BARCELONA — The accelerating costs of chronic diseases, the progressive aging of Europe’s population and a hoped-for miracle to solve the problem through information technology (IT) drove the agenda at the World Health Care Congress Europe, held here at the end of March.

Behind the headlines was an unspoken but well-known theme: European state health insurance funds are sagging to the breaking point under current pressures and are poorly prepared to absorb the coming shock.

Six health ministers participated in the program, and key executives from health ministries in 10 other European countries addressed the gathering of more than 500 participants from 40 countries.

Immediately following the 50th anniversary celebration of the European Union (EU), the picture of European healthcare emerging from the congress was strikingly similar to the bewildering patchwork of the expanded union that now counts 27 member states. Under the treaty that underpins the EU, each state manages its own program and problems.

The moderator for the keynote session, Stanislaus Cozon, managing director for global public sector at Capgemini (Paris), acknowledged the widely different approaches and pilot projects for meeting the challenges of healthcare, but she said, “considerable progress has been made since we met last year.”

Marina Géli i Fabrega, minister for health for Spain’s Catalonia region, responded in discussions with the audience that “IT is good, but only with expectations set for quality metrics and measuring outcomes. This is what the systems are supposed to achieve.”

Catalonia spends e1,100 per person per year, she said, “which is low but is also fragile,” as 60% of the expense is for staff not paid very well and not motivated to meet ministry goals for care. “The burn-out factor is significant,” she said.

Austrian Minister of Health and Women’s Affairs Andrea Kdolsky reported a surplus of beds in acute-care centers and that the challenge is to convert capacity to elderly care facilities.

Across the Danube, the Czech Republic is struggling with financing. Minister of Health Tomas Julinek told the Congress flatly that problems cannot be solved with the existing financing formula. “A critical moment for the Czech Republic is coming in 2015 with our aging population,” he said. “An increase in financing is impossible,” given the current tax burden and level of insurance premiums.

“The only solution is to link responsibility of individuals to the healthcare costs that they impose on the system,” he said.

Meanwhile, Spain is inspiring European ministries with diverse approaches to reforming healthcare delivery among the 17 autonomous regions. Catalonia and Andalusia are references for e-health initiatives on the leading edge of the federally endorsed roadmap, Plan Avanza, developed within the framework of the EU action plan i2010.

Despite gains, home care has formidable barriers in Europe

BARCELONA — At the World Healthcare Congress Europe, the chief executive for the UK’s National Health Service (NHS) neatly described a significant problem that he shares with colleagues from the 26 other member states of the European Union. And he then presented a solution.

“On any day, one-fourth of hospital beds are filled with patients with more than one chronic condition, and most could be better served in their community,” said David Nicholson, who went on to show how England’s Connecting for Health program is an IT-centered strategy that enables delivery of healthcare services for the chronically ill at the community level.

Jennifer Dixon, director of health policy at the King’s Fund, set off a buzz among the 500 conference participants with her presentation of an interactive tool used by NHS primary care trusts to target, in real-time, patients requiring an intervention for chronic disease prevention.

And the creation of a 100-bed virtual ward for chronic disease management at the UK’s Croyden Primary Care Trust was promoted by Capgemini (Paris) as a model for community-based treatment. Patients are identified using the Combined Predictive Model from the King’s Fund and assigned to a virtual ward team that meets daily.

Patients are cared for in their own homes. Specialists, including pharmacists, social workers and physiotherapists, are called upon to respond to what are often multiple-morbidity conditions.

The enthusiasm for the pioneering British model, though, gave way at the conference as delegates returned to the sobering workshops on topics such as healthcare financing, data security, patient safety concerns and the fragmented state of IT systems that impede, rather than encourage, such programs, which while aligned with their ambitions, are for the moment far beyond their grasp.

Biobank is Euro pacesetter with genomic data/health record link

BARCELONA — April 16 was opening day for the UK’s Biobank, a project of the National Health Service, in the hunt for 500,000 middle-aged volunteers to contribute blood and urine specimens for what will become the world’s largest database linking individual genomic data to patient medical records.

More than 5 million UK citizens received an invitation to join the project by contributing the biomaterials, completing a 90-minute physical examination and interview during which they are asked to respond by touch-screen to 200 questions about health, lifestyle and family.

Biobank will progressively build a database toward the goal of connecting in late 2007 for the first time with individual medical records from the NHS, including both hospital and primary care documents.

A genomic analysis of each patient sample will then be added. The cross-referenced datasets are expected to yield 30 years of research into causes of diseases, individual patients’ interactions with the British medical system and the effectiveness of therapeutics by pathology and genetic disposition.

The only criterion is age, and the volunteers give their consent at six stages of the interview for a broad use of the data.

In exchange for the broad consent, the Biobank agrees to inform any patient if a significant disease association is found within his or her data. A detailed process will reverse the anonymity of records to make the patient aware of the problem.

For the recruitment campaign, Biobank is subject to strict constraints of the British Data Protection Act and has followed guidance of the Office of the Information Commissioner. The recruitment was given a green light after a review of procedures by the Patient Information Advisory Group.

The physical specimens will be stored in automated archives kept at -112 degrees Fahrenheit in a center in Manchester that is expected to use some 70 liters of liquid nitrogen a week.

Smiths Medical launches lab for studies at high altitudes

Smiths Medical (Carlsbad, California), part of the Smiths Group (London), has opened the Smiths Medical High Altitude Laboratory at Namche Bazaar, Nepal. The lab, located at an altitude of 11,154 feet, is one of four main laboratories for Caudwell Xtreme Everest, described as the largest human biology study ever performed at high altitude.

More than 200 volunteers will be studied by about 60 doctors and scientists as they climb progressively higher to Everest base camp at 17,225 feet. More detailed research will be performed on a group of experienced mountaineer scientists who aim to climb to the summit of Everest at 29,035 feet to take the first measurement of arterial blood oxygen on the mountain’s summit.

Caudwell Xtreme Everest is being conducted by doctors and scientists at the Center for Altitude, Space and Extreme Environment Medicine of the University College London (UCL) and is supported by John Caudwell, the entrepreneur/founder of The Caudwell Charity who is also a volunteer on the trek to Everest base camp. The laboratory also is the base for the Smiths Medical Young Everest Study (SMYES), investigating how nine British children cope with the low oxygen levels in the foothills of the world’s highest mountain. SMYES is being conducted by doctors and scientists from Great Ormond Street Hospital and UCL’s Institute of Child Health.

The laboratory will operate until the end of May. It will be equipped with advanced medical testing equipment, including heart and lung function monitors and cardio pulmonary exercise testing equipment.

German clinic banners initial use of IGRT therapy from Varian

The Klinikum Memmingen (Memmingen, Germany), a private radiotherapy institute in Bavaria, has begun treating cancer patients with what it calls a new, more precise form of radiotherapy using a linear accelerator and special On-Board Imager (OBI) accessory from Varian Medical Systems (Palo Alto, California).

The equipment is the first of its kind in clinical operation in Germany and is being used at the institute at to treat breast, prostate and head/neck cancer patients with image-guided radiotherapy (IGRT).

The On-Board Imager makes it possible for clinicians to image and treat on a single machine that rotates around the patient to take X-ray images and deliver treatments from virtually any angle. Mounted on the medical linear accelerator, the OBI device produces high-resolution X-ray images of the tumor and tracks changes in tumor shape, size or position over a multi-week course of treatment. It also allows clinicians to track and adjust for tumor motion caused by the patient’s breathing during treatment sessions.

The new imaging capability enables doctors to locate and target tumors more accurately during treatments.

The Klinikum Memmingen is offering the IGRT treatments in collaboration with nearby Klinikum Kaufbeuren, which has treated cancer patients on Varian linear accelerators for many years. Although the new Varian Clinac 2100 high-energy linear accelerator equipped with the On-Board Imager device has been located at the new center in Memmingen, much of the planning and preparation work is carried out at Kaufbeuren.

Varian said it has equipped about 3,000 radiotherapy centers around the world with treatment machines, accessories and software for the most advanced forms of radiotherapy and radiosurgery. The company had more than 400 installations of the On-Board Imager complete or in progress at the beginning of 2007.

Varian has European manufacturing and engineering centers in Baden, Switzerland; Crawley, UK; Haan, Germany; Helsinki, Finland; and Toulouse, France. Its headquarters for Europe, the Middle East, India and Africa is based in Zug, Switzerland.

Study cites ColonCAD results at ECR conference

A study presented during March’s European Congress of Radiology (ECR) conference in Vienna, Austria, cited the effectiveness of the ColonCAD from Medicsight (London) for the detection of colorectal cancer in symptomatic patients.

Professor Steve Halligan of University College Hospital (London) has been investigating computer-aided detection (CAD) for colorectal cancers in symptomatic patients. In his presentation, Halligan provided preliminary results from an ongoing study investigating the potential for CAD to detect colon cancers demonstrated on computed tomography (CT) colonography.

Medicsight said Halligan’s study “supports the expansion of the clinical usage of ColonCAD, which has increasingly been advocated for the detection of adenomatous polyps in asymptomatic patients.” The study involved 59 patients, each with proven cancers established by colonoscopy and histology. The patients were examined with Medicsight ColonCAD to analyze paired prone and supine datasets over a range of four user-adjustable CAD filter settings. Across the range of settings, ColonCAD detected 47 to 54 of the 59 cancers (sensitivity range of 88.7%-91.5%).

The study showed Medicsight ColonCAD to be “very effective” in the detection of colon cancer on CT colonography. Both prone and supine datasets are required for optimal CAD results.

Diamics lands three-year, $22M-plus contract in China

Diamics (Novato, California), a private developer of cancer screening and diagnostics products, last month reported signing a three-year, $22 million-plus contract for the use and distribution of its system for cervical cancer screening in China. It said that Beijing Jingmin Hospital Group will buy at least 1 million tests a year. It will initially start with the company’s CerCol collector, part of the Pap-Map cervical mapping system. The CerCol collector received FDA clearance in March.

Product registration in China is being funded and organized by Beijing Jingmin Hospital Group. Once registered, the CerCol collector initially will be used in China in conjunction with the Diamics Transfer Station, to automatically create a “touch-prep” impression onto a pre-treated slide, which then can be processed by normal Pap staining methods.

Diamics said the Pap-Map technique is able to create a “map” of the sample collected from the cervix, providing the physician with Pap stain-qualitative aspects of abnormal areas of the cervix to help direct colposcopy and biopsies.

The second phase of the agreement will be triggered by the registration in China of Diamics’ automated C-Map cervical cancer screening system, now in testing. Once registered, the C-MAP system — collector, transfer device, reagents and scanner — will replace the individual CerCol sales, with volumes reflective of the original three-year contract.

The C-Map system is a molecular-based diagnostic device being developed to allow for real-time, “see and treat” applications, Diamics said. It combines sampling with the CerCol collector and slide preparation with discreet immunological probes to determine the ratio between proliferating and apoptotic cells and by means of a third marker, identify cells that have been integrated by HPV.

Beijing Jingmin Hospital Group will target government institution sales and distribute via its associated hospitals to expand C-Map usage within China. Beyond their own hospital group use, they will have certain non-exclusive distribution rights for the C-MAP system in China.

Diamics noted that China has a high incidence of cervical cancer and it has recently become a government priority to address the issue by promoting more widespread screening programs. Cancer of the cervix is the second-most-commonly-diagnosed cancer in women worldwide. About 500,000 new cases are diagnosed each year, 80% of which occur in developing countries.

Enrollment in COREL stent trial underway in India

Cinvention (Weisbaden, Germany) and Relisys Medical Devices (Malakpet, India) reported enrollment of the first patients in the COREL drug-eluting stent trial, a prospective, open-label, randomized clinical trial that will enroll 150 patients in 10 centers in India. Enrollment in the study will be carried out through 10 clinical trial centers in Ahmadabad, Bangalore, Chandigarh, Hyderabad, Mumbai, New Delhi and Vellore.Principal investigator of the study is Balram Barghava, MD, of the All India Institute of Medical Sciences (New Delhi).

The primary endpoint is nine-month in-stent late loss within the stented segment post-procedure and historical comparison with six- to nine-month in-stent late loss with other drug-eluting stents. Secondary endpoints include angiographic binary restenosis, target lesion revascularization, target vessel revascularization and target vessel failure rates at nine months; major adverse cardiac events; acute, sub-acute and late stent thrombosis at 30 days and nine and 12 months; lesion, device and procedure success.

Relisys’ Corel + C drug-eluting stent includes a cobalt-chromium stent that is coated with a macro-porous, nano-structured, carbon-composite matrix containing the active drug paclitaxel. Developed and by Cinvention, the coating eliminates the use of polymers and provides a bioactive coating with less thrombogeneity and pro-endothelialization surface design, reducing tissue inflammation and reaction, enhancing engraftment and endothelialization.