Day: June 14, 2024

Categories : Uncategorized

More Blood Transfusions may Improve Major TBI Outcomes 

On By ModernMedia
Photo by Charliehelen Robinson on Pexels

Increased use of blood transfusions after major traumatic brain injury could help patients in intensive care units to regain greater functional independence and a better quality of life.

Six months after a major traumatic brain injury (TBI), patients who benefited from this approach regained more functional independence and had a better quality of life than those subjected to a more restrictive approach, even though the combined incidence of death and major disability was not significantly different between the two treatment groups.

This is the conclusion of an international research team led by Alexis Turgeon, professor at Université Laval, Canada Research Chair in Neurological Critical Care and Trauma, critical care physician and researcher at CHU de Québec-Université Laval, whose work is published today in the New England Journal of Medicine.  

“This randomized clinical trial, initiated in 2017, was carried out in 34 hospital centres in Canada, the United Kingdom, France and Brazil. Its aim was to compare two blood transfusion strategies – one so-called restrictive and the other liberal – employed to care for people hospitalized in an intensive care unit following a TBI. These approaches differ in the degree of anemia, or the minimum hemoglobin concentration that must be present in patients’ blood before a blood transfusion can be given,” explains Professor Turgeon. 

“Most patients hospitalised after a TBI suffer from anemia, defined as low haemoglobin concentration, which could reduce oxygen transport to the brain during a period when it is most vulnerable,” points out François Lauzier, also a professor at Université Laval and who co-led the study with Professor Dean Fergusson of the Ottawa Hospital Research Institute. 

The restrictive approach consists in tolerating a low haemoglobin level before giving a transfusion, while a liberal approach aims to maintain high haemoglobin levels, thus giving more blood transfusion.  

“By improving oxygen transport to the brain during the acute phase of care, it may be possible to save more nerve cells in the days following a TBI, thereby preventing additional brain damage,” says Professor Turgeon. 

To conduct the study, the research team recruited 742 critically ill patients with moderate or severe TBI and anaemia defined as a haemoglobin level of 10g/dL or less during hospitalisation. Randomly divided into two groups, these individuals were subjected to one or other of the transfusion strategies during their stay in the intensive care unit. To maintain these thresholds, the care teams administered blood transfusions whenever necessary. 

Six months after TBI, the research team assessed the level of overall recovery for each group, including neurovegetative status, dependence on activities of daily living and impairments preventing resumption of activities that had been performed prior to TBI. “The combined incidence of death and major disability was not statistically different between the two groups, but seemed favouring the liberal strategy in all analyses,” says Professor Turgeon. What’s more, those treated using the liberal approach showed a higher functional independence measure and quality of life index than those treated using the restrictive approach.  

“In light of the overall results of our study and considering the safety of current blood transfusions, the liberal strategy is probably the option that should be preferred in the acute phase of care to improve long-term prognosis following TBI,” concludes Professor Turgeon. 

Source: Université Laval

Categories : Diseases, Syndromes and Conditions Pain ManagementTags :

In Knee Osteoarthritis, Inactivity may be more Complex than Believed

On By ModernMedia
Photo by Towfiqu barbhuiya

Knee osteoarthritis (OA) is a common cause of pain and joint stiffness. And while physical activity is known to ease symptoms, only one in 10 people regularly exercise. Understanding what contributes to patients’ inactivity is the focus of a world first study from the University of South Australia. Here, researchers have found that people with knee OA unconsciously believe that activity may be dangerous to their condition, despite medical advice telling them otherwise.

The study, published in PAIN, found that of those surveyed, 69% of people with knee pain had stronger implicit (unconscious) beliefs that exercise was dangerous than the average person without pain. It’s an interesting finding that not only highlights the conflicted nature of pain and exercise, but also that what people say and what people think, deep down, may be entirely different things.

Lead researcher, and UniSA PhD candidate based at SAHMRI, Brian Pulling, says the research provides valuable insights for clinicians treating people with knee OA.

“Research shows that physical activity is good for people with knee OA, but most people with this condition do not move enough to support joint or general health,” Pulling says.

“To understand why people with OA might not be active, research studies typically use questionnaires to assess fear of moving. But unfortunately, questionnaires are limited – what we feel deep down (and how our system naturally reacts to something that is threatening) may be different to what we report. And we still know that many people are avoiding exercise, so we wanted to know why.”

To assess this, the researchers developed a tool that can detect and evaluate people’s implicit beliefs about exercise; that is, whether they unconsciously think activity is dangerous for their condition.

“We found that that even among those who said they were not fearful about exercise, they held unconscious beliefs that movement was dangerous,” Pulling says.

“Our research shows that people have complicated beliefs about exercise, and that they sometimes say one thing if asked directly yet hold a completely different implicit belief.

“People are not aware that what they say doesn’t match what they choose on the new task; they are not misrepresenting their beliefs.

“This research suggests that to fully understand how someone feels about an activity, we must go beyond just asking directly, because their implicit beliefs can sometimes be a better predictor of actual behaviour than what people report. That’s where our tool is useful.”

The online implicit association test presents a series of words and images to which a participant must quickly associate with being either safe or dangerous. The tool intentionally promotes instant responses to avoid deliberation and other influencing factors (such as responding how they think they should respond).

Associate Professor Tasha Stanton says that the new tool has the potential to identify a group of people who may have challenges increasing their activity levels and undertaking exercise.

“What people say and what people do are often two different things, Assoc Prof Stanton says.

“Having access to more accurate and insightful information will help health professionals better support their patients to engage with activity and exercise. It may also open opportunities for pain science education, exposure-based therapy, or cognitive functional therapy…things that would not usually be considered for someone who said that they were not scared to exercise.”

Researchers are now looking to see if implicit beliefs are directly associated with behaviour and are asking for people to complete the Implicit Association Test (takes seven minutes). At the end of the test participants are given their results in comparison to the rest of the population.

To take the test, please click here: https://unisasurveys.qualtrics.com/jfe/form/SV_0OZKUqzBNtiKGF0

Source: University of South Australia

Categories : Lab Tests and ImagingTags :

New Biomarker Database for Astronaut Health may be Useful to Earthlings

On By ModernMedia
Photo: Pixabay CC0

As space travel becomes more frequent, a new biomarker tool was developed by an international team of researchers to help improve the growing field of aerospace medicine and the health of astronauts.

Dr Guy Trudel (Professor in the Faculty of Medicine), Odette Laneuville (Associate Professor, Faculty of Science, and Director of the Biomedical Sciences) and Dr Martin Pelchat (Associate Professor in the Department of Biochemistry, Microbiology and Immunology) are among the contributors to an international study led by Eliah Overbey of Weill Cornell Medicine and the University of Austin. Published today in Nature it introduces the Space Omics and Medical Atlas (SOMA), a database of integrated data and sample repository from a diverse range of space missions, including from SpaceX and NASA.

Space travel creates cellular, molecular, and physiological shifts in astronauts. SOMA is expected to provide a much necessary biomedical profiling that can help tease out the short and long-term health impacts of spaceflight. This will bring needed health monitoring, risk mitigation, and countermeasures baseline data for upcoming lunar, Mars, and exploration-class missions. It is meant to help keep astronauts and space travellers alive and healthy.

It may also have some intended use here on Earth.

“This represents a breakthrough in the study of human adaptation and life in space. Since many of the changes in astronaut in space resemble those of people who are immobile in bed, these studies can be clinically relevant. The data are therefore important for future space exploration while also providing a correlation to people on Earth with limited mobility or who are bedridden before their rehabilitation,” says Dr Trudel, a rehabilitation physician and researcher at The Ottawa Hospital who has focused on space travel and its effects on the human immune system.

Highlights of the study, include:

  • The Atlas includes extensive molecular and physiological profiles encompassing genomics, epigenomics, transcriptomics, proteomics, metabolomics, and microbiome data sets, which reveal some consistent features across missions.
  • Samples were taken pre-flight, during, post-flight and throughout the recovery period.
  • Comprehensive profile of the physiological changes of the I4 crew (ages 29, 38, 42, 51) and 13 unique biospecimen sample types were collected and processed.
  • 2911 samples were banked with over 1000 samples processed for sequencing, imaging, and biochemical analysis creating the first-ever aerospace medicine biobank.
  • The SOMA resource represents an over 10-fold increase in total publicly available human space omics data.

“The University of Ottawa’s Faculty of Medicine, its Faculty of Science, and The Ottawa Hospital’s Bone and Joint Research laboratory have a long history of contributions and successes in studying human adaptation to space. They also involve students from different programs, providing a unique learning experience in both bone and joint health, and in the rapidly developing field of aerospace medicine,” adds Dr Trudel.

Source: University of Ottawa

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Debunking Myths: The Truth About Medical Schemes in South Africa 

On By ModernMedia

Despite the promise of Universal Health Coverage (UHC) for all, the recent signing of the NHI Bill has brought with it several misconceptions around medical schemes that undermine the very foundation of our healthcare system, writes Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders (BHF).

In a historic move aimed at transforming the South African healthcare landscape, President Cyril Ramaphosa signed the National Health Insurance (NHI) Bill into law. This landmark decision promises to move South Africa towards Universal Health Coverage (UHC) for all citizens, regardless of socio-economic status.

While the goal of UHC is commendable, the rhetoric leading up to the NHI Act’s announcement has created misconceptions about the role of medical schemes. 

With many believing that they should cancel their memberships immediately to enjoy free health services for the foreseeable future. However, Dr Katlego Mothudi clarifies that the implementation of NHI will take several years, dispelling this misconception.

The NHI Act introduces a single-payer system, central to the idea is that healthcare is a ‘public good’, suggesting all healthcare funding should exclude medical schemes, and should be government-funded. Dr Mothudi counters that healthcare is more accurately described as a social good. A public good, like military services, is one that the government must provide and from which no one can be excluded, regardless of payment. While healthcare is essential, it is not feasible to provide it as a public good.

The Board of Healthcare Funders (BHF), concerned about the numerous misconceptions propagated by government representatives since 2009, commissioned Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at Wits Health Consortium, to investigate these claims. Despite their hyperbolic nature and lack of systematic research, these statements have significant weight due to their endorsement by influential individuals. Prof van den Heever’s report identified frequently repeated assertions that he concluded were unsubstantiated and untrue.

Key Findings from the Report:

1. Medical Schemes are Unsustainable – False

In 2009, claims suggested that many medical schemes were headed for collapse due to unsustainable financing models, with 18 schemes reportedly nearing insolvency. Prof van den Heever’s report refutes this, showing stability in medical schemes from 2005 to 2022. The number of beneficiaries increased by over one million from 2009 to 2022, with consolidated reserves of R114 billion in 2022, far exceeding the required 25% reserve ratio. Broker costs have not been a systemic concern, and total non-health costs per average beneficiary per month for all medical schemes decreased by 34.7% in real terms from 2005 to 2020.

2. Health Services are a Public Good – False

   In 2011, Health Minister Aaron Motsoaledi claimed that private healthcare was a “brutal system” due to commercialisation. However, Prof. van den Heever clarified that healthcare is not a public good in the economic sense, as it does not meet the criteria of being jointly consumed without exclusion. Healthcare is a crucial service but providing it as a public good is not feasible.

3. Most Medical Scheme Beneficiaries are White – False

Last year, Prof Olive Shisana, an honorary professor at the University of Cape Town and special advisor to President Ramaphosa, stated that the private sector predominantly serves the privileged white population. However, Statistics South Africa’s 2021 research indicates that of the total population utilising private healthcare services, 50.2% are Black African, 32.3% are White, 9.8% are Coloured, and 7.6% are Indian/Asian.

Need for Balanced Perspectives

While the BHF supports healthcare reform, it raises concerns about the NHI Act’s constitutionality and calls for a factual review of claims about medical schemes. It is crucial to present both sides of the debate to understand the implications fully. Including government perspectives and addressing how the NHI will affect individual citizens would provide a more comprehensive view.

Medical schemes remain a valuable national asset that plays a crucial role in ensuring the long-term viability of South Africa’s healthcare ecosystem. BHF advocates for a balanced approach to healthcare reform that considers both public and private sectors’ strengths and weaknesses.

For a comprehensive look at findings from the report commissioned by BHF, see Prof van den Heever’s presentation at the 2024  Annual BHF Conference here. (Click to download PDF)