Investing in the health of the 41-60 year old : reaping the return in the 60+ population?

Introduction: Ageing brings an increased burden on healthcare systems. In Malta cardiovascular disease is the main cause of morbidity and mortality accounting for approximately 40% of all deaths. It is assumed that effective prevention strategies targeted at the middle-aged population would translate in better health outcomes in our elderly population. Aim: To investigate how lack of awareness of conditions such as high blood pressure and high blood glucose level in the 41-60-year age group could influence the health status of future generations of elderly in our population. Methodology: Two risk factors for cardiovascular disease namely raised blood pressure and raised blood glucose were identified for analysis: (i) The comparison of perception and measurement of the selected risk factors assessed in 2 cohorts aged 41-60 years at two different time points: (a) 1981/4 and (b) 2008/2010; (ii) The analysis of any changes in perception and measurement of these risk factors over time between the 1981/4 sample and a follow-up sample drawn from the first cohort 30 years later, now 60 plus years of age. Results: Awareness for hypertension has increased in the 41-60-year olds over the 30-year period. However, awareness for diabetes has decreased in the same cohorts. Awareness for both hypertension and diabetes has increased as the 41- 60-year olds reach 60+. Conclusion: Improved perception for hypertension and diabetes in the 60+ group is not matched with better control of the condition. Medical intervention in the 41-60-age group in the 2008/2010 sample has resulted in better control of blood pressure, but not of blood glucose. These results highlight the need for stepping up awareness and screening for these conditions especially in the 41-60 group coupled with better control.peer-reviewe

Using electronic health records to support clinical trials: a report on stakeholder engagement for EHR4CR

Background. The conduct of clinical trials is increasingly challenging due to greater complexity and governance requirements as well as difficulties with recruitment and retention. Electronic Health Records for Clinical Research (EHR4CR) aims at improving the conduct of trials by using existing routinely collected data, but little is known about stakeholder views on data availability, information governance, and acceptable working practices. Methods. Senior figures in healthcare organisations across Europe were provided with a description of the project and structured interviews were subsequently conducted to elicit their views. Results. 37 structured interviewees in Germany, UK, Switzerland, and France indicated strong support for the proposed EHR4CR platform. All interviewees reported that using the platform for assessing feasibility would enhance the conduct of clinical trials and the majority also felt it would reduce workloads. Interviewees felt the platform could enhance trial recruitment and adverse event reporting but also felt it could raise either ethical or information governance concerns in their country. Conclusions. There was clear support for EHR4CR and a belief that it could reduce workloads and improve the conduct and quality of trials. However data security, privacy, and information governance issues would need to be carefully managed in the development of the platform

Expanding the use of real-time electromagnetic tracking in radiation oncology.

In the past 10 years, techniques to improve radiotherapy delivery, such as intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT) for both inter- and intrafraction tumor localization, and hypofractionated delivery techniques such as stereotactic body radiation therapy (SBRT), have evolved tremendously. This review article focuses on only one part of that evolution, electromagnetic tracking in radiation therapy. Electromagnetic tracking is still a growing technology in radiation oncology and, as such, the clinical applications are limited, the expense is high, and the reimbursement is insufficient to cover these costs. At the same time, current experience with electromagnetic tracking applied to various clinical tumor sites indicates that the potential benefits of electromagnetic tracking could be significant for patients receiving radiation therapy. Daily use of these tracking systems is minimally invasive and delivers no additional ionizing radiation to the patient, and these systems can provide explicit tumor motion data. Although there are a number of technical and fiscal issues that need to be addressed, electromagnetic tracking systems are expected to play a continued role in improving the precision of radiation delivery

Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement

OBJECTIVES There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised. METHODS Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species. RESULTS Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD. DISCUSSION The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine

Improved reception of in-body signals by means of a wearable multi-antenna system

High data-rate wireless communication for in-body human implants is mainly performed in the 402-405 MHz Medical Implant Communication System band and the 2.45 GHz Industrial, Scientific and Medical band. The latter band offers larger bandwidth, enabling high-resolution live video transmission. Although in-body signal attenuation is larger, at least 29 dB more power may be transmitted in this band and the antenna efficiency for compact antennas at 2.45 GHz is also up to 10 times higher. Moreover, at the receive side, one can exploit the large surface provided by a garment by deploying multiple compact highly efficient wearable antennas, capturing the signals transmitted by the implant directly at the body surface, yielding stronger signals and reducing interference. In this paper, we implement a reliable 3.5 Mbps wearable textile multi-antenna system suitable for integration into a jacket worn by a patient, and evaluate its potential to improve the In-to-Out Body wireless link reliability by means of spatial receive diversity in a standardized measurement setup. We derive the optimal distribution and the minimum number of on-body antennas required to ensure signal levels that are large enough for real-time wireless endoscopy-capsule applications, at varying positions and orientations of the implant in the human body