Health and Disability

Many of us are impatient for a future where telehealth reduces our visits to health professionals. Whether you are geographically isolated, tired of waiting hours in a waiting room for an overdue appointment or simply have felt the pain of dragging yourself from your sick bed to a doctor’s surgery to acquire a sick note for an employer, consumers are keen to see a change. Current health providers are expanding their services to include remote health. Health tech startups such as mediconecta and couch are creating new stand-alone services for remote care.

However substantial barriers exist for telehealth in practice according to a new survey of the 114 chief information officers, IT directors, telehealth managers and other professionals by the College of Healthcare Information Management Executives and KLAS.

About 59% of respondents listed reimbursement as a limitation, noting that some payers have been slow to reimburse telehealth visits1 and or reimburse at rates lower than face-to-face care. Most said integration between their electronic medical record and virtual care platform vendor was nonexistent or unidirectional. They also cited improved patient access as a major benefit, and three-quarters reported that they were actively planning to either expand the number of specialties served or expand patient access to providers using their present solution.  

Another interesting pharmacological crossover. Lots of people take glucosamine.....

https://goo.gl/TGoigg

Seizure disorders — including epilepsy — are associated with pathological hyperexcitability in brain neurons. Unfortunately, there are limited available treatments that can prevent this hyperexcitability. However, University of Alabama at Birmingham researchers have found that inducing a biochemical alteration in brain proteins via the dietary supplement glucosamine was able to rapidly dampen that pathological hyperexcitability in rat and mouse models.

These results represent a potentially novel therapeutic target for the treatment of seizure disorders, and they show the need to better understand the physiology underlying these neural and brain circuit changes.

Proteins are the workhorses of living cells, and their activities are tightly and rapidly regulated in responses to changing conditions. Adding or removing a phosphoryl group to proteins is a well-known regulator for many proteins, and it is estimated that human proteins may have as many as 230,000 sites for phosphorylation.

Odd drug crossover effect of the week.......

https://goo.gl/Z78jkL

Dental fillings may soon be left in the ash heap of history, thanks to a recent discovery about a drug called Tideglusib.

Developed for and trialled to treat Alzheimer's disease, the drug also happens to promote the natural tooth regrowth mechanism in mice, allowing the tooth to repair cavities.

Tideglusib works by stimulating stem cells in the pulp of teeth, the source of new dentine. Dentine is the mineralised substance beneath tooth enamel that gets eaten away by tooth decay.

Teeth can naturally regenerate dentine without assistance, but only under certain circumstances. The pulp must be exposed through infection (such as decay) or trauma to prompt the manufacture of dentine.

But even then, the tooth can only regrow a very thin layer naturally - not enough to repair cavities caused by decay, which are generally deep. Tideglusib changes this outcome because it turns off the GSK-3 enzyme, which stops dentine from forming.

In the research, the team inserted small, biodegradable sponges made of collagen soaked in Tideglusib into cavities. The sponges triggered dentine growth and within six weeks, the damage was repaired.

The collagen structure of the sponges melted away, leaving only the intact tooth.

Thus far, the procedure has only been used in mouse teeth.

In light of previous laboratory studies of the antihistamine compound at UCSF, the researchers said, the drug most likely exerted its effect by repairing damage MS had inflicted on myelin, an insulating membrane that speeds transmission of electrical signals in the nervous system.

The drug tested in the trial, clemastine fumarate, was first identified as a candidate treatment for MS in 2013 by UCSF’s Jonah R. Chan, PhD, Debbie and Andy Rachleff Distinguished Professor of Neurology, vice chief of the Division of Neuroinflammation and Glial Biology, and senior author of the new study. First approved by the U.S. Food and Drug Administration (FDA) in 1977 for allergies, the drug has been available over the counter in generic form since 1993.

The researchers said that the Phase II results, published online on Oct. 10, 2017, in The Lancet, are the first in which a drug has been shown to reliably restore any brain function damaged by a neurological disease in human patients.

“To the best of our knowledge this is the first time a therapy has been able to reverse deficits caused by MS. It’s not a cure, but it’s a first step towards restoring brain function to the millions who are affected by this chronic, debilitating disease,” said the trial’s principal investigator, Ari Green, MD, also Debbie and Andy Rachleff Distinguished Professor of Neurology, chief of the Division of Neuroinflammation and Glial Biology, and medical director of the UCSF Multiple Sclerosis and Neuroinflammation Center.

Chan and Green are co-directors of the UCSF Small-Molecule Program for Remyelination, and both are members of the UCSF Weill Institute for Neurosciences.

This is an exciting possibility. Heart failure is debilitating and lacks effective restorative treatments.....

https://goo.gl/oFP99y

This is a video

Original Article: http://www.nature.com/nature/journal/...

This is a little bizarre......

https://goo.gl/DdGshn

For years, researchers have been trying to confirm an apparent link between the Escherichia coli in poultry and urinary tract infections (UTIs) in humans. Now, there's another hint of a connection between contamination back on the farm and nasty germs in our bladders.

Researchers who examined meat from retail stores in California and urine from patients with UTIs found that nearly 25% of chicken and turkey samples shared the same genotypes that were found in the urine samples, according to Reina Yamaji, MD, PhD, of the University of California at Berkeley.

Analysis showed 72 E coli genotypes that were unique to retail meat, 49 genotypes unique to human UTIs, and 12 shared genotypes, Yamaji reported at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Of the six most common E coli genotypes in humans, three of them were found in both retail meat and humans, she said.

The findings don't solve the mystery of whether the meats we eat -- especially poultry -- are directly related to human UTIs, an outside expert told MedPage Today.

"Evidence is growing, but a direct link has not been made yet," according to Amee Manges, PhD, of the University of British Columbia School of Population and Public Health in Vancouver. Still, she said, "these results add to the existing body of research."

The effectiveness of the mumps vaccine wanes at an average of 27 years after the last dose, potentially explaining the resurgence of cases over the past 11 years, researchers said here.

But mumps cases spiked in 2006 and again in 2016 and 2017, they said in a presentation at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

The findings point to the need for booster doses in adults, according to Lewnard. "If you want to put mumps on the track to elimination, it's not an unreasonable expectation," he stated.

"We've largely eliminated it, but the [MMR] vaccine is not a perfect dose," said Paul Offit, MD, of the Children's Hospital of Philadelphia, to MedPage Today.

Hospitals appear to be doing better at preventing healthcare-associated infections (HAIs), a researcher said here.

The decline was driven by sharp drops in skin and soft tissue infections and urinary tract infections (UTI), Magill said at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

The rise in community-acquired Clostridium difficile appeared to be at least partly fueled by a surprising source -- dentists, according to researchers here.

But 15% of those patients were given the drugs by their dentists. In many cases that fact didn't find its way into the patient's primary care records, Holzbauer told reporters at the annual IDWeekmeeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Dentists are allowed to write prescriptions for antibiotics, and often do when they are performing oral surgery or simply for prophylaxis in some patients, Holzbauer said. Indeed, one estimate suggests they write 10% of all such prescriptions, although the guidelines of the American Dental Association say that relatively few patients need such treatment.

Holzbauer said that at least part of the problem is that dentists, unlike primary care physicians, don't necessarily see the adverse effects of antibiotics, even though they might be aware of the risk in principle.

"No one goes to the dentist when they have diarrhea so [dentists] don't get the feedback," she said.