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In “I’ve Seen The Future Of Healthcare. I Like What I See,” I noted ZOOM+ had a radically different approach to emergency rooms. Now that ZOOM+ is also a health plan, it’s logical that they would go after one of the biggest areas of unnecessary and expensive care—the ER. Rather than viewing it as a profit engine, they simply view their ER as one of the important pieces of the puzzle in building the Kaiser Permanente for the 21st century . This new approach implicitly addresses the Quadruple Aim more effectively than any other ER I’ve seen or heard about. I expect this approach to ERs will be a new component of the Health Rosetta that raises the bar on the under-performing status quo. As you visit their facilities or see the pictures in this article, I’m struck with the thought that if Steve Jobs was creating a clinic or an ER, ZOOM+ is what he would have created. The radical simplicity of this and the Transparent Medical Network that was highlighted in “The Silver Bullet To Solving Healthcare’s Most Vexing Problem” are the two most straightforward ways I’ve seen to slay the healthcare cost beast. One could imagine how next generation health plans such as Alignment Healthcare, CareMore, Clover Health, Humana’s Medicare Advantage (where they partner with ChenMed and Iora Health) and Oscar would employ these two strategies. Not only does it save money, it also would serve a “ billboard” for these new brands. There aren’t many “try before you buy” options available to healthcare. This would be one. [Disclosure: As I've disclosed many times, the Health Rosetta is a non-commercial open-source project that provides a reference model for how purchasers of healthcare should procure health services. In my role as managing partner of Healthfundr, a seed stage venture fund, we invest in companies adhering to precepts of the Health Rosetta.]   In the earlier piece, I summarized what ZOOM+ is doing with their ZOOM+ Super ER concept that is meant to radically reduce unnecessary hospitalizations. Unlike many new freestanding ER concepts that do little to positively impact the Quadruple Aim, it’s clear that the ZOOM+ Super concept is designed to be pleasant for the board-certified ER docs. This naturally leads to a better patient experience, which in turn helps improve outcomes. The byproduct is an approach that clearly lowers overall healthcare spending. That stands in stark contrast to many freestanding ERs where there has been quite a bit of abuse. To read full story Click Here Credit Dave Chase
A plant-based ointment recipe pulled from a 1,000-year-old manuscript is spiking excitement about what historical knowledge and traditional remedies can do to defuse the antibiotic crisis. At the same time, it’s highlighting how difficult it can be to move any compound—natural or synthetic, ancient or modern—from the lab bench to where it might do the most good. You might have seen coverage of this: At the annual conference of the British Society for General Microbiology last week, a team of researchers from the University of Nottingham in England and Texas Tech University in the United States presented the results of their attempt to translate and manufacture an ointment described in a medieval manuscript held at the British Library. (The abstract doesn’t seem to be online, except within the conference program, so I snipped it and uploaded it to my Scribd account here.) The text, called Bald’s Leechbook, is in Anglo-Saxon; you can think of it as one of the earliest medical textbooks written in the West. The recipe is presented as a remedy for styes, pustular infections of an eyelash follicle that, in the pre-antibiotic era—and the 10th century was definitely pre-antibiotics—could cause blindness or even death if the infection spread to the nearby brain. It specifies garlic, leek, onion, honey, and bile from the digestive system of a slaughtered cow, and describes in detail how the potion should be made, by boiling up a solution in a brass vessel and fermenting it. And, apparently, it works. The UK arm of the team translated the recipe, concocted it, and conducted initial tests on bacteria on culture plates. The US side tested it on infected tissue harvested from lab mice. In both settings, the potion killed MRSA, drug-resistant staph—and killed at higher rates than vancomycin, a last-ditch drug that medicine reserves for serious infections with that superbug. “We were really surprised, and I was surprised,” Christina Lee, PhD, a medieval scholar on the team, confessed by phone. “I have always held up the idea of the pragmatic Middle Ages, that they had knowledge and method, but I was not sure whether that would hold up.”   To read full story Click Here Credit Maryn McKenna  
An outbreak at a Pennsylvania hospital in late 2012 should have been an early warning that a reusable medical scope was spreading deadly infections and nearly impossible to disinfect. But staff at the federal Food and Drug Administration lost the report, one of multiple missteps that allowed doctors and hospitals to continue using the scope for three more years even as dozens of patients were sickened. The missing paperwork, revealed in a recent Senate inquiry, underscores the serious shortcomings in the antiquated national database used to monitor the safety of medical devices, which even the FDA has long admitted is flawed. But the fix called for by the Senate investigators — the speedy implementation of a new system already a decade in the making — has hit a roadblock put up by two powerful opponents who say an essential part of the safety upgrade will cost too much. Patients may now have to wait another decade for the new system, a delay that could lead to more patient deaths. "We need to build a better system to find these problems more quickly," said Dr. Josh Rising, director of healthcare programs at the Pew Charitable Trusts. Further postponement, he said, "could compromise the safety of millions of Americans." The device known as a duodenoscope is only the most recent example of a risky medical device that was used in tens of thousands of patients before regulators finally pinpointed a deadly problem in its design. Regulators did not warn hospitals about its risks until after The Times reported an outbreak at UCLA that killed three patients.   To read full story Click Here Credit Melody Petersen 
Imagine your child requires a life-saving operation. You enter the hospital and are confronted with a stark choice.    Do you take the traditional path with human medical staff, including doctors and nurses, where long-term trials have shown a 90% chance that they will save your child’s life?   Or do you choose the robotic track, in the factory-like wing of the hospital, tended to by technical specialists and an array of robots, but where similar long-term trials have shown that your child has a 95% chance of survival?   Most rational people would opt for the course of action that is more likely to save their child. But are we really ready to let machines take over from a human in delivering patient care?   Of course, machines will not always get it right. But like autopilots in aircraft, and the driverless cars that are just around the corner, medical robots do not need to be perfect, they just have to be better than humans.   So how long before robots are shown to perform better than humans at surgery and other patient care? It may be sooner, or it may be later, but it will happen one day.   But what does this mean for our hospitals? Are the new hospitals being built now ready for a robotic future? Are we planning for large-scale role changes for the humans in our future robotic factory-like hospitals?   To read full article Click Here   
Doctors train for years in order to be able to correctly diagnose cancer - but could they soon be replaced by pigeons?   Well, no. Obviously not.   However, scientists have now discovered that pigeons are surprisingly adept when it comes to spotting cancerous cells.   In a study led by Professor Richard Levenson of the University of California, pigeons were shown microscope images of breast tissue, and then rewarded with food if if they correctly pecked a coloured button that corresponded to either cancerous or healthy tissue.      In 15 daily sessions, each an hour long, the pigeons got the right answer 85 per cent of the time - with accuracy levels increased to 99 per cent when responses from a panel of four pigeons were pooled.   In their introduction to the study, Pigeons as Trainable Observers of Pathology and Radiology Breast Cancer Images, researchers said: "Although pigeons are unlikely to be called upon to offer clinical diagnostic support, it does seem quite possible that their discriminative abilities may be turned to a useful purpose."   To read full story Click Here   Credit Adam Boult
Red meat has been linked to cancer for decades, with research suggesting that eating large amounts of pork, beef or lamb raises the risk of deadly tumours. But for the first time scientists think they know what is causing the effect. The body, it seems, views red meat as a foreign invader and sparks a toxic immune response. Researchers have always been puzzled about how other mammals could eat a diet high in red meat without any adverse health consequences. Now they have discovered that pork, beef and lamb contains a sugar which is naturally produced by other carnivores but not humans. It means that when humans eat red meat, the body triggers an immune response to the foreign sugar, producing antibodies which spark inflammation, and eventually cancer. In other carnivores the immune system does not kick in, because the sugar – called Neu5Gc – is already in the body. Scientists at the University of California proved that mice which were genetically engineered so they did not produce Neu5Gc naturally developed tumours when they were fed the sugar. "This is the first time we have directly shown that mimicking the exact situation in humans increases spontaneous cancers in mice,” said Dr Ajit Varki, Professor of Medicine and Cellular and Molecular Medicine at the University of California. "The final proof in humans will be much harder to come by. "This work may also help explain potential connections of red meat consumption to other diseases exacerbated by chronic inflammation, such as atherosclerosis and type 2 diabetes.   To read full story Click Here Credit Sarah Knapton, Science Editor   
New research attempts to shed light on the most common reasons patients are readmitted post-surgery, and how hospitals can nip the issue in the bud.  In a study recently published in the Journal of the American Medical Association (JAMA), a team of researchers looked at readmission rates after surgical procedures overall, as well as rates for several specific surgeries. The goal was to determine what sorts of problems caused complications requiring unexpected readmission. Information was pulled from the American College of Surgeons National Surgical Quality Improvement Program. The program tracks the primary reason for a patient’s readmission, which helped researchers figure out whether the subsequent hospital visit was related to the person’s initial condition. After looking at the data for close to 450 hospitals over a year-long period, researchers found that the number one reason for patients to be readmitted to the hospital after surgery was experiencing a surgical site infection. The second reason: an obstruction or ileus. To read full story Click Here Credit Jess White 
By Aliya Barnwell        2.4K                     Subscribe on YouTube   When tech and medicine meet, everyone benefits. The tech doesn’t have to be a new MRI or laser printed organs, either — even the lowly bandage can benefit from an upgrade. Different researchers worldwide are using their particular expertise to develop a host of newer, smarter, more effective bandages; many of which are steadily making their way out of the lab and into the real world. Here’s a quick overview of all the awesome bandage tech that you can expect to see in the not-so-distant future:   A Bandage of a Different Color   In 2010, a German team from the Fraunhofer Research Institutions for Microsystems and Solid State Technology EMFT created a bandage that looks like any other self-adhesive band-aid, but changes color to indicate infection by reacting to the pH of the skin beneath. Healthy healing wounds have a pH of about five or six. If this gets too alkaline, that can mean there’s an infection brewing underneath. The bandage will turn purple between 6.5 and 8.5 pH.   Another team from South Korea, Germany, and the US represented by Dr. Conor Evans from the Wellman Center for Photomedicine took a different tack: Liquid bandages funded in part by the Department of Defense. These can also clearly indicate wound healing, but not by detecting pH. The liquid bandage is designed to map oxygen concentrations in skin, including burns. In case you didn’t know, blood supply rich with oxygen and glucose is integral to wound healing. A deficit can result in poor recovery and chronic sores.   Current wound assessment is limited to the sniff test, visual inspection, or electrochemical analysis, which requires sticking electrodes (like needles) into the wound. The latter sounds like a miserable process for patients. A less invasive measurement option is available if you have the equipment to trace radioactive markers, but positron emission tomographs are pricey and not widely available.   For full story Click here
Newswise — Jan. 22, 2016─A diet rich in fiber may not only protect against diabetes and heart disease, it may reduce the risk of developing lung disease, according to new research published online, ahead of print in the Annals of the American Thoracic Society. Analyzing data from the National Health and Nutrition Examination Surveys, researchers report in “The Relationship between Dietary Fiber Intake and Lung Function in NHANES,” that among adults in the top quartile of fiber intake: • 68.3 percent had normal lung function, compared to 50.1 percent in the bottom quartile. • 14. 8 percent had airway restriction, compared to 29.8 percent in the bottom quartile.In two important breathing tests, those with the highest fiber intake also performed significantly better than those with the lowest intake. Those in the top quartile had a greater lung capacity (FVC) and could exhale more air in one second (FEV1) than those in the lowest quartile. “Lung disease is an important public health problem, so it’s important to identify modifiable risk factors for prevention,” said lead author Corrine Hanson PhD, RD, an associate professor of medical nutrition at the University of Nebraska Medical Center. “However, beyond smoking very few preventative strategies have been identified. Increasing fiber intake may be a practical and effective way for people to have an impact on their risk of lung disease.” Researchers reviewed records of 1,921 adults, ages 40 to 79, who participated in NHANES during 2009-2010. Administered by the Centers for Disease Control and Prevention, NHANES is unique in that it combines interviews with physical examinations. Fiber consumption was calculated based on the amount of fruits, vegetables, legumes and whole grains participants recalled eating. Those whose diets included more than 17.5 grams of fiber a day were in the top quartile and represented the largest number of participants, 571. Those getting less than 10.75 grams of fiber a day were in the lower group and represented the smallest number of participants, 360. Researchers adjusted for a number of demographic and health factors, including smoking, weight and socioeconomic status, and found an independent association between fiber and lung function. They did not adjust for physical activity, nor did the NHANES data allow them to analyze fiber intake and lung function over time—limitations acknowledged by the authors. Authors cited previous research that may explain the beneficial effects of fiber they observed. Other studies have shown that fiber reduces inflammation in the body, and the authors noted that inflammation underlies many lung diseases. Other studies have also shown that fiber changes the composition of the gut microbiome, and the authors said this may in turn reduce infections and release natural lung-protective chemicals to the body. If further studies confirm the findings of this report, Hanson believes that public health campaigns may one day “target diet and fiber as safe and inexpensive ways of preventing lung disease.” To read the article in full, please visit: http://www.thoracic.org/about/newsroom/press-releases/resources/White-201509-609OC.PDF
Newswise — DURHAM, N.C. -- Doctors at the Duke University School of Medicine have tested a new injectable agent that causes cancer cells in a tumor to fluoresce, potentially increasing a surgeon’s ability to locate and remove all of a cancerous tumor on the first attempt. The imaging technology was developed through collaboration with scientists at Duke, the Massachusetts Institute of Technology (MIT) and Lumicell Inc. According to findings published January 6 in Science Translational Medicine, a trial at Duke University Medical Center in 15 patients undergoing surgery for soft-tissue sarcoma or breast cancer found that the injectable agent, a blue liquid called LUM015 (loom – fifteen), identified cancerous tissue in human patients without adverse effects. Cancer surgeons currently rely on cross-sectional imaging such as MRIs and CT scans to guide them as they remove a tumor and its surrounding tissue. But in many cases some cancerous tissue around the tumor is undetected and remains in the patient, sometimes requiring a second surgery and radiation therapy. “At the time of surgery, a pathologist can examine the tissue for cancer cells at the edge of the tumor using a microscope, but because of the size of cancer it’s impossible to review the entire surface during surgery,” said senior author David Kirsch, M.D., Ph.D., a professor of radiation oncology and pharmacology and cancer biology at Duke University School of Medicine. “The goal is to give surgeons a practical and quick technology that allows them to scan the tumor bed during surgery to look for any residual fluorescence.” Researchers around the globe are pursuing techniques to help surgeons better visualize cancer, some using a similar mechanism as LUM015, which is activated by enzymes. But the Duke trial described in the journal is the first protease-activated imaging agent for cancer that has been tested for safety in humans, Kirsch said. LUM015 was developed by Lumicell, a company started by researchers at MIT and involving Kirsch. In companion experiments in mice described in the journal, LUM015 accumulated in tumors where it creates fluorescence in tumor tissue that is on average five times brighter than regular muscle. The resulting signals aren’t visible to the naked eye and must be detected by a handheld imaging device with a sensitive camera, which Lumicell is also developing, Kirsch said. In the operating room after a tumor is removed, surgeons would place the handheld imaging device on the cut surface. The device would alert them to areas with fluorescent cancer cells. Going into surgery, the goal is always to remove 100 percent of the tumor, plus a margin of normal tissue around the edges, explained senior author Brian Brigman, M.D., Ph.D., chief of orthopedic oncology at Duke. Pathologists then analyze the margins over several days and determine whether they are clear. “This pathologic technique to determine whether tumor remains in the patient is the best system we have currently, and has been in use for decades, but it’s not as accurate as we would like,” said Brigman, who is also the director of the sarcoma program at the Duke Cancer Institute. “If this technology is successful in subsequent trials, it would significantly change our treatment of sarcoma. If we can increase the cases where 100 percent of the tumor is removed, we could prevent subsequent operations and potentially cancer recurrence. Knowing where there is residual disease can also guide radiation therapy, or even reduce how much radiation a patient will receive.” Researchers at Massachusetts General Hospital are currently evaluating the safety and efficacy of LUM015 and the Lumicell imaging device in a prospective study of 50 women with breast cancer. Afterward, Kirsch said, multiple institutions would likely evaluate whether the technology can decrease the number of patients needing subsequent operations following initial breast cancer removal. In addition to Kirsch and Brigman, study authors include Melodi Javid Whitley, Diana M. Cardona, Alexander L. Lazarides, Ivan Spasojevic, Jorge M. Ferrer, Joan Cahill, Chang-Lung Lee, Matija Snuderl, Dan G. Blazer III, E. Shelley Hwang, Rachel A. Greenup, Paul J. Mosca, Jeffrey K. Mito, Kyle C. Cuneo, Nicole A. Larrier, Erin K. O’Reilly, Richard F. Riedel, William C. Eward, David B. Strasfeld, Dai Fukumura, Rakesh K. Jain, W. David Lee, Linda G. Griffith and Moungi G. Bawendi. Duke author Kirsch and MIT authors Griffith, Bawendi, Ferrer and W. David Lee hold interest in or are involved with Lumicell Inc., a company commercializing LUM015 and the imaging system. Duke and MIT hold a patent on the imaging device technology. More detailed conflict-of-interest information is included in the manuscript published by Science Translational Medicine. The study was funded in part by an American Society of Clinical Oncology Advanced Clinical Research Award to Kirsch, the National Institutes of Health (NIH) (T32GM007171), a National Cancer Institute Small Business Innovation Research award to Lumicell Inc. (1U43CA165024), the NIH National Center for Advancing Translational Science (UL1TR001117), and Duke Comprehensive Cancer Center Support (5P30-CA-014236-38). Lumicell Inc. provided the imaging agents.