“The National Minority Quality Forum is pleased to acknowledge the leadership demonstrated by Medtronic in helping to eliminate health disparities,” said Gary Puckrein, Ph.D., chief executive officer of the National Minority Quality Forum. “Medtronic is an outstanding example of a company’s dedication to the development and implementation of best practices to combat health disparities.”

Medtronic’s initiatives to eliminate health disparities incorporate work with providers, patients and health system leaders. Some examples of these initiatives include developing and disseminating clinic-based tools that streamline and increase adherence to clinical guidelines for underserved populations; development of a disparity advisory board that assists in identifying solutions to barriers to equality of care; participating in and sponsoring education and health screening events; and leading a pilot program in partnership with 10 hospitals across the country to measure the impact enforcing guideline protocols along with providing physician and patient education has on improving the quality of care for underserved populations.

“We are honored to receive this award from the National Minority Quality Forum, a group that is leading the charge in tackling the issue of health disparities,” said H. James Dallas, senior vice president of Quality and Operations at Medtronic. “We are committed to investing time, resources and employees to implement and support initiatives that work to reduce health disparities by putting every patient first.”

Despite welcoming the framework, Asthma UK Northern Ireland is urging the Department of Health, Social Services and Public Safety (DHSSPS) to address key gaps, which include:

- Limited reference to allergy. We know that more than half of people with asthma also have an allergy and that poor management of allergies may lead to asthma, and affect asthma control. There is clear need for greater expertise on allergy among healthcare professionals to ensure that people with asthma and allergies receive the best and most appropriate care.

- Lack of reference to occupational asthma, which is the most frequently reported work-related respiratory condition in the UK and results in 12.7 million working days being lost each year. It’s therefore vital that employers and employees are fully aware of the risks of occupational asthma and how to minimise them.

- The need for a separate section setting out clear standards for transition services from childhood to adulthood. As young people go through adolescence and into early adulthood, it is essential that services are tailored to meet their varying needs.

- Limited mention of links with other services which impact on the health of people with asthma, such as education, transport and social services. Education in particular is crucial as there is an average of two children in each classroom with asthma and schools are an important partner in helping to improve asthma management.

- The need for external scrutiny of the framework and of asthma services, involving people with asthma, their carers and representative organisations. The framework sets out a plan for health services to assess their own performance. This is important but must be accompanied by independent review.

Once finalised, the framework will provide a key role in improving the respiratory health of people in Northern Ireland, including those with asthma. Northern Ireland has among the highest prevalence rates of asthma in the world with around 2,000 people admitted to hospital for their condition every year, almost half of whom are children.

The framework’s formal consultation period ended on 22 April 2009 and the DHSSPS will now make final changes to the document before publication in the summer.

Asthma UK Northern Ireland Director, Joan O’Hagan, says: ‘We very much welcome this draft framework from the DHSSPS and the open way in which the Department has involved us in its development. It is a ground-breaking initiative which will ensure there are clear standards for both adults and children with asthma for the first time anywhere in the UK. The draft is a good start but there is still a way to go to ensure the delivery of excellent services for people with asthma for the longterm.’

Asthma UK Chief Executive, Neil Churchill, says: ‘The framework serves as a wake up call to other parts of the UK who need to follow the lead set by Northern Ireland. Asthma is a widespread and serious condition which sadly still kills an average of three people a day in the UK and can, for many people, limit their opportunities and impair their quality of life.’

Asthma UK Northern Ireland has issued its response to the DHSSPS ahead of World Asthma Day on Tuesday 5 May, when it will be issuing a report highlighting the exclusion faced by children and young people with asthma. Key issues highlighted in the report will be discussed at a special event to be held at the office of the Children’s Commissioner in Belfast. The Northern Ireland Commissioner for Children will be the keynote speaker at the event and local children with asthma will also be attending.

To coincide with World Asthma Day, Asthma UK Northern Ireland will also be holding its first ever fundraising week called Putting Asthma in the Limelight running from 2 - 10 May, to raise money for services for children and young people with asthma.

The DR-70 cancer test has been approved by the US FDA for CRC monitoring and by Health Canada for Lung Cancer screening. However, a growing body of data reveals that the test is effective as a general cancer screen as well. The DR-70 ELISA assay quantifies Fibrin and Fibrinogen Degradation Products (FDP) in the blood, which are elevated in the presence of a malignant tumor and increase as the malignancy grows. International studies have linked the DR-70 cancer test to at least 14 different types of cancer, including lung, breast, stomach, liver, colon, rectal, ovarian, esophageal, cervical, trophoblastic, thyroid, malignant lymphoma, brain and pancreatic cancer making it one of the most versatile cancer biomarkers available.

The GenWay team is looking forward to the future impact of the DR-70 test in the field of cancer diagnostics. Robert Gans, CEO of GenWay Biotech Inc., says that, “The DR-70 cancer test can revolutionize the way people are able to easily screen their risk of cancer with a simple blood test. We are excited to play an instrumental role in advancing cancer diagnostics by making this test directly available to consumers. The marketing and distribution agreements for DR-70 will be financially significant programs for both GenWay and AMDL, while the impact and life-saving potential of this test personally drives our motivation for commercialization success.”

The market potential for DR-70 is significant with an estimated 21,000 people in Canada diagnosed with Lung Cancer each year and close to 1.5 million Americans diagnosed with cancer each year (1,2). Since DR-70 is a non-invasive blood test that can be utilized for cancer screening, diagnosing, and monitoring, the test may play a significant role in cancer awareness and improving cancer treatment management.

The addition of the DR-70 test to GenWay’s diagnostic portfolio further solidifies its presence as a robust and reliable provider of complete immunodiagnostic solutions. GenWay currently has the ability to produce immunodiagnostic solutions beginning with the biomarker or target gene sequence and then incorporate all the critical components needed into the final diagnostic kit.

A Brain-Computer Interface, or BCI, enables its user to send commands to a computer or machine only by means of brain activity. In 2005, while research in this field was almost non-existent in France, research scientists initiated a project called OpenViBE to carry out innovative research on brain-computer interfaces. By combining their knowledge on the workings of the brain with their technical and computer science expertise, the researchers succeeded in perfecting an ergonomic, easy to use programme four years after the project started.

The result of the eponymous project, OpenViBE is a genuine “interface” designed to translate what takes place in the brain into a command for a computer. In producing a support of this kind, the researchers at Inserm and INRIA have opened up new prospects in a rapidly developing field of research, as regards not only signal processing and the optimisation of Man-Machine Interfaces, but also research on communication aids for people with reduced mobility, the treatment of certain neurological disorders and our understanding of how the brain works.

Four applications using the properties of the OpenViBE programme have already been developed by scientists. Three prototypes involve virtual reality and video games. The user, wearing helmets equipped with electrodes, will be able to pilot a space ship, play handball or move around in a virtual world, depending on the application. A fourth prototype, designed as a communication aid for people with reduced mobility, makes it possible to write on a computer simply by using thought.

The project has brought together four other partners around INRIA and Inserm, each taking action in a specific scientific area: CEA LIST, AFM, GIPSA LAB and FRANCE TELECOM R&D

Chest pain is a common and costly health complaint in the United States, bringing 8 million Americans to hospital emergency departments each year. Although just five to 15 percent of those patients are found to be suffering from heart attacks or other cardiac diseases, more than half are admitted to the hospital for observation and further testing. CTA streamlines the process and provides a faster, and less expensive way to evaluate which patients have an acute coronary syndrome that require treatment.

“The ability to rapidly determine that there is nothing seriously wrong allows us to provide reassurance to the patient and to help reduce crowding in the emergency department,” says lead author Judd Hollander, MD, professor and clinical research director in Penn’s department of Emergency Medicine. “The use of this test is a win-win.”

Among patients enrolled in the trial after getting a negative scan - a scan showing no evidence of dangerous blockages in the coronary arteries - no patients in the study had heart attacks or required bypass surgery or placement of cardiac stents in the year following their test. The authors say the findings provide a roadmap for how to appropriately and cost-effectively use this advanced imaging technology, which generates lifelike, three-dimensional photos of the heart and the matrix of blood vessels that surround it.

Investigators followed 481 patients who received negative CTA scans for one year after their hospital visit. The patients studied had a mean age of 46. While 11 percent of patients were rehospitalized and 11 percent received additional cardiac testing - stress tests or cardiac catheterizations - over the following year, none had heart attacks or needed revascularization procedures to prop open blocked coronary arteries. One patient in the study died of an unrelated cause during the year.

Previous Penn research has shown that CTA is both a quicker and less expensive way to screen low-risk chest pain patients than conventional testing methods. Costs for patients who receive immediate CTA in the emergency department average about $1,500, while costs for patients admitted to the hospital for stress testing and telemetry monitoring total more than $4,000 for each patient. Those studies also showed that CTA helps get patients home faster, since patients who received immediate CTA were discharged after an average of eight hours, compared to stays that exceeded 24 hours for those who were admitted for scheduled testing and monitoring.

Despite the mounting evidence that CTA provides cost savings, it remains unclear whether Medicare or any individual insurer will cover the tests in an emergency department setting.

A ruling from the Centers for Medicare and Medicaid Services in the spring of 2008 laid out a specific, narrow set of circumstances under which coronary CTA costs would be reimbursed, but some physicians are continuing to lobby for a re-examination of the issue given the increasing pressure to cut health care costs and increase emergency department efficiency.

“The evidence now clearly shows that when used in appropriate patients in the ED, we can safely and rapidly reduce hospital admission and save money,” Hollander says. “It seems time to make a national coverage decision that will facilitate coronary CTA in the emergency department.”

These results were published in the May 15, 2009, edition of the journal Transplantation, which is currently in press.

Yun Miao, MD, PhD, Jason Everly, PharmD, Steve Woodle, MD, and colleagues at UC compared lung, colon, breast, prostate, bladder, kidney and skin cancer data in 635 adult transplant recipients from the Israel Penn International Transplant Tumor Registry with that of about 1.2 million adults from the general population in the Surveillance, Epidemiology and End Results (SEER) database.

“It has been known for some time that transplant recipients are at an increased risk of developing cancer, but the outcomes of cancers that arise in organ transplant recipients have not been defined,” says Woodle, professor and chief of transplant surgery and co-author of the study.

“In this study, we wanted to examine the influence of transplantation on the outcomes of individual types of cancers arising in organ transplant recipients,” adds Miao, co-author and research fellow in the division.

The Israel Penn International Transplant Tumor Registry is the largest and most comprehensive transplant tumor registry in the world and was created by doctors at the UC College of Medicine.

The SEER registry collects information on cancer incidence, survival and prevalence for roughly 26 percent of the United States population and compiles reports and statistics based on this information along with cancer mortality rates for the entire nation.

A comparison of results in transplant recipients to the general population also demonstrated that transplant patients were more likely to have early stage renal cell (kidney) cancer and more advanced colon, breast, bladder and skin cancer at the time of diagnosis.

Disease-specific survival was worse in the transplant population for each of these seven cancers analyzed and was a negative risk factor for survival.

Now, researchers want to conduct further studies to find out why this may be the case.

“Transplant patients receive immunosuppressive therapies to prevent them from rejecting transplanted organs,” says Woodle. “We want to see if immunosuppressive therapies contribute to the poorer outcomes in transplant recipients.”

He says the worse outcomes in transplant recipients may have occurred because this population is not as healthy as the general population or because their cancers may be more aggressive as a result of their immunosuppression treatments.

“Some of our data supports this premise, as the extent of the cancers at diagnosis were greater in the transplant recipients,” Woodle continues. “This was surprising since transplant recipients are generally followed more closely than the general population.”

Everly, co-author and board-certified oncology pharmacist in the division, says that this data may change the way physicians screen transplant patients for cancer.

“We found that most cancers developed within five years following transplantation,” he says, noting that more frequent and detailed checks should be made in order to catch the cancer in its earliest stages. “This may alter the way doctors should screen these patients for cancer.”

This study was investigator-initiated and supported by research grants from Astellas Pharmaceuticals.

At the 45th Annual Meeting of the American Society of Clinical Oncology (ASCO), researchers from the Mayo Clinic campus in Florida report that using a combination of capecitabine, vinorelbine, and trastuzumab offers a treatment option that is at least as beneficial as other current options - and doesn’t cause hair loss in patients.

“This is a very well tolerated regimen. The combination is a good example of an excellent therapeutic ratio: good activity and low toxicity,” says the study’s senior investigator, Edith Perez, M.D., director of Mayo Clinic’s Breast Center in Jacksonville.

The clinical trial is the first in the United States to study this particular combination of therapies in patients with HER2+ metastatic breast cancer, researchers say. The chemotherapy regimen was previously tested in Europe and demonstrated good anti-tumor activity and low toxicity, so Mayo researchers combined it with Herceptin, says the study’s lead author, Winston Tan, M.D., a medical oncologist at Mayo Clinic.

Sixty-seven percent of the 45 patients in this trial responded to treatment, with their tumors decreasing in size by at least 30 percent. Historic response to conventional drug regimens (one chemotherapy drug with Herceptin) that are currently used to treat metastatic HER2+ breast cancer is about 50 percent, Dr. Tan noted.

“The results are encouraging, and would support a larger, randomized Phase III study,” he says. “This is a Phase II study of this triple combination, so we would need to study this treatment against the standard best two-drug treatment in a randomized Phase III study to know if this triplet is more effective.”

“This regimen seems to be a very reasonable choice, and it offers the added advantage that women who use it do not lose their hair,” he says. The drug combination used most commonly for patients with HER2+ breast cancer that has spread - paclitaxel or docetaxel with trastuzumab - always causes hair loss, Dr. Tan says.

All of the agents are approved for use by the U.S. Food and Drug Administration for cancer, although vinorelbine has not been approved for this particular treatment regimen in the U.S., the researchers say.

Capecitabine chemotherapy is not usually paired with trastuzumab because some studies had suggested it does not offer a synergistic, or additive, benefit. However, Dr. Tan says that newer research has shown the combination is in fact promising.

Among the patients studied, 28 (58 percent) had a partial response, a reduction in the size of the metastatic tumor of more than 30 percent by computed tomography. Four patients had a complete response with no more evidence of metastasized tumors on diagnostic scans, the researchers say.

Average survival was improved when compared historically to traditional treatment, Dr. Tan says. “Normally, survival for metastatic breast cancer is two years,” he says. “In this study, average survival was 27 months.” He cautioned that these results should be validated in a Phase III study.

“The toxicity was tolerable, no more than is seen with a two-drug regimen,” he says. The majority of patients (61 percent) experienced a low white blood count, but only about ten percent of patients had fatigue or other common side effects.

Tan stressed that this regimen does not offer curative treatment, but it offers patients an improved quality of life compared to other commonly used regimens.

“It is very difficult to treat cancer that has spread, but we believe that combining treatments together is important to help shrink tumors that are rapidly growing,” he says.

He adds that 80 percent of the patients who showed benefit had been treated with other chemotherapy drugs - mostly anthracyclines and paclitaxel - and at least half of the patients had used trastuzumab in the adjuvant or metastatic setting as well. “They still got a response to these combination of two chemotherapies plus the biological agent, and that is encouraging,” he says.

At the annual meeting of the American Society of Clinical Oncology (ASCO), Mayo investigators report that cancer in about two-thirds of 37 patients with aggressive differentiated thyroid cancer treated with the drug pazopanib either stopped growing, or quickly shrank.

The patient responses seen to date are promising, the researchers say, because all patients had fast-growing cancers that had spread to their lungs, with half involving lymph nodes and 39 percent also involving bones.

“The benefits were striking in many patients to a degree we have not previously seen in thyroid cancer in response to other therapies, including the standard treatment of radioiodine,” says Keith Bible, M.D., Ph.D., a medical oncologist and researcher who led the multicenter clinical trial funded by the National Cancer Institute. Most of the patients treated were enrolled at the Mayo Clinic campuses in Minnesota and Florida.

Approximately one-third of patients achieved sustained and dramatic benefit from pazopanib, while another one-third experienced stabilization of their cancer or some tumor shrinkage. The remaining one-third of patients did not benefit from the drug. The agent was also well tolerated by the majority of patients, Dr. Bible adds.

What is not yet known, however, is the drug’s effect on overall survival. “We need more time to establish that definitively,” says Dr. Bible. “The trial has been going on for just over a year, and some of our patients are still maintaining a response, while others have not been in the study long enough for us to confirm duration of response.” He notes that of the 37 original trial participants, two have died - one from cancer progression and another from other causes.

The National Cancer Institute estimated that 37,340 new cases of thyroid cancer would be diagnosed in 2008, with 1,590 deaths from the cancer. The cancer is much more common in women; it is the seventh most common cancer in women in the U.S. The occurrence of thyroid cancer has recently been rising.

Most thyroid cancers are of two major “differentiated” types - papillary thyroid cancer (the most common, accounting for 75 percent of cases) and follicular thyroid cancer (15 percent).

Fortunately, most patients with thyroid cancer respond well to surgery and to follow-up treatment with radioiodine; even if the cancer recurs and spreads, the disease progresses slowly in most patients, Dr. Bible says. “Many patients do well for a long time without the need of additional therapy,” he says. However, about 5 percent of these patients experience rapidly progressing life-threatening disease that is insensitive to radioiodine and other treatment approaches. “Until only recently, we have not had any effective therapies for such patients.”

Pazopanib is an experimental agent that is also being studied in advanced kidney, ovarian and other cancers. The drug, administered in pill form, targets proteins involved in angiogenesis, the growth of new blood vessels that has a critical role in the growth and spread of tumors. The proteins that pazopanib targets include vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR), c-kit and Ret.

Mayo investigators are also leading clinical trials to test pazopanib in two other thyroid cancer subtypes -medullary, which does not respond to radioiodine, and anaplastic, the most aggressive subtype.

Dr. Bible says plans are also under way to test pazopanib in a larger, controlled and randomized clinical trial of patients with advanced differentiated thyroid cancer. Researchers want to more accurately assess benefits and risks.

Meanwhile, a separate study led by Dr. Strote looked at every use of force by the Seattle Police Department in one year. Again, despite nearly 900 incidents, injuries related to the use of force were rare. Just over one percent required hospital admission for an injury related to the use of force by police. There were two deaths, both due to firearms.

The researchers conclude that injuries inflicted by police officers in the process of subduing suspects are relatively rare. Other related findings include a high incidence of drug and alcohol use and psychiatric history among those being restrained.

The presentations, entitled “Injuries Associated With Law Enforcement Use Of Conducted Electrical Weapons” and “Injuries Associated With Law Enforcement Use Of Force,” were presented in the Trauma forum at the 2009 SAEM Annual Meeting at the Sheraton New Orleans on May 17 at 10:00 AM. Abstracts are published in Vol. 16, No. 4, Supplement 1, April 2009 of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine.

A group of researchers led by Dr. Stacie Zelman from Wake Forest University examined a national database of over two million injured patients, and found over 2,400 pregnant women injured in car crashes. Women wearing a seat belt, having an air bag, or both were significantly less likely to have pregnancy-related complications than women with neither a seat belt nor an air bag. The combination of a seat belt and air bag resulted in the lowest rate of complications.

The researchers conclude that pregnant women should use seat belts with confidence that they will help, not hurt, in a crash.

The presentation, entitled “Automobile Safety Restraints Do Not Increase The Chance of Fetal Complications Following Motor Vehicle Collision,” was given by Dr. Stacie Zelman in the Injury Prevention forum at the 2009 SAEM Annual Meeting at the Sheraton New Orleans on May 16 at 4:30 PM. Abstracts are published in Vol. 16, No. 4, Supplement 1, April 2009 of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine.