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School to provide increased access to preventative health services for young students so they can learn, grow and thrive To address health issues at the earliest and most preventable stages, provide whole child health, and advance health equity in the community, ChristianaCare opened a new school-based health center at Kuumba Academy Charter School in Wilmington on Friday, May 6th. The creation of the center, made possible through ChristianaCare’s partnership with the Community Education Building (CEB), which houses Kuumba Academy, means that students at the kindergarten-through-8th grade school will have increased access to an array of health services. “At ChristianaCare, we recognize the comprehensive health needs of adolescents in our community and are committed to partnering and using our resources wisely and effectively to expand our school-based health centers,” said Bettina Tweardy Riveros, J.D., chief health equity officer and senior vice president of Government Affairs and Community Engagement at ChristianaCare. “We know that childhood trauma adversely affects the ability of children to learn and build healthy relationships and it increases their risk of mental health issues and lifelong chronic disease. The opening of our school-based health center at Kuumba Academy means that ChristianaCare can support medical and behavioral health services and wraparound social care our children need, so we can positively influence their health, their education and their futures.” With the latest opening, ChristianaCare now operates 21 school-based health centers throughout the First State, in partnership with the Delaware Department of Health & Social Services, the Delaware Division of Public Health and several school districts. Kuumba Academy students, who spoke at an event Friday to celebrate the grand opening, will have access through its school-based health center to the following: Comprehensive behavioral health services. Crisis intervention and suicide prevention. Substance use disorder treatment. Tobacco cessation. Nutrition and weight management. Physical examinations. Health screenings. Treatment for minor illnesses and injuries. Reproductive health. In addition, Kuumba Academy students also will have access to resources that help their families surmount obstacles such as transportation, challenging appointment times, and worries about cost and confidentiality. “Kuumba Academy remains committed to meeting the needs of the whole child and family,” said Sally Maldonado, head of school at Kuumba Academy, the mission of which is to provide an innovative learning environment for the whole child from kindergarten through eighth grade. “The opening of this school-based health center means that our students and families will have daily access to the high-quality behavior and health services that they deserve, and we are grateful to ChristianaCare and CEB for their partnership. We are beginning to see ourselves on the other side of this pandemic and we are energized to emerge with these newfound partnerships focused on health and wellness for our village.” ChristianaCare has partnered with CEB and Kuumba Academy on community-focused health initiatives in the past. In February 2021, ChristianaCare provided more than 800 vaccinations to community members and staff at CEB. On February 7th of this year, ChristianaCare vaccinated 38 people, including 19 children, against COVID-19. This added to the more than 6,000 vaccinations that ChristianaCare Community Health has administered since 2021. “At CEB, we understand the importance that health plays on a child’s ability to learn and succeed,” said Linda Jennings, CEO at CEB. “We are beyond excited to partner with Kuumba and ChristianaCare to launch the Kuumba Academy School-Based Health Center at CEB and add to the list of holistic and integrated support we provide to students and their families.” Today’s event coincides with Better World Day, an annual, national event on the first Friday in May. During Better World Day, students showcase their learning about initiatives that they believe will have a positive impact on their community and the world. Through collaboration and acts of service, students learn the power of their voice to make change. About ChristianaCare Headquartered in Wilmington, Delaware, ChristianaCare is one of the country’s most dynamic health care organizations, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. ChristianaCare includes an extensive network of primary care and outpatient services, home health care, urgent care centers, three hospitals (1,299 beds), a freestanding emergency department, a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. It also includes the pioneering Gene Editing Institute. ChristianaCare is nationally recognized as a great place to work, rated by Forbes as the 2nd best health system for diversity and inclusion, and the 29th best health system to work for in the United States, and by IDG Computerworld as one of the nation’s Best Places to Work in IT. ChristianaCare is rated by Healthgrades as one of America’s 50 Best Hospitals and continually ranked among the nation’s best by U.S. News & World Report, Newsweek and other national quality ratings. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. With its groundbreaking Center for Virtual Health and a focus on population health and value-based care, ChristianaCare is shaping the future of health care. About Kuumba Academy Charter School Kuumba Academy Charter School’s mission is to provide an innovative learning environment for the whole child from kindergarten through eighth grade. Our directors, staff, and families share the core belief that parents are children’s primary educators. KACS parents, in partnership with teachers and administrators, believe that every child can maximize his or her learning potential given the opportunity to do so. In response to the outcry from Wilmington parents looking for a high-quality public education and increased access to arts education for their children, Christina Cultural Arts Center leaders, parents, and community supporters took action and were granted a Department of Education charter to create Kuumba Academy Charter School (KACS) in 2001. KACS was the first school model in the state that partnered a public charter school with a nonprofit community organization. Christina Cultural Arts Center (CCAC) and KACS form a unique nonprofit/public school partnership committed to educational excellence. Through the innovative union of academics, arts, technology, and family engagement, each KACS student’s individual learning style is nurtured—resulting in creative learners who are agents of positive change in the community. The CCAC/KACS model is regarded by many as the single most significant achievement in Wilmington’s post public school desegregation history. About the Community Education Building (CEB) CEB was established in 2012 after Bank of America donated the former MBNA Bracebridge IV building to The Longwood Foundation. Living up to its commitment of increasing access to education, the Longwood Foundation created CEB as an independent entity, and transformed the space into an ecosystem to support the social, emotional, physical, and academic development of Wilmington’s youth. CEB is an innovative co-location and shared services model. Focused on supporting the entire family, CEB offers vibrant programs and support systems that provide a sound foundation for each student. It serves as a hub for families by offering services such as healthy meals, life coaches, and mental health services. This model leads to deeper family engagement in their child’s learning and allows schools to focus on teaching and learning, not operations and overhead. CEB is an educational ecosystem that holistically integrates programs and resources for students and their families, ensuring that every student has an equitable opportunity to succeed.
Does medical marijuana work? Florida consortium seeks answers
By Emma Richards A consortium of nine universities in Florida, led by faculty at the University of Florida, is in the early stages of investigating the effectiveness of marijuana as a medical treatment. Almut Winterstein, a professor at the University of Florida who also serves as the director of the Consortium for Medical Marijuana Outcomes Research, says there is promising data on pain therapy and epilepsy but much still to learn about cannabis as a medical treatment. The Consortium for Medical Marijuana Outcomes Research is assessing the drug’s risks and benefits for different medical conditions and its safety and side effects when used alone or in conjunction with other prescription medications. “What I can tell you is that right now there is promising and fairly solid data that supports the use of medical marijuana as an adjuvant for pain therapy,” said Almut Winterstein, a professor in the College of Pharmacy at UF who also serves as the director of the consortium. “And there’s also evidence that supports the use for certain types of epilepsy.” As for other conditions, the impacts of medical marijuana are still unknown. The Florida State Legislature created the consortium in 2019, four years after enacting legislation that permits use of marijuana for certain clinical conditions. Currently, 37 states have a medical marijuana program, though the programs vary as far as how and to whom cannabis can be prescribed. But, Winterstein said, little is known about marijuana’s clinical safety and effectiveness. “I think that the Legislature was really forward looking in creating something that supplements the research that is currently not sufficient,” she said in an episode of the From Florida Podcast. The consortium will also gauge who is using and able to access medical marijuana and determine the benefits and drawbacks of different dosages. To do so, the group is working on three primary branches of research. The first area is a competitive grants program that funds researchers across all participating universities. The second branch is M3, or Medical Marijuana and Me, a new study that will track patients from their first use of medical marijuana for a year to assess their experiences. “That will give us ideas about what type of dosage, form and product do patients eventually end up on,” Winterstein said. “That is a very empirical approach because we have no head-to-head comparison of what works better or worse, but we can capture patients’ experiences, what they think works, what doesn't, what kind of side effects they might experience and so on.” Finally, what Winterstein calls the consortium’s “biggest baby and most important baby” is the Medical Marijuana Outcomes Research Repository, known as MEMORY. The repository will allow researchers to use de-identified dispensing data from the Department of Health to monitor health outcomes of the large population of 700,000 registered medical marijuana patients. These data will give researchers insight on cannabis safety and effects, whether positive or negative, linking to healthcare utilization, such as hospitalization or emergency department visits. The consortium is hosting the second annual Cannabis Clinical Outcomes Research Conference May, 19-20 in Orlando, where researchers will discuss the latest research on medical marijuana. “We are really trying to get people interested in this topic,” Winterstein said. “And in particular making sure that they have access to objective information that really allows them to make the right decision with respect to the use of medical marijuana.” To hear more about the consortium’s medical marijuana research, listen to the episode on From Florida at this link. Listen to other episodes in the From Florida podcast here. Read a recent article quoting Professor Winterstein here:
INNOVATORS BRING AI INTO IMAGING SKILLS DEVELOPMENT
Originally from CHT Magazine By Jerry Zeidenberg October 30, 2019 Two Ontario hospital organizations – encompassing six sites – will soon deploy artificial intelligence to help with continuous learning and peer review in their imaging departments. By automatically detecting the types of cases being read by radiologists at St. Joseph’s Healthcare Hamilton and Hamilton Health Sciences, the system will deliver the latest journal findings, as well as personal pattern recognition and error avoidance, direct to their desktops. While radiologists at all Canadian hospitals are experts in their field, with years of education and experience, our understanding of diseases and illnesses is rapidly expanding and new insights are constantly appearing. To ensure that they’re aware of the latest research and best practices, many radiologists conduct journal and web searches while they’re reading cases at the hospital, or at night, from home. “Our radiologists and physicians spend a lot of time reading and searching for literature,” said Shairoz Kherani, who until recently was Director of Diagnostic Services at HHS. (She has since moved to Halton Health Care, in nearby Oakville, Ont., where she is Director of Diagnostic Services and Laboratory.) “Finding the right information can be a daunting process. Now it will be readily available.” “There are hundreds of new findings every day,” said Ian Maynard, CEO of RealTime Medical, of Mississauga, Ont., the company that’s providing the AI-powered solution, called AICloudQA™. “Radiologists can spend two or more hours a day searching independent medical data sources,” said Maynard. “Our solution saves radiologists a significant amount of time and effort by searching multiple data sources simultaneously, relative to the case at hand. We’re like a Google search on steroids for relevant medical data, helping radiologists apply the latest findings to their patient care”. Indeed, RealTime Medical is collaborating with Google Cloud and Sightline Innovation to deliver its AI-fueled solutions. The project is also supported by the National Research Council of Canada’s Industrial Research Assistance Program (NRC IRAP), resulting in a collaboration between these organizations and the hospitals using the solution. Not only does the automated searching save time and contribute to better medical outcomes for patients, but it helps reduce radiologist “burnout”, a serious issue today as radiologists feel overloaded by the demands placed on them, Maynard said. St. Joseph’s Healthcare Hamilton and Hamilton Health Sciences will introduce AICloudQA for peer learning and skills development across their sites by the end of this year. The hospitals will probably start with one site, or one physician group across all sites, and then steadily roll out the solution. The context-sensitive provision of journal articles and other sources of medical information is expected to be of great help to the radiologists, nuclear medicine physicians, cardiologists and other clinicians who use the system. There are 70 to 80 radiologists and medical imaging experts at Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton who will be the prime users of AICloudQA. RealTime Medical’s Ian Maynard said the importance of timely and accurate information cannot be underestimated. As they’re reading cases, radiologists want the latest literature and personal pattern recognition notifications of what to be on the lookout for. “What they don’t want our patients and their families coming back to them later, asking why they didn’t know about the latest finding from Cleveland Clinic for example,” said Maynard. Dr. Karen Finlay, radiologist and Interim Chief of Radiology at Hamilton Health Sciences, agreed that radiologists are currently taking “a lot of time for research”. “If a radiologist steps off a case for five to 10 minutes to go to Google Scholar, that can really add up over the course of a day,” she said. Additionally, for those familiar with the impact of interruptions on the efficiency of the diagnostic process, that time impact can be significantly magnified to the detriment of diagnostic efficiency, which collectively impacts system-wide efficiency. The feed from AICloudQA, by contrast, is instantaneous, meaning the radiologist doesn’t have to stop what they are doing. Notably, the RealTime Medical system also uses AI to scan the readings done by radiologists, and to provide feedback on areas where they might want to focus on or look more closely in future. “It’s like the blind-spot warning system in your car, only it’s anonymously helping you avoid possible gaps in your own reading patterns,” said Maynard. “This is very valuable,” said Kherani. “The system can do intelligent sampling and note where a radiologist may want to improve. It can even spot patterns, time of day and other conditions when they may be more vulnerable.” Dr. Finlay observed that AICloudQA will also transform the process of peer learning at Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton. It will do this, in one way, by increasing the pool of radiologists participating. One of the limitations of current peer review methods is that there’s often a limited number of potential reviewers, especially when a sub-specialty is involved – such as breast or neuro-imaging. RealTime Medical’s cloud-based solution offers the potential to connect with other hospitals across the province and the country, creating a critical mass of peers with a cross-section of experiences in each sub-speciality. This will enable a level of peer learning and best practice sharing that’s simply not possible with site-based systems. Increasing the number of radiologists in the peer learning pool also helps with the issue of anonymity. With site-based solutions, it’s sometimes possible to guess the identity of the radiologist or clinician being assisted, as physicians are often familiar with the reporting styles of their peers. Like all physicians – and people in general – radiologists don’t like to be judged. By making the system more anonymous, the Real Time Medical system makes peer learning more objective, valid and hence palatable for participants. This part of what is being called a “just culture” approach, that physicians are calling for in such solutions. AICloudQA embraces the “just culture” principles that physicians want and deserve. It is not punitive, and the information is not shared. Instead, it’s sent privately to the participating radiologist or clinicians, who can use it for self-improvement. At Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton, the peer-reviewing will be prospective – that is, it’s done before the results are reported to the referring physician. Of course, there are only so many cases that can be reviewed before the process becomes counter-productive. The need for continuous learning must be balanced with the extra burden that’s placed on reviewers. “The trick is to make it a rich and rewarding learning experience, but not burdensome,” said Dr. Finlay. Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton currently aim to review 2 percent of the cases, which is in keeping with other Canadian programs. Kherani noted there are other potential benefits to the AICloudQA platform. It has a workload balancing function, where it uses its intelligence to feed cases to the appropriate radiologist – based on availability and expertise. That not only offers the organization advantages with workflow and wait times, but it also benefits patients, as they obtain the most expert radiologist available. She said the system can eventually support different types of physicians involved in imaging, such as cardiologists, and not only radiologists. “It’s a multi-ology solution.” Dr. Finlay noted the system also supports critical results reporting – so that urgent findings are quickly sent to referring doctors. It can also be tweaked to include notification of unexpected findings – flagging colleagues about problems that were unanticipated, but should be addressed.
VANCOUVER IMAGING TO IMPLEMENT REALTIME MEDICAL AI
ORIGINALLY PUBLISHED IN CHT MAGAZINE VANCOUVER – Vancouver Imaging, a group of over 70 radiologists, has signed on to use RealTime Medical’s smart workload-balancing, physician skills development and error-avoidance platform. Vancouver Imaging, which provides reading services for hospital and out-of-hospital imaging centres, will implement the system in the first half of 2020 at its non-hospital clinics. Vancouver Imaging offers a wide variety of sub-specialty readings across all disciplines, including specialized expertise in emergency trauma radiology. The organization is the only group of radiologists in Canada offering around-the-clock, on-site, sub-specialty emergency reading services. “Emergency radiology is itself a sub-specialty and requires a unique set of skills,” said Dr. Savvas Nicolaou (pictured), the CEO of Vancouver Imaging and director of Emergency & Trauma Imaging at Vancouver General Hospital. “It’s unpredictable, with frequent interruptions. You often have to work with a limited amount of information from clinicians, and it can include everything from head-to-toe, including mass casualty situations that require proactive decision-making.” He added, “You’re always on, and never off.” The Emergency & Trauma sub-specialty requires “appropriate, patient-centered judgement in a matter of seconds.” Vancouver Imaging will deploy RealTime Medical’s AICloudWorks and AICloudQA platforms within their clinics. Collectively, the offerings encompass several AI applications, including high throughput workload balancing. RealTime Medical holds the U.S. and Canadian patents for its workload balancing algorithms and is one of only two patent holders for diagnostic workload balancing, along with the U.S. company, Virtual Radiologic. The cases are assigned to the appropriate radiologists based on sub-specialty, current workload and other parameters, creating an intelligent, diagnostic operations platform that is “context-aware,” a term originally coined by RealTime Medical to describe the capabilities of the platform. For example, radiologists with expertise in neurology will be the first to receive neuro cases, while thoracic or pediatric experts will be the first to receive cases of that type. The system also “balances” the work, to ensure that radiologists are receiving equal caseloads, subject to the case-specific service levels and business parameters established by the group. “The AI additions to this proven platform make it even more advantageous for us as a group as we pursue the delivery of Emergency Radiology services globally,” said Dr. Nicolaou, a world-renowned expert in Emergency & Trauma radiology, often referred to as the Founder and Pioneer of Emergency/Trauma Radiology in Canada. Dr. Nicolaou noted that AICloudWorks is vendor-neutral and can work with any HL7 and DICOM-based HIS, RIS and PACS solutions. “PACS integration can be very problematic,” said Dr. Nicolaou. “Being vendor-neutral is important to our flexibility as a group.” Vendor neutrality is important to Vancouver Imaging as their current environment includes workflows across multiple PACS solutions. Download CHT Reprint of Full Article
Findings point to potential new therapeutic targets for this highly aggressive, drug-resistant breast cancer subtype In breakthrough research at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute, scientists have discovered that a protein secreted by tumor cells can switch off the body’s natural defenses against triple negative breast cancer (TNBC). The study, led by Jennifer Sims-Mourtada, Ph.D., lead research scientist at the Cawley Center for Translational Cancer Research (CTCR), at the Graham Cancer Center, is reported in The Journal of Translational Medicine, available online. “What we found is that TNBC tumor cells can effectively shut down the body’s defense systems against the tumor by secreting a type of protein called IL-10,” Dr. Sims-Mourtada said. “The presence of this immune system protein forces the antibodies that would normally be created to attack the tumor to become non-reactive and not do what they are supposed to do.” The study was initiated in partnership with The Wistar Institute of Philadelphia, Pennsylvania, in collaboration with the late Raj “Shyam” Somasundaram, Ph.D., a cell biologist at the Melanoma Research Center. “Dr. Sims-Mourtada and her team have brought us tantalizingly close to understanding what drives the aggressive nature of triple negative breast cancer, a treatment-starved disease that disproportionately affects Delaware women,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “Their work underscores our belief that scientific collaborations such as this one between our Cawley CTCR clinicians and Wistar scientists can smooth the way for new findings to become effective therapies, especially for hard-to-treat and aggressive forms of cancer like TNBC.” Understanding the mechanism behind TNBC Delaware ranks highest in the nation for incidence of triple negative breast cancer. TNBC is an aggressive form that affects Black women at twice the rate of white women with poorer outcomes. Patients have higher rates of early recurrence than other breast cancer subtypes, particularly in the first five years after diagnosis. Currently there is no targeted therapy for TNBC. “One of our missions within the Cawley CTCR is to understand the mechanisms behind TNBC and find a treatment for it,” Dr. Sims-Mourtada said. “Our study sheds new light on what is prompting the body’s immune response to the cancer cells and offers clues to potential new therapeutic targets.” Normally it is the job of the B cells to regulate the immune response against foreign invaders like cancer. Among other jobs, they control inflammation at the site of an attack by releasing proteins including IL-10 to signal the defender cells to stand down. “Previously it was thought that the immune cells were the ones to express IL-10 to regulate themselves,” Dr. Sims-Mourtada said. “But our study shows that the tumor cells also release this protein, which means they are driving how the immune system behaves.” Within the tumor microenvironment, IgG4 is one of four antibody subclasses expressed and secreted by B cells. Whereas another type of antibody would urge the immune system to press on with the attack, activation of IgG4 signals the job is done. TNBC and activation of IgG4 “Our findings support that TNBC may create a tumor environment that supports activation of IgG4, and messaging from IL10 is triggering the switch,” Dr. Sims-Mourtada said. As previously reported with other cancers, such as melanoma, this study confirms that the presence of IgG4-positive B cells within the tumor associates with advanced disease increased recurrence and poor overall breast cancer survival. It is also possible that IL-10 expression by tumor cells may also be a cause of poor outcomes in TNBC, and this may be independent of IgG4+ B cells. “At this point, we don’t know what causes tumor cells to start secreting IL-10, but we know that B cell-tumor cell interactions are involved,” Dr. Sims-Mourtada said. “We still have to look at what is really going on in the B cell population to determine which subtypes of B cells are affected by this tumor crosstalk and why some forms of TNBC express IL-10 (the ones with poor outcomes) and others do not. “We think that the presence or absence of other immune cells in the microenvironment may affect how B cells interact with tumor cells to drive IL-10 expression,” she said. Resources for the study, including blood and tissue samples from consenting patients, were obtained through the Graham Cancer Center’s Tissue Procurement program. Interestingly, in a small subset of samples, the researchers found that IL-10 expression was significantly higher in Black patients than non-Hispanic white patients. These findings need to be confirmed in a larger more diverse population with different TNBC subtypes. Understanding tumor-infiltrating B cells “Our growing understanding of the contribution of IgG4+ cells to the immune microenvironment of TNBC and what drives IL-10 expression may reveal ways in which tumor-infiltrating B cells can contribute to tumor growth and provide new targets to increase the immune response to TNBC,” Dr. Sims-Mourtada said. As partners for more than a decade, Graham Cancer Center research clinicians and Wistar scientists collaborate across disciplines to translate cancer research into more effective therapies for patients everywhere. In addition to providing high-quality, viable tissue samples for Wistar research studies, Graham Cancer Center clinicians actively participate in concept development, sharing their unique understanding of the everyday patient experience.
Aston Institute of Health and Neurodevelopment officially launches new £2.8m MRI scanner
A new £2.8 million MRI scanner has been unveiled at Aston University. The showcase took place in Aston Institute of Health and Neurodevelopment on Monday 25 April. The event was attended by Aston University Interim Vice-Chancellor Saskia Loer Hansen and other members of the University executive team, together with academic researchers in the University’s College of Health and Life Sciences. After an official ribbon-cutting ceremony hosted by the Institute co-directors Professor Jackie Blissett and Professor Gavin Woodhall, guests were invited to take a tour of the new MRI scanner facilities where imaging researchers were on hand to showcase and discuss their research for which the new MRI scanner is a vital facility. Interim Vice-Chancellor Saskia Loer Hansen said: “I am delighted that Aston Institute of Health and Neurodevelopment is home to this state-of-the-art facility. Having a new MRI scanner on our campus will not only enable our scientists to undertake their neuroimaging research, but will also benefit so many patients in the region who urgently need this facility as part of their medical treatment. “Our new MRI scanner further highlights the world-class research that our scientists are undertaking at Aston University.” The new Siemens MAGNETOM Prisma 3T MRI scanner was installed over a period of four months starting in November 2021, including the work undertaken to remove the old machine from the building. The scanner has been made ‘child friendly’ with suitable images and the room which hosts the scanner has a wall mural of cherry blossom trees. The new MRI scanner will enhance the world-class neuroimaging research facilities within the Institute of Health and Neurodevelopment and support the development of the next generation of researchers. Professor Jackie Blissett, co-director of Aston Institute of Health and Neurodevelopment, said: “The new MRI scanner will enhance the world-class neuroimaging research facilities within the Institute of Health and Neurodevelopment. It will allow us to answer the questions that matter to children and young people, their families and the services that support them.” Aston University researchers use advanced neuroimaging techniques to examine brain health in children with neurological diseases and developmental disorders and are developing a research programme focused on children and young people to deliver a new understanding of development, disorder and disease and the interventions that will make a difference. The new scanner will also enable the Institute to provide the most recent innovations in MRI for patients visiting through the clinical service Aston University Imaging. Patients visiting for MRI scans come through private referrals, as well as from local institutions such as the Birmingham Royal Ballet and Aston Villa Football Club.
Aston University psychologists to take part in major study to improve concussion prognosis
Researchers from the Aston Institute of Heath and Neurodevelopment, in the College of Health and Life Sciences at Aston University, are taking part in a major multiple partner study to identify new ways to accurately predict whether patients will develop long-term complications as a consequence of concussion. Experts from the University of Birmingham and the Defence Medical Rehabilitation Centre, in collaboration with Defence Medical Services, are to lead the UK consortium carrying out the study. With year one funded by the Ministry of Defence (£2m) and projected to run over eight years, the multi-faceted study will include a trial involving 400 civilians and 400 military personnel aged over 18 with a new diagnosis of concussion (also known as a mild traumatic brain injury or mTBI) which has resulted in them needing hospital treatment or rehabilitation. At specific time intervals over two years, the participants will take part in nine different areas of research using a variety of medical techniques and assessments to establish if these can be used routinely by medics as ‘biomarkers’ to indicate prognosis and long term impact of concussion. Medical techniques and assessments being trialled include brain imaging and function, analysis of blood and saliva samples, and headache measures, as well as mental health, vision, balance, and cognitive performance. mTBI is common and has been declared a major global public health problem, with 1.4 million hospital visits due to head injury annually in England and Wales - 85% of which are classified as mTBI. It is also estimated that up to 9.5% of UK military personnel with a combat role are diagnosed with mTBI annually. The research will involve 20 University of Birmingham experts working across disciplines, including neurology, psychology, sports medicine, mathematics and academics within the University’s Centre for Human Brain Health, and will be coordinated by Birmingham Clinical Trials Unit. It will also be driven by experts at the Defence Medical Rehabilitation Centre Stanford Hall; Imperial College London; University of Westminster; University of Nottingham; Royal Centre for Defence Medicine; and University Hospitals Coventry & Warwickshire. Dr Caroline Witton, reader in psychology and scientific lead for magnetoencephalography (MEG) at the Aston Institute for Health and Neurodevelopment (IHN), Aston University said: "I am very excited to be part of this landmark study of traumatic brain injury. At IHN we are focussed on improving lives through brain imaging and this work has the potential to help the thousands of people each year who suffer long term disability following a concussion." Dr Jan Novak, lecturer in psychology and MRI lead at Aston University said: "It is outstanding that this prestigious work is being conducted at Aston University’s Institute of Health and Neurodevelopment. We will provide our expertise in brain imaging, prediction of outcomes in patient groups, and credentials in mTBI research to enrich the study. It is hoped that it will build upon existing collaborations with other local institutions and government bodies such as the Ministry of Defence." Alex Sinclair, professor of Neurology at the University of Birmingham and chief investigator of the mTBI-Predict project explained: “Although classified as mild, and many recover, the consequences of concussion can be profound with many patients suffering long-term disability due to persistent headaches, fatigue, imbalance, memory disturbance, and poor mental health including post-traumatic stress disorder, while it can have a significant impact on the economy through loss of working hours and demand on the health system. Identifying those patients most at risk of these disabling consequences is not currently possible. There is therefore a pressing need to develop accurate, reproducible biomarkers of mTBI that are practical for use in a clinical setting and can predict long-term complications. "Our programme of research will deliver a step change in the care of patients with mTBI, enabling a personalised medicine approach to target early intervention for those most in need but also identifying those with a good prognosis who can return rapidly to activities of daily living.” Co-Chief Investigator, Air Vice-Marshall Rich Withnall QHS Director of Defence Healthcare, UK Ministry of Defence said: “I am delighted that the Defence Medical Services, including the Defence Medical Rehabilitation Centre at Stanford Hall, will be working hand-in-glove with class-leading civilian colleagues and the National Rehabilitation Centre Programme. I fully support this ground-breaking research which I am confident will lead to significant clinical innovation to benefit military and civilian patients and have a translational positive impact for sporting activities from grass-roots to elite levels.” Chief Executive of Headway, Peter McCabe said: “We know that even a seemingly minor head injury can have a major impact on a person’s life – and often the lives of those closest to them. This is particularly the case if the brain injury goes undiagnosed or its effects are mistaken for other conditions. The frustration of not having an accurate diagnosis or receiving the right support can be compounded by the lack of a clear recovery pathway or timeline. We therefore welcome this study in the hope that it can advance our understanding of concussion and mTBI.”
Questions about colon cancer? Our experts are here to help with your coverage
Every year, National Colorectal (colon) Cancer Awareness Month is observed during the month of March in an effort to raise awareness of the importance for colon cancer screenings. The recognition offers health care providers the opportunity to educate the general public about a disease that can be preventable, but can sometimes be seen as difficult for patients to discuss with their doctors. In the spirit of education, one of Augusta University’s experts has provided some insight into the subject of colon cancer. Dr. Asha Nayak-Kapoor is an associate professor of medicine in the Division of Hematology/Oncology in the Department of Medicine at the Medical College of Georgia at Augusta University. Nayak is certified by the American Board of Internal Medicine in Hematology and Oncology Specialties. Q: What are the primary risk factors for colon cancer? “Risk factors for colon cancer include: being overweight or obese, not being physically active, certain types of diets, smoking, alcohol use, being older, a personal history of colorectal polyps or colorectal cancer, a personal history of inflammatory bowel disease, a family history of colorectal cancer or adenomatous polyps, having an inherited syndrome. Common symptoms of colorectal cancer include: bloody stool or rectal bleeding, an ongoing change in bowel habits (diarrhea, constipation, chance in stool consistency), abdominal pain or cramping, gas or persistent abdominal discomfort, you feel like your bowels are not voiding completely, weakness, fatigue, or unexplained weight loss.” Q: How can a person protect themselves from the risks of colon cancer? “Colon cancer is largely preventable if patients undergo screening tests, like a surveillance colonoscopy starting at 45 years or earlier depending on family history. Many lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer. Getting to and staying at a healthy weight may help lower your risk. A diet that's high in red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some luncheon meats) raises your colorectal cancer risk. Cooking meats at very high temperatures (frying, broiling, or grilling) creates chemicals that might raise your cancer risk. It’s not clear how much this might increase your colorectal cancer risk. Stop smoking. It is best not to drink alcohol. People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 50, or if more than one first-degree relative is affected.” Q: It sometimes seems that colon cancer prevention is aimed more towards men compared to women, but cancer.org lists the risks at 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. Is there a reason why perhaps a stigma about colon cancer affecting men more has been created? “According to focus group studies, it can be seen as a taboo topic that is uncomfortable to discuss, and it is not discussed as openly in public as prostate and breast cancer screenings. It can seem embarrassing or humiliating, and can be seen as distasteful dealing with prolonged bowel preparation.” Nayak is a member of several committees, including Onyx and Bayer Speaker Bureau for Nexavar, MCG Cancer Center Molecular Oncology Programme, and MCG Cancer Center Gastrointestinal Tumor Board Committee. If you are a journalist looking to know more about colorectal cancer and would like to speak with an expert for your stories, then let us help. Nayak is available to speak with media about this important subject. Simply click on her icon now to arrange an interview today.
ChristianaCare MICU becomes first in United States to renew Beacon Award for Excellence for fifth-consecutive three-year cycle ChristianaCare’s Medical Intensive Care Unit (MICU) has earned an unprecedented honor from the American Association of Critical-Care Nurses. Among the thousands of intensive care units in the United States, ChristianaCare’s MICU is the first unit in history to earn a Beacon Award for Excellence from the association, also known as AACN, five times in a row. The Beacon Award is one of the highest achievements in nursing. The recognition lauds hospital units that employ evidence-based practices to improve patient and family outcomes. The award provides gold, silver and bronze levels of recognition to hospital units that exemplify excellence in professional practice, patient care and outcomes. Of the six Beacon Award-winning patient care units currently in the state of Delaware, five are at ChristianaCare: MICU (gold – five-time winner). Cardiovascular Critical Care Complex (gold – three-time winner). Transitional Medical Unit (silver). Surgical Critical Care Complex (silver). Transitional Surgical Unit (silver). ChristianaCare was one of 34 hospitals in the nation in 2021 with multiple units receiving Beacon Awards. Beacon Award designations are active for three years. “Through their relentless and uncompromising pursuit to deliver care that is nonpareil, the nurses of ChristianaCare’s MICU have become the paragon of what our profession can accomplish,” said Ric Cuming, EdD, MSN, RN, NEA-BC, FAAN, ChristianaCare’s chief nurse executive and president of ChristianaCare HomeHealth. “The success of our ChristianaCare MICU, even in the face of this pandemic, also has inspired our health system’s other intensive care units to achieve unprecedented gains in safety and quality that have been recognized with the AACN’s Beacon Award, the touchstone by which all critical care nursing excellence and quality are measured.” Success in caring for patients amidst COVID-19 ChristianaCare’s values of love and excellence are at the heart of the 24-bed MICU at Christiana Hospital, which holds the most Beacon Awards in Delaware. This year’s award is especially meaningful on the heels of yet another difficult surge of COVID-19. “It is a testament to our nurses and the entire care team that we continued to reach milestones in patient safety and satisfaction even during the COVID-19 pandemic,” said Carol Ritter, MSN, RN, CCRN-K, CNML, who has been nurse manager on the MICU for 10 years and a leader on the unit during all of its Beacon Award wins. “Everyone brings a level of expertise to the unit. We truly serve together.” Beacon awards celebrate the professional dedication that a nursing team demonstrates in going above and beyond to provide respectful, expert care. “Meaningful recognition takes on even greater relevance and importance as we continue to meet the challenges of the COVID-19 pandemic,” said AACN President Beth Wathen, MSN, RN, CCRN-K. “Being recognized as a Beacon unit underscores these teams’ ongoing commitment to providing safe, patient-centered and evidence-based care to patients and families. This achievement is a tremendous honor to those who have worked so hard to achieve excellence in patient care and positive patient outcomes.” ChristianaCare is one of only 152 health care institutions in the nation and the only in Delaware to have gold-level units. In 2008, the MICU was the first unit in the state to receive the Beacon Award. MICU’s culture of continuous improvement The MICU’s commitment to data-driven, evidence-based care proved especially valuable during the pandemic’s early days. Prone positioning, a technique to help patients with acute respiratory distress syndrome (ARDS) to breathe better, had been a longtime practice in ChristianaCare’s ICU. ChristianaCare critical care nurses Maureen Seckel, MSN, APRN, ACNS-BC, CCNS, FCCM, FCNS, and Dannette Mitchell, MSN, APRN, ACNS-BC, CCRN, published an article in AACN Advanced Critical Care that described ChristianaCare’s pioneering adoption of this technique, which ultimately became standard practice nationally in the treatment of patients with COVID-19 and ARDS. “On our unit, we empower the team to provide evidence-based care and have the tools to guide the practice,” Seckel said. “Because of this we were able to incorporate a highly effective, life-saving measure into COVID-19 care early in the pandemic.” Continuous improvement is a hallmark of the unit. The MICU has seven Comprehensive Unit-based Safety Program teams that follow data-collection processes to view trends and compare them to national standards to improve care and outcomes. “The whole unit is involved in collecting data to assess and make changes,” said MICU nurse Olivia Ross, BSN, RN, CCRN. Among the MICU’s accomplishments are excellent outcomes in preventing common hospital-acquired infections, even during the pandemic: Zero instances of catheter-associated urinary tract infections in three years. Zero instances of central line bloodstream infections in one year. The unit’s dedication to being exceptional today and even better tomorrow also focused inward during the pandemic. During a time of constant change, the team recognized the need for support to handle the unprecedented stress and strain of the pandemic. “To give the most vulnerable patients the highest levels of care on a consistent basis, we needed to take care of ourselves and one another too,” Ritter said. Ritter and team leaders committed to open-door policies throughout the pandemic, and they partnered with ChristianaCare’s Center for WorkLife Wellbeing to enable licensed psychologists to round on the unit, offering real-time check-ins with caregivers to provide support. The Beacon Award has been a resounding lift and reward for the MICU team members. “Having this recognition, especially during times of distress in the community and the world, signifies excellent nursing care,” said MICU nurse Paige Merring, MSN, RN, CCRN. “And to me it signifies an amazing team and great outcomes, which is the primary purpose of why we are all here.”
Major study reveals the lasting impact of Covid lockdowns
New research from the University of East Anglia reveals first-hand the lasting impact that lockdowns may have had on people’s mental and physical health. The UK’s first Covid lockdown was announced by Prime Minister Boris Johnson exactly two years ago today. Just a few days later, researchers at UEA launched a major project to track the mental and physical health of the nation through lockdowns and beyond. More than 1,000 participants carried out daily surveys – with questions on a range of lifestyle behaviours including physical activity, diet, sleep, smoking, drinking, and drug use. Some of the participants were then interviewed by the research team, to try to understand what was happening for people from their own viewpoints. Listen to what they had to say in our oral history project Lockdown Voices. New findings published today show how people responded very differently to social restrictions depending on their existing circumstances. For those who were less well-off to start with, adapting to lockdown was more difficult, and health behaviours typically worsened to a greater extent. In contrast, those who were better off at the start of the pandemic demonstrated faster adaptation and were more able to respond positively to restrictions, for example by taking to online exercise classes. It is likely that any lasting impact to mental and physical health will therefore be much greater for those who were worse off to start with. Those with good social links and healthy behaviours already in place described in their interviews how they were able to adapt to lockdown and thrive, whereas some of the more vulnerable in our communities had fallen into unhealthy spirals. Prof Caitlin Notley, from UEA's Norwich Medical School, said: “When the first lockdown was announced back in 2020, we started surveying participants from around the UK daily. Our initial results showed that people were eating less fruit and veg, getting less exercise and drinking more alcohol. “It quickly became apparent that lockdown may have lasting consequences for the physical and mental health of the nation. “We wanted to see whether people’s lifestyles changed in the long-term so we continued the study by carrying out regular surveys with the participants, and interviewing some people to find out more.” Now, two years on, the team’s results show how health inequalities are likely to have widened. Prof Notley said: “Social restrictions imposed as a result of the coronavirus pandemic have had a significant impact on health behaviours at the individual and population level. “It’s fair to say that all of our participants’ lives were disrupted by lockdown and they were forced to adapt. “But people responded to the lockdowns very differently and their experiences of social restrictions varied considerably. “Fundamentally, people were hindered or helped by their existing support structures and resources, such as access to technology to engage with the outside world, or private outdoor space. “Those people who had good friends, community links and who were already health conscious, were able to respond positively and better able to cope. “They were able to adapt to the ‘new normal’, use technology to keep in touch with friends and relatives, order veg boxes, carry on with a healthy diet and take part in healthy pursuits in new and innovative ways such as online fitness classes or ‘doing Joe Wicks’. “But lockdowns are very likely to have caused a sustained widening of social and health inequalities. “Those who remained in work outside the home, or who were retired, were the least impacted overall. But those who were unemployed, younger, on a lower income, clinically unwell or told to fully shield were particularly impacted by strict restrictions. “For these more vulnerable people, supportive social factors were taken away or severely restricted. Anxiety and depression worsened, and unhealthy behaviours like exercising less, drinking more alcohol, and eating a poor diet increased. “As we work through the ‘roadmap to recovery’, emphasis needs to be placed on a collaborative, community-based approach, with a focus on what makes us well. “Encouraging membership of community exercise groups, for example, may help those most impacted to engage again with healthy behaviours to keep them well. We also need to pay attention to how those who are less well-off responded more negatively to the policy of lockdown, so that lessons can be learnt for the future,” she added. ‘Disruption and adaptation in response to the coronavirus pandemic – assets as contextual moderators of enactment of health behaviours’ is published in the British Journal of Health Psychology.
