The World Health Organization has launched the first global strategy on health policy and systems research (HPSR) at the Second Global Symposium on Health Systems Research. This document represents a unique milestone in the evolution of health policy and systems research and has three broad aims. First, it seeks to unify the worlds of research and decision-making and connect the various disciplines of research that generate knowledge to inform and strengthen health systems. Second, the strategy contributes to a broader understanding of this field by clarifying the scope and role of HPSR. It provides insight into the dynamic processes through which HPSR evidence is generated and used in decision-making. Finally, it is hoped that this strategy will serve as an agent for change and calls for a more prominent role for HPSR at a time when the health systems mandate is evolving towards broader goals of universal health coverage and equity. This strategy on health policy and systems research is intended to augment and amplify WHO

A major study of Medicare beneficiaries shows that the risk of hip fractures was significantly reduced in patients who had had cataract surgery, compared to patients who did not undergo the procedure. The researchers believe their study is the first to demonstrate that cataract surgery reduces the rate of fractures in older patients with vision loss. This suggests that cataract surgery could be an effective intervention to help prevent fractures and reduce associated morbidity and costs. The American Academy of Ophthalmology and the Jules Stein Eye Institute at the University of California, Los Angeles, collaborated on the study.
The study tracked hip fracture incidence in a cohort of Medicare patients with cataracts from 2002-09. Anne L. Coleman, M.D., Ph.D., the Fran and Ray Stark professor of ophthalmology at the Jules Stein Eye Institute at UCLA and director of the Academy’s Hoskins Center for Quality Eye Care, led the research. The medical records of about 400,000 patients who had cataract surgery were analysed for hip fractures that occurred within one year of cataract surgery. This data was then compared to hip fracture incidence in a matched group of patients who had cataracts, but did not have cataract surgery. Cataract surgery was associated with a 16 percent decrease in patients’ adjusted odds of suffering a hip fracture within one year of the procedure.
This is particularly significant because older people’s higher risk of falling makes them especially vulnerable to fractures of the hip and other bones. Previous studies have found that vision loss is a major factor in seniors’ risk of falling. When visual sharpness and depth perception decline, people also lose their ability to maintain balance, stability and mobility.
‘Our study suggests that people should never be regarded as ‘too old’ to have their cataracts removed,’ said Dr. Coleman, who also serves as the Academy’s secretary for quality of care. ‘In fact, the greatest reduction in hip fracture risk was in patients who had cataract surgery when they were in their 80s.’
Overall, the greatest decrease in hip fracture risk was seen in patients aged 80 to 84 who had cataract surgery. Another notable group was patients with severe cataracts, for whom risk was reduced by 23 percent. Although U.S. health statistics show that women are more susceptible to hip fractures than men, this study found no significant gender-linked differences in fracture risk.
‘When older people’s vision improves following cataract surgery, they, their families, and society gain from the resulting reductions in suffering and medical costs,’ said William L. Rich, M.D., a cataract specialist and the Academy’s medical director for health policy. ‘Ophthalmic research continues to demonstrate that cataract surgery is highly successful in terms of patient-reported outcomes such as improved vision and quality of life. The new study provides data on an important ancillary health benefit.’ EurekAlert

Currently repeated operations are needed to replace batteries in pacemakers, but according to US researchers a device which could harness energy from a beating heart can produce enough electricity to keep a pacemaker running.
Piezoelectric materials generate an electric charge when their shape is changed. They are used in some microphones to convert vibrations into an electrical signal. Researchers at the University of Michigan are trying to use the movement of the heart as a source of electricity.

In tests designed to simulate a range of heartbeats, enough electricity was generated to power a pacemaker. Tests suggested the device could produce 10 times the amount of energy needed. The designers now want to test the device on a real heart and build it into a commercial pacemaker.

The British Heart Foundation said clinical trials were needed to show it would be safe for patients.

Dr Amin Karami told a meeting of the American Heart Association that pacemaker batteries needed to be replaced approximately every seven years. ‘Many of the patients are children who live with pacemakers for many years. You can imagine how many operations they are spared if this new technology is implemented.’

Prof Peter Weissberg, the medical director at the British Heart Foundation, said: ‘Advancing technology over recent years has meant people with pacemakers need to change their battery less often. This device could be another step forward along this path. ‘If researchers can refine the technology and it proves robust in clinical trials, it would further reduce the need for battery changes.’

Cancers are notorious for secreting chemicals that confuse the immune system and thwart biological defences.
To counter that effect, some cancer treatments try to neutralise the cancer’s chemical arsenal and boost a patient’s immune response–though attempts to do both at the same time are rarely successful.
Now, researchers have developed a novel system to simultaneously deliver a sustained dose of both an immune-system booster and a chemical to counter the cancer’s secretions, resulting in a powerful therapy that, in mice, delayed tumour growth, sent tumours into remission and dramatically increased survival rates.
The new immunotherapy incorporates well-studied drugs, but delivers them using nanolipogels (NLGs), a new drug transport technology the researchers designed. The NLGs are nanoscale, hollow, biodegradable spheres, each one capable of accommodating large quantities of chemically diverse molecules.
The spheres appear to accumulate in the leaky vasculature, or blood vessels, of tumours, releasing their cargo in a controlled, sustained fashion as the spherule walls and scaffolding break down in the bloodstream.
For the recent experiments, the NLGs contained two components: an inhibitor drug that counters a particularly potent cancer defence called transforming growth factor-β (TGF-β), and interleukin-2 (IL-2), a protein that rallies immune systems to respond to localised threats.
‘You can think of the tumour and its microenvironment as a castle and a moat,’ says Tarek Fahmy, the Yale University engineering professor and NSF
CAREER grantee who led the research. "The ‘castles’ are cancerous tumours, which have evolved a highly intelligent structure–the tumour cells and vasculature. The ‘moat’ is the cancer’s defence system, which includes TGF-β. Our strategy is to ‘dry-up’ that moat by neutralising the TGF-β. We do that using the inhibitor that is released from the nanolipogels. The inhibitor effectively stops the tumour