Economic impact of a nationwide interoperable e-Health system using the PENG evaluation tool

OBJECTIVE

The aim of this paper is to evaluate the costs and benefits of the Estonian interoperable health information exchange system. In addition, a framework will be built for follow-up monitoring and analysis of a nationwide HIE system.

METHODS

PENG evaluation tool was used to map and quantify the costs and benefits arising from type II diabetic patient management for patients, providers and the society. The analysis concludes with a quantification based on real costs and potential benefits identified by a panel of experts.

RESULTS

Setting up a countrywide interoperable eHealth system incurs a large initial investment. However, if the system is working seamlessly, benefits will surpass costs within three years. The results show that while the society stands to benefit the most, the costs will be mainly borne by the healthcare providers. Therefore, new government policies should be devised to encourage providers to invest to ensure society wide benefits.

Standardized Patient Instructor (SPI) interactions are a viable way to teach medical students about health behavior counseling

OBJECTIVES

We explored comfort levels of third-year medical (M3) students through two health behavior counseling (HBC) interactions with Standardized Patient Instructors (SPIs) in tobacco cessation (TCC) and nutrition and physical activity (NPA).

METHODS

Nearly 200 M3s participated in two SPI HBC interactions; including a role-play interview and subsequent feedback session on performance. Students completed a 5-point Likert scale evaluation measuring pre- and post-comfort level on two HBC sessions.

RESULTS

Both interactions resulted in statistically significant increases in student's pre- and post-interaction comfort levels. A paired-sample t-test revealed a mean increase of 0.91 for TCC (t = 14.01, df = 197, p<0.001), and a mean increase of 0.69 for NPA (t = 12.65, df = 198, p<0.001).

CONCLUSION

The use of SPIs is a viable approach to exposing medical students and future doctors to health behavior counseling, and increasing comfort level with such skills. The SPI experience ensures that HBC opportunities are available and contain meaningful feedback on performance.

PRACTICE IMPLICATIONS

Encouraging patient behavior modification is a skill that can be developed during undergraduate medical training. Combining HBC with SPI sessions and traditional learning approaches could prove effective in a curriculum intended to teach students strategies that improve patient health behavior.

An unusual guanyl oligonucleotide regulates cellulose synthesis in Acetobacter xylinum

The mechanism of GTP-specific activation of the membrane-bound cellulose synthase system of Acetobacter xylinum has been further elucidated. The supernatant fraction derived from washed membranes of this organism contains an enzyme which reacts with GTP to form a low molecular mass, heat-stable compound,tentatively characterized as a cyclic oligonuleotide composed of GMP residues, which is the immediate activator of the cellulose synthase. This activation is reversed by a membrane-bound enzyme that degrades the activator; the latter enzyme is inhibited by Ca (2+). It is suggested that the interaction between these enzymes and nucleotide derivatives, mediated by Ca (2+), may regulate cellulose synthesis in VIVO.

The influence of the therapeutic relationship in treatment for alcohol dependency

The substance abuse field has been slow to embrace research into the impact of the therapeutic relationship on treatment outcome. Limited previous research has demonstrated that therapist factors such as unconditional regard and empathy are associated strongly with treatment outcome. This study examined the relationships between client perception of the therapist and client characteristics; client response to out-patient relapse prevention treatment; and client outcome 3 months following treatment for alcohol dependence. One hundred and sixty-one male clients of a 3-week relapse prevention programme participated in the research, completing questionnaires assessing their perception of therapist regard, empathy, congruence, attractiveness, expertness and trustworthiness. Treatment outcome was measured at the conclusion of treatment, and 3 months post-treatment. Clients who were more anxious and those with poorer cognitive functioning appeared to perceive therapists as showing less unconditional regard, empathy and congruence. Self-efficacy and coping skills acquisition measured at the end of treatment correlated significantly with clients' perceptions of the therapist as empathic, congruent and displaying high regard for them. Treatment outcome at 3 months was associated significantly with degree of perceived therapist expertness and empathy. These relationships held when cognitive functioning and skills acquisition were controlled for. Self-efficacy moderated the relationships between regard and empathy and outcome, but not perceived therapist expertness. A lower than desirable follow-up rate limits the generalizability of the findings. The quality of the therapeutic relationship as perceived by clients appears to be associated with client characteristics, response to treatment and treatment outcome.

The effect of hand dominance on recurrent idiopathic paediatric epistaxis

OBJECTIVES

No published data exists to support the belief that nose picking contributes to recurrent idiopathic paediatric epistaxis. If nose picking is implicated then there may be a higher incidence of epistaxis on the side of the dominant hand. The objective of the study was to determine whether nose picking has a significant role in paediatric epistaxis by comparing hand dominance and side of epistaxis.

DESIGN AND SETTING

A prospective, consecutive cohort of new epistaxis referrals to a tertiary paediatric centre over a 14-month period were assessed for hand dominance and reported side of the epistaxis. The presence of septal excoriation, crusting and prominent blood vessels was also recorded.

PARTICIPANTS

One hundred and forty-eight new epistaxis referrals.

MAIN OUTCOME MEASURES

Dominant hand, side of epistaxis history and side of positive examination findings.

RESULTS

No statistically significant association between hand dominance and either epistaxis history or examination findings was identified. A statistically significant association between epistaxis history and examination findings was identified P < 0.001, K = 0.614, SE 0.571.

CONCLUSIONS

The study does not provide evidence to support the belief that paediatric epistaxis is influenced by nose picking. The study provides evidence that patients' epistaxis history and positive examination findings are a consistent marker of previous epistaxis.

Safety study of induction chemotherapy and synchronous radiotherapy (RT) and cetuximab in stage III non-small cell lung cancer (NSCLC): SCRATCH (Cohort I)

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Background: The addition of cetuximab can increase the efficacy of chemotherapy for advanced NSCLC. Concomitant cetuximab and RT is superior to RT alone for locally advanced squamous cell head & neck carcinoma. The SCRATCH study (cohort I) is a phase I study to assess the safety of synchronous cetuximab and radical RT in patients with Stage III NSCLC. Methods: Cohort I will contain 12 patients with inoperable stage III NSCLC. Inclusion criteria are performance status 0–1, adequate organ function, and disease encompassable within a radical RT volume. Exclusion criteria are previous malignancy, thoracic RT or treatment with EGFR targeted therapy. Patients receive platinum-based induction chemotherapy, followed by weekly intravenous cetuximab (initial dose 400mg/m2; maintenance dose 250mg/m2) and concomitant RT (64Gy/32fractions/45days). The primary end-point is toxicity. NCI Common Toxicity Criteria (CTC) V3.0 assessments are performed weekly during radiotherapy, and at regular follow-up visits. Results: Data from the first 9 patients is available. 2 patients stopped receiving cetuximab early due to toxicity. 1 experienced grade 3 fatigue following the initial dose, and the other declined further treatment after developing grade 2 skin toxicity. 2 patients have died, 1 from disease progression and 1 from thromboembolic disease. Both deaths occurred between months 2 and 4 post RT and were not attributed to the cetuximab therapy. Of the 7 living patients, 2 have survived 1 year (measured from the first day of induction chemotherapy). The maximum NCI CTC V3.0 scores are summarised in the table below. Conclusions: The results suggest that the early and late toxicities of synchronous cetuximab and radical RT are acceptable. Data on all 12 patients will be available by June 2007. SCRATCH Study cohorts II-IV follow on and will recruit sequentially. They will assess the safety of adding concomitant cisplatin (±vinorelbine) to cetuximab and radical RT.

[Table: see text]

No significant financial relationships to disclose.

Phase I evaluation of OXi4503, a vascular disrupting agent, in patients with advanced solid tumours

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Background: OXi4500, the active product of OXi4503, is a vascular disrupting agent acting at the colchicine binding site on the β subunit of tubulin. OXi4503 has greater anti-tumour activity in human cancer cell lines, causes a greater reduction in tumour blood flow than combretastatin A4P and has single agent activity in human tumour xenograft models. A phase I trial has commenced to examine the safety, tolerability and pharmacokinetics of OXi4503, with the primary objective being determination of MTD. FDG-PET scans were performed prior to and 28 days after the first infusion of OXi4503. Several other pharmacodynamic endpoints are also being assessed including DCE & BOLD MRI, circulating endothelial progenitor cells and cytokeratin 18. Methods: OXi4503 is administered by 3 weekly iv infusions to a maximum of 6 cycles. Starting dose was 0.06mg/m2. 100% dose escalation in single patient cohorts proceeded to 3.84mg/m2, when cohorts were expanded to three patients and 30% escalation due to emergence of grade 2 drug-related toxicity (thrombocytopaenia). Results: 11 patients have so far received OXi4503 (5F 6M, median age 54, range 33–68); median cycles received was 2 (range 1–4). Common AE’s include hypertension, pyrexia and anaemia. PK profiles show a dose-dependent linear increase in peak plasma concentrations and AUC of both OXi4503 and OXi4500. OXi4500 concentrations at current dosing (5 mg/m2) are close to that seen at the MTD in rats and dogs. DCE-MRI showed significant reduction in Ktrans in one patient (0.24mg/m2). In the 2 patients studied to date, PET images showed a decrease in the standardised uptake value (SUV) in 3 out of 4 metastases for one subject (1.92mg/m2) and in 5 out of 7 metastases for the other subject (3.84mg/m2) demonstrating a reduction in FDG uptake following drug treatment. Of 10 patients assessed, 2 have stable disease and 8 disease progression. Conclusions: OXi4503 has been tolerated at doses up to 5mg/m2 with no DLT observed, but changes in functional activity have been seen in 3 patients. MTD has not been reached and recruitment is ongoing.

[Table: see text]

Effect of sperm cryopreservation and supplementing semen doses with seminal plasma on the establishment of a sperm reservoir in gilts

Frozen-thawed (FT) boar sperm have a reduced fertile life, due in part to a capacitation-like status induced by cooling. Reversal of this cryocapacitation in vitro by exposure to boar seminal plasma (SP) has been demonstrated. The objective of these studies was to determine the effect of SP on the ability of FT sperm to create an oviductal sperm reservoir following artificial insemination (AI). In Experiment one, 35 pre-pubertal gilts were injected (IM) with 400 IU eCG plus 200 IU hCG to induce oestrus. At detection of oestrus, gilts were inseminated with 3 x 10(9) live sperm, either fresh (FS; n = 13), FT (n = 10), or FT supplemented with 10% v/v SP (n = 12). Gilts were killed 8 h later, their reproductive tracts recovered and the uterotubal junctions (UTJs) flushed to recover sperm. Fewer (p < 0.01) sperm were recovered following FT, compared to FS, inseminations, and there was no evident effect of SP. In Experiment two, 30 pre-pubertal gilts received IM injections of 1000 IU eCG followed by 5 mg pLH 80 h later to control time of ovulation. Gilts were inseminated with 3 x 10(9) live FS sperm (n = 6), FT sperm (n = 15) or FT sperm plus 10% SP (n = 9) at 12 h before ovulation and then sacrificed 8 h later. The UTJs were dissected and flushed for sperm recovery. Fewest (p < 0.001) sperm were recovered following FT insemination and there was no evident effect of SP. These data demonstrate that the size of the sperm reservoir is markedly reduced in gilts inseminated with FT sperm. However, the lack of effect of SP suggested that either it did not reverse cryocapacitation or that such a reversal does not impact the in vivo ability to create a sperm reservoir.