I do not know what to make of all the recent news and stories about the Swine/North American/Newly mutated flu virus and how virulent it actually is.
Nonetheless, The 1x Objective has some nice videos and other links on the proposed pathogenesis for the mutated strain.
BBC News (3/10) reported, "Nanotechnology has been used for the first time to destroy cancer cells with a highly targeted package of 'tumor busting' genes," and it "could potentially offer hope to people with hard-to-treat cancers where surgery is not possible." Detailing their work, researchers in the UK explained that first they wrapped the genes "in microscopic nano-particles 80,000 times smaller than the width of a human hair, which were taken up by cancer cells, but not their healthy neighbors." Then, "once inside, the genes stimulated production of a protein which destroys the cancer," the authors added. Specifically, "the gene enclosed in the particle recognizes the cancerous environment and switches on." Although the "result is toxic," it only impinges on "the offending cells, leaving healthy tissue unaffected," whereas "traditional chemotherapy indiscriminately kills cells in the affected area of the body, which can cause side effects like fatigue, hair loss, or nausea."
A number of people have asked me recently if healthcare IT initiatives will receive any funding from the recently passed stimulus package. Here is a nice summary I saw recently:
The $787 billion economic stimulus package includes $19 billion for HIT. The HHS Office of the National Coordinator (ONC) will receive $2 billion to use to coordinate health IT policy and programs. Programs will be initiated by the Secretary but the National Coordinator will have the responsibility to move and expand the electronic movement of health information.
The ONC will be able to award grants to states or to Indian Tribes to use to establish a certified EHR Technology Loan Fund Program to help providers. Loans may be used by providers to purchase certified EHR technology, improve EHR technology, to train personal to use the new technology, and to improve the secure electronic exchange of health information. These loans won’t be available until 2010.
The National Coordinator has the responsibility for standards and certification. New health IT Policy and HIT standards committees will be formed to serve as federal advisory committees and the committees will then forward their recommendations to the National Coordinator.
With this legislation, all health care providers and insurers plans that are providing services or products for the federal government will now be required to use only standards compliant health IT systems and products.
Incentive payments of $17.2 billion will be made through Medicare to go to health professionals and hospitals for certified EHR technology. Incentive payments will be made to physicians for the first five years from 2011-2015 if the use of EHR technology is demonstrated. The Medicare payment schedule for eligible professionals is $15,000 for the first year. However, if by 2015, a health professional does not demonstrate the use of EHR, then Medicare reimbursement payments will be reduced.
Hospitals will also receive incentive payments for the first five years for making use of EHR technology. If an eligible hospital does not make meaningful use of the EHR technology by 2015, their reimbursement payments will also be reduced.
According to the publication “Health Data Management”, the Congressional Budget Office projects that health IT provisions in the stimulus package will result in 90% of doctors and 70% of hospitals using certified EHR systems by 2019.
The National Coordinator will be responsible for developing a health IT extension program to provide health IT assistance and to help providers adopt health technology. In addition, Regional Centers will be developed to provide technical assistance.
To enhance educational possibilities in the field of health IT, grants may be provided for demonstration projects to help move and integrate certified EHR technology into clinical education. In addition, assistance will be provided in consultation with the National Science Foundation to establish or expand medical health informatics programs in universities and colleges.
The stimulus package will also provide $4.7 billion for NTIA’s Broadband Technology Opportunities Program, $2.5 billion for USDA’s Distance Learning, Telemedicine, and Broadband Program, $1.5 billion for HRSA to use to build or repair health centers and/or to purchase equipment, $1.1 billion to provide for research within AHRQ, NIH, and HHS, $85 million for health IT and telehealth technologies within the Indian Health Service, $500 million for SSA, and $50 million to provide IT within the Veterans Benefits Administration.
Came across this post from NY Times Health blog this week. Couple of thoughts:
Biopsies required to fix for certain time should need for certain IHC (i.e. HER2) required. Formal guidelines coming on ER/PR as well just as we know have ASCO/CAP guidelines for HER2 testing. Despite the time requirement, processing can and often occurs in 1 day and can be signed out the following day. I would gather most laboratories will complete majority of sign-outs in one day. We do it routinely here otherwise get calls from clinicians by mid-day asking for results. Of course some require additional levels, review, consultation and/or IHC but the exception, not the rule. 2.5 day turn around time seems excessive. 5 days for 73 of 126 women not to have a result seems protracted. I would have hoped the patients' clinician explained reason for delay but this did not seem to occur either.
Nonetheless, in the laboratory industry the goals are to have high diagnostic accuracy, rapid turnaround time and cost control; said another way, you can have it right, fast or cheap, pick any two. If given a choice, I gather all of us would choose the right answer in a timely fashion at a reasonable cost. Nonetheless, it sometimes takes a little longer to ensure the right answer & may involve more tests increasing costs. Having been on both sides of this equation I would rather have the right answer even if it costs more and takes longer. I wonder what happens to cortisol levels with misdiagnoses and inappropriate, unnecessary or unindicated therapy...
Post and abstract from paper published below.
Waiting days for the results of a breast biopsy appears to affect stress hormone levels just as much as finding out you have cancer does, a new study shows.
Harvard researchers tracked 126 women who were undergoing breast biopsy, monitoring their levels of the stress hormone cortisol while they waited.
One of the most surprising findings, researchers said, was how long many women had to wait before receiving their results. While the average wait time was 2.5 days, many women had to wait five days or longer. By the fifth day, 37 women learned their biopsy was benign, 16 learned they had cancer and 73 still did not have a result, according to the report, which appeared in the medical journal Radiology. Most of the women who did not have a diagnosis had not received any information or explanation for the delay.
Women who were still uncertain about their diagnosis had abnormal cortisol levels that were “essentially indistinguishable’’ from the cortisol profiles of the women who were told they had cancer. And women without a diagnosis had significantly worse cortisol profiles compared to women who had received benign test results.
“If you talk to any woman who has had a biopsy who has had to wait for results, she will tell you it’s a horrible roller coaster,’’ said Dr. Elvira V. Lang, associate professor of radiology at Harvard Medical School and Beth Israel Deaconess Medical Center. “Even when patients hear they have a cancer, they can start doing something. But if you hang in there for five days and you still don’t know what direction it goes, it’s just very stressful.’’
The concern, Dr. Lang said, is that cortisol levels can influence wound healing and immune response, raising a woman’s potential health risks if she ultimately needs to be treated for cancer. And the stress and anxiety of waiting also affects the quality of life of a woman, her family and her ability to function well at work, she said.
Dr. Lang said the research should spur hospitals to focus not only on speeding up test results, but on improving communication and possibly offering psychological services to women who are waiting for a diagnosis. The study was funded by the Department of Defense breast cancer research program. Dr. Lang has a financial interest in a consulting firm that trains medical personnel how to improve communication with patients.
“We have to work much faster to get results to women,’’ Dr. Lang said. “You want to keep stressors as profound as this as short as possible.’’
Large-Core Breast Biopsy: Abnormal Salivary Cortisol Profiles Associated with Uncertainty of Diagnosis
Elvira V. Lang, MD, FSIR, FSCEH, Kevin S. Berbaum, PhD, and Susan K. Lutgendorf, PhD
From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115 (E.V.L.); and Departments of Radiology (K.S.B.) and Psychology (S.K.L.), University of Iowa, Iowa City, Iowa. Received June 19, 2008; revision requested July 22; revision received July 31; accepted August 27; final version accepted September 16. Supported by the U.S. Army Research and Materiel Command DAMD 17-01-01. E-mail: elang@bidmc.harvard.edu.
Purpose: To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels.
Materials and Methods: This study was institutional review board approved and HIPAA compliant, and all patients gave written informed consent. One hundred fifty women aged 18–86 years collected four salivary cortisol samples per day for 5 days after LCBB. t Tests were used to compare diurnal cortisol slopes among three groups: patients who did not have a final diagnosis (uncertain group), patients who knew they had cancer (known malignant group), and patients who knew they had benign disease (known benign group).
Results: Women learned their diagnosis on days 1–6 (mean, day 2.4) after LCBB. Analysis was truncated at day 5, when the data from a sufficient number of patients from each group were available for meaningful analysis: 16 patients from the known malignant group, 37 from the known benign group, and 73 from the uncertain group, which totaled 126 patients. The mean cortisol slope for the women with an uncertain diagnosis (–0.092 ln [µg/dL]/hr; 95% confidence interval [CI]: –0.113 ln [µg/dL]/hr, –0.072 ln [µg/dL]/hr) was significantly flatter (less desirable) than that for the women who learned that they had benign disease (–0.154 ln [µg/dL]/hr; 95% CI: –0.197 ln [µg/dL]/hr, –0.111 ln [µg/dL]/hr; P = .014) but not significantly different from that for the women who learned that they had malignant disease (–0.110 ln [µg/dL]/hr; 95% CI: –0.147 ln [µg/dL]/hr, –0.073 ln [µg/dL]/hr; P = .421).
Conclusion: Uncertainty about the final diagnosis after LCBB is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results.
© RSNA, 2009
UPMC and its partnership with Omnyx recently announced the formation of 25 oncology clinics over the next 10 years in the start of a global healthcare business they may expand elsewhere.
Part of this initiative includes Omnyx as part of the project. Oncology care has at its center, pathology and this use of digital pathology will help further validate the technology, field and use.
This venture offers proven premium clinical services with UPMC, GE Healthcare's experience in global healthcare and IT support, combining key elements essential in the successful implementation and use of digital pathology.
In doing so, UPMC and its partners will be able to provide "subspecialty care as far forward as possible," and help to elevate the standard of care for the affected patients.
Full story below.
Oncology specialists take care of in-patient and specialised treatment at the hubs, while outpatient care is offered at more than 30 satellite centres.
UPMC has awarded $300 million contract to Alcatel-Lucent for the development of an IP network project to provide improved communication. It has set up a start-up with GE Healthcare with an investment of $40m for developing and marketing digital pathology systems.
Other major projects include a $367m project for developing IT infrastructure.
Twenty-five oncology clinics will be opened over a 10-year period in the Middle East and Europe by the University of Pittsburgh Medical Centre (UPMC), a global healthcare business.
And UPMC is considering establishing centres in other countries as it seeks to tackle cancer and raise the global standard of healthcare.
"We are in the process of identifying the countries in Europe and the Middle East where we will set up 25 oncology centres," Simona Abbro, UPMC's International Marketing Director, told Emirates Business.
"We see a greater need for treatment facilities for the increasing number of cancer patients in the region. We estimate that one out of three people gets cancer in Europe against the ratio of one in 20 that was seen 20 years ago." The centres will offer advanced diagnosis and radiotherapy treatment in patients' homes.
"We find that most cancer patients wait for months to get advanced treatment," added Abbro.
"To address this problem we are setting up oncology centres with a focus on developed and developing nations. Countries such as Germany, Turkey, Greece, South Korea and Qatar are under consideration.
"We have entered into an agreement with GE Healthcare, which would as a strategic supplier provide medical equipment for our global initiative. We are also actively forging long-term partnerships with global majors from the technology and healthcare sectors."
Full story: UPMC to set up 25 oncology clinics
When our drugs, medical devices and wellness tools become smart, and when the resulting personal health information is linked to mobile and internet-based systems, who or what is going to control all that? A poll was conducted to find out what people think the use and control of such personal information will look like in ten years from now:
The poll was done on the LinkedIn business social network. LinkedIn provided a very quick and easy way to poll (e.g., posting to completion was done in just a few hours), but the tool has some big limitations. The poll is small (54 responses) and not statistically significant because they place payment requirements on larger polls. In addition, the wording length, and therefore the ability to convey the full meaning of an answer, is severely constrained by the LinkedIn tool. You can find the complete results here, including analysis by respondent title, company size, job function, age and gender (membership required).
The goal was to contrast the current use of personal health data (controlled by providers like the Mayo Clinic) with three possible futures–control by consumer and health services-focused companies (like Visa does today for similarly sensitive financial information), control by the individual (like LinkedIn and Facebook allow us to do today for our personal relationships), and a bleak, out of control situation (like FEMA during Katrina). 55% of those polled think they will be in control of their personal health information in 10 years. This endorsement of the future health-empowered individual was tempered by 40% who thought the situation would look either similar to today (like Mayo Clinic) or worse (like FEMA). Only 3% thought the future of our health information looked like Visa.
There are some interesting nuggets in the demographics behind the poll results. People from medium sized companies had the most mixed responses: 44% Mayo, 22% Visa, 22% LinkedIn, and 11% FEMA. Do these companies struggle the most with our current healthcare system and appreciate complexities that will shape and limit the future that others do not? In the age demographic, the older the respondent, the less likely their answer was for a future that looked like the provider control of information we see today: 33% of age 18-24 bracket, 20% of age 25-34, 16% of age 35-54, 0% of age 55+. As we get older and increasingly confront disease and health challenges, do we recognize the need to control our health information more and not rely on institutions? In the gender demographic, 36% of women vs. 15% of men thought our health information future looked like FEMA! Do women see our healthcare system in ways men do not because they have a different window on their own care and that of their children and elderly parents? If so, isn’t it critical that women have an increased voice in the development of health policy and new health innovations, services and products?
As a philatelist, I am aware of the fact that few physicians worldwide end up on postage stamps when history reviews their life's work in their respective countries. Several of the stamps issued portraying physicians for their scientific achievements to medicine are available here.
Missing from that list are a couple of brothers who were surgeons that started a small clinic:
Some may consider Dr. Walter Reed a pathologist (of sorts) and he has a stamp (shown here as a plate block):
The most famous pathologist to appear on a postage stamp is Rudolph Virchow "The Father of Pathology" who I have read performed over 10,000 autopsies:
And now as seen on Aperio's blog, Peruvian pathologist, Dr. Javier Arias-Stella is one of very few pathologists to have a postage stamp:
Who will be the next pathologist to be honored on a postage stamp?
J Gastroenterol Hepatol. 2007;22(9):1490-1493.
Abstract
Background and Aim: Currently, an increasing number of liver biopsies are performed by radiologists under real-time ultrasound control. A routine ultrasound assessment of a puncture site before performing percutaneous biopsy is reported to increase diagnostic yield and decrease complication rates. It is not clear if real-time ultrasound is superior to marking the puncture site before biopsy as regards reducing biopsy size and avoiding fragmentation and complications. The aim of this study was to compare ultrasound assessment of the puncture site before performing percutaneous liver biopsy with real-time ultrasound liver biopsy for suspected diffuse liver disease.
Methods: Consecutive percutaneous liver biopsies (n = 631) for diffuse liver disease were evaluated. Group A consisted of patients who had real-time guided-ultrasound biopsy performed by radiologists (241 patients; M/F, 35/106; median age 48 year [range, 17-76]; needle 18 G). Group B patients were assessed by radiologists using ultrasound of the puncture site on the same day that biopsies were performed by experienced gastroenterologists/hepatologists on the ward using the marked site (390 patients; M/F, 276/114; median age 43 year [range, 15-75]; needle 16 G).
Results: There were no differences in severity of liver disease, establishing a diagnosis (OR, 1.92 [95% CI, 0.84-4.34]; P = 0.12), length of liver biopsy specimens, number of fragments or complications. Two independent variables were significantly associated with a histological diagnosis: longer biopsy length (P < 0001) and fragment number of two or less (P < 0.001).
Conclusion: Real-time ultrasound did not improve diagnostic yield or result in fewer complications. Marking the puncture site seems adequate and has the practical advantage that it takes up less of the radiologists' time.
The quality of sound, reproducibility for computer analysis and file-sharing potential of MP3 recordings may nudge the doctor's stethoscope out of favour, according to Canadian researchers presenting here at the Annual Congress of the European Respiratory Society (ERS). Determining whether the classic stethoscope could be replaced by a cheap, off-the-shelf MP3 recorder/player was the purpose of the study by Neil Skjodt, MD, MSc, Assistant Professor, Divisions of Pulmonary Medicine and Critical Care, and Bill Hodgetts, MSc, Assistant Professor, Department of Speech Pathology and Audiology, University of Alberta, Edmonton, Alberta, Canada. The team was able to record a range of respiratory sounds with different patterns by pressing its microphone directly to the chest. Different baseline breath sounds -- normal (right mid-4th clavicular interspace) and then bronchial (posterior T6 spinous process), with or without added wheezing -- were studied after pairwise time and short Fast Fourier Transform frequency spectrogram correlations were calculated. "The quality, clarity and purity of the loud sounds were better than I have ever heard with a stethoscope," Dr. Skjodt told the Congress. The MP3 files were later transferred to a computer and converted into frequency curves. Computer analysis of the stored sounds showed that each had a distinct signature. The computer -- like the human ear -- did, however, sometimes have difficulty in processing complex or quiet breathing sounds. Dr. Skjodt next tested respiratory specialists in training, having them identify the MP3 recordings of breath sounds. The results of this test were mixed, he noted, but promising. Wheezing noises were recognised much better than in similar historic studies, but differences in baseline breath sounds and in recognizing combinations were still not better than chance. Dr. Skjodt and Mr. Hodgetts plan to examine whether brief training in the ability to use reference recordings could improve auditory recognition. "The improved quality [of the MP3] is only one of the benefits," Dr. Skjodt emphasized, "and there would be many other advantages to using an MP3 device instead of a stethoscope." The recorded breathing sounds can be included in the patient's file for future reference. They can also be sent to a specialist, or processed with more sophisticated software for particularly detailed analysis. The researchers plan to continue their study, examining other clinical sounds, and assessing the impact of more highly developed audio techniques on sound recognition by the human ear. They call their device a "stethophone". The team added that further studies of custom machine recognition, correlation with human perception, Bluetooth (TM) transmission, other clinical sounds, and discrete wavelet transformations are underway. |
Stumble It!