D2 Digital by Design: service delivery innovation award runner-up

Service users are sent personalised messages of support by the Response Prevention Project team. Photograph: Jason Lock/Jason Lock Photography

Text messages that support people recovering from alcohol misuse has significantly cut the number of people who relapse and have to be referred back to services.

Daily personalised support messages – which prompt a service user who has recently completed an alcohol misuse programme to reflect on their recovery – are delivered automatically as part of the Bolton Response Prevention Project called Shine.

The questions take into account the user's triggers to drink, such as the time of day they are likely to crave alcohol and also what motivates them to stop drinking such as their relationships with their family.

Service users are also asked whether they feel OK, or are struggling and need more support, and are sent appropriate messages.

Project manager Renate Kalnina at digital technology company D2 Digital by Design in Manchester, which is behind the initiative, says: "If they respond 'OK' we send them back a congratulatory message; if they are 'struggling' then the personalised intervention messages come into play.

"If they say that they need more support then the services get notified within 15 minutes and they get in touch with the client."

Service users are also sent a reminder via text message for appointments as part of the project, which ran from April 2010 to December 2012 in partnership with alcohol misuse services in Bolton.

Only 2.2% of Shine service users had to be re-referred for treatment, compared to 9.5% of non-Shine service users; a significant" reduction according to an analysis of the project.

Clients' attendance rates for relapse prevention programmes improved – rising from 42% to 72% in tier three services (medical intervention and psychosocial support) and from 17% to 72% in tier two services, which offer less intensive support and aftercare, the analysis revealed.

It is estimated the initiative has saved between £68,260 and £399,150, depending on individual client need.

D2 Digital by Design is in discussion with Public Health England about using the same model to support opiate users.

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Sandwell and West Birmingham hospitals NHS trust: technology innovation award runner-up

Dr Matthew Lewis (far right) takes part in an electronic board round with his team.

Sandwell and West Birmingham hospitals NHS trust's established electronic bed management system (eBMS), which runs across its three acute hospitals, was expanded to help reduce bed-blocking and improve the quality of patient care.

The system can track a patient from admission to an acute medical unit until they are discharged to go home and keeps a log of the care they receive along the way.

Dr Matthew Lewis is the trust's group director for medicine and emergency care and a consultant in gastroenterology. He says: "At an individual patient level it's a single tool which enables us to co-ordinate the care we provide in different teams both inside and outside the hospital."

The eBMS, says Lewis, has become "the centrepiece of an electronic board round", where every day a ward's multi-disciplinary team will refer to the system to discuss a patient's progress and his or her readiness to go home.

The eBMS has other benefits too. "On a different level, it is also used as a way for us to look at the [bed] capacity issue. It means at any one time we can see whether we are on track or not," he says.

The eBMS has real-time operational dashboards, which track variations in patient flow, showing any reduction in length of stay, bed turnover intervals and delayed discharge. "The dashboards allow key staff to monitor at ward level any specific area of patient care during the inpatient stay which will cause a queue," says Lewis.

eBMS also includes 44 manual flags that can be applied to highlight a clinical patient alert and another 37 clinical alert flags are automatically triggered via electronic messaging from the hospital's other IT systems. These alerts are passed on to doctors via text, email, dashboard or bleep.

Lewis adds: "The combined functionality of patient-flow tracking, coupled with the many alerts and flags, enables the clinicians to have up-to-date information in real time to enable them to make informed clinical decisions quickly, that not only saves lives but improves the overall experience of patients during their inpatient stay."

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Healthcare Innovation Awards - profiles

Connect and Do, delivered in Lambeth, brings people together through shared interests and a desire to meet new people

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Guardian Healthcare Innovation Awards ceremony - in pictures

Richard Stubbs, head of commercial and international innovation at NHS England addresses the audience at the innovation awards. Photograph: Anna Gordon

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Department of primary care health sciences, University of Oxford: winner, service delivery innovation award

Daniel Lasserson, senior clinical researcher, and Maggie Webb, unit manager, in the emergency multidisciplinary unit.

An emergency unit designed exclusively for old and frail patients is keeping them out of acute hospital and helping to prevent bed-blocking.

The emergency multidisciplinary unit (EMU) established at Abingdon community hospital in Oxfordshire is hoped to become the national model for the future of emergency care for older people.

Patients can be referred to the EMU, which is seen as an alternative to an acute hospital A&E, by either their own GP, a community nurse or ambulance paramedic.

The unit, which is open seven days a week from 8am-8pm on weekdays and 10am-4pm on weekends, is not available for patients who have suffered a stroke or a heart attack, who would still be taken to the local acute hospital's A&E. The majority of the 5,500 patients it has seen arrive with chest or bladder infection or heart failure. The average patient age is 89.

Staffed by elderly care physicians, GPs, nurses, healthcare assistants, therapists and social workers, the unit can quickly assess a patient. It has point of care blood testing with rapid results and X-ray facilities so the unit can guarantee speedy diagnosis.

The EMU has five hospital beds available for patients who may need to be kept in for a maximum 72 hours. A "hospital at home" nursing team is also available to provide support to patients who are sent home to recover.

"I would say that the EMU is more than just a casualty for older frail patients – it's more intensive because we aim to provide care for the episode at the time or for a number of days," says Dr Daniel Lasserson, a GP and senior clinical researcher at the department of primary care health sciences, University of Oxford, who helped design this new model of care.

Lasserson adds: "Its aims to deliver an acute care pathway for frail older patients that does not rely on bed-based care, yet can still provide appropriate medical, nursing and therapist treatments within an individually tailored care plan as close to the patient's home as possible.

"It was designed to challenge the existing urgent care pathway of admission to an acute hospital with its associated harms of unfamiliar and physically challenging environment and loss of independence."

The EMU, he says, addresses the dilemmas of how to best care for a growing elderly population with complex needs and multiple chronic conditions and to provide an alternative to "office hours" general practice or acute hospital bed-based care.

According to the EMU audit, 65% of patients who are assessed by the unit are able to stay in their own home – only 17% of patients need acute hospital care.

Lasserson says this new way of working, known as "interface medicine", is challenging the traditional medical training and care. Oxford has created an Interface Medicines Fellowship and is in discussions with Health Education England about how it can be developed nationally.

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Office of the Chief Scientific Officer: winner, workforce innovation award

The new electron linear accelerator facility, which offers an independent radiotherapy calibration service and a unique research facility.

The NHS's healthcare scientists punch above their weight. Although they account for just 5% of the health service workforce, their work is linked to 80% of patients' clinical diagnoses.

Historically though, the career paths and education and training of the 50,000 NHS scientists who come from 45 different scientific backgrounds, has been adhoc.

But now the healthcare scientists have their own defined career paths, which can take somebody starting off in a staff support role right to the top to become a consultant clinical scientist.

The pathways, backed up by a training and education framework, are part of Modernising Scientific Careers (MSC), which has already been three years in the making and is still being implemented. The intention is that, once fully introduced, healthcare scientists will be a sustainable and flexible workforce that can meet the future demands of the NHS and respond to changes brought about by science and technology.

Chief scientific officer professor Sue Hill says: "We recruit some of the best science graduates in the country but we were not developing them to their full potential.

"I think we now know the value of healthcare scientists working in the health system – we have pulled this valuable resource out of the shadows and placed them centre stage so that their knowledge, skills and expertise is more explicit and they can fully make their contribution.

"I think through this programme we have also ensured the sustainability and fitness for purpose in the future of the healthcare scientists' workforce to respond in a health system which is going to be driven by science and technology."

The MSC allows scientists to move between different scientific specialities, broadening their experience and creating a more flexible workforce.

MSC, which has been described as an ambitious and "complex workforce change programme", had to take into account NHS staff and patients, as well as all four UK countries, two Whitehall departments, the higher education sector, professional bodies, the royal colleges and sector skills councils.

Hill says one of the key obstacles was building new relationships with higher education: "We had to enter into and establish new partnerships between higher education and the NHS in particular, which weren't there before.

"We also had to make sure that people understood what they were letting go of, what they had before, and how this would be better and more flexible and was more about the future."

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National blood service, Oxford University hospitals NHS trust: technology innovation award runner-up

Oxford University hospitals NHS trust uses handheld computers at the bedside to scan the identity barcode on a patient's wrist band.

Introducing an identity barcode on a patient's wrist band, using handheld computers at the bedside, electronically controlling the temperature of blood fridges and tracking stock have improved patient safety Oxford University hospitals NHS trust's national blood trust and saved £528,000.

The trust wanted to reorganise its bedside and laboratory transfusion service in order to reduce the number of deaths from "wrong transfusion" – the second most frequent cause of death from transfusion reported to the UK's serious hazards transfusions scheme. In the past 15 years, errors in the UK transfusion service were responsible for 27 deaths and 120 cases of major morbidity.

Oxford hoped that by using technology it would also reduce the amount of time staff spent checking blood, reduce blood wastage and the inappropriate use of supplies, as well as speed up the supply of blood in emergencies.

Consultant haematologist professor Michael Murphy says: "For many members of the public or patients to think a process that is so important is relying on bits of paper and people looking at long numbers, is just unbelievable."

Today transfusion patients are identified by a barcode on their wrist band, which is scanned by a nurse at the bedside using a handheld computer. The nurse also scans his or her own barcode before following the transfusion process written on the computer screen.

There is now a complete electronic audit trail of blood supplies after the blood bank IT system was linked to others in the trust, which has led to significant improvements in blood sample collection, the collection of supplies from fridges and the transfusion-related admin.

Paperwork has been cut by 52 minutes per patient and the bedside transfusion process now requires one nurse instead of two. The initiative is recognised as an exemplar NHS evidence, quality, innovation, prevention and productivity project. The Oxford team wrote a national specification for the electronic transfusion service for the former National Patient Safety Agency.

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Moorfields eye hospital: service delivery innovation award runner-up

Nurses at Moorfields administer a third of all eye injections. Photograph: Moorfields eye hospital

Nurses at Moorfields eye hospital NHS foundation trust in London have been trained to give eye injections to patients in a groundbreaking move, which is changing professional practice and benefiting patients.

The hospital decided to teach senior nurses how to administer the drug Lucentis as an injection in the eye because of increased patient demand, following new national clinical guidelines and a lack of ophthalmologists to carry out the procedure. New guidelines from the National Institute for Health and Care Excellence (Nice) recommended that Lucentis should be injected into the eye to treat patients with diabetic maculopathy.

The decision put more pressure on the hospital because its doctors were already busy administering 10,000 Lucentis eye injections every year to patients with the wet form of age-related macular degeneration.

Moorfields decided to train its senior nurse to give the eye injections, even though it was opposed by the Royal College of Ophthalmologists because Lucentis is only licensed in the UK to be administered by a doctor.

Hospital lawyers were consulted and a special patient consent form was drawn up. The NHS Litigation Authority also guaranteed the nurses the various liability cover they needed.

So far, 15 Moorfields nurses have given 3,000 eye injections, representing 33% of the hospital's eye injection workload. Moorfields has also been able to run 15 extra eye injection sessions a week because of the new skills mix.

Moorfields fellow Joanna DaCosta says: "This model of working is instrumental in removing professional barriers, increasing job satisfaction and providing a cost effective healthcare system."

The success of the initiative is illustrated by the decision in May taken by the Royal College of Ophthalmologists to issue new guidelines that non-medically trained professionals can administer eye injections, provided they have appropriate training and supervision.

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University College London hospital: workforce innovation runner-up

University College London Hospital's training programme helped staff identify weaknesses in their clinic’s processes.

A leading London teaching hospital is giving staff the power to decide how outpatient clinics are run, which is transforming services, reducing waiting times and improving the patient experience.

University College London hospital sees more than 800,000 people in outpatient clinics every year.

But it realised it had to improve the system after a questionnaire revealed 47% of outpatients ranked the service they received as "not at all" or "fairly" well organised, and 59% complained that they had to wait at least 30 minutes before they were seen in a clinic.

The trust's quality, efficiency and productivity team designed a 24-week staff training programme which, with the support of service improvement coaches, aimed to help clinic staff identify where there were weaknesses in their clinic's processes and procedures and to come up with solutions to solve the problems.

So far the team has worked with 31 different multi-disciplinary staff teams and 300 outpatient clinics.

The results are impressive. The endocrinology clinic has halved waiting times to 45 minutes by staggering patient arrival times and realigning clinic templates. The musculoskeletal clinic has cut its waiting list from 15 weeks to seven by pooling its booking queues system.

The introduction of a 24-hour telephone advice line in maternity has reduced clinic waiting times, taken the pressure off labour wards and improved the experience of patients.

Louise Molloy, productive programme manager, says: "In essence, this programme gives teams the permission to focus on and improve their services.

"It allows them to take all those things that they see are not working and bring them together with the right staff, and working with a professional coach, to develop a programme of work to solve those problems."

At least 80% of outpatient clinics are scheduled to go through the process by 2015.

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Spice and the Young Foundation: partnership innovation award runner-up

The Uplift scheme 'helps you anchor yourself, to anchor your place in society and your sense of identity', says one service user. Photograph: Spice

A time-bank project designed for health and social care service users is helping them feel less isolated and has the potential to transform their lives.

Under the Uplift scheme service users spend time volunteering for local organisations in return for time credits. They receive a credit for every hour given; in return the earned credits can be spent at local leisure or cultural venues which have signed up to the scheme.

Uplift has been established by the social enterprises Spice and the Young Foundation. It involves four local authorities in England, more than 200 local organisations and 1,000 service users who have notched up 20,000 credits.

As part of Uplift, each local authority hosts a Spice facilitator whose job it is to create a local time credit network made up of service users, community organisations, public services and private businesses. Each network offers a mix of earn or spend opportunities.

David Russell, head of health and social care at Spice, says: "Uplift is a large and ambitious project across four geographical areas, involving a wide range of service types and communities.

"On average we find that 40-60% of participants have never given time before ... this is having a wide range of positive outcomes particularly around culture change, increased physical activity, mental wellbeing, confidence and community pride."

One service user from Norfolk who has signed up to Upflit says it has made him more "anchored". He says: "It's opened up social avenues – I've now got a group of nodding acquaintances at the gym, which helps you anchor yourself, to anchor your place in society, and your sense of identity."

Spice and the Young Foundation are also working with commissioners, service heads, support workers and service users to see how the idea of time credits can be adopted more widely into their own systems and approaches to work. Russell says: "This can range from large scale service asset mapping to redesigning support working systems, to building co-production into the commissioning process."

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United Response: workforce innovation award runner-up

United Response Stamp of Support programme encourages carers to allow people with disabilities to take sensible risks.

A disabled woman made herself a cup of tea for the first time after her support workers realised providing her with a surface-mounted cup and a hot water dispenser meant she was no longer in danger of scalding herself.

Staff at the charity United Response came up with the solution because they realised that the benefit of making a cup of tea far outweighed the possibility of her being scalded. The support workers felt confident that it was a risk worth taking.

A young adult with a learning disability now travels to work by bus on his own, rather than taking expensive taxis. The staff knew there was a possibility that he could get lost on the way, so they gave him a mobile phone to ring them if needed. Staff realised that the financial and personal benefits were greater than the chances of him getting off the bus at the wrong stop.

Both cases illustrate the success of the charity's Stamp of Support initiative – which is encouraging "positive risk-taking" by staff in the organisation, which supports 1,300 adults with learning disabilities, physical disabilities or mental ill-health.

The charity wanted its 3,500 support staff to have the confidence to take a calculated risk when making decisions which would help service users achieve their "hopes and dreams".

"We didn't want them to risk their safety, but we wanted them to know that so long as they have acted reasonably then we will support them all the way," says Shonagh Methven, the charity's senior business partner for risk management.

The Stamp of Support slogan now appears on all its health and safety material and on a staff keyring.

Staff guidance and advice to support them to make a positive risk decision – even if it ends in failure – has been written into the charity's risk management strategy.

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Rivington and Blackrod and Ladybridge high schools: winner, partnership innovation award

Pupils have also been trained as 'health ambassadors' and hold theme-led assemblies on a range of health issues. Photograph: Rivington and Blackrod high school

It could easily have been a bureaucratic nightmare that failed at the first hurdle. The dilemma was how do you bring together the NHS, local government, education and sports centres to deliver a school-based health project that the students would be happy to use?

The answer, according to Michelle Howard, director of business development at Rivington and Blackrod high school in Lancashire, was to be committed to the vision and have the confidence and trust in each other to share information and best practice.

"We worked with all our partners to ensure that all our procedures and practices worked well together," she says. "We learned so much more about each other and how we could best use our skills, resources and specialisms to deliver the best outcomes for us all. It was also about sharing that responsibility."

The teenage health project at Rivington and Blackrod high school and the Active Health scheme at its linked federated school, Ladybridge high school, has gone from strength to strength since it was first established in 2007.

The intention, following wide consultation with parents, young people, the local community and public services, was to create a student-friendly accessible health and wellbeing service offering advice, guidance and information on the school site. "It started out when we were looking at Every Child Matters, which was on everybody's minds at the time," says Howard. "It was about looking at what we could do to help young people stay healthy and safe."

A steering party was set up, which included representatives from parents, pupils, schools, the local authority and leisure providers to design and develop the project, which had £450,000 of Big Lottery Fund money.

Today more than 3,000 young people have made use of the project, which offers them a range of advice and information including healthy eating, sexual health and contraception and drug and alcohol awareness.

Support for emotional wellbeing and advice about how to cope with stress is also offered by the project, which is run by school nurses alongside a project co-ordinator who can refer students to different services as required. "There isn't one aspect of health that we shy away from," says Howard.

School students have also been trained as "health ambassadors" – taking the healthy message to their classmates by holding theme-led assemblies and teaching them how to carry out CPR and other lifesaving first aid skills.

At the same time, 13 members of staff have learned about healthy eating and nutrition and are now passing on their knowledge to students across the school.

The project, says Howard, has generally improved the students' physical and emotional health. But there have been more tangible results: the behaviour of 81% of children who attended its anger management programme has improved; the local teenage pregnancy rate has started to fall and 87% of children who received counselling said they were feeling better.

Howard attributes the success of the project to the depth of the relationships between the different partners. She says: "It's about trust and acknowledging that 'I am really good at this' and saying 'how can we work together to get the best outcomes?'. We also had a very strong vision, which we all focused on and never lost sight of."

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Intelesant: winner, technology innovation award

With the End of Life Monitoring and Assessment tool, GPs can be notified of care home residents' end of life wishes.

An app-like tool that has the potential to change the culture around advanced plans for frail and older people in care homes has been developed in Trafford, Greater Manchester.

The End of Life Monitoring and Assessment (Elma) tool allows care homes to electronically send a resident's advanced plan – a statement of their end of life wishes – via a handheld device direct to the individual's GP computer system. The plan, which is Read-coded and compatible with the practice system, can then be accessed around the clock by other NHS staff from ambulance teams to A&E doctors and community nurses.

It means that for the first time care home staff can directly share their knowledge about a resident with the wider NHS. Crucially, Elma also allows GPs and other NHS staff to be kept up-to-date with the advanced plan of an older person living in the residential care system whom they may rarely see and may be little known to them.

With the resident's consent, Elma can also be accessed by their family or friends using a secure two-factor authentication. Uniquely, Elma has also been designed to be used as an experiential training tool by care home staff to teach them how to create and develop an advanced plan with a resident.

Before Elma was introduced, care homes that did promote advanced plans for residents used paper versions, which then had to be faxed to the GP surgery. The time-consuming process was open to error and the information the plans held was often inconsistent, says physiotherapist Louise Rogerson, director of service development at Intelesant – the company behind Elma.

Because of Elma, it is hoped that eventually all people living in Trafford – not just care home residents – will have an advanced plan, which can be securely accessed by healthcare professionals and the individual's family. Rogerson said: "Any of us who have an advanced plan can use this system; it's not just for people in the last years of their life, it's for anybody who wants an advanced plan."

Additional coded data about the resident, which has been added by the care home staff can also be accessed via Elma by healthcare professionals, if necessary. That data includes latest information about a resident's usual level of consciousness; their mobility; their diet and their weight.

Rogerson says: "These are key indicators about how well a patient is, about how frail they are, and was something which the doctors in A&E said would be useful. It's the kind of information which the care home staff would have."

The electronic tool, developed by Intelesant, Trafford clinical commissioning group and the local hospice, has already been used by one local care home and is in the process of being rolled out to another nine.

The data Elma captures also reflects that required by the electronic palliative care co-ordination system, which is part of the national end of life care programme in England.

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Michael Yoakley's Charity: partnership innovation award runner-up

Manager Julie Wickenden shows off one of the hospital avoidance beds, which helps prevent inappropriate hospital admissions. Photograph: Michael Yoakley's Charity

A care home in Kent is helping to free up hospital beds and preventing older people being inappropriately admitted to hospital, following a partnership with a local GP surgery.

The Michael Yoakley's Charity in Margate provides the North Down surgery with two short-term hospital avoidance beds, which are offered to older patients who are unable to be cared for at home and need support.

The patients spend a maximum of seven days in the home at a charge of £500 a week, which is significantly cheaper than the £500-a-day it would cost to pay for a high-dependency NHS hospital bed. So far this year the home has looked after 24 older people who have been recovering from common infections and viruses, including chicken pox.

The charity's executive manager Julie Wickenden says the scheme turns on its head the traditional relationship between the home and GPs, where family doctors have traditionally served the needs of the home.

"We have a large local hospital where we have many elderly people clogging the system when they don't need to be there," she says. "Our seaside area also has a high proportion of elderly residents many of whom are geographically distanced from their family members who might otherwise care for them, so the default when they are unwell, or even just vulnerable, is a hospital admission.

"A lot of care homes are looking to develop different kinds of initiatives because they are not having so much success with social services funding as the councils are really holding back putting people into residential care, so we have had to look for other ways of making up the finances."

The initiative, which allows continuity of care by the patient's own GP, has been so successful that the home is now in the process of building an extension, so that it can provide more hospital-avoidance beds.

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Guardian unveils Healthcare Innovation Awards shortlist

The Guardian Healthcare Innovation Awards celebrate and share best practice across different areas of the healthcare sector. Photograph: Pilar Olivares/REUTERS

A school, a charity, and a social enterprise are all in the running for the first Guardian Healthcare Innovation Awards.

The shortlist for the awards includes entries from outside the healthcare sector, as well as NHS trusts and clinical commissioning groups.

The awards, sponsored by GE, Unipart and 3M, are an opportunity to celebrate and share best practice across different areas of the healthcare sector – both inside and out of the NHS.

They aim to showcase ideas or services which significantly improve the quality or management of care for patients and share them with the rest of the sector.

The judges, including Dean Royles, chief executive of NHS Employers, Chris Hopson, chief executive of the Foundation Trust Network, and Dame Barbara Young, chief executive of Diabetes UK, looked at a number of entries in different categories including service delivery, technology, hospital admissions, leadership, partnership and workforce.

Here is the full list of organisations shortlisted this year. The winners will be announced at a ceremony on Thursday 24 October 2013 in London.

D2Digital by Design
Department of primary care health sciences, University of Oxford
Moorfields eye hospital

National Blood Service, John Radciffe hospital
Intelesant
Sandwell and West Birmingham hospitals NHS trust

Portsmouth hospitals NHS trust
Sussex partnership NHS trust
NHS South Worcestershire CCG

Southern health NHS foundation trust
NHS Dorset CCG
Centre for Patient Leadership

Spice and the Young Foundation
Rivington and Blackrod high school
Michael Yoakleys' charity

Office of the Chief Scientific Officer
University College London hospitals
United Response

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Purdue innovation could improve personalized cancer-care outcomes

Main Category: Cancer / Oncology
Also Included In: Medical Devices / Diagnostics
Article Date: 16 Aug 2013 - 2:00 PDT Current ratings for:
Purdue innovation could improve personalized cancer-care outcomes

An innovation created by Purdue University researchers could improve therapy selection for personalized cancer care by helping specialists better identify the most effective drug treatment combinations for patients.

David D. Nolte, a professor in Purdue's Department of Physics, and his collaborators Ran An, a graduate student in physics, and John J. Turek in the Department of Basic Medical Sciences have created a technique called BioDynamic Imaging that measures the activity inside cancer biopsies, or samples of cells. It allows technicians to assess the efficacy of drug combinations, called regimens, on personal cancers.

"Technicians can use BioDynamic Imaging to measure tumor response to cancer therapy, such as metabolism and cell division. This can tell how well the drug is working and if there are side effects," Nolte said. "Our approach is called phenotypic testing, which is more pertinent than genetic testing because it captures the holistic response of cancer to chemotherapy."

BioDynamic Imaging tailors therapies to fit each cancer patient.

"No two cancers are alike," Nolte said. "Therefore, every patient needs his or her own selected therapy to get the best results."

Nolte said BioDynamic Imaging has other applications, including drug discovery and improving success rates for in vitro fertilization.

"BioDynamic Imaging is a new type of imaging that has broad uses and many applications," he said. "In IVF clinics, it can select the most viable embryos for implantation, improving pregnancy rates and decreasing the risk of having twins or triplets. It also can be used on a large scale to help search for new types of drugs."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject.

Animated Dynamics LLC, based in the Purdue Research Park, is commercializing the BioDynamic Imaging technology. The company will manufacture the first commercial units for laboratories and clinics for testing and appraisal. The company won first place and $30,000 in the 2013 Burton D. Morgan Business Plan Competition.

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Innovation in mouse model helps researchers distinguish disease mechanisms and biomarkers

Main Category: Urology / Nephrology
Article Date: 30 Jul 2013 - 2:00 PDT Current ratings for:
Innovation in mouse model helps researchers distinguish disease mechanisms and biomarkers

A team led by researchers at the National Institutes of Health has overcome a major biological hurdle in an effort to find improved treatments for patients with a rare disease called methylmalonic acidemia (MMA). Using genetically engineered mice created for their studies, the team identified a set of biomarkers of kidney damage - a hallmark of the disorder - and demonstrated that antioxidant therapy protected kidney function in the mice.

Researchers at the National Human Genome Research Institute (NHGRI), part of NIH, validated the same biomarkers in 46 patients with MMA seen at the NIH Clinical Center. The biomarkers offer new tools for monitoring disease progression and the effects of therapies, both of which will be valuable in the researchers' design of clinical trials for this disease.

The discovery, reported in the July 29, 2013, advance online issue of the Proceedings of the National Academy of Sciences, paves the way for use of antioxidant therapy in a clinical trial for patients with MMA. It also illustrates the mechanisms by which dysfunction of mitochondria - the power generators of the cell - affects kidney disease. Mitochondrial dysfunction is a factor not only in rare disorders, such as MMA, but also in a wide variety of common conditions, such as obesity, diabetes and cancer.

MMA affects as many as one in 67,000 children born in the United States. It can have several different causes, all involving loss of function of a metabolic pathway that moderates levels of an organic compound called methylmalonic acid. Affected children are unable to properly metabolize certain amino acids consumed in their diet, which damages a number of organs, most notably the kidneys.

"Metabolic disorders like MMA are extremely difficult to manage because they perturb the delicate balance of chemicals that our bodies need to sustain health," said Daniel Kastner, M.D., Ph.D., NHGRI scientific director. "Given that every newborn in the United States is screened for a number of inherited metabolic disorders, including MMA, there is a critical need for better understanding of the disease mechanisms and therapies to treat them."

MMA is the most common organic acid disorder and invariably impairs kidney function, which can lead to kidney failure. The most common therapy is a restrictive diet, but doctors must resort to dialysis or kidney transplantation when the disease progresses. MMA patients also suffer from severe metabolic instability, failure to thrive, intellectual and physical disabilities, pancreatitis, anemia, seizures, vision loss and strokes.

"There are no definitive treatments for the management of patients with MMA," said Charles Venditti, M.D., Ph.D., senior author and investigator in the Organic Acid Research Section of NHGRI's Genetics and Molecular Biology Branch. "This study is the culmination of collaboration with the patient community. It uses mouse modelling, coupled with innovations in genomics and biochemical analyses, to derive new insights into the causes of renal injury in MMA. Our studies have improved our understanding of the basic biology underlying MMA, created a novel animal model for testing interventions and, now, led us to the promise of a new therapy."

The researchers performed the studies using mice bred to carry gene alterations that disrupt the production of the same mitochondrial enzyme that is defective in patients with MMA. These are called transgenic mice. The enzyme, called methylmalonyl-CoA mutase (MUT), is an important component of the chemical process that metabolizes organic acids, specifically methylmalonic acid.

By measuring gene expression in the transgenic mice using DNA microarrays, researchers discovered 50 biomarkers of gene expression that each indicated declining kidney function. DNA microarrays are silicon chips with many spots to which a given molecule may bind. In this case, the DNA microarrays were used to precisely generate, with the aid of a computer program, a profile of gene expression in a kidney cell.

The researchers chose one of the biomarkers, called lipocalin-2, to test how it correlated with kidney function in 46 MMA patients. Plasma levels of this biomarker rose with kidney deterioration in patients with MMA, and may serve as a valuable indicator of MMA kidney disease progression in the clinic.

"The detection of biomarkers through microarray technology is immensely helpful in pointing to downstream pathways affected by the defective MUT activity," said Irini Manoli, M.D., Ph.D., lead author and a physician scientist and staff clinician in NHGRI's Genetics and Molecular Biology Branch. "The biomarkers provide new plasma or serum tests to follow disease progression in our patients."

Having discovered these important biomarkers of kidney function, the authors turned to kidney physiology experts on their team to explore the structural changes that occur in MMA disease. They analyzed the rate at which the kidneys filter waste from the blood. Co-author and renal physiology expert Jurgen Schnermann, M.D., and members of his laboratory at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), also part of NIH, demonstrated the early and significant decrease in this rate in MMA mice.

With further studies, the researchers identified increased production of free radicals in tissues from the mice, as well as in the MMA patients. Detection of free radicals indicates chemical instability in cells, which the researchers sought to remedy with antioxidant therapy. After treating the mice with two forms of dietary antioxidants, the researchers observed that the biomarkers of kidney damage diminished and the faltering kidney filtration rate tapered off. The findings demonstrated that readily available antioxidants can significantly affect the rate of decline of kidney function in transgenic mice, which replicate the kidney disease of MMA.

"The next step will be to translate these findings to the clinic," Dr. Venditti said. "With a progressive disorder like MMA, we are hopeful that we have achieved a laboratory success that our patients will benefit from in the near future."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our urology / nephrology section for the latest news on this subject.

Irini Manoli, Justin R. Sysol, Lingli Li, Pascal Houillier, Caterina Garone, Cindy Wang, Patricia M. Zerfas, Kristina Cusmano-Ozog, Sarah Young, Niraj S. Trivedi, Jun Cheng, Jennifer L. Sloan, Randy J. Chandler, Mones Abu-Asab, Maria Tsokos, Abdel G. Elkahloun, Seymour Rosen, Gregory M. Enns, Gerard T. Berry, Victoria Hoffmann, Salvatore DiMauro, Jurgen Schnermann, and Charles P. Venditti, "Targeting proximal tubule mitochondrial dysfunction attenuates the renal disease of methylmalonic acidemia", Published online before print July 29, 2013, doi: 10.1073/pnas.1302764110

For information about the MMA clinical trial, go to ClinicalTrials.gov and search with NCT00078078.

Learn more about the study

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What healthcare leaders can do to nurture innovation

Innovation is more than a shiny gadget. It is about identifying, developing and successfully exploiting new ideas. Photograph: CJ Burton/Corbis

To nurture innovation in healthcare, leaders must do less. This counter-intuitive advice draws on years of innovation research and the practices of the world's most innovative organisations, the ones that get 10 times more bang for buck on their innovation activities than the rest.

Innovation is more than a shiny gadget or an elegant new pathway. It is the organisation's process of identifying, developing and successfully exploiting new ideas, which is deceptively complex. I've worked with only 19 health providers and commissioners so far, yet I consistently see the same challenges which, if addressed, would lead to phenomenal leaps in innovation outcomes. Here are five top tips for leaders of health and care organisations:

Kill half your projects. A lack of clear focus leads ambitious people to try and do too much. Write an innovation plan to assert which quality, prevention, productivity and revenue objectives you wish to achieve, and then kill the projects that don't fit. It's likely that 20 to 50% will be stopped or paused, liberating resources and allowing you to fund the projects that align with your plan properly. This focus also helps to create a call to arms for your people and networks – a common goal around which they can all work.

Empower your people. The wisdom of your workforce is much greater than you might think. To harness this potential, your people need a licence to innovate. They need to know where to go when they have an idea and that, when they do, they'll be listened to and heard. The smart application of crowdsourcing tools and capability will engage and empower your staff quickly and cheaply. You'll be doing less of the work, but achieving much more.

Sack your 'blockers'. Close your eyes and ask yourself who the key person is that talks down all new ideas as soon as they are shared, and then sack them (or at least move them to one side). Almost every organisation has an influential character who consistently blocks innovation. Their voice is usually associated with responses such as: "That won't work here" and "The patients will never use that". Remove this person, and your people will be free to innovate.

Get disruptive. I first used internet banking in 2000. It seemed like a step backwards as it seemed to be doing less. But by starting small, choosing the right niches and proving the model, it has grown to transform the convenience, efficiency and security of consumer banking. Technology-enabled care models can drive the same transformation in health. New approaches can mature and eventually be good enough for a larger population.

Integrate patient experience and service improvement. You probably have a patient experience/public involvement/patient advice and liaison services team. They build genuine patient, family and public insight – deep data about the experiences and expectations of your service users. This data should be central to your service improvement and transformation efforts. I've sat in sessions with the likes of P&G and Nissan where there's an empty chair in the room representing the customer. What would our customer think of this meeting, this idea, this proposal? Their customer insight people answer these questions and, in doing so, create a laser-sharp focus for service improvement. Are you genuinely patient centred? You've probably captured the insight, now it's time to use it.

Dr Peter Thomond is co-founder and managing director of Clever Together, an organisation that helps leaders empower people using crowdsourcing

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here