Sunday, July 4, 2010
Saturday, July 3, 2010
" Top Turkish Transplant Hospital Begins Certification Training On SynCardia Total Artificial Heart."
"We are excited to deliver this technology to our sickest patients who do not have any other chance to survive until a donor heart is available," said Prof. Ozbaran. "The SynCardia Total Artificial Heart is an important and complementary tool for our assist device program."
Ege University is one of the biggest and oldest universities in Turkey.
The heart transplant program, started in 1998, has become the most active program in the country, performing a total of 130 Heart Transplants. Each year, Ege University performs approximately 1,100 Open Heart Surgeries.
In Turkey, the average wait time for a donor heart transplant is 18 to 24 months. There are currently 43 patients on the waiting list for a donor heart. Ege University is the first transplant hospital in Turkey and the 46th in the world to begin certification training for the SynCardia Total Artificial Heart.
Originally used as a permanent replacement heart, the Total Artificial Heart is currently approved as a bridge to human heart transplant for patients dying from end-stage biventricular failure. The Total Artificial Heart is the only device that provides immediate, safe blood flow of up to 9.5 L/min through both ventricles.
The SynCardia Total Artificial Heart is the first and only FDA, Health Canada and CE Mark approved Total Artificial Heart in the world. There have been more than 800 implants of the Total Artificial Heart, accounting for more than 170 patient years of life on the device.
In Turkey, the average wait time for a donor heart transplant is 18 to 24 months. There are currently 43 patients on the waiting list for a donor heart. Ege University is the first transplant hospital in Turkey and the 46th in the world to begin certification training for the SynCardia Total Artificial Heart.
Originally used as a permanent replacement heart, the Total Artificial Heart is currently approved as a bridge to human heart transplant for patients dying from end-stage biventricular failure. The Total Artificial Heart is the only device that provides immediate, safe blood flow of up to 9.5 L/min through both ventricles.
The SynCardia Total Artificial Heart is the first and only FDA, Health Canada and CE Mark approved Total Artificial Heart in the world. There have been more than 800 implants of the Total Artificial Heart, accounting for more than 170 patient years of life on the device.
Friday, July 2, 2010
Infertility Tourism - a recession proof opportunity in Medical Tourism
UK / United Kingdom:
Increasing trend in "Infertility Tourism",looks at recent European research into the sector and some of the underlying drivers of this recession proof market.. Many medical tourism businesses are feeling the pinch of the recession. The economic downturn is affecting healthcare spending in the same way that it has affected consumer spending in other sectors. In many countries, the number of “self pay” patients (who are paying out of their own pocket for healthcare) has decreased. In the UK, we know that the self pay market whether it is expenditure on elective surgery such as knee or hip replacement or discretionary spend on cosmetic surgery is significantly down; private hospitals are seeking NHS work to fill their beds. The financial pressure on consumers and their discretionary healthcare spend is significant which means less paying patients whether they are domestic patients or medical travellers. So, there are less medical tourists around and increasing competition for these patients. But are there segments of the medical tourism market that are going against the trend? Infertility treatment is one area of healthcare that is relatively recession proof; patients are reluctant to delay treatment, and will stretch their financial resources to pay for treatment. A recent paper presented at the Annual Meeting of the European Society of Human Reproduction and Embryology in Rome highlights the growth of “infertility tourism” The article, “Cross border reproductive care in six European countries” provides a review of inbound infertility tourism to six European countries receiving patients - Belgium, Czech Republic, Denmark, Slovenia, Spain and Switzerland. Data was collected from 46 centres in these countries. Patients came from 49 different countries, but almost two thirds came from only four countries - Italy (31.8%), Germany (14.4%), The Netherlands (12.1%) and France (8.7%).
-Drivers of infertility tourism....
Why are these infertile couples crossing borders for infertility treatment? It varies from country to country but the main driver is the law on infertility treatments within the home country. This is the predominant reason for patients coming from Italy, France, Germany, Norway and Sweden. Italian law banned sperm donation in 2004; German law bans egg donation; in France, assisted conception for single women or same sex couples is illegal and there is a ban on advertising for egg donors; regulation regarding donor anonymity affect Scandinavians and British patients; some countries have regulations that limit reimbursement of assisted conception to a maximum age.; some countries have legal limits on the amount that can be paid to donors thus reducing availability of sperm and eggs.Difficulties in accessing treatment at home were a driver for a third of UK patients, and a wish for “anonymous” donation was expressed by around one in five patients. There’s also some indication of specific cross border flows: Italians favour Switzerland and Spain, the Germans prefer Czech Republic, the Dutch and French opt for Belgium. 18.3% of patients were looking for semen donation, 22.8% for egg donation and 3.4% for embryo donation.
-A market opportunity for medical tourism businesses..?
The study estimated that “a minimum estimated number of 11.000 – 14.000 patients per year” visits the six countries in the study; it may well be much higher than this.According to the study, the internet was a frequent source of information about infertility treatment abroad in Sweden (73.6%), Germany (65.0%) and the UK (58.5%). Infertility tourism is going against the overall trends in the medical tourism market and could provide a worthwhile opportunity for both the short and long term.
Scientists identify melanoma stem cells
Many researchers think that tumour growth is fuelled by a subset of 'immortal' cancer stem cells. When they multiply, they produce 'bulk' tumour cells, as well as more stem cells.
Cancer stem cells may explain why cancer can return in patients who first appear to have been successfully treated. Although treatments such as chemotherapy and radiotherapy are effective against bulk tumour cells, they don't appear to target cancer stem cells.
Cancer stem cells have been identified in a number of different types of cancer, but until now, they have not been discovered in melanoma.
The researchers analysed protein molecules on the surface of cells from melanoma samples that had been taken from patients at the Stanford Cancer Centre. They found that between 2.5 and 41 per cent of cells had a protein called CD271 on their surface.
The researchers then transplanted human melanoma cells into mice, some of which received cells with CD271 on their surface while others received cells which lacked CD271.
Cells with CD271 were much more likely to grow into tumours than cells without the protein, suggesting they may have stem cell-like properties.
All but one of the new tumours arising from CD271 cells contained a mixture of CD271-positive and CD271-negative melanoma cells.
This shows that the stem cells could produce bulk tumour cells as well as new stem cells - a classic hallmark of stem cell behaviour.
The team also found that melanoma stem cells lack proteins that are targeted by immunotherapy - a treatment that harnesses the patient's immune system to destroy cancer cells. This helps to explain why some melanomas don't respond to immunotherapy, and could shape the design of future therapies for the disease.
Commenting on the discovery, which is published in the journal Nature, lead researcher Dr Alexander Boiko, a post-doctoral fellow at Stanford, revealed: "These cells lack the traditional melanoma cell surface markers targeted by these treatments. Without wiping out the cells at the root of the cancer, the treatment will fail.
"This could be the reason why we often see melanoma patients relapsing and coming back to the clinic. Our research indicates that it may be more appropriate to also target cells expressing CD271."
Dr Kat Arney, science information manager at Cancer Research UK, said: "Researchers are finding cancer stem cells in many different types of tumour, and many scientists believe they are at the heart of a wide range of cancers.
"Understanding these elusive 'immortal' cells will be the key to developing more effective treatments for cancer in the future, so this research is an important step towards beating melanoma."
Thursday, July 1, 2010
" Meaty Diets May Increase Men's Diabetes Risk.."
An Atkins-style diet that emphasizes animal protein may actually be linked to higher incidence of type 2 diabetes, according to a large observational study. Low-carbohydrate eating habits were associated with 12% elevated risk of new onset diabetes over more than 20 years of follow-up, found Lawrence de Koning, PhD, of Harvard School of Public Health, and colleagues.
Controlling for animal protein and fat eliminated the significance of the association whereas adjustment for vegetable fat and protein intake strengthened it.. Note that an Atkins-style diet that emphasizes animal protein and red/processed meat may actually be linked to higher incidence of type 2 diabetes, according to a large observational study.
The main drivers were red and processed meat and the heme iron found in red meat, de Koning's group reported here at the American Diabetes Association (ADA) meeting. Carbohydrates can drive up glucose levels, so low-carb diets have been seen as a way to prevent diabetes. Shifting toward protein for the bulk of calories might improve insulin sensitivity and metabolic rate through the "high thermic effect of protein," the researchers said in the poster presentation. But indiscriminately cutting carbs in favor of protein may have unintended consequences, suggested Sue Kirkman, MD, senior vice president of medical affairs and community information for the ADA.
"If you're not eating carbohydrates, you've got to eat something," she said. "It's a little too simplistic to say carbs increase glucose and cause diabetes.Indeed, it's too simplistic to say a high-protein diet is harmful, too " de Koning said.
"It's important to replace red and processed meat with chicken and fish and also vegetable sources of protein and fat, so nuts and legumes would be top choices," he said in an interview.
A wealth of literature supports the link between red and processed meats and diabetes, "particularly through heme iron," de Koning said.
The prevailing hypothesis for the link involving red meat -- and the heme iron it is a major dietary source of -- is that eating red and processed meats may encourage development of diabetes because of oxidative stress from accumulation of heme iron in tissue systemically and within the pancreas, de Koning explained.
"Beta-cells in particular are sensitive to oxidative stress, so we believe that the heme iron leads to beta cell dysfunction and perhaps dysregulation," he told MedPage Today.
For the red and processed meats, which included pork, the sodium nitrites added to processing to improve flavor and extend shelf life may play some role, he speculated.
Following findings in the Nurses Health Study suggesting no overall significant link between diabetes incidence and carbohydrate intake but an increased risk with red and processed meat, de Koning's group looked for similar relationships among men.
They analyzed food frequency results and diabetes incidence findings for 41,140 men in the Health Professionals Follow-Up study who had no baseline cardiovascular disease, cancer, or diabetes.
Participants completed food questionnaires every four years.
Over more than 20 years of follow-up, 2,761 men developed type 2 diabetes.
After adjustment for smoking, body mass index, physical activity, coffee and alcohol intake, family history of diabetes, and total energy intake, the hazard ratios for diabetes incidence showed the following trends:
-Progressive increase with higher low-carbohydrate score for overall proportion of a diet composed of protein and fat..
-A dose-dependent increase with greater score for low-carbohydrate, high animal protein and fat diet..
-A flat, nonsignificant association with greater low-carbohydrate, high vegetable protein and fat diet score..
Adjusting for BMI appeared to attenuate the associations but not eliminate them, the researchers noted.
Controlling the high vegetable protein and fat score for whole grains, nuts, or legumes as components for glycemic index didn't appear to have much effect.Kirkman cautioned that the observational findings could not be interpreted as causal. And although the researchers attempted to control for other potential factors, no model can entirely eliminate confounding, she noted.De Koning added that the study did not account for how foods were cooked, which might be a factor in the impact of red and processed meats.But the finding of a diabetes incidence link to red and processed meats in similar large cohorts of both women and now men supports generalizability. "It's not so much men are choosing more wrong proteins than women," de Koning said in an interview. "It's just that if you choose wrong proteins, being a man or a woman, you will increase your risk of diabetes."
"STEM CELL : Stem Cells Rescue Mice from Sepsis.."
As well, the dose of stem cells alone reduced systemic and pulmonary cytokine levels, preventing acute lung injury and organ dysfunction, Stewart and colleagues said online in the American Journal of Respiratory and Critical Care Medicine.
In a gene expression analysis, genes involved in inflammation were turned down and those involved in phagocytosis and bacterial killing were turned up in animals given the stem cells, the researchers found. After the cells were given, the gene expression profiles of mice with sepsis resembled those of animals that had not developed the condition, they said.
Despite appropriate antibiotic treatment, sepsis is the second leading cause of death in the intensive care unit and the 10th leading cause of death in the U.S., at a cost of some $16 billion a year, Stewart and colleagues noted.
"Our results suggest that mesenchymal stem cells may provide a promising new approach for treating organ damage caused by severe infection and we are looking to test this in patients in the near future," Stewart said in a statement.
The researchers studied animals that had developed sepsis after a procedure called a cecal ligation and puncture, which releases bacteria from the gut into the abdomen, resulting in severe infection, inflammation and organ damage. Control animals had a sham surgery, including opening the abdomen but without tying off or puncturing the cecum.
Six hours later -- to mimic the delay that would be seen in clinical treatment of sepsis -- animals with induced sepsis were given saline or 2.5 x 105 cells. (Animals that had the sham surgery were only injected with saline.)
Compared with sham-operated mice, the animals with induced sepsis had plasma concentrations of pro-inflammatory cytokines, such as interleukin-6 and interleukin-1β, that were markedly elevated, but administration of the stem cells significantly reduced them -- in some cases to levels approaching those seen in the control animals.
In the absence of antibiotics, Stewart and colleagues found, injecting the stem cells cut mortality nearly in half: 45% of the septic animals that got saline were dead at 28 hours, compared with 24% of those treated with the stem cells. However, the difference did not reach statistical significance.
On the other hand, adding the antibiotic imipenem changed the picture, they reported. After five days, 15% of the controls remained alive, compared with 50% of those given the stem cells, a difference that reached significance at P<0.05.
The researchers also found that adding the stem cells improved bacterial clearance. At 28 hours, the septic animals treated with saline had a median of 107 colony-forming units in the spleen, compared with just over 105 for the stem cell-treated mice. The difference was significant at P<0.05, they said.
"..EUROPE: The Venice Declaration on Medical Travel.."
The European medical travel industry has issued the “Declaration of Venice” supporting the rights of European Union citizens to travel for health care services. The declaration was one of the key outcomes of the European Medical Travel Conference 2010 in Monastier, near Venice, Italy.
Drafted by a group of medical travel experts, the Venice Declaration calls for public tourism organizations to encourage greater cooperation and synergies between the tourism and health sectors. Medical travel services should be assisted through the provision of additional health services for tourists. The declaration stresses the need for stakeholders to collaborate more effectively in integrating elements of the health and travel sectors by investing greater resources to improve quality, customer orientation and the healing competency of health services.
The Declaration of Venice also calls for improved quality of medical travel agencies and service providers, as well as greater emphasis on patient safety; follow up care in their home countries; cross-border case management executed by medical professionals; patient referral and re-referral systems to guarantee continuity of care; economic models that protect patients from fraud and corruption; and the availability of inexpensive no-fault medical malpractice coverage.
T h e M a i n P o i n t s o f t h e D e c l a r a t i o n ;
• The right of citizens to travel to receive access to better health care services.
• The need for global health systems to respond better to the needs of increasingly mobile citizens seeking the best quality, most timely, most cost-effective, and convenient medical treatment and healing capacity in Europe and throughout the world.
• The need to integrate better health and tourism services by investing more resources to improve quality, customer orientation, and healing competency of health services.
• The need for controllable patient safety.
Attendees at the Venice conference signed the declaration in a bid to affirm the rights of citizens of European Union states to travel and request and receive medical care and treatment. Key statements by the signees:
• Recognise the need for health systems worldwide to provide improved responses to the health care needs of increasingly mobile citizens who look to obtain the best quality, most timely, most cost-effective, and most conveniently located medical treatment and healing capacity available in Europe and throughout the world.
• Stress the need to encourage stakeholders to collaborate more effectively in integrating elements of the health and travel sectors together.
• Agree the need for a combination of a sound infrastructure, high quality medical facilities, and a healthy environment to provide to citizens high standard destinations for medical reasons.
• Want the quality of tourist attractions to be balanced by high quality medical facilities.
• Recognize that the main motivating factor for citizens looking abroad for medical treatment is access to health care, value; and outcomes for healing.
• Aagree that access to medical travel services should be encouraged through the provision of additional health services for tourists.
• Believe that public tourism organizations should encourage greater cooperation and synergies between the tourism and health sectors.
• Want equal access for tourists, whether in good or poor health.
• See the need for patient safety to be made a top priority.
• Agree that patients' rights must be recognized.
• Want patients to have neutral medical professional guidance for the selection of their services.
• Agree that for patient safety there is a need for:
- effective medical follow-up of patients on their return to the home country;
- cross-border case management executed by medical professionals;
- patient referral and re-referral systems that guarantee continuity of care;
• Countries and regions should invest greater resources to improve the quality, customer orientation, and healing competency of hospital and tourism services.
" USA : Four million likely to pay health fine for failing to buy health insurance.."
About four million people in the United States could be fined for failing to buy health insurance when the health overhaul law is fully in force in 2016, the Congressional Budget Office forecasts.
Starting in 2014, individuals must maintain minimum essential coverage or pay a penalty. The penalty will equal the greater of 1 percent of modified adjusted gross income (AGI) or $95 per person in 2014, 2 percent of AGI or $325 per person in 2015, and 2.5 percent of AGI or $695 per person in 2016, indexed for inflation in later years. Minimum essential coverage includes cover under a qualifying or grandfathered insurance company or employer-sponsored plan, government-sponsored program such as Medicare or Medicaid or a state-based exchange. The penalty for dependents under the age of 18 will be capped at 50 percent of the adult individual's penalty. The penalty for each family will be capped at 300 percent of the adult individual's penalty. The maximum penalty will also be capped at an amount equal to the average national premium for exchange coverage.
There are a number of exceptions to the individual mandate, including exceptions for individuals who have income below the tax filing threshold, incur hardships, have religious objections, are not lawfully present in the United States, are incarcerated or are overseas. The new law waives insurance premiums for those with very low incomes as well as some other groups, while subsidies are provided to help poorer people buy coverage.
Most individuals must buy health insurance under the landmark legislation passed by Congress last month, or face fines that will be phased in. By 2016, those without coverage may be fined up to 2.5 percent of their income.
Of the estimated 4 million who will, some 9 percent will be under the poverty line -- $11,800 in annual income for an individual and $24,000 for a family of four, said the CBO, which analyzed expected compliance rates. The U.S. population is about 309 million, according to the Census Bureau. The CBO also forecast the government would collect about $4 billion annually from related penalties between 2017 and 2019.The number predicted to pay tax penalties amount to less than 1.5 percent of the population.
To put the number of uninsured into perspective and to indicate that the deliberately uninsured are neither a real medical tourism target, nor indicate that health care reform can never work- 1.5 % pales into insignificance compared to the latest figures for the number of Americans driving without car insurance- between 15 and 20% - the figures vary by state; this suggests that whatever government does there is going to be a part of the population with a total disregard for any laws.
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