Vaccine researchers at HZI find c-di-IMP molecule

The vaccine researchers at the HZI found the molecule "c-di-IMP".

"This molecule leads to a strong immune response and it is significantly more effective than known adjuvants," says Rimma Libanova, who is examining the molecule in her PhD thesis.

To investigate how it works, she vaccinated mice with a harmless protein, which acts as a foreign structure for the immune system of a mouse. Like during a vaccination against a virus or bacterium, an immune response starts against the protein - without the danger of a real infection. One group of mice received the vaccine with the enhancer molecule, the other without the additive. After 42 days, she analyzed the immune reaction of the mice to the foreign protein. "We found a strong immune reaction in mice that received the optimized vaccine. Furthermore, we measured the stimulation of important effector mechanisms, which are key for the success of a vaccination," says Thomas Ebensen, who is working with Rimma Libanova on the new enhancer. Until now, the researchers were only able to show the effect in mice - but they think one step further: "With this new adjuvant, we want to improve already existing vaccines, such as those against influenza or hepatitis. Maybe it also helps to create new vaccines using component that in the past did not promote efficient immune responses using known adjuvants."

"The molecule might also help us to develop new vaccination strategies," says Professor Carlos A. Guzm-n, head of the "Vaccinology and Applied Microbiology" Department at the HZI. His department is working on an alternative to the "shot": the snuff vaccination. Here, the vaccine is taken as a nasal spray to work where most pathogens enter the body: at the mucosae. Guzm-n highlights, "c-di-IMP enhances also local mucosal immune responses, representing a strong candidate for the implementation of such type of vaccines. This is very important because mucosal vaccines can prevent not only diseases, but also to block infections before they even take place, thereby protecting also non vaccinated contacts against disease."

PerkinElmer announces launch of NexION™ 300 ICP-MS

PerkinElmer, Inc., a global leader focused on the health and safety of people and the environment, announced the launch of the NexION™ 300 Inductively Coupled Plasma-Mass Spectrometer (ICP-MS) for elemental analysis at PITTCON® 2010, March 1-4, 2010, Booth 2769.

“The NexION 300 platform advances trace element analysis, and its introduction is perfectly timed to help address global problems ranging from contamination of our air, water and food, to the integrity of pharmaceuticals and nutritional supplements, as well as the safety of emerging nanomaterials,” explained Martin Long, vice president, spectroscopy, Analytical Sciences and Laboratory Services, PerkinElmer.

He added, “Researchers can now benefit from a simplified system for analysis of trace elements in the parts-per-trillion range, allowing even non-expert users to perform complex analyses. The new NexION 300 system also greatly reduces the need for daily user maintenance and cleaning, translating into minimal downtime and less need for highly-skilled operators."

The NexION 300 instrument features the patented Universal Cell Technology™ (UCT) and is the only instrument of its kind with three modes of interference removal - Standard, Collision and Reaction. These three modes allow scientists to choose the appropriate technique for their particular application, based on the complexity of the problem to be solved.

NexION’s Standard mode can be used for simple and routine analyses. Collision mode is effective for semi-quantitative analyses, environmental sample monitoring and testing unknown samples. Reaction mode, using patented DRC™ technology, provides the best detection limits available, for even the most difficult elements and matrices such as semiconductor testing.

The NexION 300 system can be integrated with chromatography systems for effective speciation analysis to enable customers to accurately separate and measure the toxicity, bioavailability, metabolism and environmental mobility of elements.

New Fair Targets Medical Devices and Supplies' Market Increase in Global HealthCare Spending Offers Opportunities

More than 130 exhibitors from around the world are expected to attend the inaugural HKTDC Hong Kong International Medical Devices and Supplies Fair, 4-6 November, at the Hong Kong Convention and Exhibition Centre.

The new fair offers manufacturers a chance to link up with buyers from around the world. It will also help buyers identify distributors to help them tap the lucrative Chinese mainland market and the Asian region in general.

“The debut event represents a timely opportunity for healthcare product distributors and manufacturers, in part because medical and healthcare spending on the Chinese mainland have been expanding despite the recent financial turmoil,” said Hong Kong Trade Development Council (HKTDC) Assistant Executive Director Raymond Yip, speaking today at a press conference announcing the new fair. “The mainland’s recent medical system reforms, worth some Rmb850 billion (US$124 billion), are expected to push up medical spending.”

The mainland is not the only growing consumer of healthcare products and services. The World Health Organisation estimates that global spending on health has exceeded US$4.1 trillion a year. Such expenditures are increasing as a percentage of GDP among all major economies. “The trend has been further strengthened by outbreaks of such diseases as bird flu, SARS and, most recently, H1N1 influenza,” said Mr Yip.

Tech Exchange

Fair highlights include the Tech Exchange, a platform for getting technology to the marketplace. Exhibitors showcasing their innovations at the Tech Exchange will include the Centre for Innovation and Technology at the Chinese University of Hong Kong, Hong Kong Polytechnic University and the Hong Kong University of Science and Technology. Displays will range from Chinese University’s fall-prevention shoes for the elderly to Polytechnic’s PDA-based wireless ultrasound devices and the University of Science and Technology’s CRP rapid tests for diagnosis of acute myocardial infarction. The Hong Kong Government’s Innovation and Technology Commission will have a booth at the exchange as well.

Fair participants will also include companies such as 3M. Its ESPE Asia-Pacific Professional Services Manager Dr Young-Chul Kwon will speak at a seminar on the future of dentistry. Johnson & Johnson is sponsoring a seminar led by Shanghai Fudan University Professor Chen Jie on healthcare reform in the mainland and its implications for the health devices market.

Exhibit categories at the fair include: Accident and Emergency Equipment; Building Technology and Hospital Furniture; Chinese Medical Devices; Diagnostics; Medical Technology; Laboratory Equipment; Medical Components and Materials; Medical Supplies and Disposables; Physiotherapy, Orthopaedic and Rehabilitation Technology; and Textiles.

Regional Regulation

The fair will host the 14 th meeting of the Asian Harmonization Working Party (AHWP), the first time the AHWP has met in Hong Kong. The AHWP is working to unify the region’s regulations regarding medical devices, and more than 400 government officials and business executives from its 16 member economies are expected to attend. The AHWP will also feature meetings and workshops daily. In addition, the Hong Kong Doctors Union will hold continuous medical education courses during the fair period.

A day-long conference, “ Hong Kong – A Medical and Health Device Industries Development Hub,” takes place 5 November, organised by t he HKTDC and the Hong Kong Medical and Healthcare Device Industries Association (HKMHDIA). The HKMHDIA, which is also hosting a pavilion, is organising the fair in concert with the HKTDC.

The HKTDC Hong Kong Optical Fair and the HKTDC Hong Kong International Wine & Spirits Fair will take place alongside the Hong Kong International Medical Devices and Supplies Fair.

Cancer Therapy: New hope for therapy in heartburn-related cancer

Cancer of the gullet, or oesophagus, is one of the ten most common cancers in the Western world, and there have been recent alarming increases in the number of cases each year in the US and UK.

There is no good treatment, and sufferers frequently face a short, painful battle which ends all too quickly in death. Many of the cancers diagnosed are in people with a long history of heartburn. Chronic heartburn leads to the lower parts of the gullet being bathed in a toxic acid solution, and the lining of the gullet defends itself against this by changing itself into something which looks a lot like the lining of the lower intestines. Although the damaged tissue, called Barrett's oesophagus, is not cancerous in itself, its presence warns doctors that the patient has taken the first step towards cancer, and triggers a rigorous programme of monitoring, coupled with therapy to prevent further damage. Patients with Barrett's oesophagus can be stabilized, and most do not go on to develop cancer, but once it is there, the mutated tissue is almost impossible to eradicate, so the risk always remains.

Researchers have long been searching for new drugs able to revert Barrett's oesophagus to the healthy, normal lining of the gullet, and now, a team led by Hans Clevers of the Hubrecht Institute, Utrecht, may have a candidate. Clevers' team, whose research into colon cancer is world-renowned, reasoned that as Barrett's oesophagus cells are very similar to the cells which line the colon, they might share vital control pathways. This turns out to be true. Clevers and his team then put this together with the fact that the anti-Alzheimer's drug DBZ, currently in clinical trials, is known to have side effects on the lower gut lining. They used a rat model of oesophageal cancer to observe the effects of DBZ on Barrett's oesophagus tissue, and found that DBZ could halt the growth of Barrett's oesophagus, and in some cases completely destroyed the mutant tissue.

Whilst the treatment is still a long way from being trialled in humans, it is an exciting step forward in the fight for a cure for oesophageal cancer.

Coventry Health Care Announces Q4 and Full Year 2009 Results

Coventry Health Care, Inc. (CVH) reported consolidated operating results for the quarter ended December 31, 2009. Operating revenues totaled $3.4 billion for the quarter with net earnings of $109.1 million, or $0.74 earnings per diluted share (EPS). For the year ended December 31, 2009, total revenues from continuing operations were $13.9 billion with net earnings from continuing operations of $315.3 million, or $2.14 per diluted share.

"I am pleased with the progress that the Company has made during 2009 including a strong finish to the year in the fourth quarter," said Allen F. Wise, chairman and chief executive officer of Coventry. "Although we continue to operate in a challenging economic environment, as we enter 2010 we remain confident that our focus on Coventry’s seven core businesses will best position us for the future."

Fourth Quarter 2009 Consolidated Highlights

• Revenues from continuing operations increased 15.2% from the prior year quarter


• Medicare Coordinated Care Product (CCP) membership growth of 36% from the prior year quarter


• Medicare Part D membership growth of 47,000 from the prior quarter


• Health plan commercial group risk medical loss ratio of 82.9%


• Excellent liquidity position -- Approximately $510 million of deployable free cash at the parent at quarter-end


• Debt repayment of $110 million during the quarter


• Investment portfolio continues to be in a net unrealized gain position at quarter-end


• Announced agreement to acquire Preferred Health Systems, Inc., a commercial health plan based in Wichita, Kansas, which closed on February 1, 2010

Full Year 2009 Consolidated Highlights 

• Revenues from continuing operations increased 18.5% from the prior year


• Fourth consecutive year of strong performance from Medicare Part D including growth of 752,000 members from the prior year, an increase of 81%


• Health plan commercial group risk medical loss ratio of 81.9%


• Individual commercial risk membership growth of 23,000 from the prior year


• Cash flows from operations were $881.8 million


• Debt reduction of $303.5 million from the prior year resulting in a 30.1% debt to capital ratio at year-end


• Completed the divestiture of a non-core business, First Health Services Corporation (FHSC), during the third quarter of 2009

Coventry Health Care is a diversified national managed healthcare company based in Bethesda, Maryland, operating health plans, insurance companies, network rental and workers’ compensation services companies. Coventry provides a full range of risk and fee-based managed care products and services to a broad cross section of individuals, employer and government-funded groups, government agencies, and other insurance carriers and administrators. For more information, visit www.coventryhealthcare.com.

Contact:
John Stelben
Interim Chief Financial Officer
301-581-5729

Drew Asher
SVP, Corporate Finance
301-581-5717

United American Healthcare Corporation Announces Fiscal 2010 Q2 Results

United American Healthcare Corporation announced financial results for the Company's fiscal second quarter ended Dec. 31, 2009.

Revenues for the second quarter were $1.7 million, down $2.8 million, or 62 percent, compared with revenues of $4.5 million for the second quarter of the prior fiscal year. The decline was primarily the result of the complete transfer of TennCare enrollees served by the Company's subsidiary, UAHC Health Plan of Tennessee (UAHC-TN), to other managed care organizations on Nov. 1, 2008, and the discontinuance of UAHC-TN's Medicaid managed care services as a TennCare contractor. The decrease in revenues was also attributable to the decrease in enrollment and associated revenue from the wind down of the Company's Medicare Advantage Special Needs Plan (MA-SNP), as the Medicare Advantage contract expired at the end of calendar 2009.

Total expenses decreased $3.3 million, or 53 percent, to $2.9 million in the fiscal 2010 second quarter, compared with total expenses of $6.2 million in the prior fiscal year's second quarter. The decrease was primarily related to reduced medical expenses, as well as lower marketing, general and administrative expenses in the quarter. For the second quarter of fiscal 2010, the Company reported a net loss of $1.1 million, or ($0.14) per share, compared with a net loss of $1.4 million, or ($0.16) per share, in the second quarter of fiscal 2009. The net loss in the most recent quarter was primarily the result of the loss of TennCare revenue and the wind down of the MA-SNP, partially offset by the reduction in expenses.

"United American Healthcare continues to move through a transitional period characterized by the end of our Medicare Advantage business at the end of the fiscal second quarter," said William C. Brooks, President and CEO of United American Healthcare. "As these operations come to an end, our revenues will no doubt be adversely affected. Moreover, the contraction of our revenue base is occurring even as we face the remaining medical expenses associated with our obligations as a Medicare provider. In light of these challenges, we continue to maintain tight control on all remaining expenses in our current lean operational structure."

As of Dec. 31, 2009, United American Healthcare reported cash, cash equivalents, short-term marketable securities and restricted marketable securities of $14.2 million, compared to $19.9 million as of June 30, 2009. The decrease in cash was primarily the result of the operating loss generated in the first half of fiscal 2010 as well as the payment in September 2009 of approximately $3.3 million in settlement of a lawsuit.

"Despite the tumultuous environment we find ourselves in, we are making progress in the ultimate transformation of our Company, while continuing to control costs and conserve our cash resources," concluded Brooks. "We now believe we are much closer to the end of this extensive process, and we remain committed to completing the hard work required to identify the best possible alternative to benefit all shareholders. When we conclude this process, we will communicate our results to shareholders and provide a strategic framework that will shape the future direction of our Company."

About United American Healthcare Corporation

United American Healthcare Corporation (UAHC) is a healthcare management company that has pioneered the delivery of healthcare services to Medicaid recipients since 1985. UAHC owns and manages UAHC Health Plan, which is based in western Tennessee and includes the Memphis market.

For more information, visit www.uahc.com .

Lab-on-chip traces circulating tumor cells

Liesbet Lagae is group leader of the nano-enabled systems group in IMEC. She is involved in several European and national research projects concerning magnetic and optical materials and devices and their application in the field of biosensing. Liesbet Lagae holds a PhD from the Catholic University of Leuven. Contact: Liesbet.Lagae@imec.be

Imagine a medical laboratory performing a genetic test to detect metastasis from blood in a breast cancer patient. Shrink this laboratory down to an area of 1x1cm² and you have a lab-on-chip. The tools in the real-life lab are replaced by microsystems, the medical staff placing the blood sample in subsequent tools, is replaced by microfluidic channels. The huge advantage of such systems is that they enable a fast, easy-to-use, cost-effective test method which can be performed in a doctor’s office or even near the patient’s bed.

Unfortunately, there are no real lab-on-chip systems on the market yet. The systems that are commercially available – often wrongfully labeled ‘lab-on-chip’ – only perform one task, for exa mple moving a fluid from one place to another. True lab-on-chips are multifunctional.

Technologies for true multifunctional lab-on-chip systems are being developed by research labs worldwide. One of these labs is situated in the Belgian nanoelectronics research center IMEC. They develop for example microsystems that are able to pick up specific cells in blood samples, to perform cell lysis, to realize amplification and detection of the cell’s genetic material.

Together with a German SME, specialized in test kits for detecting circulating tumor cells (CTC) in cancer patients, IMEC tailored its generic lab-on-chip technologies towards this application. Three lab-on-chip modules were developed integrating the different analytical steps for the isolation and characterization of circulating tumor cells in a blood sample.

Figure 1: Schematic presentation of the different operations to be performed by the lab-on-chip for the isolation and characterization of rare cells.

Circulating tumor cells are tumor cells that invade the bloodstream and cause distant metastases. The levels of CTC detected in metastatic breast cancer patients before and after therapy were shown to be significant predictors of progression and overall survival. The very low levels of CTC in peripheral blood, i.e. down to less than 1 cell per ml, make their detection very challenging.

Module 1: Cell isolation and detection

In a first step, the blood sample is injected into the LOC and mixed with antibody-coated magnetic beads. These beads bind specifically with the tumor cells. Next, a magnetic force is applied, allowing the transport of both the bead-cell complexes and excessive beads. Due to their different magnetophoretic mobility, the bead-cell complexes have a different velocity and can be separated from free beads. Combining such an isolation device with an H-shaped fluidic channel allows to specifically force the beads-cell complexes into the detection channel, where they are counted by flowing them over a spin-valve magnetic sensor.

Figure 2: Cell isolation device bridged between two channels. Cell-bead complexes are moved towards a detection channel, while free beads are flown to the outlet.

Module 2: RNA extraction and amplification

Following isolation and detection, the CTC are lysed and their mRNA is extracted. The genes that are important for the identification of the tumor cells are amplified (cDNA). For this step, MRC Holland has developed kits for the multiplexed amplification of specific breast cancer genes.

The microsystem for cell lysis and mRNA amplification is based on an intelligent design of heating elements, active cooling principles and fluidic channels together with IMM, a german institute specializing in microfluidics.

Module 3: DNA detection

In the detection module, the amplified cDNA is identified. This can be done using an array of electrochemical or magnetic sensors. With the electrochemical detection (implemented by URV), one can reach a sensitivity in the range of nanomolar, while the magnetic-based detection is currently much more sensitive (picomolar). The magnetic-based detection strategy consists of binding functionalized magnetic beads to the target cDNA and counting these complexes with a magnetic sensor.

Even in the large equipment that is used today to count tumor cells in blood (e.g. Cellsearch), this extra step of DNA detection is not performed. However, it increases the test reliability and provides interesting information for doctors about the subclasses that the tumor cells belong to so that the best therapy can be selected.

Many possibilities

Today, the three modules described above are ready and are being tested with spike blood (i.e. blood with a known number of tumor cells). In a next phase, the lab-on-chip modules will be tested with blood from patients, and finally the modules will be integrated on one chip.

Future work will focus on clinical studies using the LOC approach as well as evaluating other application domains for the LOC technology, for example: detecting other sorts of cancer, tracing fetus cells in the blood of the mother (to detect mucoviscidose or other genetic diseases) or assisting in stem cell research.

This research was performed in the framework of the European MASCOT project. Project partners are: IMEC, Universitat Rovira i Virgili (URV), Fujirebio Diagnostics AB , Institut für Mikrotechnik Mainz (IMM) , AdnaGen AG, Norwegian Radium Hospital and MRC-Holland.

Science and Technology in Clinical Sterilization.

Hemant Shah is Chief Executive at Medica Instrument Mfg Co. He has more than 30 years experience in the manufacture of lab instruments. Under his stewardship, Medica has progressed from manufacture of simple pathology & sterilization equipments, to include products today for QC, QA, Micro, Organic Chemistry and R&D labs. Medica's Fully Automatic Autoclaves with documenting options are the preferred option at all leading Microbiology labs in the Indian Pharma Industry. The whole organization is focused towards customer support with over 50% of the Staff being in the QC, Sales & Customer Support departments.

There has been a growing understanding of the microbial threats that exist in laboratory & medical practice as of today. Simultaneously these threatening trends have been accompanied by a tremendous advance in the science and technology of in-clinic sterilization.

All Medical Professionals must possess a good basic knowledge about the process of sterilization as otherwise their patients' as well as their staff & their own health & lives are at risk.

So what exactly is sterilization?

Sterilization is the destruction or removal of all viable microorganisms, including many of the resistant bacterial spores. Since this process covers the broad range of pathogens that may be found in dental, ophthalmic & any surgical procedure, it is the only clinically acceptable means for dealing with reusable instruments between patients.

In order to understand "Why Class B Autoclave?", let us first understand how a Steam Pressure Steriliser - commonly known as an Autoclave - sterilizes.

Autoclaves commonly sterilize by exposing its charge (items to be sterilized) to elevated temperatures of 121 to 134ºC under pressure of 15 to 30 psi, for a holding time of anywhere between three to 30 minutes. Please note that the three to thirty minutes time is the holding time at the set elevated temperature & not the total process or cycle time. Total cycle time would be far greater. The combination of the three lethal parameters of time, temperature and steam, deliver a powerful kill rate which even the hardiest of bacteria find hard to survive. This effective & yet clean method of lethality is unmatched by any of the other methods of sterilisation.

Saturated steam at this temperature is an excellent carrier of heat. The operative word is saturated steam. The steam condenses onto its charge and as it does so it not only expends its huge latent heat but also draws in additional steam to replace the condensed steam. Thus the heat transfer is very efficient and the penetration levels extremely high.

However, if there is residual air in the chamber and load, it will interfere with steam-instrument contact, and may compromise sterilization. This residual air can prevent penetration of steam to the depths of the load, leaving your sterilisation incomplete. Why & how would this happen? When you load the Autoclave with instruments and close the lid, there is already a lot of stale air trapped inside. For sterilisation to take place, this air needs to be effectively purged and replaced with saturated steam.

To resolve this problem of purging entrapped air, normal Autoclaves will have a manual, mechanical or electrically operated valve open till about 100ºC. Once it is closed the pressure & temperature begins to rise. It is presumed that by this time, the entire entrapped inner air has been purged. However, tests have shown that this is not an effective method for vials, wrapped items, implants, garments and certain types of hollow ware. You can never be assured of efficient penetration of steam right inside, if you are using a regular Autoclave. Even a small volume of entrapped air can compromise your sterility assurance level simply because ordinary entrapped air is a very bad conductor of heat & moisture. These pockets of air cannot conduct heat to the load with the same vigor as steam and therefore cold spots remain within the load.

The type N-cycle is suitable for sterilizing only unwrapped and solid instruments. N-cycle sterilizers are the most popular bench top autoclaves (top or front loading), and are classified as passive systems (also known as gravity or non-vacuum). Typically, as steam is generated or admitted into the sterilization chamber, it forces unsaturated and saturated air out through a vent. The major concern with the N-cycle sterilizers is the non-removal of trapped air (especially air pockets in lumens and difficult-to-access areas of the load) during displacement.

Errors in packaging or overloading the sterilizer chamber can result in cool air pockets where items are not sterilized.

The type B sterilisation cycle is used to process loads that can retain air. It can sterilize solid, hollow, and porous instruments, be they wrapped or unwrapped. Pressurized steam is an effective sterilizing agent providedthat the internal air has first been removed from the chamber as well as the air retentive load. Residual air prevents direct contact between steam & the load to be sterilised. Hence this B-cycle involves the use of active (forced) air removal, usually by using an inbuilt vacuum pump. These pre vacuum or Class-B sterilizers create a vacuum, thus removing air from the load prior to the chamber being pressurized with steam. This can be done from 1 to 3 times - depending on the cycle selected. This technique allows faster and more effective steam penetration throughout the entire instrument load than the gravity displacement technique typically employed in sterilizers with N-cycles.

 

A typical cycle of a Class B Sterilizer:

A Class-B Autoclave is essential if you are:

• Pouching your instruments


• Double wrapping your instruments


• Sterilising lumens, implants or instruments that have difficult to access areas


• Sterilising porous loads like garments, gowns, dressings sterilizing


• Hollow ware of Type A Sterilising Vials

Contact Us:

E-mail: hs@medicainstrument.com

Ph: 022-66189999

http://www.medicainstrument.com

Telehealth: a keystone for future healthcare delivery

Written by Matthew Marshall, Director, Tunstall

Matt Marshall is responsible for developing Tunstall’s range of telehealth propositions within the health sector. He started his career within medical equipment before moving into telecoms and software and has nearly 20 years of experience building secure and rewarding customer relationships. He spends a lot of time working very closely with customers who are early adopters of telehealth and those evaluating the technology. Matthew Marshall of Tunstall explains the role telehealth is playing in supporting health and social care professionals and enabling them to deliver more integrated, flexible and person-centred care Over 17.5 million people in the UK live with a long-term condition, which places a significant strain on health and social care resources.  It is estimated that 80% of GP consultations relate to a long-term condition, and that 60% of hospital bed usage is by people with a long-term condition. The treatment and care of those with long-term conditions also accounts for 69% of the Primary and Acute care budget in England, placing a clear economic burden on the NHS.  Indeed, it is estimated that the UK economy stands to lose £16billion over the next 10 years through premature deaths due to heart disease, stroke and diabetes. As a result, momentum for telehealth has been growing over the last few years, as those with health and social care responsibilities look for innovative ways to manage long-term conditions effectively and help reduce some of the pressure on the NHS. Monitoring Long-Term Conditions with Telehealth The UK Government is making committed steps towards more person-centred and flexible care delivery.  Its Our Health Our Care Our Say white paper, Lord Darzi’s NHS Next Stage Review and Putting People First agenda all place a clear emphasis on longer-term planning and on providing more preventative community-based care delivered at a local level that is tailored to meet the specific health and social care needs of the individual. Telehealth supports the Darzi report’s call for greater provision of care closer to people’s homes, by supporting those living with single or multiple long-term conditions, including Chronic Heart Failure, COPD, diabetes and hypertension, helping them to continue living independently by providing more personalised, community-based care. Telehealth is now being mainstreamed by PCTs across the country in order to prevent avoidable hospital admissions to hospital and monitor long-term needs within the home. The increasingly widespread use of telehealth solutions is also transforming the ability to manage chronic disease and long-term conditions in the community and shift the balance away from a reliance on hospitals and long term institutional care. Telehealth: supporting effective, community-based care Telehealth allows nursing staff to remotely manage patients, ensuring support can be provided at an early stage when needed, and at the same time enabling them to prioritise visits and manage their case loads more effectively, for best use of healthcare resources. Patient data is transmitted to community nurses on a daily basis, enabling them to triage their ‘virtual ward’ against agreed vital signs criteria and apply an order of priority to the visitation schedule.  This approach provides clinical staff with more accurate information about a patient’s condition, allowing them to focus their time accordingly so patients experiencing a critical change receive treatment as soon as it is required. Being able to monitor and detect changes at an early stage also enables nursing staff to reduce the number of acute admissions to hospital and resulting dependency on secondary care, improving outcomes and ensuring best use of available resources. A key additional benefit of telehealth is that it also educates patients to be more aware of their own symptoms and to proactively manage them which leads to an improved quality of life for patients and carers. It encourages patients to feel more in control of their condition, which is a key factor in helping to improve healthcare outcomes. Measuring the benefits of telehealth: reducing admissions and ensuring effective use of resources Sheffield PCT took the decision to deploy telehealth solutions from Tunstall, in order to tackle the issue of COPD in the community.  During a recent pilot, home visits by community COPD nurses were reduced by an astonishing 80%, cutting travel costs and enabling healthcare staff to prioritise their workload, which ensured the most effective use of their time. This innovative approach saw COPD-related hospital admissions dramatically decrease by 50%, saving the PCT £30,000 to £40,000 on a small number of patients and allowing them to purchase more monitors, to further expand the use of telehealth for the management of long-term conditions. Meeting individual patient needs in Nottingham With around 22,000 hospital admissions per year in Nottingham linked to long-term conditions – 40% of all hospital activity – mainstreaming telehealth has dramatically reduced hospital admissions and GP visits, lessening the burden on primary and acute care providers and ensuring NHS resources are used effectively. Nottingham PCT uses the telehealth technology from Tunstall to monitor around 800 people each year with long-term conditions such as COPD and congestive heart failure. This approach supports independent living, promotes patient self-management and reduces the need for repeat hospital admissions. A key benefit of the telehealth solutions is that they can be tailored to meet the specific needs of the individual patient.  As well as using the monitor to measure vital signs, the community matron can programme the monitor to ask the patient a set of medical questions specific to their condition; this helps clinicians further determine the status of their patient’s condition. A healthy outlook for telehealth Telehealth solutions are playing a pivotal role in supporting older people and those with long-term needs to live independently, by effectively managing their health and well-being. Primary Care Trusts mainstreaming telehealth have demonstrated telehealth delivers clear benefits to the patient and the PCT and also to carers and other secondary care sources. As well as delivering significant reductions in hospital admissions, telehealth has also enabled Trusts to make financial savings. The use of telehealth in Sheffield has seen a 50% decrease in hospital admissions. It has been calculated that based on a cost of £2,000 per admission, saving 50 admissions a month, could potentially save the PCT £1,200,000 per year. Sheffield and Nottingham PCTs have witnessed the benefits of telehealth in improving patient care and in helping to ensure best use of resources.  Tunstall is working with these and many other Trusts across the country to further extend their use of telehealth to address other long-term conditions and continue to make it an integral part of their overall model of care. www.tunstallhealth.com  01977 661234

Healthcare Challenge: To Heal or Die

Fewer hospitals are dealing with more patients, more diseases, more costs, and bigger headaches. The good news is that we have answers! We can save costs while saving lives.

John Shoemaker is President of Shipcom Wireless and has focused on delivering hybrid data capture, RFID, and data management solutions across several industries, including transportation, aviation, government, and, most recently, healthcare with an important contract with the Air Force to create a technology showcase for a major medical center. Formerly VP of Amtech/Subsidiary of Intermec, Executive VP of TransCore, and Senior VP of Matrics and Symbol Technologies, he has extensive experience in the Middle East and Asia. Mr. Shoemaker is also a U.S. Army combat infantry veteran and is committed to leveraging technology to bring improved healthcare for active and retired military personnel. E-Mail: jshoemaker@shipcomwireless.com

Charles Olmeda is a Sr. Project Manager for Shipcom Healthcare Solutions focusing on delivering Automatic Identification Technology solutions to the healthcare industry, most recently as the Project Manager for a contract with a major Air Force Medical Center. Formerly an IBM Systems Engineer, Shared Medical Systems (now Siemens) Healthcare Systems Consultant and First Consulting Group Integration Manager. Before joining Shipcom Mr. Olmeda provided independent healthcare consulting and project management to various healthcare organizations, he has over twenty years in Healthcare Information Technology.E-Mail: colmeda@shipcomwireless.com

From the TV show, “House”, the irascible but brilliant Doctor House tells a class of med students that they will make mistakes and they will lose lives and that they better get used to it or either find another job or become a teacher. The silence in the room was deafening.  Tough words, but unfortunately they are very true.  And the likelihood of making more mistakes that cost lives increases with the rapid introduction of millions of baby boomers as they enter their sixties and seventies. All of this is coming at a time of increasing healthcare costs, fewer numbers of hospitals as consolidation continues from the past decade, lack of an agreed upon national healthcare strategy, the crunch on Social Security and government medical programs like Medicare and Medicaid, and the overall economic malaise we find ourselves experiencing today.

Answers are needed as at the statistics show that as healthcare needs increase, so do the errors, deaths, and lawsuits. DOA has succumbed all too often to DIH or died in hospital. Reports show 90,000 people had avoidable deaths in hospitals last year in the U.S.

Yet, there are answers.  Healthcare beckons innovation.

There is one potential hero that could come to the rescue at a time of great need for the healthcare industry: Hybrid AIDC Technologies for Real Time Visibility (RTV). This is quite a mouthful.

Although most of us are familiar with bar codes (UPC or uniform product codes) and routinely manage them at the supermarket with coupons, or purchases in retail stores or self service POS (point of sale) in places like Home Depot and airline check-in kiosks. Interestingly, hospitals have yet to exploit what is known as automatic identification and data collection (AIDC) and one of its related technologies, RFID (radio frequency identification) which now have electronic product codes, formerly EPC, now GS1 or one global standard for the world.

As a result and one example, President Obama has repeatedly called for a national effort to convert paper documents to secure digital form (EMR or EHR: electronic medical or health records) that will allow uses not currently available in the health care industry, but is routine in other industries.

Bar codes can be used to track items in hospitals, especially medical supplies or pharmaceuticals in inventories, but even that is not commonly used. Just as many third world countries have bypassed the use of wired communications or landlines and have implemented wireless/cell phone technologies; hospitals now have the chance not to necessarily bypass bar codes, but to complement their use where it makes sense while exploiting the wireless world with RFID.

Not all RFID is the same. There is active, battery powered RF; there is passive, non-battery or backscatter RF; and RF used with different frequencies – all dependent on the application. In simple terms, RF Active is used when long range is needed and passive use is best when very low cost tags are needed. Then there is RTLS (real time locating system) that wirelessly transmits signals to read a tag, obtains an ID and then calculates (using triangulation) the location of the tag.  But the list of applications is long, especially when including sensors for temperature, humidity, motion, or chemical presence.

So, for hospitals, we can deploy RFID, Bar Code and other sensor technologies to provide RTV for many specific medical applications. The first priority is to tag the items/people/assets that move or can move that can influence operational decisions.  We have lots of opportunities to leverage these hybrid technologies to a hospital’s operational and financial advantage. Hospitals are bleeding, but they may not know how badly, where or for how long.

Let’s take a look at some specific examples of target applications…

1. 
   
   General Asset Management of Medical and IT Equipment 
   Hospitals across the nation are faced with an equipment financing and management squeeze. The expense of constantly buying new equipment can annually strain the finances of even the best managed healthcare organizations. Medical equipment that is essential to maintaining a high standard of patient care and competitive advantage also involves high cost and the complexity of maintaining and managing equipment that may affect the hospital operations and could divert valuable facility resources away from the core mission of patient care. A hospital, by using RFID or other sensor technologies, could enable the automated collection of asset information including location, maintenance status, and more without a person needing direct line of sight or contact with that asset. Once the sensor technology gathers data, the information is passed to the organization's enterprise or asset management application. As a result, the system may trigger an alert, release a work order, update inventory, conduct inspections, create an invoice or locate an asset.  Hospitals could experience improvements in productivity, reduce costs by implementing automated maintenance schedules rather than an arbitrary calendar-based schedule, increase revenue by accurately valuing assets being used, and increase equipment longevity by identifying usage patterns.
   
   


2. 
   
   Patient Tracking/Flow 
   As the evolution of RFID moves forward, most hospitals are still waiting for continued technology development and for prices to perhaps inch downward. Experts in the industry estimate that only about 200 hospitals out of over 5,600 in the US are using automatic identification technology. Very few have implemented the technology for patient tracking to optimize  patient flows, reduce wait times in waiting rooms and improve patient satisfaction.  A small RFID tag on a patient wristband emits a radio wave that is detected by a network of receivers around the hospital. The system graphically displays the locations on a virtual map of the facility, or in a table view or into a hospital information system (HIMS).  In the few situations where RFID has been implemented, it has mainly been for emergency departments, operating rooms or small pilot programs on a single floor. RFID technology for patient tracking improves and streamlines patient care processes by coordinating crucial events from patient admission to discharge processes, all while improving patient safety by giving hospital staff the real-time data and task coordination tools required to improve patient care.
   
   


3. 
   
   Inventory Control 
   RFID technology has great potential in healthcare to significantly reduce cost, while improving materials management and inventory operations. Cost-conscious industries like retail and manufacturing traditionally have focused on using RFID systems to enhance the efficiency in supply management and logistics processes, including inventory control. Effective inventory management affects costs that can range 45-90% of total expenses. If the use of automatic identification technology can save just a percentage of that cost, the cost saving is real and drives to the bottom line profitability of the hospital. Use of RFID for managing and controlling inventory can provide more control over uses of capital that affects all departments. After all, why buy inventory when it is not needed. Overstocking is expensive. Also, having the right stock available at the right time is critical. A lack of RTV data on stock levels means that stocks often run low or even run out altogether, causing unnecessary disruption to operations. Additionally, staff normally must fill in paper-based forms so that supplies can be distributed to the wards or departments. This can waste valuable staff time and reduce hospital efficiency. RFID can provide real-time data on inventory logistics as items move from storage cabinets in the hospital and out to the wards and individual users, and back to storage if necessary.
   
   


4. 
   
   Bedside Services 
   The escalation of healthcare costs has created market pressure to increase the efficiency of patient care while continuing to increase quality. One means of addressing that challenge has been the advancement of computing solutions in various digital health initiatives. RFID introduces a new approach involving proximity-detection and association of the patient to assets, items, caregivers and other points of concern with automatic detection and presentment.  This approach enables a new generation of patient identification solutions for the healthcare industry that is going “digital”. An integrated patient-identification solution addresses the inefficiencies and potential for human error associated with traditional patient identification. Increased accuracy helps to avoid hospital liabilities associated with bedside services mistakes. While many hospitals are considering technology for patient identification, most hospitals have not considered automated patient association to create an audit trail with automated tracking and tracing and with a system of alarms/alerts when mistakes are anticipated or in progress.
   
   


5. 
   
   Surgical Trays and Instruments, Track & Trace 
   Surgical instrument storage and sterilization systems include surgical instrument trays and kits which typically consist of trays or boxes that hold a variety of general purpose and or specific surgical instruments such as forceps, scissors, clamps, retractors, scalpels, etc. These pre-prepared, surgery-specific instrument trays are brought into the operating room (OR) when preparing for surgery and are used as a means to organize and store surgical instruments. These trays are used to transport medical instruments within a hospital or even in and out of medical facilities. Advances in medical technology have created an enormous increase on the number and type of surgical instruments now in use.  It has become necessary to manage and track these instrument trays more quickly and efficiently to ensure they are properly cleaned and sterilized (autoclave) and that the kit is complete and accurate.  Use of RFID technology is effective for tracking surgical trays and managing the number of instruments within a tray or surgical kit to ensure “right instrument, right kit”.
   
   


6. 
   
   Medication Administration 
   One of the most difficult areas for technology to address is the medication administration process.  This is due to complex staff workflows and procedures - and in many cases, mandate compliance. A fundamental set of requirements that nurses must satisfy on a daily basis is embodied in the 'five rights': getting the right medication, in the right dose, using the right methodology, to the right patient at the right time. Errors in administering medication can have grave impacts on a patient's health.  There are the challenges for nurses of maintaining accuracy on long shifts while juggling multiple patients. Despite the importance of accuracy in meeting this set of requirements, nurses and other caregivers too often must rely upon hand-written orders from doctors, matched up to hand-written or printed ink patient wristbands. Those wristbands may be partially illegible, and the manual transcription of data when they are made can introduce errors. Mismatching patients to the proper care can result in consequences such as incorrect medications or missed doses, use of the incorrect blood type, mixed-up pathology samples and incorrect surgical procedures (e.g., wrong parts of the body operated on or removed). Automatic identification technology complements and may eliminate the use of manual patient identification using somewhat unreliable wristbands, which can reduce the prevalence of errors and improve efficiency. It involves tracking the patient at every stage of their treatment, using a digital means of automatic identification that is machine-read and allows matching the actual patient to their medical chart and physician's orders, plus non-medical aspects of their care such as meals and billing.
   
   

We have presented six areas of opportunity for hospitals to re-examine how they operate and offer more effective and efficient solutions to save costs and lives. Hospitals need to manage multiple business processes, just like any other business. This includes management of medical equipment, medication administration, tracking of blood and specimen and tracking patients from admission to discharge to optimize the patient flow.

We need to make these opportunities visible to hospital management, not only to smooth process flows, but to verify each process step and help prevent problems before they occur. It all starts with collecting relevant, real time information that allows you to analyze what is happening: identify errors, determine what and who are causing errors and then adjusting or modifying processes to resolve these issues.  Hopefully we can assist the medical community with our expertise in providing real time visibility to operational and clinical processes and improve Patient Safety and quality of care and at the same time reduce   costs and errors. We want to heal both the patient and the hospital and keep them both healthy.