Newswise — PHILADELPHIA — A new trial led by the Perelman School of Medicine at the University of Pennsylvania will evaluate whether the use of medications to treat high blood pressure affect outcomes among patients who are prescribed the medication and hospitalized with COVID-19. As part of the multi-center, international trial called REPLACE COVID, investigators will examine whether ACE inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs)—two classes of medications to treat high blood pressure—help to mitigate complications or lead to more severe symptoms and worse outcomes. The study (NCT04338009) is enrolling patients now. Through the trial, investigators will randomly assign patients who are hospitalized with COVID-19 to either stop or continue taking their prescribed medication. The team will closely monitor the patients to evaluate the effect of temporarily stopping the therapy. Julio A. Chirinos, MD, PhD, an associate professor of Cardiovascular Medicine, and Jordana B. Cohen, MD, MSCE, an assistant professor in the division of Renal-Electrolyte and Hypertension, are the study’s co-principal investigators. “While some data suggests patients with underlying health conditions, like heart disease and high blood pressure, have a higher risk of developing a more severe form of COVID-19, we don’t know whether ACE inhibitors or ARBs are beneficial or harmful,” Chirinos said. “There’s an urgent need to understand how these medications may alter the disease course so we can better guide our treatment for patients who are prescribed these therapies and infected with COVID-19.” High blood pressure, defined as a top reading of at least 130 or a bottom one of 80, affects nearly half of American adults. If left untreated, the condition increases one’s risk for severe complications, including heart attack and stroke. More than one-third of people with high blood pressure are prescribed ACEIs or ARBs. Past research has shown that these medications may enhance the virus’ ability to bind to cells in the body. However, separate studies have found that the medications may, in fact, result in an improved response in the kidney, lung, and heart to protect against the virus. For this trial, investigators plan to enroll 152 patients who are hospitalized with a suspected diagnosis of COVID-19 and who already use one of the medications. The team, which also includes Thomas C. Hanff, MD, MPH, a Cardiovascular Medicine fellow at Penn, will perform the study on a pragmatic intent-to-treat basis, meaning clinicians can change the dose or discontinue the medications if there is a compelling clinical reason. Ultimately, investigators aim to develop a global risk score that ranks patient outcomes based on four factors: time to death, the number of days supported by mechanical ventilation or extracorporeal membrane oxygenation (ECMO), length of time on renal replacement therapy, and a modified sequential organ failure assessment score. “Many people are changing their usual medical management right now based on limited or incomplete information,” Cohen said. “Until we have high quality evidence, we recommend that patients continue to take these medications as prescribed unless they are told to stop them by their medical provider.” Given the study’s expedited timeframe, investigators are pursuing a variety of funding mechanisms. The team also established a social fundraising campaign to help support the study. Jesse L. Chittams, managing director of the Biostatistics Analysis Core at the University of Pennsylvania, is also an investigator on the study.
Photo by James Zanewicz The new COVID-19 testing being done at the medical school will save time from having to ship samples to the state lab in Baton Rouge. The goal is to do about 100 tests a day, with results available within 24 hours. Newswise — Tulane University has added a second avenue for COVID-19 testing, this one taking place at a Tulane School of Medicine repurposed research lab where results can be processed within a day. The test is identical to the PCR test being used by the Centers for Disease Control (CDC) and is another way that Tulane is working to ease the testing crisis and stop the spread of COVID-19, which has hit the New Orleans area especially hard.Earlier this week, a laboratory based at Tulane Medical Center in partnership with LSU and UMC-LCMC began conducting a different new test for COVID-19 that can yield results within four hours. Researchers at the HCA-TMC Laboratory ran its first set of tests using the Cobas 6800 analyzer over the weekend and is now capable of running nearly 200 tests a day on patients at both Tulane Medical Center and University Medical Center. The testing being done at the medical school will save time from having to ship samples to the state lab in Baton Rouge, where because of demand, results can take days, rather than hours, to obtain. “Tulane’s efforts could help more quickly triage patients to the appropriate section of the hospital, speed up recruitment into clinical trials for interested patients, and even, over time, provide the ability to determine whether viral loads are affected by various interventions,” said Dr. Dahlene Fusco, an infectious disease specialist at Tulane University School of Medicine. “This information is crucial in our understanding of how to best treat patients.”The School of Medicine test was developed by Tulane virologist Bob Garry and his team in collaboration with Drs. Xiao-Ming Yin and Di Tian in the Department of Pathology. It is based on the PCR (Polymerase Chain Reaction) test being used by the CDC, which determines a positive or negative diagnosis through a nasal swab. For now, the test is available only to members of the Tulane medical community who show symptoms of COVID-19, such as coughing, respiratory struggles and fever. They include patients, health care providers, faculty, staff, residents and students. The goal is to do about 100 tests a day, with results available within 24 hours. Eventually, Tulane hopes to double the number of tests and, if possible, extend their availability to the community.Garry, who played an integral role in test development during the Lassa and Ebola crises, said Tulane’s ability to offer the test is a significant achievement, given the complex and ever-changing regulatory environment under which the nation’s medical community is operating.“Because it’s an in-house test, we don’t need to send samples to a central lab to wait for the result,” Garry said. “It’s not rocket science but it does take a supply chain which is challenging but getting better.” Garry facilitated the test in collaboration with the Pathology Department, which has validated and is administering the test in a lab certified by the Clinical Laboratory Improvement Amendments (CLIA) which ensures quality lab testing. Patrice Delafontaine, executive dean of the School of Medicine, said the availability of CLIA-certified lab in pathology was essential in getting the COVID-19 testing lab up and running. “Dr. Lee Hamm (dean of the School of Medicine) and I felt it was critical to organize this effort very quickly,” he said, “and the extraordinary expertise in virology at Tulane, in particular through Bob Garry and his program, provided the most efficient method to get this done.”
Numerical data sometimes reveal facts that are otherwise concealed within an onslaught of information from an overwhelming number of sources. Prof. Ron Milo and research student Yinon Bar-On of the Weizmann Institute of Science’s Department of Plant and Environmental Sciences, together with American colleagues Prof. Rob Phillips of Caltech and Dr. Avi Flamholz of the University of California, Berkeley, have now employed an original research method to organize the flood of coronavirus information in an orderly framework. The scientists examined hundreds of studies from around the world. The first stage of the project required the scientists to understand the different measurement and estimation methods so that they could coordinate and translate all the findings into the same “language” – a complex task requiring great care. The scientists’ experience helped them in this task, as they translated and consolidated a wealth of data and findings that they accumulated in previous studies: the number of cells in the human body, biomass distribution on Earth, and more. (For example, see: http://book.bionumbers.org/.) The research was fast-tracked to publication in the journal eLife. One of the interesting findings highlighted by the collected data is the similarity between the coronavirus genome and the genome of other viruses. For example, the genome of the coronavirus is: 96% identical to a coronavirus genome that infects bats 91% identical to a coronavirus genome that infects scaly anteaters (pangolins) 80% identical to the SARS virus that erupted about two decades ago 55% identical to the MERS virus that erupted eight years ago 50% identical to the coronavirus that causes “common colds” The scientists also present numerical data on the coronavirus’s attachment to various organs in the body (bronchi, lungs, different types of cells, and more). The study presents the number of copies and other quantitative features of virus “targets,” which are relevant for developing vaccines and pharmaceuticals that block the virus’s ability to adhere to and penetrate a human cell. An additional part of the team’s research relates to the virus’s mutation accumulation rate. This value is related to the chance (risk) that the virus will bypass vaccines developed against it – and return to attack humans. The coronavirus’s mutation accumulation rate is relatively slow compared to influenza viruses; Prof. Milo cautiously estimates that this may indicate that drugs and vaccines developed by scientists will be more durable in curbing this virus over time. Prof. Ron Milo’s research is supported by the Mary and Tom Beck – Canadian Center for Alternative Energy Research, which he heads; the Zuckerman STEM Leadership Program; Dr. and Mrs. Brian Altman; the Larson Charitable Foundation New Scientist Fund; the Ullmann Family Foundation; Dana and Yossie Hollander; and the European Research Council. Prof. Milo is the incumbent of the Charles and Louise Gartner Professorial Chair. The Weizmann Institute of Science in Rehovot, Israel, is one of the world’s top-ranking multidisciplinary research institutions. The Institute’s 3,800-strong scientific community engages in research addressing crucial problems in medicine and health, energy, technology, agriculture, and the environment. Outstanding young scientists from around the world pursue advanced degrees at the Weizmann Institute’s Feinberg Graduate School. The discoveries and theories of Weizmann Institute scientists have had a major impact on the wider scientific community, as well as on the quality of life of millions of people worldwide.
Experts from Seattle Cancer Care Alliance share lessons learned from early experiences treating people with cancer during COVID-19 outbreak via free online article in JNCCN—Journal of the National Comprehensive Cancer Network Newswise — PLYMOUTH MEETING, PA [March 18, 2020] — Experts from the Seattle Cancer Care Alliance (SCCA)—a Member Institution of the National Comprehensive Cancer Network® (NCCN®)—are sharing insights and advice on how to continue providing optimal cancer care during the novel coronavirus (COVID-19) pandemic. SCCA includes the Fred Hutchinson Cancer Research Center and the University of Washington, which are located in the epicenter of the COVID-19 outbreak in the United States. The peer-reviewed article sharing best practices is available for free online-ahead-of-print via open access at JNCCN.org. “Responding quickly and confidently to the COVID-19 crisis is the health care challenge of our generation,” said co-lead author F. Marc Stewart, MD, Medical Director, SCCA. “Our overarching goal is to keep our cancer patients and staff safe while continuing to provide compassionate, high-quality care under circumstances we’ve never had to face before. We are working around the clock to develop new guidelines and policies to address situations that we couldn’t have imagined several weeks ago. When the pandemic ends, we will all be proud of what we did for our patients and each other in this critical moment for humanity.” “The COVID-19 pandemic is impacting every facet of our global and domestic societies and health care systems in unprecedented fashion,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “People with cancer appear to be at increased risk of COVID-19, and their outcomes are worse than individuals without cancer. The NCCN Member Institutions are rapidly gaining experience in preventing and managing COVID-19. As is the nature of the NCCN Member Institutions, they are sharing their experience in organizing and managing institutional and care systems responses and best practices in this rapidly evolving global effort.” The article stresses the importance of keeping channels of communication open between administrators and staff, patients, caregivers, and the general public. The authors recommend forming an Incident Command Structure (as illustrated in included image) to provide early coordination of institution-wide efforts and to rapidly respond to changing information. They highlight the need to remain flexible and ready for unexpected challenges. Some of the anticipated challenges include: Staff shortages due to potential exposure and/or school closings Limitations of resources such as hospital beds, mechanical ventilation, and other equipment Impact on treatment from travel bans, including reduced access to international donors for allogeneic stem cell transplantation The authors recommend mitigating some of these concerns through proactive measures that include: Providing patient information via handouts, signs, web-based communication, and a dedicated phone line for questions and triage Rescheduling “well” visits and elective surgeries, and deferring second opinion consultations (where care is already appropriately established) Increasing hours of general hospital operations to reduce the unnecessary use of emergency department resources Reinforcing a strict “stay at home when ill” policy and insuring staff have access to testing Restricting travel and enabling work-from-home wherever possible Prioritizing the use of soap and water over hand gel Limiting the number of team members who enter patients’ rooms Considering lower thresholds for blood transfusions Moving some procedures from inpatient to outpatient Adopting a no visitor policy with rare exceptions such as end-of-life circumstances Having upfront, proactive palliative and end-of-life conversations with cancer patients who may become infected with COVID-19 The article also addresses the importance of self-care within and beyond the medical community. The authors call for the prioritization of measures to protect health and frontline staff and assure a safe work environment in order to prevent provider burnout. Those measures include compensation policies, reassignments to administrative roles for immunocompromised staff, and the creation of a back-up labor pool. NCCN is also gathering documents and links from the leading cancer centers that comprise the nonprofit alliance, and sharing them all online at NCCN.org/covid-19. These include print outs for patient information, screening tools, visitation policies, and other essential forms. Hospitals worldwide are free to use or adapt these resources immediately. The site will be continuously updated as new resources become available. The entire article can be read at https://jnccn.org/fileasset/jnccn1804-Ueda_20118_preprint.pdf, or via a link at NCCN.org/covid-19. # # # About the National Comprehensive Cancer Network The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world. The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT. Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news. Follow NCCN on Twitter @NCCN, Facebook @NCCNorg, and Instagram @NCCNorg.
JUMP TECHNOLOGIES SUPPLY CHAIN PLATFORM TEMPORARILY NO COST FOR HOSPITALS TRACKING COVID-19 SUPPLIES
Hospitals can quickly and safely implement free reporting tool to manage utilization of critical supplies and avoid stockouts during high-volume COVID-19 response EAGAN, MN (March 18, 2020) — The rapid spread of the novel coronavirus (COVID-19) has placed unique pressures on the hospital supply chain, forcing facilities to maintain a detailed picture of what inventory they have available, where it’s located, and how fast it’s moving – all of which is essential to treating the high volume of patients with COVID-19 symptoms. To help hospitals achieve this critical balance and to ensure health care providers have the proper personal protective equipment (PPE) to safely perform their jobs, Jump Technologies announced today it will temporarily open it’s inventory management platform up to all hospitals at no cost to help them ensure they have the proper PPE and related COVID-19 supplies available for hospital workers. “At times like this, it’s vitally important for hospitals to have the supplies their employees need to stay safe. To do this, they need a clear picture of PPE inventory so they understand the resources available to them and whether they are at risk of running out of essential supplies before their next shipment,” said John Freund, CEO of Jump Technologies. “Because we understand the challenges this pandemic creates for hospital supply chain, we are waiving our fees to ensure as many hospitals as possible have access to tools that will give them insight into high-demand supplies that are essential to their employees.” According to Freund, the Jump Technologies’ solution runs in the cloud and does not require any special hardware, so it can be set up quickly and with no disruption to hospital operations. Supply chain staff can be up to speed on using the system with just a 30-minute training session. Key elements of the reporting tool include: Using JumpStock, hospitals can easily see where existing supplies are located (in hospital storage or in a warehouse); track consumption by department, clinic, or user; and forecast potential stockouts. The new solution does not require integration into the hospital ERP or EMR and does not require access to sensitive data such as patient information or pricing. Because it is a cloud-based solution, it is safe, simple, and secure for hospitals. Hospitals and health systems can access the Jump Technologies solution by filling out a form at www.jumptech.com/covid19. A representative from Jump Technologies will contact the hospital to discuss setup options, configure the account, and upload data.
By Dr. Charles Herrick, Chair of Psychiatry, Nuvance Health Newswise — Does the COVID-19 pandemic have you feeling anxious and worried? If yes, please know that you’re not alone! Being nervous about the chances that you, a loved one, or a friend may come down with this novel coronavirus is common. These feelings can be intensified by the seemingly nonstop news coverage on the topic. While meant to provide information and, to some degree, to reassure the public, such round-the-clock coverage can lead to panic, especially as the COVID-19 outbreaks are now closer to home. Thankfully, there are a number of ways to deal with these feelings, including that old favorite, taking a deep breath. Doing so enables more air to flow into your body and can help calm your nerves while also reducing stress and anxiety. So let’s start there. Deep breath in … deep breath out … Here are answers to common questions and more tips to help you during this stressful time: What can we do to manage anxiety and fear during this COVID-19 pandemic? Recognize it’s normal to panic: As human beings, we’re susceptible to panic during unknown and stressful events. Having this awareness can actually help to manage the panic because you know it’s not uncommon. If you already have existing anxiety, focus on the coping strategies you regularly practice when there are triggering events like this outbreak of COVID-19. Stick to the facts: Focusing on facts is a better way to judge the risk, rather than relying on peers and social media. Even with standard media, make sure the sources of your information are from trusted sources. The Centers for Disease Control and Prevention (CDC) is an excellent and sound source for factual, current information, as well as your state and local health departments and hospitals. Stick to what you can control: Keep to your routine as best you can, while following the guidelines provided by the CDC, state and local health departments, and your local hospitals. Routines can be soothing because they are familiar. Remember to exercise, eat well, stay hydrated, and get enough sleep to keep your immune system strong, which is important to reduce the risk of getting sick with other illnesses (we’re still in cold and flu season) and to help manage stress. Remember that you’re not alone: Touch base with loved ones, family, and friends through your usual daily activities; if that doesn’t include in-person get-togethers, try phone calls or video chats. Keep in mind that everyone is going through this now. With all of us in essentially the same situation, you can achieve a sense of “we’ll figure this out together.” This mindset can be empowering and uplifting. Put things in perspective: The vast majority of viral infections are not from this new coronavirus; they continue to be common cold and flu. Refrain from thinking that anyone who has a cough or fever must have COVID-19. The risk of serious illness from COVID-19 remains low. Most infected people will experience mild upper respiratory symptoms, including cough, nasal congestion, and a fever. As of this writing, more people have died from flu this year in just the United States alone, compared to deaths from COVID-19 worldwide. The CDC estimates that from October 1, 2019 to February 29, 2020, between 20,000 and 52,000 Americans died from flu, and predicts that at least 12,000 Americans will die from the virus in any given year. Consider opioids too, which were involved in a staggering 47,600 overdose deaths in the United States in 2017, according to the latest data from the CDC. Continue to enjoy life: The sun is still shining. Babies are still being born. People are still producing great work, such as your care teams and staff at Nuvance Health who are continuously working to keep you safe as we fight against COVID-19. So continue to enjoy your life, and feel good when you follow guidelines to reduce your risk of possible exposure to COVID-19. Is there anything we can look forward to? Yes! Every crisis is an opportunity. If you end up in self-isolation, and your routine changes in some way, find something positive in that. For example, take up a new home-based hobby that you’ve been wanting to do, such as meditation or yoga; start that book you’ve been wanting to read. Strong bonds are formed during times like these that probably wouldn’t have formed under normal circumstances. Remember that we’re facing adversity together, and that strong social connections are how we survive these types of events. Again, fear — and even panic — are normal emotions to experience during events like these. Accept that, stay informed with accurate facts, and remember that we’re all in this together. And, yes, take a deep breath. Nuvance Health is keeping the communities informed on our website at nuvancehealth.org/coronavirus, and on social media @NuvanceHealth, or search for your hospital’s name.
Newswise — The Families First Coronavirus Response Act (H.R. 6201) represents swift action by the House of Representatives to bolster federal responses to the spread of coronavirus and aims to reduce the pandemic’s impacts on Americans’ safety and financial security, while addressing an ongoing COVID-19 testing backlog. The Infectious Diseases Society of America, however, is alarmed that the bill only allows coverage for in vitro diagnostic test kits and laboratory developed tests that have already received Emergency Use Authorization by the U.S. Food and Drug Administration, excluding tests from developers that are in the process of finalizing EUA applications. This runs counter to the updated Feb. 29 policy allowing immediate use of tests that have been validated by developers, reduces patient access to urgently needed diagnostic tools and leaves patients open to surprise billing for tests administered under current policy. The current bill language will potentially exclude thousands of tests that can be used to identify transmission and stanch the outbreak. With the bill now heading to the Senate, IDSA strongly encourages Congress to provide accessible testing for all Americans who require it by amending the current bill language to cover tests that have been validated in accordance with existing policy. This will ensure broad and sustained rollout of lifesaving testing, even in the event of delays in the EUA process.
50% ALZHEIMER’S & DEMENTIA DOCTORS SURVEYED: MED. PROFESSION NOT PREPARED TO MEET EXPECTED DEMAND INCREASE
Newswise — CHICAGO, March 11, 2020 – A new survey of primary care physicians appearing in the Alzheimer’s Association 2020 Alzheimer’s Disease Facts and Figures report finds nearly 9 in 10 primary care physicians (87%) expect to see an increase in people living with dementia during the next five years, but half (50%) say the medical profession is not prepared to meet this demand. The new report estimates there are currently more than 5 million Americans 65+ living with Alzheimer’s – a number expected to nearly triple by 2050. The 2020 Facts and Figures report provides an in-depth look at the latest national statistics on Alzheimer’s prevalence, incidence, mortality, costs of care and impact on caregivers. For the first time, the accompanying special report, “On the Front Lines: Primary Care Physicians and Alzheimer’s Care in America,” examines the experiences, exposure, training and attitudes related to dementia care among primary care physicians (PCPs), recent medical school graduates, and recent residency program graduates, now in primary care practice. The report found that 82% PCPs say they are on the front lines of providing dementia care, but not all are confident in their care for patients with Alzheimer’s and other dementias. Nearly 2 in 5 (39%) report they are “never” or only “sometimes comfortable” making a diagnosis of Alzheimer’s or other dementias. Nearly one-third (27%) report they are “never” or only “sometimes comfortable” answering patient questions about Alzheimer’s or other dementias. 22% of all PCPs had no residency training in dementia diagnosis and care. Of the 78% who did undergo training, 65% reported that the amount was “very little.” “The perspectives of primary care physicians raise an important alarm regarding the current reality and future of dementia care in this country,” said Joanne Pike, Dr. P.H., chief program officer, Alzheimer’s Association. “The number of Americans living with Alzheimer’s and other dementias is increasing and primary care physicians, who are the front line of providing care, are telling us the medical profession is not prepared to meet the future demand. The Alzheimer’s Association is committed to working with physicians, health systems, policymakers and others to develop strategies and solutions that ensure timely, high-quality dementia care is available for all who need it.” Ensuring PCPs are adequately prepared to provide dementia care is especially critical given a severe shortage of dementia care specialists. A state-by-state analysis in the report examines the number of geriatricians needed to meet future care needs for seniors living with dementia in 2050. It revealed severe shortages in several states, with 14 needing to increase the number of practicing geriatricians at least five-fold to meet projected demands. Other analyses have shown large projected needs for neurologists and other specialists who provide critical expertise in dementia diagnosis and care, according to the report. While more than one-third of PCPs (37%) say they refer dementia patients to specialists at least once a month, more than half (55%) say there are not enough dementia care specialists in their area to meet patient demand, a problem more common in rural areas. According to the report, 44% of PCPs practicing in large cities and 54% in suburbs reported there are not enough specialists in their area, while 63% practicing in small cities or towns and 71% in rural areas noted this challenge. “The shortage of dementia care specialists needs to be addressed, but considerable focus must be given to ensuring dementia care education, training and ongoing learning opportunities are available for primary care physicians,” Pike said. “In addition, we need to consider how primary care physicians are supported within the health system to provide robust, quality care. Demands for dementia care are increasing and primary care physicians are about to be under siege.” PCPs participating in the survey report that 4 in 10 of their current patients are age 65 and older, and, on average, 13% of their patients have been diagnosed with dementia. The majority of PCPs (53%) say they are answering questions related to Alzheimer’s or other dementias every few days or more. More than 9 in 10 PCPs (92%) believe patients and caregivers expect them to know the latest thinking and best practices around dementia care. The Facts and Figures report reveals nearly all PCPs (99%) say it is important to stay current on new developments in diagnosis and care for Alzheimer’s and other dementias. Areas cited as most important by PCPs include: management and treatment (83%), screening and testing (69%), diagnosis (64%), prevention (49%), family support (49%), managing dementia alongside other conditions (46%) and signs and symptoms (44%). While a majority of PCPs (58%) feel that the quality of existing training options is either “good” or “excellent,” challenges in obtaining dementia care training were noted. Nearly a third (31%) say current options are difficult to access, and half (49%) say there are too few options for continuing education and training on dementia care. In fact, 37% of PCPs reported that they learned the most about dementia care from their own experiences treating patients, second only to CME courses (40%). “We’re heading toward a medical emergency, when it comes to ensuring dementia care will be available for all who need it and it must be addressed,” Pike said. “Individuals and families impacted by Alzheimer’s and other dementias already face enough challenges; having access to doctors providing quality and timely dementia care should not be another.”
Achilefu lab A new imaging agent, developed at Washington University School of Medicine in St. Louis, illuminates cancerous cells of a breast tumor. The new agent lights up cancer cells and the supporting cells that act as a shield, protecting the tumor from various treatment strategies. The new investigational agent is being tested in small clinical trials. Newswise — Scientists at Washington University School of Medicine in St. Louis have developed a new imaging agent that could let doctors identify not only multiple types of tumors but the surrounding normal cells that the cancer takes over and uses as a shield to protect itself from attempts to destroy it. The study appears March 9 in the journal Nature Biomedical Engineering. The imaging agent, referred to as LS301, has been approved for investigational use in small clinical trials at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. The first trial will investigate its use in imaging breast cancer. “This unique imaging agent identifies cancer cells as well as other compromised cells surrounding the tumor,” said Samuel Achilefu, PhD, the Michel M. Ter-Pogossian Professor of Radiology. “Cancer transforms surrounding cells so that it can proliferate, spread to other parts of the body and escape treatment. This imaging compound can detect cancer cells and their supporting cast, the diseased cells that are otherwise invisible.” The compound binds to the activated form of a protein called annexin A2, which is present in many types of solid tumors but not healthy tissue. The activated form of the protein promotes inflammation and invasiveness of these tumors, which allows cancer to spread. Solid tumors that contain activated annexin A2 are found in breast, colon, liver, pancreatic, head and neck, and brain cancers. Since the activated form of the protein also is present in the cells that surround the tumor — and not normal, healthy cells — doctors potentially could use this imaging agent to identify cells the tumor has hijacked. Despite their benign status, these hijacked cells protect the tumor from chemotherapy, radiation and other attempts to kill the cancer cells. Such co-opted cells also conceal cancer stem cells, whose stealth presence can lead to a recurrence of the tumor. “We are coming to the realization that to eradicate cancer, we also need to focus on the microenvironment of the tumor,” said Achilefu, who also directs the university’s Optical Radiology Lab at the Mallinckrodt Institute of Radiology and is co-leader of the Oncologic Imaging Program at Siteman. “Most cancer drugs are designed to target cancer cells. But cancer cells create their own fiefdom, where they impose their own rules. If a normal cell nearby wants to continue living, it must follow the new rules. And slowly these cells come to identify with the tumor rather than their normal identity.” Achilefu expects that with a tumor and its surrounding fiefdom illuminated by the new imaging agent, doctors would have a better chance of removing the entire tumor as well as any areas that are likely to harbor microscopic cancer cells. In past work, Achilefu’s team has developed cancer goggles that allow surgeons to visualize cancer cells in real time during surgery to remove a tumor. The new imaging agent can be used with these goggles, which are being evaluated in clinical trials. The researchers also are working on a version of the compound that could be used in positron emission tomography (PET) scans, which many cancer patients undergo to assess whether cancer has spread. As Achilefu and his colleagues saw that the compound lit up the hijacked cells on the periphery of the tumor, they were surprised to see the imaging agent light up parts of the central core of the tumor as well. “We were amazed when we saw this because it’s extremely difficult to access anything inside a tumor,” Achilefu said. “There seems to be a type of immune cell that carries the imaging agent into the core of the tumor. So we now see the tumor margin and the core light up. This allows us to imagine a situation in which we could deliver a drug to the outside and the inside of the tumor at the same time. This dual targeting is not something we purposefully designed — it’s not something we ever anticipated.” With this in mind, Achilefu’s team conducted mouse studies to show that the researchers can attach a chemotherapy drug to the compound and use it to image the tumor and treat the disease simultaneously. “Attaching a chemotherapy drug to this targeted imaging agent could reduce side effects as we are delivering the drug directly to the tumor,” he said. “If the clinical trials are successful with the imaging, we will move into therapy.”
Sandia National Laboratories Sandia National Laboratories scientists Peter Schwindt, bottom, and Amir Borna have been awarded $6 million to convert the quantum-sensor-based magnetoencephalography system shown here into an adjustable, wearable one. Newswise — ALBUQUERQUE, N.M — It might not start a fashion trend, but Sandia National Laboratories is designing a wearable brain imager. The National Institutes of Health has granted Sandia $6 million to build the prototype medical device that would make magnetoencephalography (MEG) — a type of noninvasive brain scan — more comfortable, more accessible and potentially more accurate. “This is the future of MEG,” said Sandia MEG scientist Amir Borna, lead author on a paper describing the proposed system recently in the journal PLOS ONE. Physicians use MEG to locate the sources of epilepsy, and researchers use it to study brain development, Alzheimer’s disease and stroke. But the procedure requires a person to hold still for long periods under a rigid, helmet-like dome, which can be difficult for children, people with chronic pain and people with motor disorders, such as Parkinson’s disease. “The goal is to expand the number of clinical indications for which MEG may inform clinical care,” said Julia Stephen, director of the MEG core lab at the Albuquerque-based Mind Research Network, a division of Lovelace Biomedical Research Institute, and an advisor on the project. According to Stephen, who is also a professor of translational neuroscience, a wearable device would give patients freedom to relax and move into comfortable positions during the procedure, enabling more people to be tested and eliminating differences in data between patient groups. Because the signal measured from the brain decreases with distance and the new system would fit closer than a one-size-fits-all helmet, measurements are expected to be more accurate for children. Sandia’s Peter Schwindt, the project’s principal investigator, said what prevented this in the past was that superconducting sensors were used, requiring containers of liquid helium. The cryogenic hardware forces designers of these systems to fix the sensors into place. But Sandia is using alternative sensor technology that works at room temperature, eliminating liquid helium and the rigid design requirements it imposes. Quantum sensors as accurate as commercial technology In the recent paper, the Sandia team showed its system, based on a kind of quantum sensor called an optically pumped magnetometer, or OPM, pinpoints brain signals with the same accuracy as a commercial, superconductor-based machine. Measurements made by each system were less than a centimeter apart. This research was also funded by NIH. “We have demonstrated a functional brain-imaging system using our quantum sensors that is as reliable as a commercial superconductor-based system,” Borna said. Borna credits the cross-disciplinary resources of a national laboratory to achieve the sensor’s high accuracy. The Sandia team designed, built and calibrated their sensors in-house, rather than buying commercial ones. Information travels through the brain by electrical currents. Sandia’s sensor uses a laser to turn rubidium gas into a tiny cloud of atomic magnets that, when in a magnetic field, spin like tops. With Sandia’s current apparatus, a patch of these sensors is placed directly against a person’s head inside a magnetically shielded tube resembling an MRI. Then, a second laser measures changes in each cloud to infer a naturally occurring but barely perceptible magnetic field immediately outside a person’s head, created by the electrical currents in the brain. Finally, the magnetic field map is inverted to give the location of brain activity. In the future, wearable version, more than 20 sensors will map the magnetic field over a portion of the brain, and the array will be housed inside a magnetically shielded room instead of a tube to allow the subject to move. “We are working to redesign our sensors and then scale up from six sensors to 27 sensors to give 108 OPM channels around the head,” Schwindt said. “We will essentially remake the whole system.” Sandia National Laboratories is a multimission laboratory operated by National Technology and Engineering Solutions of Sandia LLC, a wholly owned subsidiary of Honeywell International Inc., for the U.S. Department of Energy’s National Nuclear Security Administration. Sandia Labs has major research and development responsibilities in nuclear deterrence, global security, defense, energy technologies and economic competitiveness, with main facilities in Albuquerque, New Mexico, and Livermore, California. Research reported in this news release was supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health under award numbers R01EB013302 and R56EB013302. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.