Northwestern Medicine Researchers Discover New Way To Prevent Some Strokes

from: http://www.redorbit.com/news/health/1113180718/northwestern-medicine-researchers-discover-new-way-to-prevent-some-strokes-2/

 

Northwestern Medicine Researchers Discover New Way To Prevent Some Strokes

June 28, 2014

      21

Northwestern Memorial Hospital

Larry Ambrose was diagnosed as having a stroke a few days after he woke up one night, wandered into his kitchen and couldn’t read the time on his microwave. Ambrose, like 25 percent of all stroke patients, experienced a cryptogenic ischemic stroke, meaning physicians were unable to determine a cause.

For these patients, physicians believe atrial fibrillation, the most common type of arrhythmia (abnormal heart beat), may occur without the patient’s knowledge, causing the stroke. During atrial fibrillation, the heart’s upper chambers, or atria, quiver rather than beat; this allows blood to stay in the chamber and potentially cause a clot. If the clot travels from the heart and reaches the brain, a stroke is imminent.

To research this connection, Northwestern Medicine® physician researchers from cardiology and neurology teamed up to conduct a four-year trial which enrolled 441 people across 55 centers. Half the patients received a small implantable cardiac monitor that continuously records the rhythm of the heart and lets the physician know over the internet when an abnormal rhythm has occurred Northwestern Memorial Hospital was the lead site in North America for the trial.

The results found that by using this device, 30 percent of people with cryptogenic stroke have atrial fibrillation detected within 3 years, which is the battery life of the device.. In those patients who received standard techniques for follow up, physicians only found atrial fibrillation in about 3 percent of these patients. Because of these results, the 30 percent were all switched to blood thinners which should protect them better from having another stroke.

The research findings were published in a June 26, 2014 article in the New England of Medicine. Because cryptogenic strokes are common, these findings could help hundreds of thousands of people every year. More than 750,000 people suffer a stroke in the United States every year and about one third of those are cryptogenic strokes.

“Having a stroke really rattles your foundations,” said Richard Bernstein, MD, director of the Northwestern Medicine Stroke Program and Telestroke. “Being told by your doctor that they have no idea why you had it and that they are just guessing at the best medication to prevent another one is even worse. With this clinical trial, we eliminated that second problem – not knowing the cause – in about a third of those patients.”

The patients monitored were part of a study called CRYSTAL AF (Study of Continuous Cardiac Monitoring to Assess Atrial Fibrillation after Cryptogenic Stroke). Bernstein, who is also a professor of neurology at Northwestern University Feinberg School of Medicine and his co-investigator Rod Passman, MD, director for the Center for Atrial Fibrillation at the Bluhm Cardiovascular Institute, are on the international steering committee for the CRYSTAL AF trial.

When atrial fibrillation is detected in a patient following stroke, anticoagulant therapy is recommended for secondary stroke prevention. While anticoagulant therapy can be successful in preventing future stroke, physicians do not use it proactively unless atrial fibrillation has been detected because of potential risk from the medication and complexity of the treatment. The continuous monitoring device captured and automatically stored any abnormal ECG activity. Passman and his team then reviewed and analyzed the remotely-transmitted data. After the participants were implanted, they are followed at one month and every six months thereafter for three years. The control group received standard of care optimal medical treatment and followed up at the same intervals.

“We found using a tiny implantable device to find atrial fibrillation is much better than the usual tests we previously used,” said Passman, who is also a professor of medicine and preventive medicine at the Feinberg School of Medicine. “This is critical because finding atrial fibrillation in patients with stroke of unknown cause is important because once we find it, we put the patients on blood thinners and they are much more effective than the aspirin-like drugs they would otherwise be on.”

Ambrose was identified by Bernstein as a cryptogenic stroke patient and was the first subject implanted by Passman as part of the CRYSTAL AF trial. While atrial fibrillation was not detected in Ambrose, he said simply having the device implanted and knowing that his heart rhythm was normal was a comfort.

“I knew people were monitoring me and I was helping doctors figure out a way to end the worry of having a second stroke for other patients like me,” said Ambrose, a Chicago resident. “Otherwise, I would have just gone home and been very nervous it was going to happen again.”

Read more at http://www.redorbit.com/news/health/1113180718/northwestern-medicine-researchers-discover-new-way-to-prevent-some-strokes-2/#GQ3cBotwx6jSm5T4.99

Pharmacology update: 2014 drug trends

NASHVILLE -- More orphan drugs approved in recent years are filling the need for treating rare disease and medical conditions, according to a presenter at the the American Association of Nurse Practitioners 2014 meeting.

Alan Agins, PhD, who gave a pharmacologic overview of drug approvals since 2012, noted a growing trend among pharmaceutical companies.


“I think what we're going to see for the next [two decades] is more specialty drugs,” Agins told Clinical Advisor. “Overall for the last 15 years, the number of drugs approved has gone down, partly because we've pretty much filled out our dance cards on chronic diseases.”
There were 27 first-of-a-kind drugs approved by the FDA in 2013 compared to 39 approvals just the year before. About a third of those approvals were indicated for the treatment of rare conditions and diseases.
Of note, afflicted patients with several conditions would benefit the most from recent approvals, Agins said.
Patients with chronic obstructive pulmonary disease (COPD) can now benefit from once-daily inhalers such as fluticasone and vilanterol (Breo Ellipta). Ease of use and convenience allow for better adherence in the patient population.
Patients with type 2 diabetes can take once-weekly GLP-1 agonists, enabling patients to avoid the hassle of maintaining the pharmacokinetics of the drug with once- or twice-daily dosing. Drugs such as exenatide, although expensive, have better efficacy and fewer side effects.
Newer oral anticoagulants such as dabigitran give patients more flexibility when it comes to diet and lifestyle modifications compared to warfarin. In studies, these medications were associated with lower rates of hemorrhage compared to warfarin, showed no interactions with diet/lifestyle, and did not need to be monitored.
Agins also warned about several unmet needs in drug development, most damagingly from growing drug resistance in antibiotics and the lack of new antibiotic classes.
“The newest class of antibiotics for primary care providers is now 32 years old,” he said about fluoroquinolones. “It's so much so [a problem] that the government actually spent about $200 million last year to hire one of the pharmaceutical companies to develop new antibiotics.”
Alzheimer disease is another condition with an increasing lack of drug treatment options. “Since 1998, over 104 drugs have entered clinical trials and have all failed in terms of AD,” Agins said. “We have an idea of what causes the disease but we're still not definitive, and we certainly don't have any drugs out there on the near horizon.”
Agins is hopeful that in the next 20 years, we will be making the switch from simply managing diseases with drugs to curing them outright.
“But it's going to take some biotechnology and microbiology,” he said. “We're treating symptoms of hypertension and cholesterol and all those other things now, eventually we're going to cure those diseases or prevent them totally.”

Reference

1. Agins AP. #14.3.039. “New Drugs in the Arsenal in Primary Care.” Presented at: AANP 2014. June 17-22; Nashville, Tenn.

from: http://www.clinicaladvisor.com/pharmacology-update-2014-drug-trends/article/356753/

Stephen Cho

June 19, 2014

 

Pharmacology update: 2014 drug trends

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NASHVILLE -- More orphan drugs approved in recent years are filling the need for treating rare disease and medical conditions, according to a presenter at the the American Association of Nurse Practitioners 2014 meeting.

Alan Agins, PhD, who gave a pharmacologic overview of drug approvals since 2012, noted a growing trend among pharmaceutical companies.

“I think what we're going to see for the next [two decades] is more specialty drugs,” Agins told Clinical Advisor. “Overall for the last 15 years, the number of drugs approved has gone down, partly because we've pretty much filled out our dance cards on chronic diseases.”

There were 27 first-of-a-kind drugs approved by the FDA in 2013 compared to 39 approvals just the year before. About a third of those approvals were indicated for the treatment of rare conditions and diseases.

Of note, afflicted patients with several conditions would benefit the most from recent approvals, Agins said.

Patients with chronic obstructive pulmonary disease (COPD) can now benefit from once-daily inhalers such as fluticasone and vilanterol (Breo Ellipta). Ease of use and convenience allow for better adherence in the patient population.

Patients with type 2 diabetes can take once-weekly GLP-1 agonists, enabling patients to avoid the hassle of maintaining the pharmacokinetics of the drug with once- or twice-daily dosing. Drugs such as exenatide, although expensive, have better efficacy and fewer side effects.

Newer oral anticoagulants such as dabigitran give patients more flexibility when it comes to diet and lifestyle modifications compared to warfarin. In studies, these medications were associated with lower rates of hemorrhage compared to warfarin, showed no interactions with diet/lifestyle, and did not need to be monitored.

Agins also warned about several unmet needs in drug development, most damagingly from growing drug resistance in antibiotics and the lack of new antibiotic classes.

“The newest class of antibiotics for primary care providers is now 32 years old,” he said about fluoroquinolones. “It's so much so [a problem] that the government actually spent about $200 million last year to hire one of the pharmaceutical companies to develop new antibiotics.”

Alzheimer disease is another condition with an increasing lack of drug treatment options. “Since 1998, over 104 drugs have entered clinical trials and have all failed in terms of AD,” Agins said. “We have an idea of what causes the disease but we're still not definitive, and we certainly don't have any drugs out there on the near horizon.”

Agins is hopeful that in the next 20 years, we will be making the switch from simply managing diseases with drugs to curing them outright.

“But it's going to take some biotechnology and microbiology,” he said. “We're treating symptoms of hypertension and cholesterol and all those other things now, eventually we're going to cure those diseases or prevent them totally.”

Reference

1. Agins AP. #14.3.039. “New Drugs in the Arsenal in Primary Care.” Presented at: AANP 2014. June 17-22; Nashville, Tenn.

Needle-Free Blood Sugar Testing

from: http://www.everydayhealth.com/diabetes/needle-free-blood-sugar-testing.aspx

 

Find out how new diabetes technology called continuous glucose monitoring could make finger pricks a thing of the past.

By Chris Iliades, MD

Medically reviewed by Pat F. Bass III, MD, MPH

Constant finger pricks with needles is a task that most people with diabetes accept as part of life. Blood tests check blood sugar or glucose, and regular glucose monitor measurements are essential for making decisions about food, exercise, and medications. In the near future, however, needle-free blood sugar testing may replace the finger prick through a technology called continuous glucose monitoring (CGM).

Diabetes and Blood and Sugar Monitoring

• Prickless Glucose Monitoring D...
• Diabetes and Blood Sugar Monit...
• Role of Insulin in Diabetes an...

How? Needle-free blood sugar testing devices replace the finger prick part of blood sugar testing with a tiny sensor that is implanted under the skin. The sensor measures glucose levels in the fluid beneath the skin, which corresponds closely to blood sugar levels. Instead of a needle prick several times a day, the CGM system sensor stays in place for several days.

"A transmitter continually picks up readings from the sensor and sends them to a monitor that will set off an alarm if blood sugar is too high or too low," says Howard Wolpert, MD, who established and directs the Insulin Pump & Continuous Glucose Monitoring Programs at the Joslin Diabetes Center in Boston. Dr. Wolpert is also the lead researcher on several CGM studies.

CGM Diabetes Technology

"What we have now is just the first generation of continuous blood sugar testing technology," says Wolpert, who notes that needle-free blood sugar testing is not widely available yet. "In the future we will have systems that are more accurate and easier to use," he says.

The sensor and transmitter are water-resistant, so patients can bathe or shower with them in place. The glucose information is sent by radio waves to a monitor sized to be handheld. The Joslin CGM program has already trained more than 570 adults with type 1 diabetes to use CGM.

CGM systems that are now available and approved by the U.S. Food and Drug Administration (FDA) include devices made by Abbott, DexCom, and Medtronic. A new system that replaces the implanted sensor with a sensor that works through the skin surface, called Symphony tCGM (made by Echo Therapeutics), is working its way through FDA approval.

In recent clinical studies at Thomas Jefferson University Hospital in Philadelphia, the Symphony tCGM system was able to give clinically accurate blood sugar readings 98.9 percent of the time in surgery patients.

The Pros and Cons of Needle-Free Blood Sugar Testing

Current CGM systems offer some big improvements in diabetic technology:

• A continuous display of glucose levels is available for five to seven days before the sensor needs to be changed.
• The information can be downloaded to a personal computer. Long-term trends appear in graph form and can be correlated with diet and activity.
• Readings on the handheld receiver can be programmed to appear every few minutes.
• An alarm system warns of high or low blood sugar levels.

"We still have a ways to go before CGM replaces the traditional finger stick," Wolpert notes. "The systems still need to be refined. They are not as accurate as they need to be." Drawbacks include:

• CGM measures glucose in fluid beneath the skin and is still not as accurate as actual blood sugar testing.
• Before an insulin dose can be changed, a CGM reading should still be verified by a blood sugar reading.
• Learning how to use the system can be challenging for some people.
• The system is expensive and may not be covered by insurance.

Researchers are also working on combining CGM systems with a computer that will respond to continuous glucose readings and trigger an insulin pump that will automatically dispense the right amount of insulin. This diabetes technology is called an artificial pancreas. "We are still several years away from replacing the finger prick and the glucose monitor, but diabetes research is moving forward all the time," says Wolpert.

For anyone with diabetes, diabetes technology could change the way you test your blood sugar in the not-too-distant future. In the meantime, using a finger prick and a glucose meter is still the best way to keep your diabetes under control and prevent complications.

from:  http://www.everydayhealth.com/diabetes/needle-free-blood-sugar-testing.aspx

BBC Horizon: SARS, The True Story (2003)

Do you remember those days' horror?

 

The goal isn't to live forever; the goal is to create something that will.   ---by Chuck Palahniuk