Tag: 7/11/24

Categories : Expert Opinion IT in HealthcareTags : Leave a comment

Opinion Piece: Business Continuity and Data Management – a Life-or-death Situation in Healthcare

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Photo by Nahel Abdul on Unsplash

By Hemant Harie, Group CTO at DMP SA / Gabsten Technologies

Ransomware attacks are a growing concern for healthcare facilities worldwide, with attacks wreaking havoc, including encrypting complex patient records, cancelling appointments, delaying life-saving surgeries, and even rerouting ambulances. The critical nature of healthcare services, combined with the sensitive personal and medical data they handle, makes hospitals and healthcare providers a prime target for cybercriminals.

When these systems are compromised, the impact is severe, jeopardising patient safety, disrupting service delivery and causing financial strain. It has become imperative for healthcare facilities to adopt more robust cybersecurity measures, including effective data management strategies as part of an overall business continuity approach. Partnering with an expert third-party service provider can assist healthcare facilities in ensuring continuity of care and business operations even in the face of cyberattacks.

Attractive targets with unique vulnerabilities

Digital transformation within the healthcare space, while vital for improving patient care,  can also introduce significant cybersecurity risks. Many hospitals and healthcare facilities are at different stages in their digital transformation , and legacy infrastructure is a common challenge, alongside immature cybersecurity posture and processes, making them more susceptible to attacks.

Cybercriminals often target these systems because they handle vast amounts of sensitive data, including Personal Health Information (PHI), which is highly valuable on the black market. In addition, these facilities often lack the dedicated IT and cybersecurity specialists they need to adequately defend against or recover from ransomware incidents.

The nature of information housed within healthcare and the consequences of a breach mean the stakes are high. This, combined with the fact that healthcare facilities are legally bound by regulations such as the Protection of Personal Information Act (PoPIA), Health Insurance Portability and Accountability Act (HIPAA) and General Data Protection Regulation (GDPR) to protect this information, means potential breaches could have catastrophic consequences.

The impact of ransomware on healthcare

Ransomware attacks can have devastating effects on healthcare organisations, leading to significant downtime that directly threatens patient care. Operations may be postponed or cancelled, disrupting treatment schedules and putting patients’ lives at risk. Additionally, the exposure of PHI can result in severe legal and ethical repercussions, including costly regulatory fines and lawsuits. Financial losses also extend to ransom payments, the cost of recovery, and reputational damage, all of which can linger long after the attack is resolved.

Moreover, a ransomware attack on one healthcare facility can damage the reputation of the entire network, as trust is critical in healthcare. Patients may be less likely to seek care from a hospital they perceive as insecure, leading to long-term financial and operational challenges.

Data management mitigates ransomware risks

To effectively combat ransomware, healthcare organisations must prioritise data management and cyber resilience. This starts with classifying and understanding the types of data being processed and stored , such as medical records, surgical files, and other critical patient information. Once this data is properly categorised, healthcare facilities can implement security controls that ensure the integrity and availability of the data.

Regular, automated backups stored offline are essential for mitigating ransomware risks. These backups allow facilities to restore their systems quickly without paying a ransom, minimising downtime and ensuring continuity of care. In addition to regular backups, hospitals should adopt advanced security measures such as multi-factor authentication, firewalls, and intrusion detection systems to safeguard against unauthorised access.

An expert partner enhances data management and security

Third-party service providers offer critical expertise and comprehensive solutions that healthcare organisations may lack in-house. These providers specialise in data management, backup, and disaster recovery, ensuring that hospitals have access to the latest technologies and best practices for defending against cyber threats. These experts bring valuable experience from handling multiple cyber incidents across various sectors, which can inform and improve the healthcare facility’s own data management practices. In addition to providing technical expertise, third-party providers can offer ongoing education, helping healthcare staff stay informed about the latest cybersecurity threats and recovery processes.

One of the key services offered by third-party providers is automated backup and disaster recovery solutions. These services typically include offsite storage, secure cloud options, and regular backups, all of which are vital for restoring data and reducing downtime during a ransomware attack. Offsite storage and cloud solutions also protect data from physical threats like floods or fires, adding an extra layer of security. In addition to traditional backup services, advanced tools can enhance data protection by providing early warning systems and simulating real-time production environments, which allow healthcare facilities to detect and respond to potential threats before they can cause damage. For example, scanning tools can identify which versions of data are clean and free from malware, enabling faster and more effective recovery.

Partnering with a third-party provider ensures that healthcare organisations have access to continuous support and the latest innovations in data protection. These providers not only help mitigate ransomware risks but also assist in compliance with industry regulations and offer scalable solutions to meet the growing needs of healthcare facilities.

As ransomware threats continue to rise, healthcare organisations must take proactive steps to safeguard their systems and protect patient data. Effective data management, including regular backups and disaster recovery plans, is essential for mitigating these risks. By partnering with third-party service providers, healthcare facilities can leverage specialised expertise and advanced technologies to enhance their cybersecurity defences and maintain continuity of care, even in the face of growing cyber threats.

Categories : Neurodegenerative DiseasesTags : Leave a comment

A New Era of Treating Neurological Diseases at the Blood-brain-immune Interface

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This is a pseudo-colored image of high-resolution gradient-echo MRI scan of a fixed cerebral hemisphere from a person with multiple sclerosis. Credit: Govind Bhagavatheeshwaran, Daniel Reich, National Institute of Neurological Disorders and Stroke, National Institutes of Health

The question of what causes complex neurological diseases such as Alzheimer’s or multiple sclerosis continues to confound scientists and doctors, with the unknowns standing in the way of early diagnoses and effective treatments.

Even among identical twins who share the same genetic risk factors, one may develop a particular neurological disease while the other does not.

That’s because unlike diseases such as cystic fibrosis or sickle-cell anaemia, which are caused by a single gene, most neurological disorders are associated with many, sometimes hundreds, of rare genetic variants. And on their own, these variants can’t predict who will develop disease, as neurological conditions are also strongly influenced by environmental factors and vascular risks such as high blood pressure, aging, heart disease, or obesity.

But there’s one often-overlooked thread that connects most neurological diseases, says Katerina Akassoglou, PhD, a senior investigator at Gladstone Institutes: They’re marked by a toxic immune reaction caused by blood that leaks into the brain through damaged blood vessels.

“Interactions between the brain, blood vessels, and the immune system are a common thread in the development and progression of many neurological diseases that have been traditionally viewed as very different conditions,” says Akassoglou. “Knowing that leaked blood is a key driver of brain inflammation, we can now approach these diseases from a different angle.”

She and her collaborators share their insights on this topic in a commentary article published in Cell’s 50th anniversary “Focus on Neuroscience” issue. 

Neutralising the Culprit

Akassoglou and her lab have long investigated how blood that leaks into the brain triggers neurologic diseases, essentially by hijacking the brain’s immune system and setting off a cascade of harmful often-irreversible effects that result in damaged neurons.

One blood protein in particular, fibrin, normally involved in blood coagulation, is responsible for setting off this detrimental cascade. The process has been observed in conditions as diverse as Alzheimer’s, traumatic brain injury, multiple sclerosis, premature birth, and even COVID-19. However, Akassoglou and her team found that the process could be prevented or interrupted by “neutralising” fibrin to deactivate its toxic properties – an approach that appears to protect against many neurological diseases when tested in animal models.

“As a first step, we know that neutralizing fibrin reduces the burden posed by vascular dysfunction,” Akassoglou says. Regardless of what initially caused the blood leaks, be it a head injury, autoimmunity, genetic mutations, brain amyloid or infection, neutralizing fibrin appears to be protective in multiple animal models of disease.

The scientists previously developed a drug, a therapeutic monoclonal antibody, that specifically targets fibrin’s inflammatory properties without affecting its essential role in blood coagulation. This fibrin-targeting immunotherapy has shown, in mice, to protect from multiple sclerosis and Alzheimer’s, and to treat neurological effects of COVID-19. A humanized version of this first-in-class fibrin immunotherapy is already in Phase 1 safety clinical trials by Therini Bio, a biotech company launched to advance discoveries from Akassoglou’s lab.

A New Era of Brain Research

In the Cell commentary, Akassoglou and her colleagues make the case that seemingly disparate neurological diseases must be viewed differently in light of new research on the blood-brain-immune interface.

They say that in the coming decade, scientific breakthroughs will emerge from collaborative networks of immunologists, neuroscientists, haematologists, geneticists, computer scientists, physicists, bioengineers, drug developers, and clinical researchers. These partnerships, forged across academia, industry, and foundations, will catalyse innovation in drug discovery and transform medical practice for neurological diseases.

“This is a new opportunity for drug discovery that goes beyond addressing genes alone or environmental factors alone,” Akassoglou says. “To usher in this new era, we must leverage new technologies and embrace an interdisciplinary approach that accounts for the important roles of immune and vascular systems in neurodegeneration.”

Source: Gladstone Institutes

Categories : Ageing NeurologyTags : Leave a comment

Extra Year of Education does Not Protect the Brain

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Photo by Andrea Piacquadio on Pexels

Thanks to a ‘natural experiment’ involving 30 000 people, researchers at Radboud university medical centre were able to very precisely determine the effect of an extra year of education to the brain in the long term. To their surprise, they found no effect on brain structure and no protective benefit of additional education against brain ageing. Their findings appear in eLife.

It is well-known that education has many positive effects. People who spend more time in school are generally healthier, smarter, and have better jobs and higher incomes than those with less education. However, whether prolonged education actually causes changes in brain structure over the long term and protects against brain ageing, was still unknown.

It is challenging to study this, because alongside education, many other factors influence brain structure, such as the conditions under which someone grows up, DNA traits, and environmental pollution. Nonetheless, researchers Rogier Kievit (PI of the Lifespan Cognitive Dynamics lab) and Nicholas Judd from Radboudumc and the Donders Institute found a unique opportunity to very precisely examine the effects of an extra year of education.

Ageing

In 1972, a change in the law in the UK raised the number of mandatory school years from 15 to 16, while all other circumstances remained constant. This created an interesting ‘natural experiment’, an event not under the control of researchers which divides people into an exposed and unexposed group. Data from approximately 30 000 people who attended school around that time, including MRI scans taken much later (46 years after), is available. This dataset is the world’s largest collection of brain imaging data.

The researchers examined the MRI scans for the structure of various brain regions, but they found no differences between those who attended school longer and those who did not. ‘This surprised us’, says Judd. ‘We know that education is beneficial, and we had expected education to provide protection against brain aging. Aging shows up in all of our MRI measures, for instance we see a decline in total volume, surface area, cortical thickness, and worse water diffusion in the brain. However, the extra year of education appears to have no effect here.’

Brain structure

It’s possible that the brain looked different immediately after the extra year of education, but that wasn’t measured. “Maybe education temporarily increases brain size, but it returns to normal later. After all, it has to fit in your head,” explains Kievit. “It could be like sports: if you train hard for a year at sixteen, you’ll see a positive effect on your muscles, but fifty years later, that effect is gone.” It’s also possible that extra education only produces microscopic changes in the brain, which are not visible with MRI.

Both in this study and in other, smaller studies, links have been found between more education and brain benefits. For example, people who receive more education have stronger cognitive abilities, better health, and a higher likelihood of employment. However, this is not visible in brain structure via MRI. Kievit notes: “Our study shows that one should be cautious about assigning causation when only a correlation is observed. Although we also see correlations between education and the brain, we see no evidence of this in brain structure.”

Source: Radboud University Medical Centre

Categories : Cardiovascular Disease Emergency MedicineTags : Leave a comment

Defibrillation Using 1/1000th the Energy could be Possible

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Photo by Mikhail Nilov

 Researchers from Sergio Arboleda University in Colombia, and the Georgia Institute of Technology in the US used an electrophysiological computer model of the heart’s electrical circuits to examine the effect of the applied voltage field in multiple fibrillation-defibrillation scenarios. Their research, published in the interdisciplinary journal Chaos, discovered that far less energy is needed than is currently used in state-of-the-art defibrillation techniques.

“The results were not at all what we expected. We learned the mechanism for ultra-low-energy defibrillation is not related to synchronisation of the excitation waves like we thought, but is instead related to whether the waves manage to propagate across regions of the tissue which have not had the time to fully recover from a previous excitation,” author Roman Grigoriev said. “Our focus was on finding the optimal variation in time of the applied electric field over an extended time interval. Since the length of the time interval is not known a priori, it was incremented until a defibrillating protocol was found.”

The authors applied an adjoint optimization method, which aims to achieve a desired result, defibrillation in this case, by solving the electrophysiologic model for a given voltage input and looping backward through time to determine the correction to the voltage profile that will successfully defibrillate irregular heart activity while reducing the energy the most.

Energy reduction in defibrillation devices is an active area of research. While defibrillators are often successful at ending dangerous arrhythmias in patients, they are painful and cause damage to the cardiac tissue.

“Existing low-energy defibrillation protocols yield only a moderate reduction in tissue damage and pain,” Grigoriev said. “Our study shows these can be completely eliminated. Conventional protocols require substantial power for implantable defibrillators-cardioverters (ICDs), and replacement surgeries carry substantial health risks.”

In a normal rhythm, electrochemical waves triggered by pacemaker cells at the top of the atria propagate through the heart, causing synchronised contractions. During arrhythmias, such as fibrillation, the excitation waves start to quickly rotate instead of propagating through and leaving the tissue, as in normal rhythm.

“Under some conditions, an excitation wave may or may not be able to propagate through the tissue. This is called the ‘vulnerable window,’” Grigoriev said. “The outcome depends on very small changes in the timing of the excitation wave or very small external perturbations.

“The mechanism of ultra-low-energy defibrillation we uncovered exploits this sensitivity. Varying the electrical field profile over a relatively long time interval allows blocking the propagation of the rotating excitation waves through the ‘sensitive’ regions of tissue, successfully terminating the irregular electric activity in the heart.”

Source: American Institute of Physics

Categories : GeneticsTags : Leave a comment

CRISPR ‘Molecular Scissors’ can Leave Gaping Holes in the Chromosome

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CRISPR-Cas9 is a customisable tool that lets scientists cut and insert small pieces of DNA at precise areas along a DNA strand. This lets scientists study our genes in a specific, targeted way. Credit: Ernesto del Aguila III, National Human Genome Research Institute, NIH

The CRISPR molecular scissors have the potential to revolutionise the treatment of genetic diseases. This is because they can be used to correct specific defective sections of the genome. Unfortunately, there is a catch: under certain conditions, the repair can lead to new genetic defects – as in the case of chronic granulomatous disease. This was reported in the journal Communications Biology by a team from the University of Zurich (UZH).

Chronic granulomatous disease is a rare hereditary disease that affects about one in 120 000 people. The disease impairs the immune system, making patients susceptible to serious and even life-threatening infections. It is caused by the absence of two letters, called bases, in the DNA sequence of the NCF1 gene. This error results in the inability to produce an enzyme complex that plays an important role in the immune defence against bacteria and moulds.

The CRISPR tool works…

The research team has now succeeded in using the CRISPR system to insert the missing letters in the right place. They performed the experiments in cell cultures of immune cells that had the same genetic defect as people with chronic granulomatous disease. “This is a promising result for the use of CRISPR technology to correct the mutation underlying this disease,” says team leader Janine Reichenbach, professor of somatic gene therapy at the University Children’s Hospital Zurich and the Institute for Regenerative Medicine at UZH.

… but unfortunately, it’s not perfect

Interestingly however, some of the repaired cells now showed new defects. Entire sections of the chromosome where the repair had taken place were missing. The reason for this is the special genetic constellation of the NCF1 gene: it is present three times on the same chromosome, once as an active gene and twice in the form of pseudogenes. These have the same sequence as the defective NCF1 and are not normally used to form the enzyme complex.

CRISPR’s molecular scissors cannot distinguish between the different versions of the gene and therefore occasionally cut the DNA strand at multiple locations on the chromosome – at the active NCF1 gene as well as at the pseudogenes. When the sections are subsequently rejoined, entire gene segments may be misaligned or missing. The medical consequences are unpredictable and, in the worst case, contribute to the development of leukaemia. “This calls for caution when using CRISPR technology in a clinical setting,” says Reichenbach.

Safer method sought

To minimise the risk, the team tested a number of alternative approaches, including modified versions of CRISPR components. They also looked at using protective elements that reduce the likelihood of the genetic scissors cutting the chromosome at multiple sites simultaneously. Unfortunately, none of these measures were able to completely prevent the unwanted side effects.

“This study highlights both the promising and challenging aspects of CRISPR-based therapies,” says co-author Martin Jinek, a professor at the UZH Department of Biochemistry. He says the study provides valuable insights for the development of gene-editing therapies for chronic granulomatous disease and other inherited disorders. “However, further technological advances are needed to make the method safer and more effective in the future.”

Source: University of Zurich

Categories : Cardiovascular Disease ExerciseTags : Leave a comment

An Extra Five Minutes of Exercise a Day could Reduce Blood Pressure

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Photo by Teona Swift on Unsplash

New research suggests that adding a small amount of daily physical activity, such as uphill walking or stair-climbing, may help to lower blood pressure. The findings were published in Circulation. 

Just five minutes of activity a day was estimated to potentially reduce blood pressure, while replacing sedentary behaviours with 20–27 minutes of exercise per day, including uphill walking, stair-climbing, running and cycling, was also estimated to lead to a clinically meaningful reduction in blood pressure. The study was done by experts from the ProPASS (Prospective Physical Activity, Sitting and Sleep) Consortium, an international academic collaboration led by the University of Sydney and University College London (UCL)

Joint senior author Professor Emmanuel Stamatakis, Director of the ProPASS Consortium said: “High blood pressure is one of the biggest health issues globally, but unlike some major causes of cardiovascular mortality there may be relatively accessible ways to tackle the problem in addition to medication.”

“The finding that doing as little as five extra minutes of exercise per day could be associated with measurably lower blood pressure readings emphasises how powerful short bouts of higher intensity movement could be for blood pressure management.”

The research team analysed health data from 14 761 volunteers in five countries to see how replacing one type of movement behaviour with another across the day is associated with blood pressure.

Each participant used a wearable accelerometer device on their thigh to measure their activity and blood pressure throughout the day and night. 

Daily activity was split into six categories: sleep, sedentary behaviour (such as sitting), slow walking, fast walking, standing, and more vigorous exercise such as running, cycling or stair climbing.

The team modelled statistically what would happen if an individual changed various amounts of one behaviour for another in order to estimate the effect on blood pressure for each scenario and found that replacing sedentary behaviour with 20-27 minutes of exercise per day could potentially reduce cardiovascular disease by up to 28 percent at a population level.

First author Dr Jo Blodgett from UCL said: “Our findings suggest that, for most people, exercise is key to reducing blood pressure, rather than less strenuous forms of movement such as walking.

“The good news is that whatever your physical ability, it doesn’t take long to have a positive effect on blood pressure. What’s unique about our exercise variable is that it includes all exercise-like activities, from running for a bus or a short cycling errand, many of which can be integrated into daily routines.

“For those who don’t do a lot of exercise, walking did still have some positive benefits for blood pressure. But if you want to change your blood pressure, putting more demand on the cardiovascular system through exercise will have the greatest effect.”

Professor Mark Hamer, joint senior author of the study and ProPASS Deputy Director from UCL, said: “Our findings show how powerful research platforms like the ProPASS consortium are for identifying relatively subtle patterns of exercise, sleep, and sedentary behaviour, that have  significant clinical and public health importance.”

Source: University of Sydney

Categories : Healthcare Politics and RegulationsTags : Leave a comment

SAHPRA Encourages the Safe Use of Medicines and Reporting of Suspected Side Effects This #MedSafetyWeek

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The South African Health Products Regulatory Authority (SAHPRA) encourages members of the public to always report any suspected side effects they may experience from taking medicines, vaccines and/or using medical devices, to help make medicines safer for everyone.  While humanity benefits greatly from medicines in the treatment of illness and management of certain conditions, medicines may at times cause side effects. However, the risk of side effects and severe harm can be drastically reduced by taking medicines correctly and following the advice of a healthcare practitioner.

SAHPRA, together with over 90 other medicines and health products regulators as well as healthcare organisations globally, is participating in the annual #MedSafetyWeek awareness initiative, which takes place between 4 and 10 November 2024, under the theme “the importance of using medicines in the right way to prevent side effects, and to report side effects when they do occur”.

The awareness initiative is spearheaded by the Uppsala Monitoring Centre under the auspices of the World Health Organisation (WHO) Programme for International Drug Monitoring, a programme whose member organisations work nationally and collaborate internationally to monitor and identify adverse effects of medicines and vaccines, to reduce risks to patients, and to establish worldwide pharmacovigilance standards and systems.

During this #MedSafetyWeek and beyond, SAHPRA is calling upon patients, caregivers and healthcare professionals to utilise its reporting tools to report all suspected side effects and adverse reactions.

SAHPRA Chief Executive Officer, Dr Boitumelo Semete-Makokotlela, indicates that handling and storing as well as taking medicines as directed by a healthcare professional is key in reducing the incidence of adverse reactions. “Research shows that about half of all side effects are preventable. Patient safety is our top priority and during #MedSafetyWeek, we wish to remind patients to take their medicines as instructed and healthcare professionals to review therapies as well as each patient’s unique health conditions before prescribing or dispensing medicines,” says Dr Semete-Makokotlela.

SAHPRA calls upon the South African public and healthcare professionals to use either the MedSafety App or the eReporting portal both accessible on the SAHPRA website to report suspected side effects from health products. All reports are assessed and examined by SAHPRA to determine the correct steps to protect medicine users in South Africa from harm. The purpose is to gain better knowledge about known side effects and to discover new ones. This can result in warnings and changes to how a medicine is used. SAHPRA’s MedSafety App and eReporting portal can be used for reporting suspected adverse drug reactions from medicines, vaccines, herbal products, biological medicines and any quality issues relating to health products.

Source: SAHPRA