Month: October 2023

Categories : Cancer Medical Research & TechnologyTags :

A New Robotic ‘Hand’ that can Carry out Clinical Breast Examination

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The device. Credit: George Jenkinson

University of Bristol researchers have created a robotic hand that could carry out Clinical Breast Examinations (CBE). The device is able to apply very specific forces over a range similar to forces used by human examiners and can detect lumps using sensor technology at larger depths than before.

This could revolutionise how women monitor their breast health by giving them access to safe electronic CBEs, located in easily accessible places, such as pharmacies and health centres, which provide accurate results. The technology is described in the journal Sensors.

Precision, repeatability and accuracy are of paramount importance in these tactile medical examinations to ensure favourable patient outcomes. A range of automatic and semi-automatic devices have been proposed to aid with optimising this task, particularly for difficult to detect and hard to reach situations such as during minimally invasive surgery.

The research team included a mix of postgraduate and undergraduate researchers, supervised by Dr Antonia Tzemanaki from Bristol Robotics Laboratory. Lead author George Jenkinson explained: “There are conflicting ideas about how useful carrying out Clinical Breast Examinations (CBE) are for the health outcomes of the population.

“It’s generally agreed upon that if it is well performed, then it can be a very useful and low risk diagnostic technique.

“There have been a few attempts in the past to use technology to improve the standard to which healthcare professionals can perform a CBE by having a robot or electronic device physically palpate breast tissue. But the last decade or so of technological advances in manipulation and sensor technology mean that we are now in a better position to do this.

“The first question that we want to answer as part of this is whether a specialised manipulator can be demonstrated to have the dexterity necessary to palpate a realistic breast size and shape.”

The team created their manipulator using 3D printing and other Computerised Numerical Control techniques and employed a combination of laboratory experiments and simulated experiments on a fake (silicone) breast and its digital twin, both modelled on a volunteer at the Simulation and Modelling in Medicine and Surgery research group at Imperial College London.

The simulations allowed the team to perform thousands of palpations and test lots of hypothetical scenarios such as calculating the difference in efficiency when using two, three, or four sensors at the same time. In the lab, they were able to carry out the experiments on the silicone breast to demonstrate the simulations were accurate and to experimentally discover the forces for the real equipment.

George added: “We hope that the research can contribute to and complement the arsenal of techniques used to diagnose breast cancer, and to generate a large amount of data associated with it that may be useful in trying to identify large scale trends that could help diagnose breast cancer early.

“One advantage that some doctors have mentioned anecdotally is that this could provide a low-risk way to objectively record health data. This could be used, for example, to compare successive examinations more easily, or as part of the information packet sent to a specialist if a patient is referred for further examination.”

As a next step, the team will combine CBE techniques learned from professionals with AI, and fully equip the manipulator with sensors to determine the effectiveness of the whole system at identifying potential cancer risks.

The ultimate goal is that the device and sensors will have the capability to detect lumps more accurately and deeper than it is possible only from applying human touch. It could also be combined with other existing techniques, such as ultrasound examination.

“So far we have laid all of the groundwork,” said George. “We have shown that our robotic system has the dexterity necessary to carry out a clinical breast examination – we hope that in the future this could be a real help in diagnosing cancers early.”

Source: The University of Bristol

Categories : Diet and NutritionTags :

The Seasons Affect Appetite in Unexpected Ways

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Photo by Julian Jagtenberg on Pexels

Many people may feel that they are healthier in the summer: the sun is shining, they get plenty of vitamin D, and the days are long. However, recent research from the University of Copenhagen suggests that eating habits in winter may be better for metabolic health than eating habits in summer – at least in the case of mice. Researchers have examined the metabolism and weight of mice exposed to both ‘winter light’ and ‘summer light’.

“We found that even in non-seasonal animals, differences in light hours between summer and winter do cause differences in energy metabolism. In this case, body weight, fat mass and liver fat content,” says Lewin Small, who carried out the research while a postdoc at Novo Nordisk Foundation Center for Basic Metabolic Research at the University of Copenhagen. He adds:

“We found this mostly in mice exposed to winter light hours. These mice had less body weight gain and adiposity. They have more rhythmicity in the way they eat over a 24-hour period. And this then led to benefits in metabolic health.”

The study, published in Cell Metabolism, is the first of its kind to examine light hour’s influence on metabolism in mice, that are not considered seasonal animals as like humans they do not only breed in specific seasons. Animals breeding in specific seasons gain weight before the breeding season to save energy supplies.

Light hours impact metabolism

Lewin Small’s inspiration for initiating the study stemmed from the significant variation in daylight hours across various regions of the world.

“We study the influence of the time-of-day on aspects of metabolism such as exercise, obesity and diabetes. However, most studies that investigate this link do so assuming an equal length of day and night all year round,” says Lewin Small.

Therefore, they wanted to find out what the seasonal light differences meant for the metabolism. Most people in the world live with at least a two-hour difference in light between summer and winter.

“I come from Australia, and when I first moved to Denmark, I was not used to the huge difference in light between summer and winter and I was interested in how this might affect both circadian rhythms and metabolism,” says Lewin Small and adds:

“Therefore, we exposed laboratory mice to different light hours representing different seasons and measured markers of metabolic health and the circadian rhythms of these animals.”

Because the research was conducted using mice as the experimental subjects, it is not possible to assume that the same thing goes for humans.

“This is a proof of principle. Do differences in light hours affect energy metabolism? Yes, it does. Further studies in humans may find that altering our exposure to artificial light at night or natural light exposure over the year could be used to improve our metabolic health,” says Juleen Zierath, Professor at the Novo Nordisk Center for Basic Metabolism Research (CBMR) and senior author of the study.

Lewin Small adds that the findings are important to understand how eating patterns are affected by the light and seasons which might help us understand why some people gain more weight or if people gain more weight in a specific time of year.

“Differences in light between summer and winter could affect our hunger pathways and when we get hungry during the day,” he says.

Source: University of Copenhagen – The Faculty of Health and Medical Sciences

Categories : Neurology Pain ManagementTags :

How Sleep Disruption Can Make Pain Feel Worse

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Photo by Andrea Piacquadio on Pexels

People often experience headaches and body pain after a lack of sleep, but the mechanisms behind this phenomenon are unclear. A new study published in Nature Communications reveals that a certain endocannabinoid neurotransmitter plays a major role.

The animal-based study, led by investigators at Massachusetts General Hospital (MGH), a founding member of Mass General Brigham (MGB), found that the heightened pain sensitivity than can result from chronic sleep disruption (CSD) – or CSD-induced hyperalgaesia – involved signalling from a part of a brain known as the thalamic reticular nucleus (TRN).

Analyses of metabolites showed that the level of N-arachidonoyl dopamine (NADA), a type of neurotransmitter called an endocannabinoid, decreased in the TRN as a result of sleep deprivation.

Activity of the cannabinoid receptor 1, which is involved in controlling pain perception, also decreased in the thalamic reticular nucleus after CSD.

Administering NADA to the TRN reduced CSD-induced hyperalgaesia in mice.

This beneficial effect of administered NADA could be countered by blocking the cannabinoid receptor 1, suggesting that both the receptor and NADA play a role in pain sensitivity due to sleep deprivation.

“We provide a mechanism as to how sleep disruption leads to exaggerated pain, suggesting that harnessing the endocannabinoid system might break the vicious cycle between pain and sleep loss,” says co-senior author Shiqian Shen, MD, the clinical director of MGH’s Tele Pain Program.

Source: Massachusetts General Hospital

Categories : ExerciseTags :

Science Finally Tackles the Question of How Warming up Improves Performance

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Photo by Olga Guryanova on Unsplash

While top sports teams like the Springboks all know the importance of warming up their muscles before a game, it has not always been clear as to what is actually going on when muscles are warmed up, and whether all muscles are the same. Now, in a study recently published in the Journal of General Physiology, a Japanese research team has revealed how heating affects the contraction of different muscles, and how this might benefit populations in need of improved exercise performance as well as on the sports field.

Skeletal muscle contracts in response to electrical signals from the nervous system, which activate proteins in muscle cells, resulting in movement. The team previously explored how cardiac muscle contractions are affected by temperature, determining that the heart can contract efficiently within the body temperature range.

Next, using muscle proteins and advanced microscopy, the Osaka University-led team wanted to determine how temperature affects skeletal muscle: do skeletal muscles have similar temperature sensitivity, or are they different from cardiac muscle?

The research team found that some of the proteins in the muscle cells act as a temperature sensor, and that heating affects skeletal and cardiac contractile systems differently. “Our findings point to differences in the temperature sensitivity of proteins responsible for contraction in skeletal vs. cardiac muscles,” says co-lead author Kotaro Oyama. “Basically, the skeletal muscle that moves our body around is more sensitive to heating than the heart.”

The physiological significance of these findings will become clear when the functional difference between skeletal and cardiac muscle is considered. While skeletal muscle only generates a certain amount of force when required, the heart is meant to beat continuously.

“The higher temperature dependence of skeletal muscle may allow it to contract relatively quickly upon warming up, even from slight warming due to light movement or exercise. This means that the muscle can save energy and rest when not needed. In contrast, the lower temperature sensitivity of the heart may be beneficial for maintaining a continuous beat, regardless of temperature,” explains co-lead author Shuya Ishii.

This study provides new insights into how, at the protein level, warm-up before exercise enhances muscle performance. The discovery that some muscle proteins act as a temperature sensor may lead to a new hyperthermia strategy, in which skeletal muscle performance is improved by warming up the muscle. Incorporating appropriate warm-up routines into the daily lives of individuals, particularly the elderly population, could improve their muscle and exercise performance, thereby reducing the risk of injury and helping to maintain their independence.

Source: Osaka University

Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: The Rise of Affordable Medical Insurance

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Reaching the masses with quality healthcare services

Photo by Hush Naidoo Jade Photography on Unsplash

By Sandra Sampson, Director at Allmed Healthcare Professionals

With its two-tiered, highly unequal healthcare system, only 14.86% of South Africa’s population can currently afford private healthcare, and rising costs are making it difficult for many to keep paying their monthly medical aid premiums. There are plans to implement National Health Insurance (NHI) to fund healthcare in the public and private sectors, although this process which began in August 2011 has been slow, and the NHI Bill is still under consideration in the National Assembly.

Despite concerns about the state’s ability to implement the NHI effectively and competently, delivering quality medical care to the population must continue to be a priority for every healthcare provider. This is where a specialist Temporary Employment Services (TES) provider can assist – delivering a flexible, competent, quality workforce on demand for institutions in both the public and private sectors.

Increasing access to quality healthcare

The public healthcare sector is primarily intended to serve those who are unable to access private medical aid and is currently accessible to all, regardless of immigration status or nationality. Significant funding is a massive drawcard for specialists in the private sector, which has resulted in a widening gap between public and private healthcare facilities in much of the country. The impending NHI is intended to address this gap and enable greater access to specialist care and more free services for all, while improving the quality of public healthcare by establishing a national fund that will allow for the purchasing of healthcare services on behalf of users. Estimates for funding this national health initiative range from R165bn to R450bn, and the government has been given the go-ahead by the Gauteng High Court to continue its recruitment drive before the bill has even passed.

Access starts with affordability

In line with this move, affordable healthcare insurance is on the rise. This trend starts with partnerships between healthcare and financial services providers, and has already been seen in the likes of Dischem, Clicks and Tyme Bank’s TymeHealth, all offering medical insurance, enabling access to high-quality healthcare specialists to a market that was previously woefully under-serviced. As the demand for quality healthcare increases, there will be a proportionate increase in the need for healthcare professionals.

Practical resourcing alternatives

It is not economically or practically feasible for healthcare institutions (whether in the private or public sector) to hire more medical professionals permanently, which means they will have to explore other resourcing options. This is becoming increasingly difficult in South Africa, as many skilled medical staff are seeking work elsewhere as a result of poor working conditions created by loadshedding, corruption, and incompetent administration. Although the Department of Home Affairs has added new skills to our country’s critical skills list (many of which include medical practitioners and individual specialisations) the healthcare industry is still severely understaffed. Hospital groups are only growing more frustrated with the government’s inability to address the decreasing number of medical practitioners, particularly nurses. The Hospital Association of South Africa (HASA) has reported that nurses in the country are reaching retirement age without the necessary inflow of younger employees. In 2020, there were more than 21,000 nurses in training, but South Africa still needs as many as 26,000 additional nurses to meet the growing demand.

Meeting the demand flexibly

TES providers in the healthcare sector have the potential to meet the demand of healthcare institutions for nurses and specialists, without these institutions having to commit to the responsibilities and costs associated with full-time employment. TES providers are on hand to supply the vetted and highly-skilled workers so desperately needed. Every healthcare institution can be supplied with the resources necessary on a shift-by-shift basis. So, if, for example, there is a deficit of five ICU nurses at a certain hospital, a TES provider can meet this with very short notice. If, on the other hand, patients are discharged or rerouted, these additional nurses can be cancelled at short notice, and the TES provider picks up the hospital’s slack and answers it with flexible resources on demand. Additionally, when it comes to meeting the fluctuating demand for speciality staff, a TES partner will become indispensable.

Equitability and affordability depend on agility

Ultimately, regardless of when the NHI comes to fruition, healthcare institutions should begin partnering with a TES provider if they haven’t already. Along with providing medical professionals on demand, this comes with cost-saving benefits for the hospital or clinic. Not having to employ full-time staff to meet fluctuating needs is a cost-saving exercise. Not only from a wage standpoint but also from an HR perspective in terms of payroll, industrial relations and skills development. The TES partner is responsible for all aspects of the employment relationship, while the healthcare institution gains access to qualified healthcare professionals as needed, at a fixed rate on flexible terms. This means that as soon as hospitals decide to invest in making their wards and spaces bigger and more efficient, they will have access to the medical resources necessary to staff them in a manner that enables equitable access to quality healthcare.

Categories : Diet and Nutrition ExerciseTags :

Strength Training may Reduce Health Risks of a High-protein Diet

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Photo by Jonathan Borba on Unsplash

Progressive strength training using resistance can protect against the detrimental effects of a high-protein diet, according to new research in mice.

The study, published today as a Reviewed Preprint in eLife, presents what the editors describe as a valuable finding on the relationship between a high-protein diet and resistance exercise on fat accumulation and glucose homeostasis, supported by solid evidence. They say the findings will be relevant to dietitians and others trying to understand links between dietary protein, diabetes and exercise.

Dietary protein provides essential nutrients that control a wide variety of processes in the body and can influence health and lifespan. Protein consumption is generally thought of as good, promoting muscle growth and strength, especially when combined with exercise. Yet in people with a sedentary lifestyle, too much protein can increase the risk of heart disease, diabetes and death.

“We know that low-protein diets and diets with reduced levels of specific amino acids promote healthspan and lifespan in animals, and that the short-term restriction of protein improves the health of metabolically unhealthy, adult humans,” explains lead author Michaela Trautman, Research Assistant at the Department of Medicine, School of Medicine and Public Health, University of Wisconsin, US. “But this presents a paradox — if high dietary protein is so harmful, many people with high-protein diets or protein supplements would be overweight and at an increased risk of diabetes, whereas athletes with high-protein diets are among the most metabolically healthy.”

To examine the possibility that exercise can protect against the detrimental effects of a high-protein diet, the researchers used a progressive resistance-based strength training program in mice. The animals pulled a cart carrying an increasing load of weight down a track three times per week for a three-month period, or pulled an identical cart without any load for the same time period. One group of mice were fed a low-protein diet (7% of calories from protein) and a second group were fed a high-protein diet (36% of calories from protein). The team then compared the body composition, weight and metabolic measurements, such as blood glucose, of the different groups.

The results were as the team expected: the high-protein diet impaired metabolic health in sedentary mice pulling no weight; these mice gained excess fat mass compared to the low-protein diet mice. But in the mice pulling the increasing weight, a high-protein diet led to muscle growth especially in the forearm, and protected the animals from gaining fat. However, the exercise did not protect the mice from the effects of high protein on blood sugar control.

Additionally, although the high-protein-fed mice gained strength more quickly than the low-protein-fed mice, there was no difference in the maximum weight each set of mice could pull by the end of the study period, even though the mice fed high-protein diets were bigger and had larger muscles.

Although the evidence supporting the claims of the study was considered to be solid, the editors highlight a couple of limitations. For instance, the use of mice might limit the generalisability of the findings to humans, due to inherent physiological differences. The editors note that the findings would also be strengthened further by the inclusion of a direct investigation into the underlying molecular mechanisms responsible for the observed results.

“We know that many people deliberately consuming high-protein diets or consuming protein supplements to support their exercise regimen are not metabolically unhealthy, despite the body of evidence showing that high-protein levels can have detrimental metabolic effects,” says senior author Dudley Lamming, Associate Professor of Medicine (Endocrinology) at the Department of Medicine, School of Medicine and Public Health, University of Wisconsin. “Our research may explain this conundrum, by showing that resistance exercise protects from high-protein-induced fat gain in mice. This suggests that metabolically unhealthy, sedentary individuals with a high-protein diet or protein supplements might benefit from either reducing their protein intake or more resistance exercise.”

Source: eLife

Categories : Lab Tests and ImagingTags :

Eyes may be the Window to the Soul, but the Tongue Mirrors Health

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Photo by Andrea Piacquadio

A 2000-year-old practice by Chinese herbalists – examining the human tongue for signs of disease – is now being embraced by computer scientists using machine learning and artificial intelligence.

Tongue diagnostic systems are fast gaining traction due to an increase in remote health monitoring worldwide, and a new paper in AIP Conference Proceedings provides more evidence of the increasing accuracy of this technology to detect disease.

Engineers from Middle Technical University (MTU) in Baghdad and the University of South Australia (UniSA) used a USB web camera and computer to capture tongue images from 50 patients with diabetes, renal failure and anaemia, comparing colours with a data base of 9000 tongue images.

Using image processing techniques, they correctly diagnosed the diseases in 94 per cent of cases, compared to laboratory results. A voicemail specifying the tongue colour and disease was also sent via a text message to the patient or nominated health provider.

MTU and UniSA Adjunct Associate Professor Ali Al-Naji and his colleagues have reviewed the worldwide advances in computer-aided disease diagnosis, based on tongue colour.

“Thousands of years ago, Chinese medicine pioneered the practice of examining the tongue to detect illness,” Assoc Prof Al-Naji says.

“Conventional medicine has long endorsed this method, demonstrating that the colour, shape, and thickness of the tongue can reveal signs of diabetes, liver issues, circulatory and digestive problems, as well as blood and heart diseases.

“Taking this a step further, new methods for diagnosing disease from the tongue’s appearance are now being done remotely using artificial intelligence and a camera – even a smartphone.

“Computerised tongue analysis is highly accurate and could help diagnose diseases remotely in a safe, effective, easy, painless, and cost-effective way. This is especially relevant in the wake of a global pandemic like COVID, where access to health centres can be compromised.”

Diabetes patients typically have a yellow tongue, cancer patients a purple tongue with a thick greasy coating, and acute stroke patients present with a red tongue that is often crooked.

A 2022 study in Ukraine analysing tongue images of 135 COVID patients via a smartphone showed that 64% of patients with a mild infection had a pale pink tongue, 62% of patients with a moderate infection had a red tongue, and 99% of patients with a severe COVID infection had a dark red tongue.

Previous studies using tongue diagnostic systems have accurately diagnosed appendicitis, diabetes, and thyroid disease.

“It is possible to diagnose with 80% accuracy more than 10 diseases that cause a visible change in tongue colour. In our study we achieved a 94% accuracy with three diseases, so the potential is there to fine tune this research even further,” Assoc Prof Al-Naji says.

Source: University of South Australia

Categories : Dermatology Immune SystemTags :

When This Itch Cytokine ‘Talks’, Neurons Respond

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Photo by FOX

Scratching an itch can be a relief, but for many patients it can get out of control, becoming a serious health problem. So what normally stops this progression?

A paper published in Science Immunology reports a breakthrough that could transform how doctors treat conditions from atopic dermatitis to allergies, they have discovered a feedback loop centred on a single immune protein called IL-31 that both causes the urge to itch and dials back nearby inflammation.

The findings, by Scientists at UC San Francisco, lay the groundwork for a new generation of drugs that interact more intelligently with the body’s innate ability to self-regulate.

Previous approaches suggested that IL-31 signals itch and promotes skin inflammation. But the UCSF team discovered that nerve cells, or neurons, that respond to IL-31, triggering a scratch, also prevent immune cells from overreacting and causing more widespread irritation.

“We tend to think that immune proteins like IL-31 help immune cells talk to one another, but here, when IL-31 talks to neurons, the neurons talk right back,” said Marlys Fassett, MD, PhD, UCSF professor of dermatology and lead author of the study. “It’s the first time we’ve seen the nervous system directly tamp down an allergic response.”

The discovery could eventually change how asthma, Crohn’s and other inflammatory diseases are treated, due to IL-31’s presence throughout the body.

“IL-31 causes itch in the skin, but it’s also in the lung and in the gut,” said Mark Ansel, Ph.D., UCSF professor of immunology and senior author of the study. “We now have a new lead for fighting the many diseases involving both the immune and nervous systems.”

More than an itch

IL-31 is one of several “itch cytokines” because of its ability to instigate itch in animals and people. Fassett, a dermatologist and a researcher, has wanted to know why since she arrived at UCSF in 2012, a few years after its discovery. She reached out to Ansel, a former colleague and asthma expert who welcomed her into his lab.

First, Fassett removed the IL-31 gene from mice and exposed them to the house dust mite, a common, itchy allergen.

“We wanted to mimic what was actually happening in people who are chronically exposed to environmental allergens,” Fassett said. “As we expected, the dust mite didn’t cause itching in the absence of IL-31, but we were surprised to see that inflammation went up.”

Why was there inflammation but no itching? Fassett and Ansel found that a cadre of immune cells had been called into action in the absence of the itch cytokine. Without IL-31, the body was blindly waging an immunological war.

IL-31 brings balance to the forces

Ansel and Fassett then homed in on the nerve cells in the skin that received the IL-31 signal. They saw that the same nerve cells that spurred a scratch also dampened any subsequent immune response. These nerve cells were integral to keeping inflammation in check, but without IL-31, they let the immune system run wild.

The findings squared well with what dermatologists were increasingly seeing with a new drug, nemolizumab, which blocked IL-31 and was developed to treat eczema. While clinical trial patients found that the dry, patchy skin of their eczema receded on the drug, other skin irritation, and even inflammation in the lungs, would sometimes flare up.

“When you give a drug that blocks the IL-31 receptor throughout the whole body, now you’re changing that feedback system, releasing the brakes on allergic reactions everywhere,” Ansel said.

Fassett and Ansel also found that these neurons released their own signal, called CGRP, in response to the itch signal, which could be responsible for dampening the immune response.

“The idea that our nerves contribute to allergy in different tissues is game changing,” Fassett said. “If we can develop drugs that work around these systems, we can really help those patients that get worse flares after treatment for itch.”

Fassett recently founded her own lab at UCSF to tease apart these paradoxes in biology that complicate good outcomes in the clinic. And Ansel is now interested in what this itch cytokine is doing beyond the skin.

“You don’t itch in your lungs, so the question is, what is IL-31 doing there, or in the gut?” Ansel asked. “But it does seem to have an effect on allergic inflammation in the lung. There’s a lot of science ahead for us, with immense potential to improve therapies.”

Source:

Categories : Medical IndustryTags :

Sharing Health Data Saves Lives: Showcasing the CareConnect Health Information Exchange in Action in SA

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In a nation where healthcare has been marred by disjointed systems and fragmented care, South Africa’s healthcare organisations are making strides to change this narrative.

South Africa’s health journey has faced challenges with siloed information, often paper-based systems, and a lack of information flow between health professionals, funders and health facilities. These barriers have significantly impacted the cost, quality, and access to healthcare for patients. In response, the Competition Commission’s Health Market Inquiry (HMI) panel spotlighted the urgent need for solutions that bolster transparency, coordination, and innovation.

South Africa’s first industry-wide health information exchange, CareConnect HIE, is a game-changing initiative and the brainchild of major hospital groups, including Life Healthcare, Mediclinic, and Netcare, coupled with leading medical scheme administrators like Discovery Health, Medscheme, and Momentum Health. Their shared vision? An interoperable health system that breaks historic barriers, promoting enhanced patient care, quality, and efficiency. This transformative approach to healthcare was showcased in action at an event in Sandton today, providing attendees a firsthand look at the potential of HIE in South Africa.

Since its launch in August 2022, CareConnect HIE has rapidly advanced, with over 5.2 million consented lives now integrated into the system. However, the true value – from population health benefits to progressive funding and health delivery models – exponentially increases as the amount of data on the exchange grows.  Therefore, the aim of the HIE is to be the hub of exchange and the single integration point for ALL health data – from both the public sector and the private sector. Bearing testament to this, representatives from the South African Private Practitioners Forum,  the Radiological Society of SA, Mediclinic, Discovery Health, Altron and Momentum Health will share their insights on how HIE will be used in their organisations. In addition, representatives from the Western Cape Department of Health will talk to the public-private collaboration with CareConnect.  

CareConnect has adopted a set of international standards (FHIR and HL7) to transfer and share data between various healthcare systems regardless of how it is stored in those systems.  These standards underpin interoperability because all participants are ‘speaking the same language’.  An interoperable health system will be critical in achieving Universal Health Coverage (UHC) which will require the ability for patients to move seamlessly between the public and private health sectors, facilities, clinicians or other service providers, depending on the expertise and care they require. To this end, there is engagement with the National Department of Health, who were represented at the event.

Dr Rolan Christian, CEO of CareConnect HIE

Central to the CareConnect HIE is a Unified Care Record (UCR), an electronic medical record that holds a patient’s entire medical journey. This constantly updated and ever-evolving record gives clinicians on-demand access to consolidated patient data, promoting swift, well-informed treatment decisions when and where they are needed.

Privacy and security of data is critical to the success of HIE. The CareConnect HIE conforms to both local and international data privacy regulations to ensure that sensitive health information remains protected at all times and will only be accessible to healthcare providers when medically necessary and only with the patient’s consent. User-based access permissions are automatically regulated by the HIE, further safeguard­ing sensitive patient information.

Sharing health data saves lives. The more data the industry shares, the more value and benefit to the patient that will be extracted from the HIE.

Dr Rolan Christian, CEO of CareConnect HIE

CareConnect’s innovative new use cases, ranging from tracking acute and chronic patient conditions, listing allergies and adverse reactions, to standardising doctor clinical (discharge) summaries, were demonstrated at the event. These features will enable better coordination of care, minimise medical errors and pave the way to a more cohesive health system. 

HIE in various forms has become common across many health systems in the world and has become a priority on many a government health policy agenda as a solution to achieving greater cohesion within health systems  and as a mechanism to address cost and quality issues in health. Reflecting global best practices, the CareConnect HIE aligns with the world’s most mature HIEs and breathes life into the National Department of Health’s National Health Digital Strategy for South Africa.  This important document outlines the country’s goals towards the development of electronic health records and building interoperability and linkages between existing patient-based information systems.

A strict code of ethics relating the use of information is governed by an internationally recognised and best practice multi-party trust agreement, called DURSA. The DURSA provides a framework that deals with sharing of data among HIE participants and defines the permitted purpose for which the data can only be used.

Dr Rolan Christian, CEO of CareConnect HIE shared: “Sharing health data saves lives. The more data the industry shares, the more value and benefit to the patient that will be extracted from the HIE. We envision that CareConnect HIE will become a ‘utility’ for the entire health sector – to enable improved quality of care, better health outcomes and a more responsive health system.”

The event today boasted a stellar lineup of speakers. Notably, Dr Stavros Nicolaou from B4SA and Aspen Pharmacare and Dominick Bizzarro, offering international perspectives from MVP Health Care, joined other industry luminaries. Their combined insights painted a promising future for healthcare – one that’s harmonised, transparent, and unequivocally cantered on the patient.

Categories : Healthcare Politics and RegulationsTags :

With Funding and Partnerships, Africa’s Healthcare Sector can Become More Capable

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Photo by Sora Shimazaki

By Robert Appelbaum & Prelisha Singh, Partners at Webber Wentzel

In Africa, dysfunctional governments are often unable to allocate sufficient funds for essential aspects of healthcare. This results in a shortage of new primary and specialised hospitals, little local pharmaceutical and medical device manufacture and the inability to train doctors beyond undergraduate level, creating a shortage of medical specialists.

In a recent seminar hosted by Invest Africa and moderated by Webber Wentzel, panelists Silven Chikengezha, Liza Eustace, Jen Pedersen, Jasen Smallbone and Dr Sue Tager, shared their insights on how to tackle the problems of financing healthcare in Africa, and building a pipeline of medical professionals who remain in Africa.

Funding

From the perspective of the IFC, the obvious need for greenfield hospitals in Africa is not sufficient to attract funding. To be attractive, projects need to meet certain criteria.

The first is that it must have a sponsor with experience in construction and operations. The second is that it has to have the potential to grow. It takes at least three years for a hospital to start making returns. Primary care is an identified area of potential growth on the continent, but it offers low margins so it needs to build up volumes. If the hospital is a primary healthcare facility that addresses an identified need in the local community, it is more likely to attract reliable footfall. But there is very little revenue in basic services like treating TB, AIDS and giving vaccination, so the facility should offer a range of affordable treatments.

The third criterion for any hospital project seeking funding is that it should have, or will be able to attract suitably qualified staff. Doctors like to work in complementary practice groups, so the hospital should be able to offer an attractive environment for medical professionals.

The next important issue is the certainty of cash flow. Although government-sourced revenue for the hospital can provide a steady income stream, governments can be slow payers. It is important to look at each government’s history of making timely payments. Commercial banks will also consider the affordability of the hospital’s services, given that a very small proportion of Africa’s population has medical insurance. In some countries, governments require employers to pay their employees’ medical bills, which provides a level of comfort to the banks. Technology can help to improve affordability, for example, innovations such as monitors that track the temperature of heat-sensitive medicines in transit, which reduces wastage.

A fifth critical issue for funders is the way the funding is structured. If a large hospital project is structured with 60-70% debt from its initial stages, it is likely to struggle to meet interest payments. It is better to start with a smaller facility that is scaleable, and structure the funding so that there is more equity than debt in the early years.

ABSA noted that they would seek strong equity holders before considering debt, and they will look carefully at who the main equity funders are. This is an area where the IFC and other Development Finance Institutions (DFIs) can play a role because they are usually willing to take the “first loss” risk, which encourages commercial banks to extend debt. Commercial banks take comfort from developers with strong balance sheets.

An emerging source of funding for healthcare projects in Africa (as well as other projects, such as in energy, water and education) are social impact bonds, in which an institutional funder will lend money to an implementer that can correctly manage a project that meets a need – often a need identified by the government. Corporates should be pooling their available funds to create scaleable projects that will make an impact.

If healthcare financing is intended to support existing service providers in Africa, it has to adapt to the capacity of what are often very small- to medium-sized businesses. These businesses, which may be anything from manufacturers of medical devices to providers of digi-health services, need far less than USD 20 million, so they tend to be ignored. But funding is essential to help established businesses build scale. This is another area where DFIs and commercial banks working together can help, as the DFI can provide the first loss facility which allows commercial banks to take risk on smaller clients.

Public-private partnerships

The pandemic made it clear that perceived obstacles between public and private entities in providing healthcare together could be overcome if there was the right will and people in the room.

Speakers discussed the Wits Donald Gordon Medical Centre as an example of a successful PPP, which could be replicated elsewhere. The Donald Gordon offers treatment to the private sector, and the derived profits are used to train medical students from Wits University, which is the public partner. The centre also performs liver transplants for all patients, both public and private. Mediclinic has a share in Donald Gordon but does not receive dividends. All profits are recycled back into the hospital.

A PPP model for the provision of healthcare needs partners who have similar levels of sophistication and can work together. Governments have to appreciate that the role of the private sector is not merely to bring money so that the government can continue running things the way they have always done. Private sector partners should be allowed to introduce the levels of efficiency in delivery that are typically found in the private sector.