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Systems medicine

Kadri Mägi, Marika Lepaste, Monika Szkultecka-Dębek
The aim of this article was to present a general overview of the health care system as well as pricing and reimbursement environment in Estonia. In Estonia the main stakeholders in the pharmaceutical sector are the Ministry of Social Affairs, the State Agency of Medicine, and the Estonian Health Insurance Fund. The national health insurance scheme is public, and approximately 95% of the population is covered by it. It is a social insurance, and universal and equal access to health care based on national health insurance is granted...
March 9, 2018: Value in Health Regional Issues
Huu H Huynh, Clara Roessle, Hélène Sauvageon, Alain Plé, Isabelle Madelaine, Catherine Thieblemont, Samia Mourah, Lauriane Goldwirt
BACKGROUND: Idelalisib is the first orally active selective phosphatidylinositol 3-kinase delta inhibitor approved by Food and Drug Administration and European Medicines Agency in 2014 for the treatment of several types of blood cancer. Idelalisib is widely used as a monotherapy or in combination with rituximab, bendamustine, or ofatumumab with a significant efficacy. However, idelalisib has shown increased risk of infection and a higher frequency of serious adverse events. It may be useful to determine idelalisib concentration in human plasma to adjust dose and to manage adverse effects in clinical practice...
April 2018: Therapeutic Drug Monitoring
Caroline C Swift, Meryle J Eklund, Jacqueline M Kraveka, Adina L Alazraki
Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system. It is the most common extracranial solid tumor of childhood and accounts for up to 15% of all pediatric cancer fatalities. The manifestation of neuroblastoma is variable depending on the location of the tumor and on the presence or absence of paraneoplastic syndromes. The prognosis of neuroblastoma is also highly variable, ranging from spontaneous regression to widespread metastatic disease that is unresponsive to treatment. The age of the patient, stage of disease, histopathologic results, and multiple biologic factors contribute to the presurgical and pretreatment risk stratification of a patient with neuroblastoma...
March 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Whitney M Zoll, Dhani Prakoso, Michael Dark, Junjie Liu, Heather Stockdale-Walden, Maureen T Long
Eosinophils within the central nervous system are abnormal and are usually associated with fungal or parasitic infections in horses. Causative agents include Halicephalobus gingivalis, Sarcocystis neurona, and Neospora hughesi. Confirmation of these organisms via specific testing is typically not performed, and final diagnoses are often presumptive. With molecular technology, many of these organisms can now be confirmed. This is important for emerging and zoonotic pathogens, including Angiostrongylus cantonensis, an emerging parasite of interest in the southeastern United States...
March 1, 2018: Journal of Veterinary Diagnostic Investigation
Marcus S Niepel, Fadi Almouhanna, Bhavya K Ekambaram, Matthias Menzel, Andreas Heilmann, Thomas Groth
BACKGROUND: Cells possess a specialized machinery through which they can sense physical as well as chemical alterations in their surrounding microenvironment that affect their cellular behavior. AIM: In this study, we aim to establish a polyelectrolyte multilayer system of 24 layers of poly-l-lysine and hyaluronic acid to control stem cell response after chemical cross-linking. METHODS AND RESULTS: The multilayer build-up process is monitored using different methods, which show that the studied polyelectrolyte multilayer system grows exponentially following the islands and islets theory...
February 1, 2018: International Journal of Artificial Organs
Rcrm do Nascimento, A A Guerra Jnr, J Alvares, I C Gomes, B Godman, M Bennie, A B Kurdi, F de A Acurcio
INTRODUCTION AND OBJECTIVES: Stains have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. METHODS: Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan...
March 12, 2018: Current Medical Research and Opinion
Philip D Hopkins, Tara Mastren, Justyna Florek, Roy Copping, Mark Brugh, Kevin D John, Meiring F Nortier, Eva R Birnbaum, Freddy Kleitz, Michael E Fassbender
The separation of Th, Pa, and U is of high importance in many applications including nuclear power, nuclear waste, environmental and geochemistry, nuclear forensics and nuclear medicine. Diglycolamide (DGA)-based resins have shown the ability to separate many elements, however, these resins consist of non-covalent impregnation of the DGA molecules on the resin backbone resulting in co-elution of the extraction molecule during separation cycles, therefore limiting their long-term and repeated use. Covalently binding the DGA molecules onto silica is one way to overcome this issue...
March 12, 2018: Dalton Transactions: An International Journal of Inorganic Chemistry
C Fedele, P A Netti, S Cavalli
The fabrication of biomaterials whose properties are activated or inhibited on demand via light is appealing for fundamental biological studies as well as for the development of new applications in tissue engineering and regenerative medicine. One of the most widely used molecules in light-controlled systems is azobenzene for its ability to isomerise in response to light. In this minireview, the fundamental landmarks towards the application of azobenzene-containing materials as cell culture substrates will be highlighted, foreseeing their massive use as next-generation cell-instructive materials...
March 12, 2018: Biomaterials Science
D Papola, C Gastaldon, G Ostuzzi
A substantial proportion of people with mental health conditions do not adhere to prescribed pharmacological treatments. Poor adherence is probably one of the most critical elements contributing to relapse in people with schizophrenia and other severe mental disorders. In order to tackle this global issue, in November 2017 the Food and Drug Administration approved a tablet formulation of the atypical antipsychotic aripiprazole embedded with a novel digital adherence-assessment device. In this commentary, we critically appraised the potential beneficial and harmful consequences of this new digital formulation of aripiprazole, and we highlighted expected implications for clinical practice...
March 12, 2018: Epidemiology and Psychiatric Sciences
Jay Burmeister, Adrian Nalichowski, Michael Snyder, Robert Halford, Geoff Baran, Brian Loughery, Ahmad Hammoud, Joe Rakowski, Todd Bossenberger
We describe the commissioning of the first dedicated commercial total body irradiation (TBI) unit in clinical operation. The Best Theratronics GammaBeam 500 is a Co-60 teletherapy unit with extended field size and imaging capabilities. Radiation safety, mechanical and imaging systems, and radiation output are characterized. Beam data collection, calibration, and external dosimetric validation are described. All radiation safety and mechanical tests satisfied relevant requirements and measured dose distributions meet recommendations of American Association of Physicists in Medicine (AAPM) Report #17...
March 11, 2018: Journal of Applied Clinical Medical Physics
Donald M Hilty, Carolyn Turvey, Tiffany Hwang
PURPOSE OF REVIEW: Psychiatric practice continues to evolve and play an important role in patients' lives, the field of medicine, and health care delivery. Clinicians must learn a variety of clinical care systems and lifelong learning (LLL) is crucial to apply knowledge, develop skills, and adjust attitudes. Technology is rapidly becoming a key player-in delivery, lifelong learning, and education/training. RECENT FINDINGS: The evidence base for telepsychiatry/telemental health via videoconferencing has been growing for three decades, but a greater array of technologies have emerged in the last decade (e...
March 12, 2018: Current Psychiatry Reports
Kathryn A Taylor, David N Durrheim, Tony Merritt, Peter Massey, John Ferguson, Nick Ryan, Carolyn Hullick
Background: System factors in a regional Australian health district contributed to avoidable care deviations from invasive meningococcal disease (IMD) management guidelines. Traditional root cause analysis (RCA) is not well-suited to IMD, focusing on individual cases rather than system improvements. As IMD requires complex care across healthcare silos, it presents an opportunity to explore and address system-based patient safety issues. Context: Baseline assessment of IMD cases (2005-2006) identified inadequate triage, lack of senior clinician review, inconsistent vital sign recording and laboratory delays as common issues, resulting in antibiotic administration delays and inappropriate or premature discharge...
2018: BMJ Open Quality
Marina Roizenblatt, Thomas L Edwards, Peter L Gehlbach
Vitreoretinal microsurgery is among the most technically challenging of the minimally invasive surgical techniques. Exceptional precision is required to operate on micron scale targets presented by the retina while also maneuvering in a tightly constrained and fragile workspace. These challenges are compounded by inherent limitations of the unassisted human hand with regard to dexterity, tremor and precision in positioning instruments. The limited human ability to visually resolve targets on the single-digit micron scale is a further limitation...
2018: Robotic Surgery: Research and Reviews
Vincenzo Mirabello, Fernando Cortezon-Tamarit, Sofia I Pascu
Hypoxia has been identified as one of the hallmarks of tumor environments and a prognosis factor in many cancers. The development of ideal chemical probes for imaging and sensing of hypoxia remains elusive. Crucial characteristics would include a measurable response to subtle variations of pO2 in living systems and an ability to accumulate only in the areas of interest (e.g., targeting hypoxia tissues) whilst exhibiting kinetic stabilities in vitro and in vivo . A sensitive probe would comprise platforms for applications in imaging and therapy for non-communicable diseases (NCDs) relying on sensitive detection of pO2 ...
2018: Frontiers in Chemistry
Charu C Garg, Sarmila Mazumder, Sunita Taneja, Medha Shekhar, Sanjana Brahmawar Mohan, Anuradha Bose, Sharad D Iyengar, Rajiv Bahl, Jose Martines, Nita Bhandari
Trial design: Three feeding regimens-centrally produced ready-to-use therapeutic food, locally produced ready-to-use therapeutic food, and augmented, energy-dense, home-prepared food-were provided in a community setting for children with severe acute malnutrition (SAM) in the age group of 6-59 months in an individually randomised multicentre trial that enrolled 906 children. Foods, counselling, feeding support and treatment for mild illnesses were provided until recovery or 16 weeks. Methods: Costs were estimated for 371 children enrolled in Delhi in a semiurban location after active survey and identification, enrolment, diagnosis and treatment for mild illnesses, and finally treatment with one of the three regimens, both under the research and government setting...
2018: BMJ Global Health
Valerie Evans, Peter Roderick, Allyson M Pollock
There is growing national and international concern about the drug regulatory system in India. Parliamentary reports have highlighted the presence of high numbers of unapproved medicines and irrational combinations of both approved and unapproved drugs in the Indian market-place. Fixed-dose combinations (FDCs) are a peculiar feature of the Indian pharmaceutical landscape. Although metformin is a first-line treatment, FDCs for diabetes in India account for two-thirds of all diabetes medicine sales, and some have not been approved by the Central Drugs Standard Control Organization (CDSCO)...
2018: BMJ Global Health
Ankur Gupta-Wright, Gillian S Tomlinson, Molebogeng X Rangaka, Helen A Fletcher
On 24th March, the world commemorates the day in 1882 when Dr Robert Koch announced his discovery of Mycobacterium tuberculosis (MTB). Over 130 years later, tuberculosis (TB) continues to affect individuals, communities, and entire health systems and economies. Koch unsuccessfully tried to 'cure' TB, and despite major advances in other areas of medicine, control of TB remains elusive- in 2016 TB was the leading infectious cause of death. The STOP TB partnership and World Health Organization (WHO) have announced their theme for World TB Day 2018 "Wanted: Leaders for a TB-Free World...
2018: F1000Research
Roman I Koning, Abraham J Koster, Thomas H Sharp
Cryo-electron tomography (CET) utilizes a combination of specimen cryo-fixation and multi-angle electron microscopy imaging to produce three-dimensional (3D) volume reconstructions of native-state macromolecular and subcellular biological structures with nanometer-scale resolution. In recent years, cryo-electron microscopy (cryoEM) has experienced a dramatic increase in the attainable resolution of 3D reconstructions, resulting from technical improvements of electron microscopes, improved detector sensitivity, the implementation of phase plates, automated data acquisition schemes, and improved image reconstruction software and hardware...
March 8, 2018: Annals of Anatomy, Anatomischer Anzeiger: Official Organ of the Anatomische Gesellschaft
Vivian E von Gruenigen, Beth Y Karlan
For the last few months, media and news outlets have exposed prominent professionals in many settings who have taken advantage of their status of power and influence to engage in sexual harassment and discrimination in the workplace. In medicine, harassment may include many types of health professionals including physicians, nurses, medical students, colleagues and even patients. Programs for sexual harassment prevention, education and training vary between industries, workplaces, medical schools and hospitals...
March 8, 2018: Gynecologic Oncology
Shubha Singhal, Vandana Roy
OBJECTIVE: To assess the knowledge, attitude, perception and practice of Ayurveda, yoga, Unani, Siddha, homeopathy and naturopathy (AYUSH) among allopathic doctors and interns and determine their opinion regarding integration of AYUSH education within the allopathic curriculum. METHODS: This prospective, cross sectional study was conducted in a tertiary care teaching Hospital, New Delhi, India, from March 2016 to March 2017. A survey of 500 allopathic doctors and 150 interns was performed using a structured questionnaire...
March 2018: Journal of Integrative Medicine
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