Tag: 10/11/23

Categories : CancerTags : Leave a comment

Study Confirms Link between CT Scans in Young People and Increased Risk of Cancer

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A multinational study of almost one million individuals confirms a strong and clear association between radiation exposure from CT scans in young people and an increased risk of blood cancers. These results, published in Nature Medicine, highlight the importance of continuing to apply strict radiological protection measures, particularly in paediatric populations. 

The benefits of computed tomography (CT) for imaging in patient management (including diagnostic efficacy, treatment planning and disease follow-up) are undisputed. But in recent decades the extensive use of this procedure has raised concerns about the potential cancer risks associated with exposure to ionising radiation, particularly in young patients.

“The exposure associated with CT scans is considered low (less than 100mGy), but it is still higher than for other diagnostic procedures,” says Elisabeth Cardis, Head of the Radiation Group at ISGlobal and senior author of the study. Previous studies have suggested an increased risk of cancer in in children exposed to CT scans, but they had several methodological limitations.

To address these limitations, clinicians, epidemiologists and dosimetrists from nine European countries (Belgium, Denmark, France, Germany, Netherlands, Norway, Spain, Sweden, and UK) came together to conduct a multinational, European-funded study, EPI-CT, coordinated by the International Agency for Research on Cancer (IARC).

“Implementing this large, multinational study was challenging – it involved extracting data from radiology records of 276 hospitals and linking them to population-based registries in nine countries, all while maintaining the confidentiality of the individuals’ data,” says Cardis.

A dose-dependent association

The study analysed data from almost one million people, who underwent at least one CT scan before the age of 22. The dose of radiation delivered to the bone marrow, where blood cells are produced, was estimated for each person. By linking this information to national cancer registries, EPI-CT researchers were able to identify those who developed a blood cancer over time. Individuals were followed for an average of 7.8 years, although for those who had CT scans in the early years of the technology, researchers were able to monitor cancer incidence for more than 20 years after the first scan.

The results show a clear association between the total radiation doses to the bone marrow from CT scans and the risk of developing both myeloid and lymphoid malignancies. A dose of 100mGy approximately tripled the risk of developing a blood cancer. These results suggest that a typical scan today (with an average dose of about 8mGy) increases the risk of developing these malignancies by about 16%. “In terms of absolute risk, this means that, for every 10 000 children who have a CT scan, we can expect to see about 1–2 cases of cancer in the 12 years following the examination,” says first author Magda Bosch de Basea, ISGlobal researcher at the time of the study.

The authors point out that more work is needed to ensure that doses and technical parameters are systematically and adequately collected in the clinics in real time to further improve risk estimates in the future.

Public health implications

Today, more than one million children in Europe undergo CT scans every year. Although radiation doses from CT scans have decreased substantially in recent years, the findings of this study underline the need to raise awareness among the medical community and to continue to apply strict radiation protection measures, especially in the youngest patients. “The procedure must be properly justified – taking into account possible alternatives – and optimised to ensure that doses are kept as low as possible while maintaining good image quality for the diagnosis,” Cardis explains. 

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Categories : COVIDTags : 1 Comment

WHO Updates COVID Treatment Guidelines

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A panel of international experts representing the World Health Organization’s (WHO) Guideline Development Group has updated its guidance on treatments for patients with COVID.

The new recommendations published by The BMJ are part of a living guideline, developed by the WHO with the methodological support of MAGIC Evidence Ecosystem Foundation, to provide up to date, trustworthy guidance on the management of COVID and help doctors make better decisions with their patients.

The guidance incorporates the latest clinical trial evidence for existing and new COVID therapies and takes account of evidence relating to safety, prognosis, resources, access, and equity issues, as well as patient values and preferences. 

The updates include:

  • Distinct risk categories to help doctors more accurately assess whether an individual is at high, moderate, or low risk of hospital admission and tailor treatment accordingly.
  • A new treatment benefit threshold of 1.5% (down from 6%) reduction in the risk of hospital admission. This reflects the lower baseline risk for most patients with non-severe COVID as well as more safety evidence and wider availability of therapies.
  • A recommendation to use the antiviral drug nirmatrelvir-ritonavir in patients with non-severe COVID at high and moderate risk of hospital admission.
  • A recommendation against use of the antiviral drugs remdesivir and molnupiravir for patients with non-severe COVID at moderate and low risk of hospital admission (treatment is suggested for patients at high risk of admission).
  • A recommendation against use of a new antiviral (VV116) for patients with COVID except in clinical trials, regardless of illness severity.
  • A strong recommendation against the use of ivermectin for patients with non-severe COVID(advice against use of ivermectin in patients with severe or critical COVID, except in clinical trials, still exists).

The experts say the new recommendations reflect changes in the virulence and transmissibility of circulating SARS-CoV-2 variants and sub-variants, along with changes in immunity related to global vaccinations, which have led to lower baseline risks of severe illness and death for most patients with non-severe COVID.

They acknowledge that there are still uncertainties around COVID therapeutics and emerging evidence and say these recommendations need to be used in light of these uncertainties.

An interactive decision support tool is available to accompany this guidance.

Source: The BMJ

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Medshield Medical Scheme And Clicks Strengthen Their Partnership to Enhance Access to Quality Care Through Medshield’s Smartcare Benefits

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Medshield Medical Scheme, a prominent medical aid scheme, and Clicks, a leading retail pharmacy chain and Designated Service Provider on the Medshield Pharmacy and SmartCare Networks, are pleased to announce the expansion and enhancement of their partnership. This partnership aims to empower members with even greater access to quality care through Medshield’s SmartCare benefit, allowing access to a network of Clicks clinics for professional nurse and nurse-led virtual Family Practitioner (GP) consultations. This further cements their commitment to delivering healthcare excellence through technology.

Expanding the SmartCare Network

Medshield and Clicks have partnered to add 123 Clicks clinics to the existing 255 clinics in the SmartCare Network. This expansion guarantees that Medshield members can conveniently and efficiently access their SmartCare benefits at these selected Clicks clinics.

SmartCare: The Gateway to Modern Healthcare

Medshield’s flagship member benefit, SmartCare, is leading the charge in digital innovation in healthcare. By utilising the power of technology, SmartCare provides access to pharmacy clinics that offer a one-stop-shop for members to access professional nurse consultations, health risk assessments, sick notes, specialist referrals, medication and nurse-led virtual access to Family Practitioners (GP) when required. This benefit is redefining the way healthcare services are accessed and delivered, making it more convenient and efficient for both healthcare providers and members.

Medshield members have access to an unprecedented level of convenience through Clicks clinics, which are powered by the Udok telemedicine solution. These consultations cover prevention, diagnosis, and treatment, focusing on connecting patients, nurses, doctors, and medication for fast and convenient care.

Kevin Aron, Principal Officer at Medshield, explains, “When we introduced SmartCare, we aimed to offer a cutting-edge solution that would add more value for our members. Medshield was the pioneer medical scheme in South Africa to integrate this service as a new benefit for all members, without additional costs.”

The Medshield SmartCare Benefit

SmartCare offers a multitude of benefits to Medshield members, providing them with a holistic approach to healthcare:

  • Enhanced Access to Care: SmartCare provides Medshield members with easy access to quality care led by professional, licensed nurses at pharmacy clinics. The nurse will facilitate a virtual Family Practitioner (GP) consultation depending on the patient’s ailment. Once the patient has been diagnosed and treatment prescribed, the relevant medication is easily obtained from the pharmacy.  
  • Stretch day-to-day medical aid benefits:  Healthcare services offered by SmartCare pharmacy clinics such as Clicks are cost-effective, and enable members to receive quality care and their medication as a complete solution. Utilising the SmartCare benefits allows the member to receive quality care whilst minimising the use of their day-to-day benefit.
  • Improved Health Outcomes: SmartCare services implemented by pharmacy providers allow members to manage and receive preventative care through wellness checks and health risk assessments, providing access to early intervention services and ultimately leading to better health outcomes. 

The Vision of Collaboration

“We are excited to announce our enhanced partnership with Clicks, a valued partner on the Medshield DSP Network. With the addition of 123 Clicks clinics to the SmartCare Network, we are reinforcing our commitment to provide Medshield members with access to high-quality healthcare services,” said Kevin Aron, Principal Officer at Medshield. “SmartCare is revolutionising healthcare delivery, and we are proud to offer this innovative solution to our members.”

The Medshield SmartCare way of adding value:

  • A Medshield member can visit any Clicks clinic on the SmartCare network for primary healthcare needs such as acute conditions, wellness checks, health risk assessments, vaccinations, or chronic medication prescriptions as prescribed by a Family practitioner (GP).
  • A registered nurse performs a thorough medical history and examination of the patient.
  • The nurse can advise the patient on over-the-counter medication available at the pharmacy.
  • A virtual consultation with a family practitioner is requested by the nurse through Clicks clinic’s Udok technology when further treatment is necessary. The doctor then completes the consultation with the assistance of the nurse.
  • The nurse can print the doctor’s written documentation, and the patient can fill their prescription at the pharmacy immediately.

Accessible Medications and Comprehensive Care

In addition to SmartCare consultations, Clicks pharmacies are available on all Medshield plans, making access to prescription medication convenient for members.

Rachel Wrigglesworth, Clicks’ Chief Healthcare Officer stated, “This partnership between Clicks and Medshield focuses on the wellbeing of our customers, which is our top priority. The collaboration has expanded to include Clicks clinics powered by Udok, a solution that offers real-time access to registered family practitioners through our Nurse-led consultations on the SmartCare benefit, funded by Medshield Medical Scheme. As a leader in the healthcare market, this partnership perfectly aligns with our commitment to increasing access to affordable primary healthcare for all South Africans. We are committed to the continued success of this collaboration.”

Embracing the Future of Healthcare

As the healthcare industry continues to evolve in the digital age, SmartCare stands as a shining example of how technology and innovation come together to provide added convenience and efficiency in healthcare. It empowers nurses to provide additional care for Medshield members through accessible technology. Unless it is a trauma situation, members can visit a Clicks clinic on the SmartCare network for acute and chronic conditions. By embracing the future of healthcare through the SmartCare benefit, Medshield members can expect to experience efficient and reliable medical consultations to enhance their wellbeing.

“Medshield is continuing to reinvent healthcare the smart way. The SmartCare benefit offers our members a new level of convenience, connecting members with nurses, doctors and medicine like never before,” concluded Aron.

A Strengthened Partnership

Expanding the Medshield and Clicks partnership demonstrates a solid commitment to providing excellent healthcare services and a shared vision of creating a more accessible and convenient healthcare experience for Medshield members. It is a testament to the excellent collaboration between Medshield and Clicks, ensuring that quality care is always easily accessible.

Categories : Ageing Immune SystemTags : Leave a comment

New Approach May Take the Guesswork out of Selecting Treatments for RA

On By ModernMedia
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New research reported in the journal Nature could lead to new targeted treatments for rheumatoid arthritis (RA). The findings showed that guesswork could be taken out of selecting treatments for each patient, and this might one day also be extended to other autoimmune conditions.

The study was led by University of Colorado School of Medicine faculty members Fan Zhang, PhD, and Anna Helena Jonsson, MD, PhD. The Accelerating Medicines Partnership: Rheumatoid Arthritis and Systemic Lupus Erythematosus (AMP: RA/SLE) Network collected inflamed tissue from 70 patients with RA from across the country and the United Kingdom. Jonsson supervised the team of scientists who processed these samples for analysis, and Zhang led the computation analysis of the data. These efforts yielded a cell atlas encompassing more than 300 000 cells from synovial tissue. Further analysis revealed that there are six different subgroups of RA based on their cellular makeup.

“We hope the data will help us discover new treatment targets,” says Jonsson, assistant professor of rheumatology. “We wanted to make it public so that researchers across the country and across the world can continue working on new treatment ideas for rheumatoid arthritis going forward.”

No more guess-and-check

Jonsson, a practicing rheumatologist as well as a researcher, knows that RA patients respond differently to different treatments. Until now, she says, rheumatologists used a “guess and check” method to find a treatment that works for an individual patient.

With the new data and powerful computational classification methods developed by Zhang and the computational analysis team, the researchers were able to quantitatively classify RA types into what they call ‘cell-type abundance phenotypes’, or CTAPs. Developed methods, together with the new cell atlas, can start to identify which patients will respond to which treatments.

“Even when you classify rheumatoid arthritis inflammation using these simple markers – T cell markers, B cells, macrophages and other myeloid cells, fibroblasts, endothelial cells – what we found is that each of those categories is associated with very specific kinds of pathogenic cell types we’ve already discovered,” Jonsson says. “Previous rheumatoid arthritis research found that T cell populations called peripheral helper T cells are relevant in rheumatoid arthritis, as are B cells called antibody-producing B cells, and other specific cell types. What we found is that they’re usually not found all together.

“For example, the peripheral helper cells are found with the B cells in only one category of RA, and the pathogenic macrophage populations tend to exist in a different category. Because of this, we can start asking questions about how these specific partners work together.”

Source: University of Colorado Anschutz Medical Campus

Categories : Cardiovascular DiseaseTags : Leave a comment

Anything is Better than Sitting for Cardiovascular Health – Including Sleeping

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Replacing sitting with as little as a few minutes of daily moderate exercise measurably improves heart health, according to new research from the University of Sydney and UCL.

The study, published in the European Heart Journal, is the first to assess how different movement patterns throughout the 24-hour day are linked to cardiovascular health. Although it was an observational study and could not attribute causation, it added to the growing body of evidence surrounding inactivity, especially sitting.

It is the first evidence to emerge from the international Prospective Physical Activity, Sitting and Sleep (ProPASS) consortium.

In this British Heart Foundation (BHF)-supported study, researchers at UCL analysed data from six studies, including 15 246 people from five countries, to see how movement behaviour across the day is associated with heart health, as measured by six common indicators. Each participant used a wearable device on their thigh to measure their activity throughout the 24-hour day and had their heart health measured.

The researchers identified a hierarchy of behaviours that make up a typical 24-hour day, with time spent doing moderate-vigorous activity providing the most benefit to heart health, followed by light activity, standing and sleeping compared with the adverse impact of sedentary behaviour.

The team modelled what would happen if an individual changed various amounts of one behaviour for another each day for a week, in order to estimate the effect on heart health for each scenario. When replacing sedentary behaviour, as little as five minutes of moderate-vigorous activity had a noticeable effect on heart health.

For a 54-year-old woman with an average BMI of 26.5, for example, a 30-minute change translated into a decrease in BMI of 0.64 (2.4%) Replacing 30 minutes of daily sitting or lying time with moderate or vigorous exercise could also translate into a 2.5cm (2.7%) decrease in waist circumference or a 1.33 mmol/mol (3.6%) decrease in HBa1c.

Dr Jo Blodgett, first author of the study from UCL Surgery & Interventional Science and the Institute of Sport, Exercise & Health, said: “The big takeaway from our research is that while small changes to how you move can have a positive effect on heart health, intensity of movement matters. The most beneficial change we observed was replacing sitting with moderate to vigorous activity – which could be a run, a brisk walk, or stair climbing – basically any activity that raises your heart rate and makes you breathe faster, even for a minute or two.”

The researchers pointed out that although time spent doing vigorous activity was the quickest way to improve heart health, there are ways to benefit for people of all abilities – it’s just that the lower the intensity of the activity, the longer the time is required to start having a tangible benefit. Using a standing desk for a few hours a day instead of a sitting desk, for example, is a change over a relatively large amount of time but is also one that could be integrated into a working routine fairly easily as it does not require any time commitment.

Those who are least active were also found to gain the greatest benefit from changing from sedentary behaviours to more active ones.

Professor Emmanuel Stamatakis, joint senior author of the study from the Charles Perkins Centre and Faculty of Medicine and Health at the University of Sydney, said: “A key novelty of the ProPASS consortium is the use of wearable devices that better differentiate between types of physical activity and posture, allowing us to estimate the health effects of even subtle variations with greater precision.”

Though the findings cannot infer causality between movement behaviours and cardiovascular outcomes, they contribute to a growing body of evidence linking moderate to vigorous physical activity over 24 hours with improved body fat metrics. Further long-term studies will be crucial to better understanding the associations between movement and cardiovascular outcomes.

Professor Mark Hamer, joint senior author of the study from UCL Surgery & Interventional Science and the Institute of Sport, Exercise & Health, said: “Though it may come as no surprise that becoming more active is beneficial for heart health, what’s new in this study is considering a range of behaviours across the whole 24-hour day. This approach will allow us to ultimately provide personalised recommendations to get people more active in ways that are appropriate for them.”

James Leiper, Associate Medical Director at the British Heart Foundation, said: “We already know that exercise can have real benefits for your cardiovascular health and this encouraging research shows that small adjustments to your daily routine could lower your chances of having a heart attack or stroke. This study shows that replacing even a few minutes of sitting with a few minutes of moderate activity can improve your BMI, cholesterol, waist size, and have many more physical benefits.

“Getting active isn’t always easy, and it’s important to make changes that you can stick to in the long-term and that you enjoy – anything that gets your heart rate up can help. Incorporating ‘activity snacks’ such as walking while taking phone calls, or setting an alarm to get up and do some star jumps every hour is a great way to start building activity into your day, to get you in the habit of living a healthy, active lifestyle.”

Source: University of Sydney