Calypso Medical Technologies, Inc., announced the publication of data from a clinician sponsored investigational study conducted at the University of Pennsylvania, demonstrating the utility of the Calypso® System in tracking tumor movement in the pancreas. The data will be presented at the 51st Annual Meeting of the American Association of Physicists in Medicine (AAPM), July 26-30, at the Anaheim Convention Center. “In areas of the body, such as the pancreas, that are susceptible to respiratory motion it can prove difficult to handle the spectrum of motion that can arise,” said James Metz, M.D., Clinical Director, Department of Radiation Oncology, The University of Pennsylvania Health System.

“The Calypso System successfully tracks such motion and enables us to address it as it occurs. We are very excited that our time response study shows the promise of expanding the use of Calypso’s GPS for the Body® technology to other anatomical areas.”

Pancreatic cancer, one of the deadliest cancers due to the advanced stage at which most patients are diagnosed, strikes over 42,000 Americans each year according to the American Cancer Society (ACS). Additionally, in 2009 over 35,000 people will die from pancreatic cancer in the United States alone. The National Cancer Institute (NCI) lists the one year survival rate at 24 percent and the five year survival rate just one percent. The Calypso System is the only product platform that provides real-time tumor tracking during radiation treatment. Tracking tumor motion is critical for radiation treatments because gross patient movement or internal motion of the organ and tumor increases the likelihood that the radiation beam will miss the intended target thereby delivering radiation to the surrounding healthy tissue. Calypso Medical’s proprietary technology utilizes miniature transponders implanted in the diseased organ to provide accurate, precise, continuous real-time information about the tumor position during external beam radiation therapy. Knowing the location of the tumor target allows the therapist to adjust the delivery of the radiation beam to accurately target the cancer. Currently, the Calypso System is cleared by the U.S. Food & Drug Administration (FDA) for use in radiation therapy for the prostate and prostatic bed; however, the technology is also designed for body-wide applications.

In addition to the promise of using the Calypso System for pancreatic targets, an independent investigation conducted at Swedish Cancer Institute in Seattle will be featured in an oral presentation in which researchers demonstrated the feasibility of using Calypso technology for tracking during accelerated partial breast irradiation (APBI) treatments. With APBI, a balance is required to ensure that the whole lumpectomy cavity and the surrounding tissue are treated while minimizing the volume of breast tissue that is irradiated. The Calypso System recorded relevant intrafraction motion, or the amount the target moves during radiation treatments. Monitoring and accounting for this motion not only allows confidence that the target is being hit, but could provide physicians the confidence to pursue tighter margins to reduce the amount of the breast that is irradiated.

“The scientific investigations of our technology into new treatment areas that have traditionally been associated with a poor prognosis is particularly gratifying,” said Eric R. Meier, president and chief executive officer of Calypso Medical. “Today’s announcement demonstrates the feasibility of our technology to extend beyond the prostate to track real-time tumor movement in other body locations even those organs like the pancreas that are susceptible to respiratory motion.”

In total, sixteen studies involving Calypso will be presented at the AAPM meeting and represent a mix of work highlighting the promise the technology holds for future applications as well as demonstrating the value of the Calypso System for current use in real-time tracking of the prostate and the prostatic bed during prostate cancer treatment. According to the American Cancer Society, prostate cancer is the leading cancer in men in the Untied States with 192,000 new cases diagnosed each year. It is also the most common location for radiation therapy in the body. Since the radiation beam is more precisely focused on the tumor target, Calypso’s technology allows physicians who are treating prostate cancer patients to more tightly contour the radiation dose to the prostate and minimize unwanted does to adjacent healthy tissues. The Calypso Medical booth will also highlight a recent enhancement to the system, the Adaptive Workflow Efficiency Release, which is designed to allow clinicians the ability to further manage patient motion and increase procedure efficiency by repositioning the patient’s treatment table remotely.

Source
Calypso Medical

The Royal Australian College of General Practitioners (RACGP) is committed to improving the health of Aboriginal and Torres Strait Islander individuals and communities. Consistent with findings in Australia and overseas, the College recognises that general practices play a key role in improving life expectancy and health for Indigenous people.

To assist in addressing these issues, the RACGP has created a position statement, ‘Identification of Aboriginal and Torres Strait Islander People in Australian general practice’, which summarises processes to identify, record and report the Aboriginal and Torres Strait Islander status of patients of health services.

A standard national identification question will be used to identify patients of Aboriginal and/or Torres Strait Islander origin, in line with Australian Institute of Health and Welfare (AIHW) guidelines, the Council of Australian Government (COAG) National Indigenous Reform Agreement (also known as the ‘Closing the Gap’ initiative), and consistent with other national data collections.

Dr Brad Murphy, Chair of the RACGP’s National Faculty of Aboriginal and Torres Strait Islander Health and an Aboriginal man from the Kamilaroi people of northwest NSW, said that asking this identifier question to all patients will allow for consistency within the practice, between practices at a local and national level and across primary and secondary care.

“Studies show that identification processes in general practices are inconsistent, leading to significant under-identification of Aboriginal and Torres Strait Islander patients. This creates several major barriers to the ability of many general practic e s to help reduce disparities in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

“The identifier captures what is required to identify Aboriginal and Torres Strait Islander patients in general practices. It is not onerous or invasive and if a patient does choose to identify, they can have access to a range of services that will help them and their health practitioners effectively manage and improve their health outcomes,” he said.

The RACGP believes providing support in terms of Aboriginal and Torres Strait Islander health across the multi-faceted spectrum of general practice helps make a difference to health outcomes in communities.

The College is also an active supporter of the Close the Gap initiative, which aims to close the significant disparity in life expectancy between Aboriginal and Torres Strait Islander people and other Australians by the year 2030.

To view the ‘Identification of Aboriginal and Torres Strait Islander People in Australian general practice’ guide, visit here.

Source:

Royal Australian College of General Practitioners (RACGP)

Health services in your community will stop and jobs are under threat. This is the stark warning from doctors across Northern Ireland today, Tuesday 21 March 2011, as a petition of over 32,000 signatures was taken to Stormont to deliver to the Minister for Health, Michael McGimpsey MLA.

Beleaguered family doctors are facing cuts of up to ВЈ50,000 this year and are facing little option but to stop providing some services in order to keep other treatments available.

Measures to mitigate this loss of core funding include:
Stopping minor surgery, leading to more referrals to hospitals
Reduction in opening hours, such as stopping evening clinics or closing one afternoon per week
Cuts to treatment room nursing hours
Staff redundancies
Reduction or cessation of essential services such as counselling, physiotherapy sessions or diabetic clinics
Larne GP Dr Brian Dunn, chairman of the BMA’s GP Committee in Northern Ireland said,

“GPs are feeling totally overwhelmed by this significant cut to their budgets and see it as yet another attack on a vital part of the health service.

“Primary care is the cornerstone of the health service, dealing with around 90% of health-related cases. However short-sighted cuts are being imposed on general practice teams with seemingly little or no thought given as to how these cuts will impact on the health service as a whole Patients are gong to suffer”.

Dr Dunn continued,

“Time and again general practice has been shown to deliver a high quality, value for money service. The tens of thousands of patients who have signed our petition clearly see the need for a properly resourced general practice service.

“Regrettably our local decision makers do not seem to appreciate the service that they have”.

Dr Paul Darragh, Chairman of the BMA’s Council in Northern Ireland added,

“As a hospital doctor, I am amazed that no thought appears to have been given to the impact this in-year funding cut will have on secondary care.

“We are already seeing a rise in waiting times for patients for their first appointments and we have highlighted repeatedly the scandal that is the wait for review appointments.

“To then prevent general practice from undertaking work, such as minor surgery or holding clinics, and force them to refer more patients to hospital does not make sense, either economically or in terms of patient care.

“The BMA would urge our decision makers to think again and to sit down with us so that we can work constructively together to improve our health service”.

Notes

BMA representatives Dr Brian Dunn, Dr Paul Darragh and Dr Allen McCullough will be handing over the petition on the steps of Stormont today at 12.30pm

A total of ВЈ5 million has been lost from general practice funding across Northern Ireland since 1 August 2010 and is recurrent in the budget.

The BMA surveyed all 361 general practices (25% response rate) in Northern Ireland and found that:
63% of practice would stop delivering a service, such as minor surgery
53% would not provide cover for e.g. maternity or staff leave
52% would reduce staff coverage and working hours for e.g. reception and nursing staff
24% would reduce surgery opening times e.g. closing one afternoon per week and stopping evening clinics
24% would reduce treatment room services
28% would take other measures
Just 4% would do nothing
The amount of money lost per practice ranged from ВЈ5,000 to ВЈ50,000, depending on patient list size.
Other measures specified included:
Reducing locum use
Diverting services such as minor surgery, diabetes insulin treatment, contraception and travel vaccinations to secondary care
Freezing pay for staff
Manning reception on a demand-led basis i.e. ring bell for attention
Temporary staff contracts
Applying charges for non-NHS work
Staff redundancies
GP partners taking a reduction in salary
Source
British Medical Association Northern Ireland

Reducing doctors’ working hours from over 80 a week does not seem to have adversely affected patient safety and has had limited impact on postgraduate training in the United States, finds a study published on bmj today.

Further work is now needed to assess the impact of reducing hours to 48 a week in Europe, say the authors.

There has been a progressive reduction in the working hours of doctors in training in both the US and Europe over the past 20 years. The maximum hours per week for trainees can range from 37 hours in Denmark to 80 hours in the US. The European Working Time Directive (EWTD) restricted the weekly hours for trainee doctors in Europe to 48 from August 2009.

While the aim of such legislation is to improve working conditions and safety, the medical profession has raised concern about the potentially adverse effects on postgraduate training for junior doctors and the provision of high quality care for patients.

So a team of UK-based researchers set out to evaluate the impact of a reduction in working hours on educational and clinical outcomes.

They reviewed 72 published studies from the US and UK and found that a reduction in working hours to less than 80 a week does not seem to have adversely affected patient safety and has had a limited effect on postgraduate training in the US.

However, studies on the impact of European legislation limiting working hours to 48 a week were of poor quality and had conflicting results, meaning that firm conclusions cannot be made, say the authors.

They believe that more high quality studies are urgently needed to evaluate the impact of restricting working hours on objective measures of medical training and patient safety, particularly in the European Union.

“Only then can both the public and the profession be reassured that the standard of medical training, and therefore the future care of patients, is of the highest possible quality and will be maintained or improved over time,” they conclude.

Weak evidence, inadequate regulation, busier doctors, and discontinuity of care are all possible explanations for these results, says Leora Horwitz from Yale University School of Medicine in an accompanying editorial. For example, trainees are often asked to do the same amount of work in less time, while the decrease in hours worked has led to a substantial increase in discontinuity of care, handovers, and transfers.

“Without careful and continued attention to these matters, followed by adjustments to regulations and to practice as required, regulation of working hours is unlikely to have the beneficial effects for patients that regulators and the general public had hoped for,” she concludes.

Link to paper

Link to Editorial

Source
British Medical Journal

Clinicians have an ethical imperative to share important decisions with patients, and patients have a right to be equal participants in their care, say a group of experts today.

In December 2010, 58 people from 18 countries attended a Salzburg Global Seminar to consider the role patients can and should play in healthcare decisions. Today, they publish a statement urging patients and clinicians “to work together to be co-producers of health.”

It comes as the government in England finalises plans to give people more say and more choice over their care than ever before.

The experts argue that much of the care patients receive is based on the ability and readiness of individual clinicians to provide it, rather than on widely agreed standards of best practice or patients’ preferences for treatment.

Results from the 2010 Cancer Patient Experience Survey seem to support this view. It found significant variations in the choice and information patients are given, and their involvement in decisions about treatment.

The experts also say that clinicians are often slow to recognise the extent to which patients’ wish to be involved in understanding their health problems, in knowing the options available to them, and in making decisions that take account of their personal preferences.

As such they call on clinicians to stimulate a two-way flow of information with patients, to provide accurate information about treatment, to tailor information to individual patient needs and allow them sufficient time to consider their options. In turn, they urge patients to ask questions and speak up about their concerns, to recognise that they have a right to be equal participants in their care, and to seek and use high-quality health information.

They also call on policymakers to adopt policies that encourage shared decision making and to support the development of skills and tools for shared decision making.

One of the signatories, Professor Glyn Elwyn from Cardiff University, says that despite considerable interest in shared decision making, and clear evidence of benefit, implementation within the NHS “has proved difficult and slow.”

Angela Coulter from the Foundation for Informed Medical Decision Making agrees and points to recent evidence showing that most patients want choice, but that many clinicians remain ambivalent or antagonistic to the idea. She believes the government’s new commitment to shared decision making presents a challenge to entrenched attitudes and the need for big change in practice styles.

The BMJ is hosting an expert roundtable event to discuss shared decision making at 3pm on Thursday 24 March 2011. Following the roundtable, at 5.30pm Muir Gray and Gerd Gigerenzer will be launching their book: “Better doctors, better patients, better decisions: Envisioning health care 2020.”

Source
British Medical Journal

The International Osteoporosis Foundation (IOF) announced the winners of the 2011 IOF-AMGEN/GSK Health Professionals Awareness Grants on March 20th at the IOF Worldwide Conference of Osteoporosis Patient Societies in Valencia. The Grants, awarded to societies from Australia, Colombia and Poland, aim to support innovative projects by IOF member societies that focus on improving knowledge of osteoporosis among clinicians and allied health professionals.

The three grants, valued at 10,000 USD each, were awarded to the following IOF member societies:
Asociacion Colombiana de Osteologia y Metabolismo Mineral – ACOMM (Colombia)
‘Continuing medical education for physicians, fellows and specialists’ encompasses training for a broad range of health professionals, including for medical residents. It will also feature a course on vertebral fractures.
Osteoporosis Australia
The initiative ‘Professional Alert: Keeping Bones Strong!’ will provide targeted online information about osteoporosis for specialists
Healthy Bone Enthusiasts Society – STENKO (Poland)
‘Os AmiGOs’ is the name of the project which will provide a dedicated osteoporosis course for medical students that emphasizes doctor-patient communication.

Osteoporotic fractures affect up to one in two women and one in five men over the age of fifty around the world. It is essential that doctors and other health professionals are adequately prepared to advise patients on the best possible care for osteoporosis in order to prevent fractures and their devastating health consequences. The IOF-AMGEN/GSK Health Professionals Awareness Grants recognize and support the non-governmental organizations which play an important role in health professional education.

About Osteoporosis

Osteoporosis, in which the bones become porous and break easily, is one of the world’s most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in some cases, death. Worldwide, one out of two women over 50 will experience osteoporotic fractures, as will one out of five men. Osteoporosis can, to a certain extent, be prevented, if it can be easily diagnosed and effective treatments are available. Nevertheless, osteoporosis often remains under-diagnosed and under-treated, leaving people at unnecessary risk of fracture.

Source:
L. Misteli

International Osteoporosis Foundation

GPs are threatening to quit en masse before the Government brings in hugely controversial changes to the NHS Pension Scheme that would raise the retirement age to 65 and beyond.

More than a third of GPs – 36% – have told a Pulse survey they plan to ‘retire as a GP before the changes come in’, amid huge anger at the proposals laid out in Lord Hutton’s report on public-sector pensions.

Almost as many – 28% – said they would take advantage of ’24-hour retirement’ to claim their pension early while coming back to work part-time, raising serious questions over whether the Government will be able to impose the pension changes on the profession.

GPs are questioning why their pensions are facing further changes just three years after they were last renegotiated, to include a retirement age of 65 for all new entrants.

Only 42% of the 200 GPs responding to the survey said they would be prepared to work as they are now under the proposed changes to the pension – which would eventually raise the GP retirement age to 68*.

The threat of the profession leaving in droves came as a further 80 GPs added their name to Pulse’s No to 65 petition, taking the number of sign-ups so far well over the 1,000 mark.

Professor Tony Avery, a GP in Nottingham, said: ‘General practice is a tough job and working that extra five years between 60 and 65 could be seriously damaging to health and life expectancy.’

Dr Colin Brunt, a GP in Manchester, said: ‘I would be willing to strike over this issue.’

Richard Hoey, editor of Pulse, said: ‘GPs, like many other public-sector workers, are furious about Lord Hutton’s proposals – they feel more strongly about pensions than about any other contractual issue.

‘The timing for the NHS pension reforms could not be worse. The Government is planning to hand GPs ВЈ80 billion of NHS budget, but it will hardly be able to do that if GPs are quitting en masse.’

* The numbers add up to more than a 100 because a small number of GPs said they would both take 24-hour retirement, and quit entirely before the changes were introduced.

Source:

Pulse

AMA Vice President and Chair of the AMA Indigenous Health Taskforce, Dr Steve Hambleton, said today that appropriate primary health care services for Indigenous people would achieve dramatic results in reducing the health inequalities between Indigenous and non-Indigenous Australians.

Ahead of Close the Gap Day tomorrow, the AMA congratulates members of the Close the Gap coalition on five years of the campaign to achieve Indigenous health equality within 25 years, and reiterates its support for integrated primary health care for Indigenous people.

“There must be a focus on delivering appropriate primary health care services for Indigenous people,” Dr Hambleton said.

“The AMA believes that collaboration and partnerships are needed where all sectors of the primary care system work together to achieve integrated, high-quality and culturally accessible care for Indigenous people where it is most needed.

“This includes Aboriginal community-controlled services, other Aboriginal and Torres Strait Islander health services, and mainstream general practices and health clinics.

“The Close the Gap campaign has put Indigenous health on the national political agenda.

“Politicians have a common will to make change happen and a recognition that Indigenous health is everyone’s responsibility, but a lot more needs to be done if we are to provide Indigenous Australians with the level of health service and delivery they need and deserve,” Dr Hambleton says.

The AMA is investigating different models of best practice in integrated primary care for Indigenous Australians.

The AMA Indigenous Health Report Card, to be released in a month, will make recommendations to the Federal Government on how best practice and collaboration can be enhanced within mainstream health and medical practices and Indigenous health services.

Source:

Australian Medical Association

Exclusive: One GP in 10 on the boards of new commissioning consortia also holds an executive-level position with a private provider, exposing the serious potential for conflict of interest in the Government’s NHS reforms, Pulse can reveal.

Our investigation, based on data released by PCTs under the Freedom of Information Act, finds almost a quarter of consortium board members have some kind of interest in private providers, with others either shareholders or advisers.

A Pulse survey last year found a similar proportion of GPs as a whole held interests in private providers of NHS services – with the BMA warning involvement beyond holding shares could preclude them from an active role in commissioning.

Our new investigation gained responses from 73 PCTs about the roles held in their local health economies by consortium board members, although 56 trusts said they were not in a position to provide information – either because boards had not yet been set up, or information on conflicts of interest had not been collected.

The analysis examined the additional roles held by 132 consortium board members across the 17 trusts that were able to provide information – and found that 15 held board-level positions in addition to their roles on shadow consortia.

The findings come as Pulse also reveals private firms are being lined up to sit on the new NHS Commissioning Board.

Roles held by consortium board members include board membership of private firm Assura’s local GP provider companies (GPcos), board roles at fellow private firm The Practice, and medical directorships of out-of-hours companies.

A further 15 consortium board members were linked to private firms in non-executive capacities, either as shareholders or in advisory roles, including seven with Assura’s GPcos.

An Assura spokesperson said GPco board members elected to consortia would be required to step down before any commissioning decisions were taken, and said a number of those named by PCTs as having dual roles had already done so.

A spokesperson for The Practice said it was ‘acutely aware’ of the need to be ‘transparent and fair’, and was evolving its organisation to support these objectives.

Dr Johnny Marshall, chair of the National Association of Primary Care and of the United Commissioning consortium in Buckinghamshire, stepped down from his role on the board of provider company Vale Health last August, because he felt the potential conflict of interest in sitting on both boards was too much to reconcile.

He said: ‘As the chair of our commissioning organisation, I felt it was inappropriate for me to be a chair or director of a provider organisation with which I could in the future be contracting. There is a public confidence issue here.’

Dr Chaand Nagpaul, a negotiator with the BMA’s GP committee, said: ‘There are real concerns about GPs with a senior-level interest in a private provider and we would suggest as far as possible to avoid such doctors sitting on commissioning boards because of perceived or actual conflict of interest.’

Source:

Pulse

Dr Laurence Buckman, Chairman of the BMA’s (British Medical Association’s) GPs Committee, said regarding the King’s Fund report “Improving the Quality of Care in General Practice”, released today (Thursday 24 March 2011):

“We are pleased the King’s Fund report recognises the importance of generalism and that most practices provide good quality care. Recent research has shown that patient satisfaction with general practice has been increasing.

Like the King’s Fund we believe that “continuity of care” is very important and GPs should strive to offer this to their patients, particularly those with complex and long-term needs. Increasingly practices are working more closely together meaning they will be able to offer the wider range of service that patients expect. However, we should not assume that bigger always means better. Many patients value smaller practices and, as they consistently perform well clinically, it is important that this choice remains.

Quality is at the centre of what general practice offers and, no matter how good the service and care, all practices can improve. We agree that GPs should be able to demonstrate the quality they offer to the public, however, as the report acknowledges, not all aspects of general practice work lend themselves to being measured easily. GPs have always been at the forefront in embracing new technology where it can make a difference to the way they provide care for their patients and, as the demands on the service continue to grow, practices will continue to adapt.

A culture of self-scrutiny has existed for many years but now more than ever, given the increased intensity and complexity of general practice work nowadays, GPs need time off the treadmill so they can look critically at what they do and make improvements. A reduction in bureaucracy would help them to do this, as would stopping the constant reorganisations within the NHS. Where GPs fall short, they need to be helped to see where they can make their service better and given the time, resources and staff support to do this.”

Source: BMA