UCSF launches online diabetes education

A complete online diabetes self-management education programme has been launched by the University of California, San Francisco (UCSF) Diabetes Teaching Center. This website mirrors the highly successful American Diabetes Association (ADA) accredited teaching programme curriculum created by UCSF clinicians and presented to thousands of patients at UCSF over the past 30 years.

Because the rate of diabetes is increasing so rapidly, the need for diabetes education and medical care far exceeds the number of dedicated diabetes care providers. Very few individuals with diabetes can expect to see a diabetes specialist – but everyone with Internet access can now be educated about diabetes.

Not only does the website offer a complete, separate curriculum for type 1 and type 2 patients, it provides a subcurriculum for type 2 patients based on treatment (oral medication management vs. insulin management) and information for healthcare providers. For the newly diagnosed, this website can help individuals understand diabetes, and facilitate the necessary lifestyle changes to manage their care. For those already living with diabetes, this programme provides training in the latest advances in self-care and problemsolving skills.

Diabetes Education Online is unique from other diabetes education websites in that it focuses on the equation, “understanding = improved management”. Through the years, UCSF clinicians have recognised that it is just as important to explain why to do something, as well as what to do. Each section provides detailed explanations and includes scientific background information, self-management instruction and optional selfquizzes to assess knowledge learned. In addition, a comprehensive library provides printable handouts of key tables, charts and illustrations, plus video access to educational presentations.

● Diabetes Education Online – www.deo.ucsf.edu

US hospitals participate in 6-way kidney transplant swap

Surgical teams at The Johns Hopkins Hospital, Barnes- Jewish Hospital in St Louis and Integris Baptist Medical Center in Oklahoma City in the United States successfully completed on 14 February the first six-way, multihospital, domino kidney transplant. All six donors – one man and five women, and six organ recipients – four men and two women – were reportedly in good condition.

The procedure, kidney paired donation (KPD), takes a group of incompatible donorrecipient pairs (recipients coming to one of the three hospitals with a willing donor who is not compatible by blood or tissue) and matches them with other pairs in a similar predicament. By exchanging kidneys between the pairs, it is possible to give each recipient a compatible kidney. In this way each recipient receives a kidney from a stranger and transplants are enabled that otherwise would not have taken place. Involving multiple hospitals created even more possibilities for matches. Robert Montgomery, MD, PhD, chief transplant surgeon at Johns Hopkins, said this could result in an estimated 1,500 additional transplants each year.

In the so-called domino swap, a surgical team made up of nine surgeons, six anaesthesiologists and 12 nurses began a cross-country set of operations with five incompatible pairs. An altruistic donor and a recipient who was next on the US United Network for Organ Sharing (UNOS) organ recipient list started and ended the domino. Altruistic donors are those willing to donate a kidney to any needy recipient.

Just like falling dominoes, the altruistic donor kidney went to a recipient from one of the incompatible pairs, that recipient’s donor’s kidney went to a recipient from a second pair and so on. The last remaining kidney from the final incompatible pair went to the UNOS recipient.

As part of this complex procedure, Johns Hopkins flew one kidney to Integris Baptist; Integris Baptist flew one kidney to Barnes-Jewish and Barnes-Jewish flew one kidney to Johns Hopkins.

New guideline for prescribing opioid pain drugs published

A national panel of pain management experts representing the American Pain Society (APS) and the American Academy of Pain Medicine (AAPM) has published the first comprehensive, evidence-based clinical practice guideline to assist clinicians in prescribing potent opioid pain medications for patients with chronic noncancer pain. The long-awaited guideline appears in the February 2009 issue of The Journal of Pain, www.jpain.org

To create this guideline, researchers in the Oregon Evidence-based Practice Center (EPC) at Oregon Health & Science University collaborated with the APS and AAPM for two years, reviewing more than 8,000 published abstracts and non-published studies to assess clinical evidence on which the new recommendations are based. The expert panel concluded that opioid pain medications are safe and effective for carefully selected, well-monitored patients with chronic noncancer pain. They made 25 specific recommendations and achieved unanimous consensus on nearly all.

Opioid prescribing has increased significantly due to growing professional acceptance that the drugs can relieve chronic non-cancer pain and the guideline acknowledges there are widespread concerns about increases in prescription opioid abuse, addiction and diversion.

Opioids, such as morphine, oxycodone, oxymorphone and fentanyl are potent analgesics. They traditionally have been used to relieve pain following surgery, from cancer and at the end of life. Today opioids are used widely to relieve severe pain caused by chronic lowback injury, accident trauma, crippling arthritis, sickle cell, fibromyalgia and other painful conditions.

Prior to initiating chronic opioid therapy, the guideline advises clinicians to determine if the pain can be treated with other medications. If opioids are appropriate, the clinician should conduct a thorough medical history and examination and assess potential risk for substance abuse, misuse or addiction.

‘Molecular Manual’ for inherited diseases online

An international research team has compiled the first catalogue of tissue-specific pathologies underlying hundreds of inherited diseases. These results provide information that may help treat conditions such as breast cancer, Parkinson’s disease, heart disease and autism. The report from scientists at the Technical University of Denmark and Massachusetts General Hospital (MGH) appears in the Proceedings of the National Academy of Sciences.

“Disease processes in humans are far from being exhaustively understood and characterised, in part because they are the result of complex interactions between many molecules that may take place only in specific tissues or organs. Experiments to directly study these interactions in human patients would not be possible, which limits our understanding of how diseases arise and which molecules and genes are involved,” says colead author Kasper Lage, PhD, of the MGH Pediatric Surgical Research Laboratories.

Co-lead author Niclas Tue Hansen, MSc, from the Center for Biological Sequence Analysis, Technical University of Denmark, adds: “We let supercomputers model biological processes in tissues across the human organism, based on the knowledge from millions of already published articles. In this way we were able to create an extensive map of the interactions of molecules in many diseases – a sort of molecular manual – without carrying out experiments in patients.”

● The catalogue is freely available on the Center for Biological Sequence Analysis website – www.cbs.dtu.dk

NIH expands open site to include new asthma data

The US National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has expanded its collection of genetic and clinical data, first made freely available to researchers in 2007, to include clinical and genetic information collected from three asthma research networks. In 2007, the NHLBI initiated SHARe, (SNP Health Association Resource), a Web-based dataset which provides qualified researchers with free access to a wealth of data from multiple large population- based studies, starting with the Framingham Heart Study. This new expansion of the project is called SHARe- Asthma Resource Project (SHARP).

SHARP includes data on 2,332 people with asthma and 805 families whose DNA was tested for 1 million genetic variations. In addition, clinical data gathered during asthma clinical trials, such as lung function, allergy status and respiratory symptoms are included in the database. In this way, SHARP will permit researchers to relate study participants’ genetic variations to their clinical and laboratory test results, thereby enabling between genes and health for asthma and other airway diseases. To protect the confidentiality of study participants, the database does not include any personal information.

The three asthma clinical research networks providing data are the Childhood Asthma Management Program (CAMP), the Childhood Asthma Research and Education Network (CARE), and the Asthma Clinical Research Network (ACRN) – all funded by NHLBI. For more than 10 years, these networks have been major sources of information about the best practices in asthma care, translating and developing new knowledge for patients and physicians.

‘SonoDrugs’ project for localised drug delivery Royal Philips Electronics announced in February that it is leading a major new European project to develop drug delivery technologies that could significantly impact the treatment of cancer and cardiovascular disease. By allowing drugs to be delivered to disease sites via the patient’s bloodstream and then activated by focused ultrasound pulses, the SonoDrugs project aims to maximise the therapeutic efficiency and minimise the side effects of drug treatments for cancer and cardiovascular disease. The project, which involves a total of fifteen industrial partners, university medical centres and academic institutions from throughout the European Union (EU), will run for four years and has a budget of €15.9 million, €10.9 million of which is being funded under the EU’s 7th Framework program.

Cardiovascular disease and cancer are currently the two biggest killers in the world. Although powerful drugs are available to treat certain types of cancer and cardiovascular disease they are mostly administered as intravenous or oral doses. This allows only very limited control over the distribution of drugs in the body, which can circulate in the patient’s bloodstream and interact with many different tissues and organs, both diseased and healthy. The SonoDrugs project aims to address this challenge by developing drug delivery vehicles that can be tracked by ultrasound or magnetic resonance imaging and triggered by ultrasound to release the drugs at the desired location. It is hoped that such control of the drug delivery process will increase therapeutic efficiency and minimise side effects, while also providing a means of tailoring the therapy to individual patients.

Call to increase medical imaging in drug development

The Society of Nuclear Medicine (SNM) Clinical Trials Network Community Workshop convened in Clearwater, Florida in February to address the importance of including imaging agents in multicentre clinical trials for a wide range of medical therapies. Speakers from the field of molecular imaging, regulatory agencies and pharmaceutical developers focused on the critical need to increase the use of imaging biomarkers in clinical trials and called for immediate action.

Presenters at the workshop spoke in-depth about the important need to have the correct imaging biomarker available to accelerate the completion of clinical trials, as well as imaging standardisation, consistent manufacturing practices and regulatory considerations. Experts in oncology, cardiology, dementia and cell therapeutics discussed the important role that imaging biomarkers – indicators of a particular disease state or a particular state of an organism – can play in drug development studies. Other speakers addressed the challenges that researchers and imagers currently face in harmonising imaging results between different locations in a multicentre trial.

“The role of medical imaging in clinical trials is rapidly increasing due to the ability to provide patient assessment and early drug trial results,” said Gustav K. von Schulthess, MD, PhD, professor and director of nuclear medicine, University Hospital, Zurich, Switzerland, who was the keynote speaker at the workshop. “SNM’s Clinical Trials Network is expected to assist greatly by creating and enforcing standards among multiple trial sites, which, in the end, will benefit imagers, pharmaceutical manufacturers and patients.”

$9.7m grant for child medicine development

WHO has received US$ 9.7 million in grant from the Bill & Melinda Gates Foundation to work with UNICEF to conduct crucial research in children’s medicines, with the aim of increasing the number of child-size medicines designed and formulated specifically for children.

Currently, many medicines are only designed for adults. More than 50% of medicines prescribed for children have either not been developed specifically for children or have not been proven to be effective and safe for their use. Therefore, many children lack access to essential treatment because no suitable paediatric dosage or formulation of the necessary medicine exists, or those that do exist are not available or are too expensive.

"We must take the guess work out of medicines for children," said Carissa Etienne, Assistant Director-General, WHO. "Children are suffering and dying from diseases we can treat, and yet we lack the critical evidence needed to deliver appropriate, effective, affordable medicines that might save them.”

The grant provides support for essential research to:

● determine the optimum dosage forms for paediatric medicines (e.g. small tablets, dispersible tablets, powders);
● develop dosing guides (e.g. a review of existing priority medicines and the identification of the appropriate doses for new medicines for children);
● develop guidelines for testing, treatment and use of medicines in children, including guidelines on conducting clinical trials in children.

According to the WHO globally, 1000 children under the age of five die every hour. Diarrhoeal diseases account for 17% of these deaths. The optimal treatment for diarrhoea is zinc with oral rehydration salts. Yet, in a recent study of health facilities zinc was the least available of all paediatric medicines. And when zinc is available, it is not licensed as a treatment to reduce diarrhoea – leaving pharmacists to concoct doses – and it is both unpleasant tasting and difficult to administer. To reduce child mortality in this area, easy-touse, palatable and appropriate dosages are needed.

Another major cause of under-five mortality is pneumonia, leading to 17% of deaths each year. Effective treatment of pneumonia requires 50mg of amoxicillin per kilogram of child's weight per day for three to five days. An easy-to-use package of oral amoxicillin providing the appropriate dose would ensure the right course of medicine is taken, and thus help reduce child mortality.

Climate change and the spread of viruses

Ever since scientists first proposed that our planet might be experiencing widespread climate change, concerns have been raised about its implications for the spread of arboviruses – viruses carried by arthropods such as mosquitoes, midges and ticks. However, while alterations in temperature and rainfall are important factors in making new territory hospitable to an invading arbovirus, many other forces also play significant parts in new patterns of viral emergence.

That’s the message of a paper in the February 2009 Transactions of the Royal Society of Tropical Medicine and Hygiene by University of Texas Medical Branch at Galveston pathology professor Stephen Higgs and Oxford University professor Ernest A. Gould. In the article, Higgs and Gould examine the relative importance of climate change in the spread of four viruses that have captured headlines in the past 10 years: West Nile virus, Chikungunya virus, Rift Valley fever virus and Bluetongue virus.

“There’s no doubt that during the past 50 years or so, patterns of emerging arbovirus diseases have changed significantly,” Higgs said. “We picked prominent examples and asked how much is climate change a factor in these emergences?” Since the viruses in question are carried either by mosquitoes (West Nile, Chikungunya, Rift Valley fever) or midges (Bluetongue), creatures whose activity and population increase in warm, moist environments, one would suspect that a transition to a warmer, wetter climate could have opened the door for their spread to a new region. According to Higgs, though, it’s not that simple. “You can’t disassociate arbovirus diseases from the climate,” Higgs said, “but many other factors affected the spread of these arboviruses.”

sThose factors include genetic mutation, the introduction of new species of mosquitoes, the presence of an immunologically vulnerable human population and ease of transportation of infected humans (Chikungunya virus); cyclic periods of high rainfall, modern irrigation projects, and livestock trade between Africa and southern Arabia (Rift Valley fever virus); and modern air transport, the availability of compatible mosquito species and large numbers of virus-spreading migratory birds (West Nile virus). 


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