In new medical guidance for England and Wales, the National Institute for Clinical Excellence (NICE; Watford, England) is promoting the expanded use of dual-chamber pacemakers for treating slow heart rhythms, or bradycardia, suffered by an estimated 100,000 UK residents. NICE advises in its latest guidance that up to 90% of all pacemakers implanted to treat sick sinus syndrome and atrioventricular block the two primary causes of bradycardia should be dual-chamber devices delivering electrical impulses to both the right atrium and the right ventricle. Currently 60% of roughly 26,000 pacemakers implanted yearly in the UK are dual-chamber devices; the other 40% are single-chamber devices, which usually stimulate only the right ventricle.
"NICE rightly recognizes that dual-chamber pacemakers improve clinical outcomes cost-effectively for the treatment of bradycardia associated with sick sinus syndrome and atrioventricular block," said cardiologist Richard Sutton, a consultant with the Royal Brompton Hospital (London). "This new guidance is based on an exhaustive review of the medical literature on the subject and should encourage specialists in heart rhythm disorders to implant a greater proportion of dual-chamber devices for patients suffering from this type of arrhythmia."
According to the guidance, NICE estimates that the cost to the National Health Service (NHS) of implementing these recommendations will range from 8 million to 10 million per year, an investment that the assessment committee deemed cost-effective.
"Dual-chamber pacemakers are well worth the extra cost," Sutton said. "The incremental cost-effectiveness ratio developed by NICE, at 8,500 per quality-adjusted life year, falls well within the generally accepted threshold of 30,000."
In addition to cost-effectiveness, the new guidance emphasizes the clinical benefits of dual-chamber pacing. For example, meta-analyses of various published studies considered by the committee showed a statistically significant reduction in atrial fibrillation, improvement in exercise capacity and improvement in quality of life, when dual-chamber pacing is compared to single-chamber pacing.
"NICE influences treatment decisions not just in the UK, but internationally as well," said Jenifer Ehreth, MD, a health economist with Medtronic (Minneapolis). "So we are especially pleased with this guidance on dual-chamber pacing. Because of these recommendations, people with bradycardia starting with those in the UK now stand a better chance of getting a dual-chamber pacemaker when that is the most appropriate choice for them."
Results of one of the randomized clinical trials considered by NICE for the new guidance appeared in the Jan. 18 issue of the journal Circulation. The authors of the study, the Mode Selection in Sinus Node Dysfunction Trial (MOST), wrote: "For patients with sick sinus syndrome requiring pacing, dual-chamber pacing increases quality-adjusted life ex-pec- tancy at a cost that is generally considered acceptable. Compared with [single-chamber] pacemakers, dual-chamber pacemakers in the MOST trial significantly reduced the rates of atrial fibrillation and hospitalization for heart failure and were associated with somewhat lower rates of stroke. This reduction in nonfatal events with dual-chamber pacemakers resulted in better quality of life observed during the trial on a number of measures and projected to an even greater extent beyond the trial because of the life expectancy of affected patients."
Three anesthesiology groups merge
The merger of three European anesthesiology organizations into a single group, the European Society of Anesthesiology (ESA), has been completed, the society's interim board of directors reported last month. The ESA represents the combination of the European Society of Anesthesiologists, the European Academy of Anesthesiology and the Confederation of European National Societies of Anesthesiologists, marking the first time a single body exists to represent European anesthesiologists, organizers said.
The interim board, an interim council and general assembly will govern the society this year. Later in 2005, a new board and new council will be elected to take office in 2006, replacing the interim bodies.
Current membership of the ESA is in excess of 5,000 individual members and, with a new society membership category, the organization has the potential to represent more than 60,000 European anesthesiologists. Although predominantly a European organization, the ESA membership base includes affiliate members from countries around the world.
The society's executive director and seven staff members are housed at its headquarters office in Brus- sels.
The organization said its aims are:
- To promote exchange of information between anaesthesiologists in Europe.
- To disseminate information in regard to anaesthesiology.
- To raise the standards of the speciality by fostering and encouraging education, research, scientific progress and exchange of information.
- To promote improvements in safety and quality of care of patients undergoing anesthesia by facilitating and harmonizing activities of national and international societies of anesthesiologists in Europe.
The society's annual meeting conducted under the name Euroanaesthesia and newsletter serve to disseminate information in regard to anesthesiology and promote exchange of information among European anesthesiologists.
The European Journal of Anesthesiology (EJA), currently the official journal of the ESA, and the society's research grants, fellowships and awards programs serve to foster and encourage education, research and scientific progress, and thereby raise the educational and scientific standards of the specialty of anesthesiology. The ESA also organizes the examination for the European Diploma in Anesthesiology and Intensive Care that serves, it said, to raise the standards of the speciality.
Bone densitometry database in China
GE Healthcare (Waukesha, Wisconsin) said it has developed the largest bone mineral density reference database in the world in order to measure osteoporosis in the Chinese population. The company said the Chinese reference database provides improved diagnostic confidence for physicians in the prevention and treatment of osteoporosis, a disease characterized by low bone mass and increased risk of fracture.
The new reference database was presented at the International Society for Clinical Densitometry's (West Hartford, Connecticut) annual meeting in New Orleans in February.
"There are likely more people with osteoporosis in China than the entire population of the U.S.," said Jennie Hanson, president of GE Lunar (also Waukesha), a division of GE Healthcare. "GE's new BMD China reference database is a critical and important step in the world's fight against osteoporosis."
In a landmark study conducted with the Chinese Medical Association, bone density of the spine and hip was measured on GE Lunar densitometers in 11,400 men and women of differing age and weight in six geographically dispersed centers in China. Those local- ly derived reference values now will serve as a reference population for interpreting the bone density of the Chinese population, the largest in the world at more than 1.3 billion. "We are proud to offer the Chinese population such a critical breakthrough in the diagnosis of this debilitating disease," said Hanson.
According the World Health Organization (Geneva, Switzerland), the worldwide number of hip fractures associated with osteoporosis could rise from 1.7 million in 1990 to 6.3 million by 2050, with the most dramatic rise expected in Asia as this population both grows and ages. It is projected that about half of all osteoporosis-related hip fractures will occur in Asia by 2050, according to the International Osteoporosis Foundation (Lyon, France).
Consortium created to study IORT
Intraop Medical (Santa Clara, California) reported the creation of a new European body to study intraoperative radiotherapy (IORT), the European Consortium for Research in IORT Studies (ECRIS). Intraop Medical said it would provide logistical support to the participants and to ECRIS. Among the tumor sites expected to be studied by ECRIS are pancreatic cancer, rectal cancer, sarcomas, lung cancer, breast cancer, prostate cancer and pediatric cancer.
With more than 30,000 cancer patients under treatment each year at the member centers, ECRIS is expected to be able to accrue IORT patients rapidly in study protocols. Other interested European centers with IORT interest and capability will be invited to participate in ECRIS.
Professor Marco Krengli, professor and chief of radi- ation oncology at the University of Piemonte Orientale Medical School (Novara, Italy) said, "Cooperation among European IORT centers will enable us to obtain answers on the proper role of integrating IORT in the management of our cancer patients much more quickly than if we each worked alone. We anticipate that the member institutions involved with ECRIS will grow as more centers develop IORT capability."
In addition to the University of Piemonte Orientale Medical School, the founding members of ECRIS are Hospital Gregorio Maranon (Madrid, Spain); Institut Gustave Roussey (Paris); Centre Oscar Lambret (Lille, France); Catharina Ziekenhuis (Eindhoven, the Netherlands); the University of Heidelberg (Heidelberg, Germany); the European Institute of Oncology (Milan, Italy); the University of Torino (Torino, Italy); and Catholic University (Rome). Also invited to participate are the University of North Carolina (Chapel Hill, North Carolina), which will contribute expertise in IORT radiobiology and its IORT breast protocol, and the University of California at San Francisco, selected for its expertise in pediatric IORT.
ECRIS said it would hold its first organizational meeting in Novara this month to establish guidelines for operation.
Intraop Medical, formed in 1993, manufactures the Mobetron, a mobile electron beam system designed for IORT treatment of cancer, coronary/vascular restenosis and other medical applications. Unlike other IORT systems, the Mobetron enables IORT to be used without requiring shielding of the operating room (OR). The Mobetron can be moved between ORs or between hospitals, increasing utilization and cost effectiveness.
New funding boosts UK imaging access
National Health Service (NHS) patients in the UK should get faster access to high-quality diagnostic tests in the future thanks to a 1 billion procurement unveiled last month by Health Secretary John Reid.
The new funding should boost the NHS's capacity to provide more efficient access MRI, CT and ultrasound scans, according to Reid.
He said, "The NHS has made fantastic progress in tackling waiting times for operations. Thanks to increased investment and improved ways of working, maximum waiting times have been halved from 18 months, only a few years ago, to a maximum of less than nine months now, and an average of a lot less for most people."
And Reid said that the NHS hopes to improve even further on this quicker timeline. "By the end of 2008, we are determined no one will wait longer than 18 weeks for hospital treatment from the time they see their general practitioner, right through to the time of their treatment."
To achieve that goal, he said, "we must expand our diagnostic service capacity rapidly."
Reid said the NHS also would attempt to end what he called "hidden" waits.
"The time patients wait for diagnostics has not traditionally been counted as part of the waiting time measurement ," he said. "We know that many pati-ents are caught in a 'bottleneck' of waiting for a scan or other diagnostic service, before they are referred for an operation."
Reid called this "worrying and uncertain" and said the new funding "makes a big step toward tackling this 'hidden waiting list.'"
He added: "Diagnostic tests do not all have to be done in a hospital. They can often be provided at the family doctor's or . . . other community setting, far more conveniently for patients." He encouraged providers to "think creatively" concerning the best means of delivering services and where they should be located.
"In buying extra capacity from the independent sector, we will significantly increase the NHS-funded diagnostic provision and increase the numbers of expert staff such as radiologists to provide these services for NHS patients, with equal access free at the point of delivery," Reid said.
The Department of Health will invite "expressions of interest" from independent sector providers, estimated a cost of 2 million per year for the procurement phase.
Last summer the Department of Health completed a deal with Alliance Medical (Phoenix, Arizona) for Alliance to provide 120,000 scans in mobile MRI scanners. This one deal boosted MRI scanning capacity by 15%. As a result, more than 25,000 patients received MRI scans.
The NHS also noted a drop in wait times in many parts of Britain: in Huddersfield, cut from 38 to eight weeks; in Ipswich, from 30 to five; and in Scarborough, halved from 36 to 18 weeks.