to this condition.
“A lack of access to trained ophthalmologists with experience diagnosing ROP sadly prevents many premature infants from receiving much-needed screening, both in developed and developing countries,” said the study’s lead researcher, Michael F. Chiang, M.D., a professor of ophthalmology and medical informatics & clinical epidemiology in the OHSU School of Medicine and a paediatric ophthalmologist at OHSU’s Elks Children’s Eye Clinic.
Retinopathy of prematurity is caused by abnormal blood vessel growth near the retina, the light-sensitive portion in the back of an eye.
Some U.S. medical associations recommend an in-person exam, which involves a special magnifying device that shines light into a baby’s dilated eye, to diagnose the condition. But trained professionals aren’t always easy to find in rural areas and developing countries.
The research team compared the accuracy of in-person exams with digital eye images that were remotely evaluated by professionals. They partnered with seven medical institutions to examine the eyes of 281 infants who were at risk for the condition. Each eye was evaluated both in-person and remotely with a wide-angle telemedicine image.
The researchers found there was no difference in the overall accuracy between the two evaluation methods. In-person examiners were found to be slightly better at accurately diagnosing the condition’s later-stage development, but the research team concluded telemedicine could be used to diagnose clinically significant cases of retinopathy of prematurity.
OHSU School of Medicinenews.ohsu.edu/2018/04/06/telemedicine-provides-accurate-diagnosis-of-rare-cause-of-blindness-in-preemies

Microscopic yeast have been wreaking havoc in hospitals around the world—creeping into catheters, ventilator tubes, and IV lines—and causing deadly invasive infection. One culprit species, Candida auris, is resistant to many antifungals, meaning once a person is infected, there are limited treatment options. But in a recent Antimicrobial Agents and Chemotherapy study, researchers confirmed a new drug compound kills drug-resistant C. auris, both in the laboratory and in a mouse model that mimics human infection.
APX001, the prodrug of the active moiety APX001A, is currently in clinical development by Amplyx Pharmaceuticals. It works through a novel mechanism of action. Unlike other antifungal agents that poke holes in yeast cell membranes or inhibit sterol synthesis, the new drug targets an enzyme called Gwt1, which is required for anchoring critical proteins to the fungal cell wall. This means C. auris can’t grow properly and has a harder time forming drug-resistant fungal biofilms that are a stubborn source of hospital outbreaks. Gwt1 is highly conserved across fungal species, suggesting the new drug could treat a broad range of fungal infections.
“The drug is first in a new class of antifungals, which could help stave off drug resistance. Even the most troublesome strains are unlikely to have developed workarounds for its mechanism of action,” said study lead Mahmoud A. Ghannoum, PhD, professor of dermatology at Case Western Reserve University School of Medicine and director of the Center for Medical Mycology at Case Western Reserve University and University Hospitals Cleveland Medical Center.
In the new study, Ghannoum’s team tested the drug against 16 different C. auris strains, collected from infected patients in Germany, Japan, South Korea, and India. When they exposed the isolates to the new drug, they found it more potent than nine other currently available antifungals. According to the authors, the concentration of study drug needed to kill C. auris growing in laboratory dishes was “eight-fold lower than the next most active drug, anidulafungin, and more than 30-fold lower than all other compounds tested.”
The researchers also developed a new mouse model of invasive C. auris infection for the study. Said Ghannoum, “To help the discovery of effective drugs it will be necessary to have an animal model that mimics this infection. Our work helps this process in two ways: first we developed the needed animal model that mimics the infection caused by this devastating yeast, and second, we used the developed model to show the drug is effective in treating this infection.”
Ghannoum studied immunocompromised mice infected with C. auris via their tail vein—similar to very sick humans in hospitals who experience bloodstream infections. Infected mice treated with APX001 and anidulafungin had significant reductions in kidney and lung fungal burden two days post-treatment, compared to control animals. APX001 also significantly decreased fungal burden in the brain, consistent with brain penetration, whereas reduction with anidulafungin did not reach significance. The results suggest the new drug could help treat even the most invasive infections.
According to Ghannoum, the most exciting element of the study is that it brings a promising antifungal one step closer to patients. It helps lay the foundation for phase 2 clinical trials that study that study the safety and efficacy of new drugs in patients with fungal infections. There is an urgent need for such studies, as C. auris infection has become a serious threat to healthcare facilities worldwide—and resistance to commercially available antifungal drugs is rising.
Case Western Reserve University Medical Schoolcasemed.case.edu/cwrumed360/news-releases/release.cfm?news_id=906&news_category=8

As the global Telemedicine market increases rapidly, the International SOS Foundation has produced a guidance paper ‘Teleconsultation Services for the Mobile Workforce; Considerations & Guidelines for the Provision of Global Services in Compliance with Regulations & Best Practice Clinical Standards of Care’. Endorsed by the International Society for Telemedicine & eHealth (ISfTeH), the paper provides multi-national organizations with insight into essential considerations when assessing a teleconsultation service. It is authored by Nathaniel Lacktman, Esq., Partner at leading law firm Foley & Lardner LLP where he is Chair of the firm’s Telemedicine and Digital Health Industry Team, and Dr Neil Nerwich, International SOS Group Medical Director, Assistance.

Nathaniel Lacktman, Esq., Partner at Foley and Lardner LLP, commented, "An estimated 96% of large companies in the USA alone provide access to teleconsultation services for their staff on a domestic basis. Attention is now shifting to how it can be applied on a global basis to support multi-national organizations and their mobile, connected, and increasingly millennial, global travelers and expatriates. Teleconsultation services may seem like an easy solution to global medical care, but there are some major legal considerations that need to be assessed. When multi-national organizations are looking for the best practices to protect the health of mobile employees, they must consider the need for a service to have appropriate licensing and medical regulations at a patient’s location. Also the ability to provide any subsequent support, such as providing locally dispensable prescriptions, is critical."

Prof. S. Yunkap Kwankam, Executive Director, International Society for Telemedicine & eHealth (ISfTeH), "It is clear that the future of health is digital health and it is an environment which, to date, has not kept pace with the changes and spread of information technology of other sectors. However, much remains to be done in terms of the regulatory environment within which digital health takes place. Industry players, governments and consumers alike need to recognize that we cannot simply transfer the consumer retail paradigm into the health care market. And major data breaches by hackers, sometimes involving the compromise of tens or hundreds of millions of data records, are only one aspect that adds fuel to these concerns. Insightful and guiding documentation such as the new ‘Teleconsultation Services for the Mobile Workforce’ are essential in the appropriate and safe implementation of such services."

The ‘Teleconsultation Services for the Mobile Workforce‘ paper includes:

• Country level review of legal requirements for the provision of teleconsultation and subsequent recommendations and treatment
• Guidelines on clinical best practices, taking into account details such as the understanding of a local healthcare environment, clinical expertise of current disease threats at the patients location and the integration into the local healthcare system when required
• Case studies demonstrating usage in both a corporate and educational sector scenarios
• List of global best practices to help guide multi-national organizations in assessing a teleconsultation service.

Dr Neil Nerwich, commenting on behalf of the International SOS Foundation, said, "Teleconsultation can be appropriate to a number of medical needs when delivered in consideration of medical best practice. It can successfully provide rapid access to care, thereby minimizing time out of the working environment and the subsequent impact on business continuity. However, along with legal considerations, issues such as local medical knowledge and accessibility to local medical care resources when necessary need to be considered. Having an efficient and medically holistic way to support mobile employees wherever they are in the world is essential to business resilience. Our aim in producing this paper is to support organizations in identifying how to achieve this in the best way for their employees and business."

To read the white paper, click here.

https://www.internationalsos.com/

Medical physicist Dr. Aswin Hoffmann and his team from the Institute of Radiooncology – OncoRay at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) are the first researchers to combine magnetic resonance imaging (MRI) with a proton beam, thus demonstrating that in principle, this commonly used imaging method can indeed work with particle beam cancer treatments. This opens up new opportunities for targeted, healthy tissue-sparing cancer therapy.
Dr. Aswin Hoffmann and his team installed an open MR scanner in the experimental room at the National Centre for Radiation Research in Oncology – OncoRay. Conducting various experiments, the HZDR researchers were able to demonstrate that MRI can be combined with a proton beam.
Radiation therapy has long been part of the standard oncological treatment practice. A specific amount of energy, called dose, is deposited into the tumour tissue where it will damage the cancer cells’ genetic material, preventing them from dividing and ideally, destroying them. The most commonly used form of radiation therapy today is called photon therapy, which uses high-energy X-ray beams. Here, a substantial portion of the beam penetrates the patient’s body, while depositing harmful dose in healthy tissue surrounding the tumour.
An alternative is radiation therapy with charged atomic nuclei, such as protons. The penetration depth of these particles depends on their initial energy. They release their maximum dose at the end of their trajectory. No dose will be deposited beyond this so-called “Bragg peak”. The challenge for physicians administering this kind of therapy is to control the proton beam to exactly match the shape of the tumour tissue and thus spare as much of the surrounding normal tissue as possible. Before the treatment, they conduct an X-ray-based computed tomography (CT) scan to select their target volume.
“This has various disadvantages,” Hoffmann says. “First of all, the soft-tissue contrast in CT scans is poor, and secondly, dose is deposited into healthy tissue outside of the target volume.” On top of this, proton therapy is more susceptible to organ motion and anatomical changes than radiation therapy with X-rays, which impairs the targeting precision when treating mobile tumours. At present, there is no direct way of visualizing tumour motion during irradiation. That is the biggest obstacle when it comes to using proton therapy. “We don’t know exactly whether the proton beam will hit the tumour as planned,” Hoffmann explains. Therefore, physicians today have to use large safety margins around the tumour. “But that damages more of the healthy tissue than would be necessary if radiation were more targeted. That means we are not yet exploiting the full potential of proton therapy.”
Hoffmann and his team want to change that. In cooperation with the Belgian proton therapy equipment manufacturer IBA (Ion Beam Applications SA), his research group’s objective is to integrate proton therapy and real-time MR imaging. Unlike X-ray or CT imaging, MRI delivers excellent soft-tissue contrast and enables continuous imaging during irradiation. “There are already two such hybrid devices for clinical use in MR-guided photon therapy; but none exists for particle therapy.”
This is mainly due to electromagnetic interactions between the MRI scanner and the proton therapy equipment. On the one hand, MRI scanners need highly homogeneous magnetic fields in order to generate geometrically accurate images. The proton beam, on the other hand, is generated in a cyclotron, a circular accelerator in which electromagnetic fields force charged particles onto a circular trajectory and accelerate them. The proton beam is also steered and shaped by magnets, whose magnetic fields can interfere with the MRI scanner’s homogeneous magnetic field.
“When we launched the project three and a half years ago, many international colleagues were sceptical. They thought it was impossible to operate an MRI scanner in a proton beam because of all the electromagnetic disturbances,” Hoffmann explains. “Yet we were able to show in our experiments that an MRI scanner can indeed operate in a proton beam. High-contrast real-time images and precise proton beam steering are not mutually exclusive.” Many experts predicted another difficulty to occur from proton beam behaviour: when electrically charged particles move in the magnetic field of an MRI scanner, Lorentz forces will deflect the beam from its straight trajectory. However, here, as well, the researchers were able to demonstrate that this deflection can be anticipated and thus corrected for.
To explore these mutual interactions, Hoffmann and his team used the experimental room at the National Centre for Radiation Research in Oncology – OncoRay. This joint research platform operated by HZDR, TU Dresden and University Hospital Carl Gustav Carus was founded in 2005 as an innovative centre of excellence. Since the UPTD (University Proton Therapy Dresden) was established in 2014, patients have been receiving proton therapy in the OncoRay facility. Today, more than 120 scientists at OncoRay conduct research on innovative approaches and technologies for radiation therapy.
“Our mission is to individualize proton therapy biologically and to optimize it technologically towards its physical limits,” says Hoffmann, head of the research group on MR-guided radiation therapy at the HZDR. OncoRay has its own cyclotron to deliver the proton beam into the therapy room as well as into the experimental room. Hoffmann and his colleagues used the latter for their research activities. With the support of IBA and the Paramed MRI Unit of ASG Superconductors SpA, they installed an open MRI scanner in the path of the proton beam, realizing the world’s first prototype of MR-guided particle therapy. “We are lucky to have an experimental room that is large enough to accommodate an MRI scanner. That is one of OncoRay’s unique features.”

Helmholtz-Zentrum Dresden-Rossendorf (HZDR)https://tinyurl.com/y9pxuykc